Rural Primary Care Practice-Based Diabetes Self-Management Intervention: Qualitative Results & Recommendations

Objective: To share an overview and research results of a primary care intervention aimed to improve patients’ diabetes self-management conducted within five clinics in two rural Missouri counties. The intervention was based on a previous research-based intervention conducted in a more controlled environment.

Methods: A nurse-partner was hired for each clinic and trained to use a variety of strategies to improve patients’ diabetes self-management. Physicians were oriented to the project’s goals. Physicians of participating clinics were interviewed at the start and approximately one year later regarding the effects of the project. Clinic observations, including interactions between nurse-partners and patients as well as physicians and patients, were conducted throughout the project. In addition, patient interviews were done to obtain data on barriers to diabetes self-management.

Results:  Clinics’ success in improving patients’ diabetes self-management varied greatly between the clinics secondary to a variety of factors including clinic flow, nurse-partner education level and experience in regards to diabetes, and space and time provided to the nurse-partner for patient interactions and other clinic characteristics. Discrepancies between clinics’ ability to improve diabetes self-management will be presented as well as recommendations for future clinic-based diabetes self-management interventions.

Conclusion: Individual characteristics of the clinics, physicians, and nurse-partners caused a widely varied response among participating primary care clinics to a diabetes self-management intervention conducted in rural Missouri.