Diabetes care and patient understanding of type 2 diabetes in remote, rural Alberta

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2007 (Oct) Canadian Diabetes Association Conference, poster presentation by BRAID Research

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Diabetes care and patient understanding of type 2 diabetes in remote, rural Alberta

  1. 1. Diabetes Care and Patient Understanding ofDiabetes Care and Patient Understanding ofType 2 Diabetes in Remote, Rural AlbertaType 2 Diabetes in Remote, Rural AlbertaEllen L. Toth, Kelli RalphEllen L. Toth, Kelli Ralph--Campbell, Mary Pick, Tracy Connor, Kari Meneen, Gloria Fraser,Campbell, Mary Pick, Tracy Connor, Kari Meneen, Gloria Fraser,Department of Medicine, University of Alberta, Edmonton, ABDepartment of Medicine, University of Alberta, Edmonton, ABAbstractMDSi, a mobile diabetes program serving remote and rural Alberta, provides complicationsscreening to clients with diabetes. Clients were asked to complete a survey to assess their accessto and satisfaction with mainstream diabetes care services; self-perceived overall and diabetes-related health status; and clients’ knowledge of diabetes. Since 2004, 223 surveys werecompleted.81% of respondents said their family doctor is their main diabetes care provider; a diabetesspecialist was the main provider for only 2%. Most had visited their main provider at least 3 times inthe previous year; 20% indicated they had seen their provider more than 12 times in the previousyear. 30% had never seen a dietitian.In the previous year, only 26% had an A1c test done; 55% had their cholesterol checked; 61%had a urine analysis. Only 25% had a retinal exam in the previous year (38% had never had one).Almost all clients (82%) had never seen a podiatrist.Most clients rated their overall and diabetes-related health as ‘Good’/’Very Good’. 4%indicated ‘Poor’/’Very Poor’.Only slightly more than half of respondents indicated ‘Good’/’Very Good’/’Excellent’ regardingtheir care providers keeping them informed about their diabetes status, available treatments, theirrecent test results, next steps in their diabetes care, and communicating with other providersresponsible for their care.60% of clients felt they had at least a good understanding of diabetes. However, only 19%had attended a formal diabetes education program in an urban centre. Regardless, most correctlyidentified “warning signs” for complications, frequencies for testing and complications screening,and steps for self-care.Few clients are receiving testing and complications screening at appropriate intervals (CDA-CPGs, 2003), despite most clients seeing their main diabetes care provider 3 times or more in ayear, providing ample opportunity. MDSi aims to empower clients to ask for timely testing andscreening, when none is offered.DIABETES SERVICES & CARE UTILIZATION:DIABETES SERVICES & CARE UTILIZATION:2%7% 3% 10%78%NurseFamily PhysicianDiabetes SpecialistNo regular providerOtherMost clients (66%) reported seeing their main diabetes care provMost clients (66%) reported seeing their main diabetes care provider 3 orider 3 ormore times per year, and most clients correctly knew how often fmore times per year, and most clients correctly knew how often followollow--upuptesting should occur. However, many clients are not receiving tetesting should occur. However, many clients are not receiving testing andsting andcomplications screening at appropriate intervals.complications screening at appropriate intervals.Male and female clientsMale and female clientswere similarly distributed inwere similarly distributed inwho provides their mainwho provides their maindiabetes care.diabetes care.However, female clientsHowever, female clientsgenerally reported greatergenerally reported greaterdiabetes care utilizationdiabetes care utilizationrates compared to males.rates compared to males.Q9. When was your last dilated eye exam?Q10. When was the last time a podiatrist checked your feet?Q1. Who is your main diabetes care provider?Q2. How many times in the past year have