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Increasing Uptake of Diabetes Self-Management Education and Support (DSMES) in Rural Kentucky Primary Care Clinics:
Mary E Lacy1, Jessica Elliott2, Vance Drakeford2
1University of Kentucky College of Public Health, Lexington, KY, USA.
Background:
Diabetes self-management education and support (DSMES) is an evidence-based intervention that improves outcomes for people with diabetes, but uptake is <10%. We conducted a pilot pragmatic trial to increase DSMES in rural primary care clinics that integrated health information technology with a quality improvement (QI) learning collaborative.
Methods:
Two healthcare systems from rural Kentucky participated in the study. Within each system, 2 clinics received the intervention and 1 clinic served as a control (N = 6 clinics). Each intervention clinic identified a QI team (5-6 individuals) who participated in a 9-month QI learning collaborative followed by 5 months of follow-up. Our primary outcome was DSMES referrals; secondary outcomes were DSMES attendance and percentage with A1c >9%.
Results:
The 6 study clinics served 1,803 patients with diabetes; n = 1083 (60.1%) from 4 intervention clinics and n = 720 (39.9%) from 2 control clinics. DSMES referrals significantly increased in the intervention clinics compared to the control clinics (31.7% vs 0.1%, P < .001) and continued to increase throughout 5-month follow-up (40.0% vs 0.1%, P < .001).
Conclusions:
A structured QI intervention can significantly increase DSMES referral rates in primary care clinics. Findings highlight the potential of systems-level approaches to address persistent gaps in diabetes care delivery in rural settings.
Clinical Trial Registry:
Using Practice Facilitation and Operationalizing Referral Information Technology to Increase DSMES Utilization (Clinicaltrials.gov registration number no. NCT05472142).
Clinicaltrials:
gov URL (https://clinicaltrials.gov/study/NCT05472142).
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