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Diabetes Education in Appalachia: Providers’ Views. S.A. Denham, K.E. Remsberg, & L. Wood Ohio University, Athens, Ohio Diabetes: A Family Matter Conference March 18, 2009. Acknowledgements. - PowerPoint PPT Presentation
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S.A. Denham, K.E. Remsberg, & L. Wood
Ohio University, Athens, Ohio
Diabetes: A Family Matter ConferenceMarch 18, 2009
Graduate assistants who contributed to this project by distributing surveys and compiling data were: Cara Butcher Tammy Collier Eimi Lev Patricia Harris Stacey Hartman Tara O’Brien
Funding sources: CDC’s National Diabetes Education Program, Ohio Department of Health Diabetes Prevention and
Control Program Ohio University, Diabetes Research Initiative &
Appalachian Rural Health Institute, College of Health & Human Services, School of Nursing
Prevalence of diabetes, U.S. 2008 all ages* Total: about 24 million people (7.8% of the
population) Diagnosed: 17.9 million people Undiagnosed: 5.7 million people
1.5 million new cases diagnosed in 2005
Mortality 7th Leading cause of death Under-reported (only 35-40% with diabetes had it
listed on death certificates) Twice as high as for others without diabetes
(2007) Direct costs $116 Billion Indirect Costs $58 Billion
BRFSS [2006], CDC/Div. of Diabetes Translation 6.6 to 10.1% said yes to “Did a doctor tell you that you have diabetes?”
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1999 2002 2005
Greater Cincinnati 1st generation White Appalachian
2005 Greater Cincinnati Community Health Status Survey: White Appalachian Chart Book
02468
1012141618
GreaterCincinnati
1st gen. WhiteApp.
2nd gen. WhiteApp.
Diabetes
2005 Greater Cincinnati Community Health Status Survey: White Appalachian Chart Book
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App. Ohio `06 Ohio BRFSS `04 US BRFSS `04
Diabetes
2006 ARHI
US Prevalence About half of those with diabetes have taken a class on
diabetes self-management, (52%) Those older than 65 years of age are less likely (46%)
Diabetes Education and Insurance (under 65 years) Uninsured (42%) Medicare (46%) Medicaid/Indian Health Service (49%) Private Insurance (54%) Veterans Administration (79%)
Other traits and Diabetes Education More likely
Female African American Insulin Use
Less likely Appalachian (Virginia Dept. Health, 2004)
Evaluate provider perceptions about the provision of diabetes education throughout the Appalachian region of the United States.
Distressed County Poverty 1.5x national average Unemployment > 1.5x national average Per capita market income no more than 2/3
national average OR, poverty 2x national average, plus
unemployment or PCMI
At-Risk County Poverty ≥ 1.25x national average Unemployment ≥ 1.25x national average Per capita market income no more than 2/3
national average OR meeting 2 of 3 distressed criteria
Federally Qualified Health Centers N = 135 (54 clinics/hospitals and 81 HD)
Health Departments N = 82
Diabetes Educators N = 47 (46 situated in hospitals/clinics
and 1 in a HD)
A 40-item questionnaire
Information collected from the survey: Amount, type of diabetes education available Providers of education Patient barriers to receiving education Provider obstacles to delivering education
Descriptive analyses of factors assessed by provider perceptions of Diabetes Education.
Cross-sectional comparison of percentages according to Distressed-At-Risk County status
P-values ≤ 0.05 were statistically significant
VariablesVariables DAR%DAR% NDAR%NDAR% P-valueP-value
Level of Rural-UrbanLevel of Rural-Urban
RuralRural
MixedMixed
UrbanUrban
48.8%48.8%28.0%28.0%23.2%23.2%
3.0%3.0%30.0%30.0%67.0%67.0%
< 0.001< 0.001
Type of SiteType of Site
Clinic/HospitalClinic/Hospital
Health DepartmentHealth Department
48.8%48.8%51.2%51.2%
60.0%60.0%40.0%40.0%
nsns
Percent of Population 0-17yo in 2000Percent of Population 0-17yo in 2000 23.9%23.9% 22.9%22.9% 0.0070.007
Percent of Population in poverty, 2000Percent of Population in poverty, 2000 20.5%20.5% 12.9%12.9% <0.001<0.001
Health, Social and Educational Health, Social and Educational WorkersWorkers
19.9%19.9% 21.2%21.2% nsns
Physicians, mean # per 100,000Physicians, mean # per 100,000 59.159.1 166.9166.9 < 0.001< 0.001
VariablesVariables DAR%DAR% NDAR%NDAR% P-valueP-value
Any Diabetes Education Programs Any Diabetes Education Programs
Separate Type 1 and 2 classesSeparate Type 1 and 2 classes
Family ParticipationFamily Participation
59.4%59.4%12.8%12.8%84.8%84.8%
44.8%44.8%27.5%27.5%78.3%78.3%
0.1010.1010.0920.092
nsns
Classes on a Single DayClasses on a Single Day
Length of Classes, 1-2 hoursLength of Classes, 1-2 hours
51.2%51.2%36.4%36.4%
31.3%31.3%34.8%34.8%
0.0540.054nsns
Primary Educator, CDEPrimary Educator, CDE 10.4%10.4% 30.9%30.9% 0.0010.001
Primary Educator, NursePrimary Educator, Nurse 46.7%46.7% 35.1%35.1% nsns
VariablesVariables DAR%DAR% NDAR%NDAR% P-valueP-value
Travel TimeTravel Time 37.337.3 39.039.0 nsns
Gas MoneyGas Money 70.170.1 56.156.1 0.0780.078
LiteracyLiteracy 38.838.8 47.647.6 nsns
Lack Public TransportLack Public Transport 64.264.2 51.251.2 nsns
Fail to Keep AppointmentsFail to Keep Appointments 67.267.2 78.078.0 nsns
No Phone to ScheduleNo Phone to Schedule 28.428.4 30.530.5 nsns
No One to Drive ThemNo One to Drive Them 68.768.7 63.463.4 nsns
Poor Personal HealthPoor Personal Health 40.340.3 47.647.6 nsns
Lack InsuranceLack Insurance 40.340.3 64.664.6 0.0030.003
VariablesVariables DAR%DAR% NDAR%NDAR% P-valueP-value
Lack StaffLack Staff 39.539.5 22.022.0 0.0140.014
Lack InsuranceLack Insurance 31.631.6 61.561.5 < 0.001< 0.001
Lack SpaceLack Space 17.117.1 9.99.9 nsns
Lack TimeLack Time 34.234.2 31.931.9 nsns
Lack Teaching ResourcesLack Teaching Resources 31.631.6 18.718.7 0.0540.054
Patient Reading LevelPatient Reading Level 13.213.2 12.112.1 nsns
Provision of Diabetes Education - Appalachia: DAR may not be worse than NDAR Provider needs: Lack of resources, medical
specialists, staff and CDEs to provide diabetes education Patient barriers: Lack of transportation, insurance,
literacy
Perception/reality of increasing diabetes, costs Lead to further discrepancy between diabetes
and education/care needed.
Fewer CDEs available in DAR, educators more likely to be busy RNs
CDEs more likely to be employed in hospitals than clinics and health departments
Fewer people in the Appalachian region appear to be getting diabetes education than nationally
Broad inclusion of family in diabetes education
Barriers (e.g., costs, distance, etc.) need to be addressed locally
Low literacy and health literacy