Accessibility of diabetes education in the United States: barriers, policy implications, and the road ahead

Author:

Tharakan Anna12,McPeek Hinz Eugenia3ORCID,Zhu Emelia4,Denmeade Brad5,German Jashalynn5ORCID,Huang Wei Angel6ORCID,Brucker Amanda6ORCID,Rinker Joanne78ORCID,Memering Chris89ORCID,Spratt Susan510ORCID

Affiliation:

1. Department of Undergraduate Studies, Duke University , Durham, NC 27710 , United States

2. Margolis Center for Health Policy , Duke University, Durham, NC 27710 , United States

3. Division of General Internal Medicine, Department of Medicine, Duke School of Medicine , Durham, NC 27710 , United States

4. Duke Primary Care , Duke University Hospital, Durham, NC 27710 , United States

5. Division of Endocrinology, Metabolism and Nutrition, Department of Medicine, Duke School of Medicine , Durham, NC 27710 , United States

6. Duke Department of Biostatistics and Bioinformatics , Duke University, Durham, NC 27710 , United States

7. Association of Diabetes Care & Education Specialists , Asheville, NC 28175 , United States

8. North Carolina Diabetes Advisory Council , New Bern, NC 28560 , United States

9. Carolina East Medical Center, Carolina East Health System , New Bern, NC 28560 , United States

10. Population Health Management Office, Duke University Hospital , Durham, NC 27710 , United States

Abstract

Abstract Diabetes Self-Management Education and Support (DSMES) programs are an effective, yet underutilized, resource to improve health outcomes and behaviors for people with diabetes. We examined the attendance and referral rates for people with diabetes to DSMES classes at an academic medical center, noting a 10% referral rate and 37% completion rate for those referred. We identified barriers to DSMES care at patient, provider, and health system levels. Current technology platforms and training fail to prioritize referrals to diabetes education; providers and people with diabetes are often unfamiliar with program content and benefits. Scheduling mechanisms often delay or lose interested patients in receiving vital education. Existing Medicare reimbursement strategies limit expansion of DSMES programs, generating significant wait times and limit capabilities for Diabetes Care and Education Specialists. We identify potential policy solutions and recommend alterations to existing referral and scheduling systems to expand existing technology platforms for DSMES programs and shift reimbursement policies to individualize and better support care for persons with diabetes.

Publisher

Oxford University Press (OUP)

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