665-P: Diabetes Self-Management Education (DSME): What Will It Take to Improve Participation?

Abstract

Despite evidence that DSME is a critical component of diabetes (DM) care, participation remains low. Innovative methods to improve attendance need to be explored. The purpose of this study was to evaluate the impact of a primary care (PC)-based DSME delivery model on DSME referrals and participation. Using a non-randomized design, diabetes educators (DEs) and PC practices were assigned to the intervention group (IG; 3 DEs, 6 practices) or control (CG; 2 DEs, 6 practices). IG practices applied patient-centered medical home elements to DSME delivery and had direct access to a DE. The CG employed traditional DSME delivery (PC patients referred to hospital-based DE). To examine DSME referrals and participation, medical record data were extracted for patients with DM, 18-75y, presenting to PC practices over 18 months (n=4,894; 59% IG, mean age 58.7y, 50.8% male) and compared between study groups. IG practices referred a higher percentage of patients to DSME compared to CG (18.4% v 13.4%; p<0.0001). Of those referred, IG patients were more likely to attend DSME than CG (34.9% v 26.1%; p=0.02). This equated to a total of 6.8% IG and 3.5% CG patients participating in DSME. Adjusted multiple logistic regression modeling found that IG practices were 1.8 times more likely to refer patients to DSME than CG (Confidence Level 1.4-2.2). Other factors that predicted referrals were female (Odds Ratio=1.3, CL 1.1-1.6), obesity (OR=1.6, CL 1.3-2), and higher A1c (OR=1.4, CL 1.3-1.4). Older patients were less likely to be referred (OR=0.98, CL 0.975-0.999). Similar adjusted regression modeling found that IG patients were 1.7 times more likely to participate in DSME than CG (CL 1.1-2.6); lower A1c also predicted DSME attendance (OR=0.9, CL 0.8-0.999). This study demonstrates the positive influence of a PC-based intervention on DSME referral and participation. However, modest improvements in DSME rates, even with targeted efforts to address barriers, raise questions as to what is truly needed to drive meaningful change. Disclosure J. Krall: None. J. Kanter: None. K. Ruppert: None. V.C. Arena: None. F.X. Solano: None. L.M. Siminerio: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases