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 42 Midwestern health centers, we surveyed 389 health providers and administrators about the barriers they faced delivering diabetes care. We report on home blood glucose monitoring, HbA1c 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, >25% of the providers and administrators agreed that significant barriers included affordability of home blood glucose monitoring, HbA1c 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.
Subject(s)
Community Health Centers , Diabetes Mellitus/therapy , Blood Glucose Self-Monitoring/economics , Diabetes Mellitus/economics , Diabetic Foot/diagnosis , Diabetic Retinopathy/diagnosis , Diet , Exercise , Glycated Hemoglobin/analysis , Health Care Costs , Health Services Accessibility , Humans , Patient Education as TopicABSTRACT
OBJECTIVES: This study assessed the quality of diabetes care in community health centers. METHODS: In 55 midwestern community health centers, we reviewed the charts of 2865 diabetic adults for American Diabetes Association measures of quality. RESULTS: On average, 70% of the patients in each community health center had measurements of glycosylated hemoglobin, 26% had dilated eye examinations, 66% had diet intervention, and 51% received foot care. The average glycosylated hemoglobin value per community health center was 8.6%. Practice guidelines were independently associated with higher quality of care. CONCLUSIONS: Rates of adherence to process measures of quality were relatively low among community health centers, compared with the targets established by the American Diabetes Association.
Subject(s)
Community Health Services/organization & administration , Community Health Services/standards , Diabetes Mellitus , Quality of Health Care , Adult , Aged , Blood Glucose/metabolism , Diabetes Mellitus/diagnosis , Diabetes Mellitus/therapy , Diabetic Foot/prevention & control , Diabetic Retinopathy/prevention & control , Diet , Exercise , Guideline Adherence , Humans , Middle Aged , Midwestern United States , Patient Education as TopicABSTRACT
Advanced practice nurses expect to care for many older adults in a variety of community settings. Through the process of reminiscence, older adults can actively evaluate their life experiences and explore the meaning of memorable events. This paper discusses the experiences of two advanced practice nurses who collaborated to conduct a reminiscence therapy group with community-based senior citizens. The process of reminiscence and group theory will be examined as applied to the well elderly in a community setting.
