Access to diabetes education an aade foundation funded project
Download
1 / 38

Access to Diabetes Education: An AADE Foundation Funded Project - PowerPoint PPT Presentation


  • 134 Views
  • Uploaded on

Access to Diabetes Education: An AADE Foundation Funded Project. Mark Peyrot, PhD [email protected] Study Purpose and Approach. To investigate factors associated with patients’ obtaining DSME Multi-focus approach Supply side issues – availability of DSME

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Access to Diabetes Education: An AADE Foundation Funded Project' - ellema


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Access to diabetes education an aade foundation funded project

Access to Diabetes Education:An AADE FoundationFunded Project

Mark Peyrot, PhD

[email protected]


Study purpose and approach
Study Purpose and Approach

  • To investigate factors associated with patients’ obtaining DSME

  • Multi-focus approach

    • Supply side issues – availability of DSME

    • Demand side issues – physician referral to and patient consumption of DSME

  • Multi-constituency approach

    • Educators, physicians, patients


Study design
Study Design

  • Two-phase design

    • Telephone focus groups (2 each for patients, educators, physicians)

    • Internet surveys (patients, educators, physicians)

  • Parallel questions asked of all constituencies where appropriate

  • Today’s presentation focuses on preliminary survey results (surveys still in progress when data pulled)


Survey topics
Survey Topics

  • Nature of DSME received by patients (according to reports of each constituency)

  • Perceptions of DSME

    • Impact, satisfaction, perceived quality

  • Barriers to obtaining DSME

    • Physician and patient beliefs, organizational factors

  • Strategies for enhancing access/demand

    • New services, new sources, increased recruiting


Patient sample
Patient Sample

  • Sample drawn from community survey panel

  • Quotas = minimums of 500 who have and 500 who have not had DSME course/class

  • N = 1169 adults with physician diagnosed diabetes (self-report)

  • 85% RX, 69% OHA, 27% insulin (~10% Type 1)

  • Mean age = 55, 57% men, 89% white, 59% college degree, 96% insurance coverage

  • 44% no DSME, 26% only at DX, 24% multiple


Educator sample
Educator Sample

  • Respondents drawn from full AADE membership

  • N = 1672, no quotas or exclusions

  • 65% nursing, 28% dietitian/nutritionist

  • Approximately equal # see patients 1-10, 11-20, 21-30 and 30+ hrs/wk

  • 48% hospital setting, 14% physician office, 13% independent/free-standing

  • Median monthly DSME population ~ 90

  • Mean facility maximum DSME population ~ 95


Physician sample
Physician Sample

  • Sample drawn from physician panel

  • Exclusion = <5 DM Pt/mo, <75% clinical practice

  • Quotas = 400 PCP, 200 Endo/Diabetology

  • N = 629

  • 39% FamPrac, 27% Gen/Int Med, 34% Specialist

  • Median monthly DM population ~ 75



Dsme content1
DSME Content

  • Parallel questions asked of patients, educators, physicians regarding DSME “course/class”

    • Patients: Did your education include…

    • Educators: What % of your DSME patients receive …

    • Physicians: What % of your patients that you refer for DSME do you want to receive …

  • PCP more likely than Endo to want topics covered (8/14 p<.05)

  • For patients, DSME at DX more likely than for most recent repeat (8/14 p<.05)


Dsme content2
DSME Content

Pt Ed MD

  • What diabetes is 74 90 83

  • How diabetes causes complications 68 89 83

  • How diet/exercise help manage DM 74 95 90

  • How meds help manage DM 53 88 77

  • How SMBG help manage DM 64 94 84

  • How to SMBG 60 77 84

  • How to administer insulin 20 41 71

  • How to self-adjust insulin 13 32 65


Dsme content cont d
DSME Content (cont’d)

Pt Ed MD

  • Create a personal diet plan 66 72 84

  • Create a personal exercise plan 48 65 76

  • Create a personal glucose monitoring plan 46 80 77

  • Create a personal medication regimen 34 58 64

  • Use behavior change strategies 42 82 78

  • Develop strategies for coping with diabetes 45 78 79


Dsme content summary
DSME Content: Summary

  • Educators report content covered more often than patients report

    • May represent different populations

    • Patients may nor recognize/remember

    • Large gaps for coping and behavior change strategies

  • Educators report content covered more often than physicians want it covered

    • Exception: Physicians want self-management support topics covered more than educators report covering them


