Year of Publication

2017

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Elizabeth Tovar

Clinical Mentor

Dr. Jo Singleton

Committee Member

Dr. Judi Daniels

Abstract

The improved management of diabetes is a critical clinical and economic challenge facing our healthcare system. Educating patients with diabetes to self-manage their disease is a vital component of diabetes care. The purpose of this DNP practice improvement project was to evaluate an innovative health care delivery method of individualized diabetes self-management education (DSME) in primary care. The approach combined individual DSME with a registered dietician and routine diabetes care with the primary care provider into one patient appointment. System data was reviewed to compare referral and attendance patterns of group and individual methods. Changes in clinical indicators of A1C, BMI, and blood pressure were evaluated in three DSME cohorts: individual, group, and none. Qualitative analysis including a focus group and provider survey were conducted to reveal facilitators and barriers to education.

Results favored higher referral and completion when education was offered as an individual appointment in the primary care office. System data analysis showed a twofold increase in referrals and a threefold increase in completion of education with the new method. One hundred and eighty-six charts were reviewed for clinical indicators of change. Each education cohort had a statistically significant reduction in A1C, but no significant differences were found between cohorts. No significant changes were found in BMI or blood pressure. Health care workers cited accessibility as the foremost factor affecting education completion. The increase in DSME completion with the individual method adds to the understanding of how health care system design can reduce barriers to diabetes education. Over time, this patient-centered design could improve the health of patients with diabetes and reduce costs spent on complications.

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