Factors Associated With Receipt of Diabetes Self-Management Education and Support for Type 2 Diabetes: Potential for a Population Health Management Approach.
diabetes
education
electronic medical record
population health
risk stratification
telemedicine
Journal
Journal of diabetes science and technology
ISSN: 1932-2968
Titre abrégé: J Diabetes Sci Technol
Pays: United States
ID NLM: 101306166
Informations de publication
Date de publication:
09 2023
09 2023
Historique:
pmc-release:
01
06
2024
medline:
9
10
2023
pubmed:
2
6
2023
entrez:
2
6
2023
Statut:
ppublish
Résumé
Population health management approaches can help target diabetes resources like Diabetes Self-Management Education and Support (DSMES) to individuals at the highest risk of complications and poor outcomes. Little is known about patient characteristics associated with DSMES receipt since widespread uptake of telemedicine for diabetes care in 2020. In this retrospective cohort study, we used electronic medical record (EMR) data to assess patterns of DSMES delivery from May 2020 to May 2022 among adults who used telemedicine for type 2 diabetes (T2D) endocrinology care in a large integrated health system. Multilevel regression models were used to evaluate the association of key patient characteristics with DSMES receipt. Of 3530 patients in the overall cohort, 401 patients (11%) received DSMES. In adjusted multivariable logistic regression, higher baseline HbA1c (odds ratios [OR] 3.10 [95% confidence interval 2.22-4.33] for HbA1c ≥9% vs <7%), insulin regimen complexity (OR 3.53 [2.59-4.80] for multiple daily injections vs no insulin), and number of noninsulin medications (OR 1.17 [1.05-1.30] per 1 additional medication) were significantly associated with receipt of DSMES, whereas rurality and area-level deprivation of patient residence were not. Diabetes Self-Management Education and Support remains underutilized in this cohort of adults using telemedicine to access endocrinology care for T2D. Factors contributing to clinical complexity increased the odds of receiving DSMES. These results support a potential population health management approach using EMR data, which could target DSMES resources to those at higher risk of poor outcomes. This risk-stratified approach may be even more effective now that more people can access DSMES via telemedicine in addition to in-person care.
Sections du résumé
BACKGROUND
Population health management approaches can help target diabetes resources like Diabetes Self-Management Education and Support (DSMES) to individuals at the highest risk of complications and poor outcomes. Little is known about patient characteristics associated with DSMES receipt since widespread uptake of telemedicine for diabetes care in 2020.
METHODS
In this retrospective cohort study, we used electronic medical record (EMR) data to assess patterns of DSMES delivery from May 2020 to May 2022 among adults who used telemedicine for type 2 diabetes (T2D) endocrinology care in a large integrated health system. Multilevel regression models were used to evaluate the association of key patient characteristics with DSMES receipt.
RESULTS
Of 3530 patients in the overall cohort, 401 patients (11%) received DSMES. In adjusted multivariable logistic regression, higher baseline HbA1c (odds ratios [OR] 3.10 [95% confidence interval 2.22-4.33] for HbA1c ≥9% vs <7%), insulin regimen complexity (OR 3.53 [2.59-4.80] for multiple daily injections vs no insulin), and number of noninsulin medications (OR 1.17 [1.05-1.30] per 1 additional medication) were significantly associated with receipt of DSMES, whereas rurality and area-level deprivation of patient residence were not.
CONCLUSIONS
Diabetes Self-Management Education and Support remains underutilized in this cohort of adults using telemedicine to access endocrinology care for T2D. Factors contributing to clinical complexity increased the odds of receiving DSMES. These results support a potential population health management approach using EMR data, which could target DSMES resources to those at higher risk of poor outcomes. This risk-stratified approach may be even more effective now that more people can access DSMES via telemedicine in addition to in-person care.
