The Division of Adult and Senior Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado (Ms Shaw)
The Department of Biobehavioral Nursing, Georgia Health Sciences University College of Nursing, Athens, Georgia (Dr Killeen, Ms Bowman)
Diabetes Educ. 2011 Nov-Dec;37(6):813-9. doi: 10.1177/0145721711424618. Epub 2011 Oct 21.
To examine accessibility, availability, and quality of diabetes self-management education (DSME) for uninsured adults or those utilizing Medicaid in a community with a high poverty rate.
A descriptive needs assessment was conducted in 8 health care agencies serving the uninsured. Face-to-face audiotaped interviews were conducted with 22 health care providers, educators, and administrators to capture descriptive characteristics about clinical care, DSME, continuity of care, and organizational function.
Twenty-nine percent of adults with diabetes were reported to be uninsured or utilizing Medicaid in these settings. Only 4% of adults received the American Diabetes Association's DSME standards of care. At 5 agencies, there was no direct access to DSME. Uninsured individuals had access to 2 programs; individuals utilizing Medicaid had access to 1 program. Certified diabetes educators were available at only 3 agencies. There were DSME programs that adhered to recommended guidelines but limited availability for these adults. The majority of education (86%) was limited to clinical encounters with providers, which were infrequent and variable in duration. Time spent on education ranged from 2 to 120 minutes depending on agency type. Education topics addressed by providers varied by agency.
Findings of this study suggest that adults who are utilizing Medicaid or are uninsured do not get the amount, type, or quality of DSME needed to sustain successful self-management. Limited availability and inadequate access to quality DSME place vulnerable adults at increased risk for devastating and costly complications despite the known benefits.
调查在一个贫困率较高的社区中，针对未参保成年人或利用医疗补助（Medicaid）的人群，糖尿病自我管理教育（DSME）的可及性、可获得性和质量。
在 8 家为未参保人群提供服务的医疗保健机构中进行了描述性需求评估。对 22 名医疗保健提供者、教育者和管理人员进行了面对面的录音访谈，以获取有关临床护理、DSME、护理连续性和组织功能的描述性特征。
据报告，这些环境中 29%的糖尿病成年人未参保或利用医疗补助。只有 4%的成年人接受了美国糖尿病协会的 DSME 标准护理。在 5 家机构中，无法直接获得 DSME。未参保的成年人可以获得 2 个项目；利用医疗补助的个人可以获得 1 个项目。只有 3 家机构有认证的糖尿病教育者。虽然有一些项目符合推荐的指导方针，但这些项目对这些成年人的服务非常有限。大部分教育（86%）仅限于与提供者的临床接触，而且这些接触的频率和持续时间都各不相同。每次教育的时间根据机构类型的不同而从 2 分钟到 120 分钟不等。各机构的提供者提供的教育主题各不相同。
这项研究的结果表明，利用医疗补助或未参保的成年人没有获得维持成功自我管理所需的 DSME 的数量、类型或质量。由于资源有限且无法获得高质量的 DSME，尽管已知有这些益处，但脆弱的成年人面临着更严重和昂贵的并发症风险。