Dsme experience and assessment

DSME Experience and Assessment


Dsme providers at dx
DSME Providers at DX

%

  • A diabetes educator 47

  • A diabetes clinic/DSME program 37

  • My family doctor 20

  • A diabetes specialist doctor 17

  • A person from product’s company 2

  • Median program exposure = 3-4 hours

    • Educators > Physicians


Most recent dsme patient report
Most Recent DSME:Patient Report

  • Impetus/referral %

    • Family doctor 39

    • DM specialist doctor 25

    • Patient 24

    • Other 12

  • Occasion/reason

    • Wanted to learn more 40

    • Got a new doctor 19

    • Diabetes got worse 17

    • Started new Rx 12


Dsme experience physician report
DSME Experience:Physician Report

  • 42% have a diabetes educator in their office/practice

  • 37% of patients receive 2 or more hours of DSME in office/practice

  • 45% of patients receive an out-referral for DSME

  • 66% of patients out-referred actually obtain DSME externally

  • Physician satisfaction (0-100 scoring) = 66


Dsme assessment 0 100 scoring or
DSME Assessment(0-100 scoring or %)

  • Patients very interested in initial DSME 33%

    • (If interested) Pt intend to get DSME = 42%

  • Patient satisfaction – DSME at DX 72

  • Patient satisfaction – most recent DSME 73

  • More DSME would benefit Pt (some/lot) 43%

  • Pt did recommend DSME to another Pt 36%

    • (If no) Pt would recommend = 85%

  • Pt discussed DSME with own physician 56%


Impact of dsme on care
Impact of DSME on Care

%

  • Changed my personal family doctor 9

  • Changed my DM specialist doctor 3

  • Started seeing a DM specialist doctor 13

  • Started seeing another specialist 18

  • Started seeing a dietitian 10

  • Started seeing an educator regularly 4

  • Any of the above 47


Perceived quality of dsme by source and respondent type 0 100 scoring
Perceived Quality of DSME by Source and Respondent Type(0-100 scoring)

Pt Ed MD

  • Patient’s personal doctor 58 26 71

  • DM specialist physician 8264 72

  • DSME program/provider 84 92 80

  • Lay health care worker 46 25 39

  • The Internet 47 35 34

  • CD used on a computer at home 51 38 40

  • DVD/videotape at home 52 39 42

  • Books/magazines 51 42 39

  • Pamphlets/brochures 47 41 42


Dsme experience and assessment summary
DSME Experience and Assessment: Summary

  • Minority of patients without DSME want it

  • Patients somewhat satisfied with DSME, minority see substantial benefit from more

  • Almost half of patients changed their health care as a result of DSME

  • Minority have recommended DSME to another patient, but most would if opportunity arose

  • Educator/program rated as highest quality DSME provider

    • DM specialist physician & DSME program tied in patient view

    • DE and MD rate Lay HCP and media lower than patients do



Barriers to dsme use
Barriers to DSME Use

  • Parallel questions to patients, educators, physicians

    • Patients who did not follow through on referral to DSME asked whether factors were barriers; % who said “yes” is presented here

    • Educators and physicians asked how important factor was as barrier to DSME; % who said “very” is presented here


Barriers to dsme use1
Barriers to DSME Use

Pt Ed MD

  • Pt doesn’t think it’s needed 45 51 28

  • Can’t fit into schedule 38 29 19

  • Insurance would not cover 21 55 62

  • Too expensive 11 38 46

  • Don’t know where to get it 2 29 14

  • No way of getting there 2 25 12


Barriers to dsme use educator reports 0 100 for importance
Barriers to DSME Use: Educator Reports (0-100 for importance)

  • MD do not tell Pt DSME important 74

  • MD do not recognize program quality 55

  • MD do not want to lose control of Pt 54

  • MD do not know referral procedure 51

  • MD do not believe DSME works 48

  • MD do not know where to get DSME 44

  • Lack of financial support 60

  • Lack of clerical support 53

  • Lack of administrative support 51


Physician beliefs about dsme disagree 0 agree 100
Physician Beliefs about DSME(Disagree = 0, Agree = 100)

