Interdisciplinary primary care team expertise and diabetes care management
Open accessAbstract
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, P < .01), diabetes educators ( β = 6.05, P < .01), nutritionists ( β = 5.21, P < .01), and other general staff ( β =4.96, P = .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, P = .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.
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DSMES results in improved A1C values.
“Evidence indicates that DSMES imparts enhanced knowledge of DM and self-care practices resulting in improved A1C values,909,912,1449–1451 modest reductions in weight, better QoL,912,1451,1452 and lower mortality risk,1453 while at the same time leading to a reduction in health care costs.1454,1455”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [1450]
The Results report that access to diabetes educators and other care-team expertise was not associated with HbA1c control in this study. The paper does not evaluate DSMES as an intervention or state whether DSMES improves A1C values; the care-team finding does not settle that claim. (LLM, conf=0.75)
Experimental — accuracy not yet measuredDSMES results in modest weight reductions.
“Evidence indicates that DSMES imparts enhanced knowledge of DM and self-care practices resulting in improved A1C values,909,912,1449–1451 modest reductions in weight, better QoL,912,1451,1452 and lower mortality risk,1453 while at the same time leading to a reduction in health care costs.1454,1455”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [1450]
The Abstract reports associations between care-team expertise and patients’ experiences of chronic care, not weight change. The Outcome Variables section identifies chronic-care experience and HbA1c control as the study outcomes. A search for DSMES and weight reduction found no passage in our copy reporting modest weight reductions. (LLM, conf=0.76)
Experimental — accuracy not yet measuredDSMES improves knowledge of diabetes mellitus and self-care practices.
“Evidence indicates that DSMES imparts enhanced knowledge of DM and self-care practices resulting in improved A1C values,909,912,1449–1451 modest reductions in weight, better QoL,912,1451,1452 and lower mortality risk,1453 while at the same time leading to a reduction in health care costs.1454,1455”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [1450]
The Introduction says patients need support to improve self-management skills, and the Abstract links access to diabetes educators with better experiences of chronic care. Neither reports that DSMES improves diabetes knowledge or self-care practices; searches for those outcomes found no supporting passage in our copy. (LLM, conf=0.73)
Experimental — accuracy not yet measured
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References 88 · Cited by 17
Research works printed but not linked: 2
- [33]33. American Diabetes Association. 12. Older adults: standards of medical care in diabetes-2019. Diabetes Care 2019;42:S139-S147.
- [81]81. Sugarman JR, Phillips KE, Wagner EH, Coleman K, Abrams MK. The safety net medical home initi- ative: transforming care for vulnerable populations. Med Care 2014;52:S1-S10.
- Authors
- Miller-Rosales, C., & Rodriguez, H. P.
- Venue
- The Journal of the American Board of Family Medicine
- Published
- 2021-01
- Volume
- 34
- Issue
- 1
- Pages
- 151-161
- ISSN
- 1557-2625 (ISSN-L)
- 1558-7118
- OpenAlex
- W3120221158
- Cited by
- 17
- References
- 88
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 5 · 2023: 1 · 2022: 4 · 2021: 4
- FWCI
- 2.61
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- The Journal of the American Board of Family Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of California Berkeley
- Sutter Health
- Agency for Healthcare Research and Quality (R18HS020120)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Health Professions › General Health Professions › Interprofessional Education and Collaboration
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Keywords
- type 2 diabetes, interdisciplinary care teams, community health centers, community health workers, diabetes educators, nutritionists, patient self-management, interprofessional care
- MeSH terms
- Adult, Community Health Centers, Diabetes Mellitus, Type 2, Glycated Hemoglobin, Humans, Patient Care Team, Pharmacists, Primary Health Care
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