you visited yourmain diabetes care provider?Q13. When was the last time your A1c was tested by a healthcare provider?DIABETES KNOWLEDGE & EDUCATION:DIABETES KNOWLEDGE & EDUCATION:Q41. How many times have you attendeda formal diabetes education program?10%46%12%3% 2%27%PoorFairGoodVery GoodExcellentNo answerQ40. Overall, your current understandingof diabetes is:13%6%47%27%7%EverydayEvery weekEvery 2-4 monthsEvery yearNo answerQ46: How often should someone withdiabetes have their A1c tested?15%60%16%4% 5%Every 6 monthsEvery yearEvery 2 yearsNot until trouble seeingNo answerQ50. How often should someone with eyedisease see an ophthalmologist?Testing Frequency:Testing Frequency:0%10%20%30%40%Never 2+yearsago 1to2monthsagoWithin12monthsDont know NoanswerTotal(n=223)Males(n=84)Females(n=139)Only 44% of clients had at least one A1c test done within 12 monOnly 44% of clients had at least one A1c test done within 12 months; only 17%ths; only 17%had one within 2 months of our survey. A1c should be tested everhad one within 2 months of our survey. A1c should be tested every 3 monthsy 3 months(4 x per yr) to ensure glycemic goals are being met (CDA 2003 CP(4 x per yr) to ensure glycemic goals are being met (CDA 2003 CPGs, p. S22).Gs, p. S22).0%5%10%15%20%25%30%35%40%1 time 1 to 2 times3 to 6 times 7 to 11times12+ times Dont KnowTotal (n=223)Males (n=84)Females (n=139)0%10%20%30%40%50%60%70%80%90%Never 2+ yearsago1-2 yearsagoWithin 12monthsDont know0%5%10%15%20%25%30%35%40%45%Never 2+ yearsago1-2 yearsagoWithin 12monthsDont knowTotal (n=223) Males (n=84) Females (n=139)82% of clients surveyed have NEVER82% of clients surveyed have NEVERhad a podiatrist check their feet forhad a podiatrist check their feet forulcers, neuropathy or foot risk.ulcers, neuropathy or foot risk.Only 6% of clients surveyed had theirOnly 6% of clients surveyed had theirfeet checked by a podiatrist within thefeet checked by a podiatrist within thepreceding 12preceding 12--month period, themonth period, therecommended interval (2003 CPGs, p.recommended interval (2003 CPGs, p.S72).S72).38% of clients surveyed have NEVER38% of clients surveyed have NEVERhad a dilated eye exam to check forhad a dilated eye exam to check forretinopathy.retinopathy.Only 43% of clients reported having hadOnly 43% of clients reported having hadtheir eyes checked for retinopathy at thetheir eyes checked for retinopathy at therecommended interval of 1recommended interval of 1--2 years (20032 years (2003CPGs, p. S77).CPGs, p. S77).60% of respondents felt they had a good or better understanding60% of respondents felt they had a good or better understanding ofofdiabetes, though few had attended a formal diabetes education prdiabetes, though few had attended a formal diabetes education program.ogram.Survey respondents demonstrated competent knowledge of diabetesSurvey respondents demonstrated competent knowledge of diabetes andandcare standards, and were generally satisfied with the quality ofcare standards, and were generally satisfied with the quality of care theycare theyare receiving. Responses indicated efficacy in terms of selfare receiving. Responses indicated efficacy in terms of self--care andcare andknowledge of signs indicating development of a complication.knowledge of signs indicating development of a complication.Dr. Ellen L. Toth,MDSi Medical LeadSigns and Symptoms:Signs and Symptoms:Q44. Numbness and tingling maybe a symptom of:SelfSelf--Care:Care:Q42. What is the best way to takecare of your feet?3%11%11%5%70%Look at and wash everydayMassage with alcohol everydaySoak for an hour everydayBuy shoes a larger sizeNo answer21%20%39%12%3% 5%PoorFairGoodVery goodExcellentNo answerSatisfaction With Services:Satisfaction With Services:Q37. How well does your diabetescare provider keep you informedabout the next step to take in yourdiabetes care?63%4%6%12% 15%Kidney diseaseNerve diseaseEye diseaseLiver diseaseNo answ er19%13%2%66%Never1 time2-5 times5+ timesDont knowNo answerFunding by AlbertaHealth and Wellness

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