Issue 110 Item 6 ADA: Effectiveness of a Diabetes Educator (DE) in Increasing Ph

DHE presence in a private practice setting was effective at increasing diabetic patient testing compliance for HbA1c, lipids and ALB. >Private practice Type II diabetes management includes providing care and testing according to established clinical guidelines. Previous studies have shown that increasing physician knowledge is an important step in better diabetes management.

Monitoring compliance with testing provides evidence that knowledge is manifested in better practice. This study examines if a Diabetes Health Educator (DE) working within a private practice can have the measurable effect on increasing patient testing.

A part time (24 hour per-week) DE instructed private practice physicians on current guidelines, standards and practices for diabetes case management to a private practice with 362 diabetics. Physician compliance with testing for hemoglobin (HbA1c), lipids and micro-albumin (m-ALB) were then followed at one year intervals for two years. Patients without direct DE involvement were treated as controls. Analysis methods included chi-square test’s between patients followed by and DHE and those in the standard practice (controls).

The results showed compliance with testing was equivalent (p>0.05) for HbA1c, Lipids and m-ALB at baseline, demonstrating equality between groups. Overall compliance rates at baseline were 62% for HbA1c, 63% for Lipids and 35% for m-ALB. At one year physicians and patients with the DE education component (n=258) increased compliance to 77% for HbA1c versus 36% in the controls (p<0.001, n=104) at two years compliance increase to 88% in the DE group and 63% in the controls (p<0.002). Data for lipids demonstrated that DE education was 65% compliant at one year compared to 30% in controls (p<0.001). At two years compliance increased to 78% in DE education compared to 74% in controls (p=0.556). Results were similar for m-ALB, with 100% compliance in the first year (p<0.001) for DHE patients, and reduced to 48% compliance in the second year (p=0.682)

The study concluded that DE presence in a private practice setting was effective at increasing diabetic patient testing compliance for HbA1c, lipids and ALB. The lack of significance for the year two results could best be explained as Hawthorne effect, indicating that physicians have learned the diabetes management program and are implementing HbA1c, lipid and m-ALB testing in all diabetic patients in their practice without DE intervention. Further efforts are continuing in making testing ‘routine’ in the private practice setting. American Diabetes Association’s 62nd Annual Scientific Sessions