Identifying Barriers to Self-Management in Uninsured Patients with Diabetes at a Safety-net Clinic

Abstract

Abstract Problem: The prevalence of diabetes continues to increase. Diabetes self-management efforts are necessary in order for diabetic patients to control their blood glucose levels, prevent disease progression, and avoid harmful complications from the disease. Patients of lower economic status who receive less diabetic education are less likely to control their diabetes leading to increased hospitalizations, health care spending, and a decrease in their overall health status. It is vital patients receive appropriate education regarding diabetes self-management; however, these education efforts are often only available to the insured population. The lack of formal diabetes education for the uninsured patient places the responsibility on the provider to educate the patient regarding this complicated disease during a clinic office visit with limited time. Project Aims: This quality improvement project concentrated on uninsured diabetic patients with a hemoglobin A1c 9% receiving primary care at a local safety net clinic and attempted to answer the following questions: (1) what factors of self-management are lacking, (2) what patient perceived barriers exist to self-management, and (3) does implementing a diabetes education bundle improve patient self-management? Project Method: This project was conducted at a safety net clinic in Leavenworth, Kansas. The Diabetes Self Management Questionnaire (DSMQ) was utilized to assess the level of diabetes self-management for each participant. A brief interview followed to assess barriers to the specific concepts highlighted by the DSMQ. A diabetes education bundle created with the seven aspects of self-management developed by the American Association of Diabetes Educators (AADE7) was implemented with a face-to-face education session. The DSMQ was then repeated after four weeks to assess for improvements in self-management strategies. A comparative analysis was performed to identify patterns and draw conclusions regarding efficacy of implementing the education bundle and improvement in DSM. The findings concluded the implementation of a diabetes education bundle did significantly alter self-management behaviors overall. The DSMQ was also found to be a timely and reliable method for assessing patients’ self-management skills and determine what areas are lacking. The findings of this project will be disseminated to the clinic staff at their monthly staff meeting, as well as to the nursing community at the University of Kansas School of Nursing.