Barriers to Providing Diabetes Care in Community Health Centers

Abstract

OBJECTIVE -We aimed to identify barriers to improving care for individuals with diabetes in community health centers. These findings are important because many such patients, as in most other practice settings, receive care that does not meet evidence-based standards. RESEARCH DESIGN AND METHODS -In 42Midwestern health centers, we surveyed 389 health providers and administrators about the barriers they faced delivering diabetes care. We report on home blood glucose monitoring, HbA 1c tests, dilated eye examinations, foot examinations, diet, and exercise, all of which are a subset of the larger clinical practice recommendations of the American Diabetes Association (ADA).RESULTS -Among the 279 (72%) respondents, providers perceived that patients were significantly less likely than providers to believe that key processes of care were important (overall mean on 30-point scale: providers 26.8, patients 18.2, P = 0.0001). Providers were more confident in their ability to instruct patients on diet and exercise than on their ability to help them make changes in these areas. Ratings of the importance of access to care and finances as barriers varied widely; however, Ͼ25% of the providers and administrators agreed that significant barriers included affordability of home blood glucose monitoring, HbA 1c testing, dilated eye examination, and special diets; nonproximity of ophthalmologist; forgetting to order eye examinations and to examine patients' feet; time required to teach home blood glucose monitoring; and language or cultural barriers.CONCLUSIONS -Providers in health centers indicate a need to enhance behavioral change in diabetic patients. In addition, better health care delivery systems and reforms that improve the affordability, accessibility, and efficiency of care are also likely to help health centers meet ADA standards of care.

Missed Opportunities in Diabetes Management: A Longitudinal Assessment of Factors Associated with Sub-optimal Quality

“…5,32 However, our study provides several novel findings. First, while many studies have evaluated the effects of failing to monitor appropriately, [33][34][35][36] no longitudinal study has directly shown the effects of lack of monitoring on cardiovascular risk factor control after removing patients non-adherent to their visits. As we hypothesized, we found that failure to monitor is associated with poorer glycemic, lipid, and blood pressure control, and further, that lack of adequate monitoring of LDL cholesterol is a significant problem.…”

Capability for Change at Community Health Centers Serving Asian Pacific Islanders: An Exploratory Study of a Cancer Screening Evidence-based Intervention

“…Community health centers (CHCs) provide affordable primary care and preventive services to some of the United States' (U.S.) most vulnerable populations. Existing literature on the dissemination of EBIs among CHCs is limited with early research focused on the introduction of electronic medical record systems (DePue et al, 2002;Amodeo et al, 2006;Miller and West, 2007;Shields et al, 2007;Trafton et al, 2007), diabetic screening (Chin et al, 2001;Walker et al, 2001;Birken et al, 2013), tobacco cessation (De Pue et al, 2002), and mental health psychoeducation (McFarlene et al, 2001). More recently, studies of CHCs have sought to understand broader, more fundamental changes to patient care, such as the long-term impact of quality improvement interventions (Chin, 2010) and newer models of care delivery like the Patient-Centered Medical Home (PCMH) (Birnberg et al, 2011).…”

Assessing Quality of Diabetes Care by Measuring Longitudinal Changes in Hemoglobin A1c in the Veterans Health Administration

“…This index has been adapted for use in administrative data (Deyo, Cherkin, and Ciol 1992), which we used to construct Charlson index scores to capture general illness burden. Charlson score was used as a time invariant measure of comorbidity, similar to other reports (Berlowitz et al 1998;Chin et al 2000;Zhang et al 2000;Safford et al 2003). …”