Diabetes-related services and programs in small local public health departments, 2009-2010

Local health departments (LHDs) vary in their capacity to perform public health services by the size of population they serve. Little is known about the extent of emerging primary prevention activities at small LHDs. The objectives of this study were to describe various diabetes-related patient care and primary prevention services offered by small LHDs (those serving a population of less than 150,000) and explore factors associated with the diversity of these services.

During 2009 through 2010, we interviewed directors of a nationally representative sample of small LHDs by telephone to obtain information about staff structure, diabetes services, and partnerships. We obtained data for demographic characteristics and health status of the population from secondary sources. We analyzed the number of patient care services and primary prevention programs through multivariate regression analyses.

Fifty-eight small LHDs completed the survey, a response rate of 81%. Most (n = 47) had at least 1 diabetes-related patient care service; referral to diabetes specialists was the most frequently identified service (n = 44). Nearly half of small LHDs also engaged in obesity prevention for adults (n = 26) or children (n = 26), but only 7 had a diabetes prevention program. Diversity of patient care services was positively associated with the proportion of the population that was rural, time commitment of a certified diabetes educator, and total staff size. Diversity of primary prevention programs was positively associated with intensity of collaboration with the state diabetes program and total staff size and inversely associated with the proportion of racial/ethnic minorities in the jurisdiction.

Most small LHDs function as a link to local diabetes care services. Staff capacity, collaboration with the state health department, and local population factors appear to influence the diversity of diabetes-related services at small LHDs.