Identifiants
pubmed: 37264614
doi: 10.1177/19322968231176303
pmc: PMC10563527
doi:
Substances chimiques
Glycated Hemoglobin
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
1198-1205Subventions
Organisme : NCATS NIH HHS
ID : KL2 TR001856
Pays : United States
Organisme : NCATS NIH HHS
ID : TL1 TR001858
Pays : United States
Déclaration de conflit d'intérêts
Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Références
J Diabetes Sci Technol. 2017 Sep;11(5):1015-1027
pubmed: 28560898
Med Care. 2009 Jun;47(6):626-33
pubmed: 19433995
Curr Diab Rep. 2017 Jul;17(7):51
pubmed: 28567711
Patient Educ Couns. 2016 Jun;99(6):926-43
pubmed: 26658704
Heart Fail Clin. 2020 Oct;16(4):457-466
pubmed: 32888640
Diabetes Care. 2023 Feb 1;46(2):391-398
pubmed: 36480729
Diabetes Educ. 2019 Oct;45(5):498-506
pubmed: 31375055
J Clin Epidemiol. 2008 Apr;61(4):344-9
pubmed: 18313558
BMC Nephrol. 2019 Mar 1;20(1):72
pubmed: 30823871
Diabetes Care. 2005 Mar;28(3):600-6
pubmed: 15735195
Popul Health Manag. 2017 Feb;20(1):74-85
pubmed: 27124406
MMWR Surveill Summ. 2017 Apr 28;66(10):1-6
pubmed: 28448482
Rev Endocr Metab Disord. 2016 Mar;17(1):129-37
pubmed: 27068710
Diabetes Educ. 2020 Aug;46(4):323-334
pubmed: 32780003
Clin Diabetes. 2020 Jan;38(1):47-55
pubmed: 31975751
Popul Health Manag. 2012 Aug;15(4):220-9
pubmed: 22731766
Prev Chronic Dis. 2012;9:E109
pubmed: 22677159
Diabet Med. 2019 Jun;36(6):761-770
pubmed: 30868654
JAMA Netw Open. 2021 Sep 1;4(9):e2123471
pubmed: 34468753
Diabetes Spectr. 2021 Jan;34(1):20-26
pubmed: 33627990
J Am Board Fam Med. 2020 Jul-Aug;33(4):600-610
pubmed: 32675271
JAMA. 2019 Aug 6;322(5):399-400
pubmed: 31246233
Arch Intern Med. 2011 Dec 12;171(22):2001-10
pubmed: 21986350
Patient Educ Couns. 2023 Mar;108:107615
pubmed: 36584557
J Multidiscip Healthc. 2014 Nov 21;7:533-42
pubmed: 25473293
Diabetes Spectr. 2017 May;30(2):124-136
pubmed: 28588379
Endocrinol Metab Clin North Am. 2016 Dec;45(4):933-942
pubmed: 27823613
J Diabetes Sci Technol. 2021 Jul;15(4):901-915
pubmed: 32476471
Diabetes Educ. 2015 Jun;41(3):281-9
pubmed: 25724969
Sci Diabetes Self Manag Care. 2021 Feb;47(1):54-73
pubmed: 34078207
JAMA Netw Open. 2020 Jan 3;3(1):e1919099
pubmed: 31922562
J Am Med Inform Assoc. 2017 Mar 01;24(2):339-344
pubmed: 27375290
Diabetes Care. 2021 Aug;44(8):1766-1773
pubmed: 34127495
Curr Med Res Opin. 2023 Jun;39(6):843-853
pubmed: 37139823
Popul Health Metr. 2018 Jun 15;16(1):9
pubmed: 29903012
J Racial Ethn Health Disparities. 2022 Dec;9(6):2375-2386
pubmed: 35000144
J Prim Care Community Health. 2020 Jan-Dec;11:2150132720967232
pubmed: 33118451
J Rural Health. 2020 Jun;36(3):410-415
pubmed: 30802321
Diabetes Care. 2020 Jul;43(7):1557-1592
pubmed: 33534729
Health Educ Behav. 2015 Aug;42(4):530-8
pubmed: 25616412
Diabetes Care. 2022 Feb 1;45(2):484-494
pubmed: 35050365
BMJ Open Diabetes Res Care. 2021 Oct;9(1):
pubmed: 34607828
Diabetes Educ. 2013 May-Jun;39(3):327-34
pubmed: 23482514