  • Pts are told to do things I do not want 46

  • My Pts not interested in DSME 41

  • Have not enough DSME referral sources 41

  • Referral procedure is not easy 34

  • DSME programs not have quality I want 28

  • I lose Pts who attend DSME 26

  • I do not get Pts to see DSME importance 22

  • Do not know procedure for referral 19

  • Do not believe DSME works 17


Patient beliefs about dsme disagree 0 agree 100
Patient Beliefs about DSME(Disagree = 0, Agree = 100)

  • My doctor tells me what I need to know 45

  • I already know everything I need to 35

  • My doctor doesn’t think it’s important 32

  • Don’t need it because I don’t have problems 25

  • DSME would not help me care for DM 19

  • DSME only for Pts on insulin 16


Barriers to dsme summary
Barriers to DSME: Summary

  • Physicians and (more so) educators tend to overestimate patient barriers

    • Exception: Both (MD more so) underestimate patient scheduling issues

    • Exception: Educators accurate & MD under-estimate patient perceived need for DSME

  • Educators overestimate physician-reported barriers



Change in patients seen
Change in Patients Seen

  • Recent change in # patients seen

    • Increase = 77%, decrease = 11%, stable = 13%

  • Reasons for increase/decrease (%)

    • Change in number of staff 21/18

    • Change in physical facilities 12/11

    • Changes in patient reimbursement 11/48

    • Changes in # of physician referrals 77/55

    • Changes in # of Pt self-referrals 44/16


Strategies to increase patients seen new programs services
Strategies to Increase Patients Seen: New Programs/Services

(% making change; increased pt seen 0-100) % Inc

  • Any new program/service 75

  • New times of day 52 52

  • New days of the week 47 48

  • Changes in program format 57 57

  • Technology-based delivery 44 48

  • More extensive 54 58

  • Specific populations 52 52

  • New populations 43 47

  • Considering new program/service 60


Strategies to increase patients seen recruitment
Strategies to Increase Patients Seen: Recruitment

Effort to Increase Recruitment

None Little/Some Lot

10% 62% 28%

Impact on # patients

seen (0-100) 42 67

Considering new recruitment efforts = 59%


Likelihood of dsme use by respondent type and source 0 100 scoring
Likelihood of DSME Use by Respondent Type and Source(0-100 scoring)

Pt Ed MD

  • Patient’s personal doctor 68 70 86

  • DM clinic/center 71 81 74

  • Freestanding DSME program 63 73 62

  • Mobile van 33 59 42

  • Neighborhood community setting 36 67 52

  • The Internet 59 51 48

  • CD used on a computer at home 52 42 40

  • DVD/videotape at home 50 44 43

  • Books/magazines 52 51 44

  • Pamphlets/brochures 49 52 50


Educator strategies
Educator Strategies

  • Most programs have grown recently

  • Many strategies (new programs/services and recruitment) have been used

  • All strategies are judged successful

  • Most programs plan more efforts

  • Patients do not like community settings as much as physicians & educators believe

  • Patients prefer traditional sources and media for DSME



Methodological limitations
Methodological Limitations

  • Sample representativeness

    • Patient and physician samples designed for analytic purposes, not representativeness

    • Patient sample under-represents minorities & lower SES, over-represents medication users

    • Physician sample may over-represent those favorable toward DSME

    • Educator sample may over-represent successful programs (self-selection)

  • Youth with DM and/or parents not included


Summary of findings
Summary of Findings

  • Paradox: Physicians want more self-management support, but complain that patients are told to do things they do not agree with

  • DSME is highly regarded among those who have received it, but not as much among those who have not received it


Summary of findings1
Summary of Findings

  • Educators rate patient barriers somewhat above physician and organizational barriers, and see physicians as key to encouraging DSME use in patients

  • Most DSME programs have grown recently as a result of adding new programs/services and recruiting efforts and most programs plan more efforts


Conclusions
Conclusions

  • Increasing DSME access requires a multi-faceted approach

  • Additional analysis required to determine:

    • The contribution of different barriers to restriction of DSME access

    • The contribution of different marketing strategies to increase or decrease in patient population

    • Are different strategies effective in different contexts


ad