Delivering diabetes self-management education (DSME) in primary care - The Pittsburgh Regional Initiative for Diabetes Education (PRIDE)

Background: Diabetes self-management education (DSME) is a critical component of the clinical management of diabetes mellitus. Although DSME is recognized as important, the number of patients with diabetes who receive education is disproportionately small. Several barriers to receiving diabetes education exist, including access and DSME delivery approaches. Objective: The purpose of this prcject was to explore opportunities to meet the Healthy People 2010 goal of increasing the proportion of people with diabetes mellitus who receive diabetes education from 40% (as it was in 1998) to 60% (in 2010). Our objectives were to examine the provision of DSME in primary care, to determine if DSME delivery in primary care increases the number of people who receive DSME, and to evaluate the effect of DSME on glycosylated hemoglobin (HbA(1c)) and low-density lipoprotein-cholesterol (LDL-C) levels. DSME was delivered in primary care practices as part of the Pittsburgh Regional Initiative for Diabetes Education (PRIDE). Research design and methods: A nurse who was a certified diabetes educator (CDE) was deployed to provide Point-Of-Service diabetes Education (POSE) to four University of Pittsburgh Medical Center (UPMC) Community Medicine Practices (CMI) primary care practices. The group of patients who received POSE was compared with patients from the same practices who were identified as having diabetes and who received usual care. The number of patients was computed and a percentage calculated for comparison against Healthy People 2010 goals. The HbA(1c) values of patients were tracked from January 2003 through December 2006, during the timeframe that POSE was provided. Results: Of the 5344 diabetes patients in the four practices, 784 received POSE. Mean HbAlc values were higher at baseline in those patients who received POSE than those who received usual care. There was a significant decrease in HbA(1c) and LDL-C levels in both groups. Although there was not a significant between-group difference in HbAlc, those who received POSE had significant improvement in LDL-C levels compared with the usual care group. Conclusions: Providing DSME in primary care is feasible and offers the opportunity to reach patients who may not be receiving DSME services. However, further research is needed to evaluate other methodologies to increase access to DSME and other factors that may influence improvement in clinical outcomes.