Access to Diabetes Self-management Education

Abstract

The purpose of this study is to explore issues related to access to diabetes self-management education (DSME), including supply and demand, educator outreach and expansion efforts, patient and physician barriers to access, and acceptability of alternative DSME delivery strategies. Telephone focus groups were conducted with 17 diabetes educators, 18 primary care physicians who treat adults with diabetes, and 14 adults with type 1 or type 2 diabetes (8 in a group for those who had received diabetes education and 6 in a group for those who had not). DSME programs develop new services to attract additional patients but do little outreach, and budget struggles are common. Some physicians establish good relationships with DSME programs, but others are critical of the available programs and experience conflicts over the role of educators vis-à-vis that of the physician. Physicians do not refer all patients to DSME and are perceived by educators and patients as not providing enough encouragement to attend DSME. Patients generally have positive experiences with DSME but do not discuss these experiences with their physicians. Patients are receptive to alternative strategies for DSME delivery (community settings, electronic media), but physicians are concerned about meeting standards, and educators want to make sure that they are available to support alternative education strategies. Future advocacy efforts should seek implementation of policies to guarantee that all people with diabetes can receive the DSME they need.