Diabetes Patient Education in The Office Setting

Abstract

The diabetes patient education provided in randomly chosen primary care physician offices in small and large communities was compared with hospital-based patient education programs in those same communities. The office programs were usually physician- delivered, informal, and interwoven with the clinical care offered. They usually did not include a systematic needs assessment, were not recorded, used educational materials sparsely, and often lacked evaluation. The time spent on education is approximately 48 minutes per year per patient in the office setting. The study suggested several developmental activities that might improve patient education in physician offices where the majority of patients with diabetes receive most of their care.The majority of care for persons with diabetes is provided in ambulatory care settings-physicians' offices and outpatient clinics. The extent to which that care is accompanied by diabetes patient education is not well known. It was hypothesized that physicians' offices (and similar ambulatory care sites) were an underutilized opportunity for effective patient education in diabetes.The literature on office-based patient education is sparse. A description by Shipp' on treatment of diabetes mellitus in the office setting includes a content list for patient education and recommendations about format and use of educational materials in the office. Shipp's article contains suggestions for securing a written &dquo;agreement&dquo; in which patients commit themselves to perform the steps of self-care and lifelong learning ; he also describes the diabetic record used in his office and his approach to office-based dietary instruction. Jamplis2 has described his experience with conducting patient education in the office-setting. The primary focus was a hypertension program produced in cooperation with the American Group Practice Association, but the methods would be applicable to diabetes. The Jamplis program included pre-and posttesting, audiovisual programs reviewed by the patient and the patient's spouse, and patient interaction with a health educator in the office. Stine and Nagle3 have described their patient education program in a family medical center setting. The topics of their programs were well-child care, diabetes, and prenatal care. Clarke and co-workers4 presented the findings of their survey of 68 pediatric diabetes specialists from a national sample. The office education provided by these diabetologists was described. None of these reports, however, analyzed the status of patient education in primary care physicians' offices.This study was undertaken to determine the current status of diabetes patient education in the office setting.

Factors contributing to attrition behavior in diabetes self-management programs: A mixed method approach

“…However, longitudinal assessment of the degree of DSME utilization and its affect on knowledge, self-care behaviors, and health outcomes is needed to substantiate this postulation. In the mean time, diabetes educators should assess patients' knowledge, including education provided by primary care physicians or during hospitalization, to complement and enhance each patient's knowledge base, and to avoid redundancy [ 51 ].…”

Patient factors associated with attrition from a self‐management education programme

“…For usual diabetes care in the community, patients are often seen solely by their doctor and given a brief explanation about the disease. Many patients do not receive in‐depth lifestyle education and training due to doctors’ time constraints and heavy caseloads [32]. Thus, a high attrition rate from DSME raises concerns about a patient’s source of information, support and skills to manage their diabetes and maintain optimal health.…”

Impact of Prospective Payment on the Role of the Diabetes Educator

“…Outpatient programs may not be viewed as a viable option for hospitals because of the costs associated with development and management coupled with the general lack of third-party reimbursement to support such ventures. 13 Although third-party reimbursement has received increased attention and represents an area of concerted effort by national diabetes organizations, both groups in this study reported only a slight increase in third-party reimbursement for diabetes education since the initiation of prospective payment. As a group, however, both educators and administrators projected that third-party reimbursement would increase within the next 5 years.…”