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Research ArticleOriginal Research

Improved Outcomes in Diabetes Care for Rural African Americans

Paul Bray, Doyle M. Cummings, Susan Morrissey, Debra Thompson, Don Holbert, Kyle Wilson, Eric Lukosius and Robert Tanenberg
The Annals of Family Medicine March 2013, 11 (2) 145-150; DOI: https://doi.org/10.1370/afm.1470
Paul Bray
1Vidant Health (formerly University Health System), Greenville, North Carolina
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  • For correspondence: pbray@vidanthealth.com
Doyle M. Cummings
2Department of Family Medicine, Brody School of Medicine, East Carolina University, Greenville, North Carolina
3ECU Diabetes and Obesity Institute, and Center for Health Disparities Research, East Carolina University, Greenville, North Carolina
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Susan Morrissey
2Department of Family Medicine, Brody School of Medicine, East Carolina University, Greenville, North Carolina
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Debra Thompson
1Vidant Health (formerly University Health System), Greenville, North Carolina
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Don Holbert
4Department of Biostatistics, East Carolina University, Greenville, North Carolina
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Kyle Wilson
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Eric Lukosius
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Robert Tanenberg
3ECU Diabetes and Obesity Institute, and Center for Health Disparities Research, East Carolina University, Greenville, North Carolina
5Department of Internal Medicine, East Carolina University, Greenville, North Carolina
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Abstract

PURPOSE Rural low-income African American patients with diabetes have traditionally poorer clinical outcomes and limited access to state-of-the-art diabetes care. We determined the effectiveness of a redesigned primary care model on patients’ glycemic, blood pressure, and lipid level control.

METHODS In 3 purposively selected, rural, fee-for-service, primary care practices, African American patients with type 2 diabetes received point-of-care education, coaching, and medication intensification from a diabetes care management team made up of a nurse, pharmacist, and dietitian. In 5 randomly selected control practices matched for practice and patient characteristics, African American patients received usual care. Using univariate and multivariate adjusted models, we evaluated the effects of the intervention on intermediate (median 18 months) and long-term (median 36 months) changes in glycated hemoglobin (hemoglobin A1c) levels, blood pressure, and lipid levels, as well as the proportion of patients meeting target values.

RESULTS Among 727 randomly selected rural African American diabetic patients (368 intervention, 359 control), intervention patients had a significantly greater reduction in mean hemoglobin A1c levels at intermediate (−0.5 % vs −0.2%; P <.05) and long-term (−0.5% vs −0.10%; P <.005) follow-up in univariate and multivariate models. The proportion of patients achieving a hemoglobin A1c level of less than 7.5% (68% vs 59%, P <.01) and/or a systolic blood pressure of less than 140 mm Hg (69% vs 57%, P <.01) was also significantly greater in intervention practices in multivariate models.

CONCLUSION Redesigning care strategies in rural fee-for-service primary care practices for African American patients with established diabetes results in significantly improved glycemic control relative to usual care.

Key words
  • diabetes
  • improved outcomes
  • African Americans
  • delivery redesign
  • rural
  • patient-centered medical homes
  • Received for publication March 13, 1012.
  • Revision received July 28, 2012.
  • Accepted for publication August 21, 2012.
  • © 2013 Annals of Family Medicine, Inc.
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The Annals of Family Medicine: 11 (2)
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March/April 2013
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Improved Outcomes in Diabetes Care for Rural African Americans
Paul Bray, Doyle M. Cummings, Susan Morrissey, Debra Thompson, Don Holbert, Kyle Wilson, Eric Lukosius, Robert Tanenberg
The Annals of Family Medicine Mar 2013, 11 (2) 145-150; DOI: 10.1370/afm.1470

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Improved Outcomes in Diabetes Care for Rural African Americans
Paul Bray, Doyle M. Cummings, Susan Morrissey, Debra Thompson, Don Holbert, Kyle Wilson, Eric Lukosius, Robert Tanenberg
The Annals of Family Medicine Mar 2013, 11 (2) 145-150; DOI: 10.1370/afm.1470
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