Interdisciplinary Primary Care Team Expertise and Diabetes Care Management.

BACKGROUND

Interdisciplinary primary care team expertise can aid patient self management of type 2 diabetes, but small community health centers (CHCs) may not have the volume to consistently provide interprofessional care. We examine whether care team role expertise is associated with patients' experiences of chronic care and whether the relationship is stronger for small CHC sites.

METHODS

Surveys of 1277 adults with diabetes (2012; response rate = 47%) that assessed nonphysician team roles involved in managing their chronic care, including community health workers, diabetes educators, nutritionists, pharmacists, mental health providers, and other general staff, were integrated with clinical and administrative data from 14 CHCs. Random effects regression models estimated the association of team expertise, CHC size, and 1) patients' experiences of chronic care; and 2) hemoglobin A1c control, controlling for patient comorbidities, sex, race/ethnicity/primary language, age, and insurance coverage.

RESULTS

Care teams with community health workers ( β = 7.67,  < .01), diabetes educators ( β = 6.05,  < .01), nutritionists ( β = 5.21,  < .01), and other general staff ([Formula: see text] =4.96,  = .02) were associated with better patients' experiences of chronic care, but not hemoglobin A1c control. Patients of small CHC sites reported better experiences of care ( β = 2.15,  = .03) with each additional team role reported, but the relationship was not significant for large CHCs.

CONCLUSIONS

Patients with access to care team expertise in self-management support, including diabetes educators, nutritionists, community health workers, and other general staff report better experiences of chronic care. These team roles may reduce barriers to patient self management and improve patients' overall experiences of chronic care, particularly in small CHC sites.