1 / 38

Access to Diabetes Education: An AADE Foundation Funded Project

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

ellema
Download Presentation

Access to Diabetes Education: An AADE Foundation Funded Project

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. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Access to Diabetes Education:An AADE FoundationFunded Project Mark Peyrot, PhD MPeyrot@loyola.edu

  2. 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

  3. 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)

  4. 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

  5. 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

  6. 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

  7. 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

  8. DSME Content

  9. 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)

  10. 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

  11. 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

  12. 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

  13. DSME Experience and Assessment

  14. 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

  15. 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

  16. 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

  17. 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%

  18. 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

  19. 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

  20. 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

  21. Barriers to DSME

  22. 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

  23. 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

  24. 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

  25. 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

  26. 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

  27. 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

  28. Educator Practice & Strategies

  29. 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

  30. 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

  31. 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%

  32. 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

  33. 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

  34. Summary & Implications

  35. 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

  36. 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

  37. 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

  38. 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

More Related