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Access to Diabetes Self-management Education

Results of National Surveys of Patients, Educators, and Physicians

From Loyola College, Department of Sociology, and Johns Hopkins University, Department of Medicine, Baltimore, Maryland (Dr Peyrot); Johns Hopkins University, Departments of Medicine and Pediatrics, Baltimore, Maryland (Dr Rubin); Department of Medical Education, University of Michigan, and the Diabetes Research and Training Center, Ann Arbor, Michigan (Ms Funnell); and the Department of Medicine and Diabetes Institute, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Siminerio).

Correspondence to Mark Peyrot, PhD, Department of Sociology, Loyola College, 4501 North Charles Street, Baltimore, MD 21210-2699 (e-mail: mpeyrot{at}loyola.edu).

Purpose

To examine factors related to access to diabetes self-management education (DSME), including services delivered and sought; patient, physician, and program barriers to access; educator outreach and expansion efforts; and perceptions of alternative DSME delivery strategies.

Methods

Internet surveys were completed by 1169 adults with diabetes (661 with prior DSME, 508 with no prior DSME) from a national community survey panel, 1871 educators who were AADE members, and 629 physicians (212 diabetes specialists, 417 primary care practitioners) from a national physician survey panel.

Results

Physicians want patients to receive more self-management support, but some report that patients are told to do things with which the physician does not agree. Provider (physician and educator)–delivered DSME is more highly regarded among those who have received it than among those who have not received it. Physicians generally have positive perceptions of provider-delivered DSME, and educators see physicians as key to encouraging DSME use in patients. Some physicians are concerned about losing patients sent to DSME, and 11% of patients report changing physicians as a result of DSME. Most DSME programs have grown recently as a result of recruiting efforts and adding new programs/services; most programs plan more such efforts. Patients prefer traditional DSME sources/settings and are moderately accepting of media sources.

Conclusions

Additional efforts are required to guarantee that all people with diabetes receive the DSME they need. This will require increased referral by physicians, increased follow-through by patients, and increased availability of DSME in forms that make it appealing to patients and physicians.

This version was published on March 1, 2009

The Diabetes Educator, Vol. 35, No. 2, 246-263 (2009)
DOI: 10.1177/0145721708329546


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