Does a 2.5-year self-management education and support intervention change patterns of healthcare use in African-American adults with Type 2 diabetes?

Abstract

To investigate the impact of a 2.5-year diabetes self-management education and support intervention on healthcare use and to examine factors associated with patterns of healthcare use. We recruited 60 African-American adults with type 2 diabetes who completed a 2.5-year empowerment-based diabetes self-management education and support intervention. Primary healthcare use outcomes included acute care visits, non-acute care visits and days lost to disability. Acute care was a composite score calculated from the frequency of urgent care visits, emergency department visits and hospitalizations. Non-acute care measured the frequency of scheduled outpatient visits. To examine change in patterns of healthcare use, we compared the frequency of healthcare visits over the 6-month period preceding the intervention with that in the last 6 months of the intervention. No significant changes in patterns of healthcare use were found for acute care, non-acute care or days lost to disability. Multiple regression models found higher levels of depression (P = 0.001) to be associated with a greater number of non-acute healthcare visits, and found longer duration of diabetes (P = 0.019) and lower levels of diastolic blood pressure (P = 0.025) to be associated with fewer days lost to disability. Participation in a long-term diabetes self-management education and support intervention had no impact on healthcare use in our sample of African-American subjects.