2007 (Oct) Canadian Diabetes Association Conference, poster presentation by BRAID Research

1. Diabetes Care and Patient Understanding ofDiabetes Care and Patient Understanding of
Type 2 Diabetes in Remote, Rural AlbertaType 2 Diabetes in Remote, Rural Alberta
Ellen L. Toth, Kelli RalphEllen L. Toth, Kelli Ralph--Campbell, Mary Pick, Tracy Connor, Kari Meneen, Gloria Fraser,Campbell, Mary Pick, Tracy Connor, Kari Meneen, Gloria Fraser,
Department of Medicine, University of Alberta, Edmonton, ABDepartment of Medicine, University of Alberta, Edmonton, AB
Abstract
MDSi, a mobile diabetes program serving remote and rural Alberta, provides complications
screening to clients with diabetes. Clients were asked to complete a survey to assess their access
to and satisfaction with mainstream diabetes care services; self-perceived overall and diabetes-
related health status; and clients’ knowledge of diabetes. Since 2004, 223 surveys were
completed.
81% of respondents said their family doctor is their main diabetes care provider; a diabetes
specialist was the main provider for only 2%. Most had visited their main provider at least 3 times in
the previous year; 20% indicated they had seen their provider more than 12 times in the previous
year. 30% had never seen a dietitian.
In the previous year, only 26% had an A1c test done; 55% had their cholesterol checked; 61%
had a urine analysis. Only 25% had a retinal exam in the previous year (38% had never had one).
Almost all clients (82%) had never seen a podiatrist.
Most clients rated their overall and diabetes-related health as ‘Good’/’Very Good’. 4%
indicated ‘Poor’/’Very Poor’.
Only slightly more than half of respondents indicated ‘Good’/’Very Good’/’Excellent’ regarding
their care providers keeping them informed about their diabetes status, available treatments, their
recent test results, next steps in their diabetes care, and communicating with other providers
responsible for their care.
60% of clients felt they had at least a good understanding of diabetes. However, only 19%
had attended a formal diabetes education program in an urban centre. Regardless, most correctly
identified “warning signs” for complications, frequencies for testing and complications screening,
and steps for self-care.
Few clients are receiving testing and complications screening at appropriate intervals (CDA-
CPGs, 2003), despite most clients seeing their main diabetes care provider 3 times or more in a
year, providing ample opportunity. MDSi aims to empower clients to ask for timely testing and
screening, when none is offered.
DIABETES SERVICES & CARE UTILIZATION:DIABETES SERVICES & CARE UTILIZATION:
2%
7% 3% 10%
78%
Nurse
Family Physician
Diabetes Specialist
No regular provider
Other
Most clients (66%) reported seeing their main diabetes care provMost clients (66%) reported seeing their main diabetes care provider 3 orider 3 or
more times per year, and most clients correctly knew how often fmore times per year, and most clients correctly knew how often followollow--upup
testing should occur. However, many clients are not receiving tetesting should occur. However, many clients are not receiving testing andsting and
complications screening at appropriate intervals.complications screening at appropriate intervals.
Male and female clientsMale and female clients
were similarly distributed inwere similarly distributed in
who provides their mainwho provides their main
diabetes care.diabetes care.
However, female clientsHowever, female clients
generally reported greatergenerally reported greater
diabetes care utilizationdiabetes care utilization
rates compared to males.rates compared to males.
Q9. When was your last dilated eye exam?
Q10. When was the last time a podiatrist checked your feet?
Q1. Who is your main diabetes care provider?
Q2. How many times in the past year have you visited your
main diabetes care provider?
Q13. When was the last time your A1c was tested by a health
care provider?
DIABETES KNOWLEDGE & EDUCATION:DIABETES KNOWLEDGE & EDUCATION:
Q41. How many times have you attended
a formal diabetes education program?
10%
46%
12%
3% 2%
27%
Poor
Fair
Good
Very Good
Excellent
No answer
Q40. Overall, your current understanding
of diabetes is:
13%
6%
47%
27%
7%
Everyday
Every week
Every 2-4 months
Every year
No answer
Q46: How often should someone with
diabetes have their A1c tested?
15%
60%
16%
4% 5%
Every 6 months
Every year
Every 2 years
Not until trouble seeing
No answer
Q50. How often should someone with eye
disease see an ophthalmologist?
Testing Frequency:Testing Frequency:
0%
10%
20%
30%
40%
Never 2+yearsago 1to2months
ago
Within12
months
Don't know Noanswer
Total(n=223)
Males(n=84)
Females(n=139)
Only 44% of clients had at least one A1c test done within 12 monOnly 44% of clients had at least one A1c test done within 12 months; only 17%ths; only 17%
had one within 2 months of our survey. A1c should be tested everhad one within 2 months of our survey. A1c should be tested every 3 monthsy 3 months
(4 x per yr) to ensure glycemic goals are being met (CDA 2003 CP(4 x per yr) to ensure glycemic goals are being met (CDA 2003 CPGs, p. S22).Gs, p. S22).
0%
5%
10%
15%
20%
25%
30%
35%
40%
1 time 1 to 2 times3 to 6 times 7 to 11
times
12+ times Don't Know
Total (n=223)
Males (n=84)
Females (n=139)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Never 2+ years
ago
1-2 years
ago
Within 12
months
Don't know
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Never 2+ years
ago
1-2 years
ago
Within 12
months
Don't know
Total (n=223) Males (n=84) Females (n=139)
82% of clients surveyed have NEVER82% of clients surveyed have NEVER
had a podiatrist check their feet forhad a podiatrist check their feet for
ulcers, neuropathy or foot risk.ulcers, neuropathy or foot risk.
Only 6% of clients surveyed had theirOnly 6% of clients surveyed had their
feet checked by a podiatrist within thefeet checked by a podiatrist within the
preceding 12preceding 12--month period, themonth period, the
recommended interval (2003 CPGs, p.recommended interval (2003 CPGs, p.
S72).S72).
38% of clients surveyed have NEVER38% of clients surveyed have NEVER
had a dilated eye exam to check forhad a dilated eye exam to check for
retinopathy.retinopathy.
Only 43% of clients reported having hadOnly 43% of clients reported having had
their eyes checked for retinopathy at thetheir eyes checked for retinopathy at the
recommended interval of 1recommended interval of 1--2 years (20032 years (2003
CPGs, p. S77).CPGs, p. S77).
60% of respondents felt they had a good or better understanding60% of respondents felt they had a good or better understanding ofof
diabetes, though few had attended a formal diabetes education prdiabetes, though few had attended a formal diabetes education program.ogram.
Survey respondents demonstrated competent knowledge of diabetesSurvey respondents demonstrated competent knowledge of diabetes andand
care standards, and were generally satisfied with the quality ofcare standards, and were generally satisfied with the quality of care theycare they
are receiving. Responses indicated efficacy in terms of selfare receiving. Responses indicated efficacy in terms of self--care andcare and
knowledge of signs indicating development of a complication.knowledge of signs indicating development of a complication.
Dr. Ellen L. Toth,
MDSi Medical Lead
Signs and Symptoms:Signs and Symptoms:
Q44. Numbness and tingling may
be a symptom of:
SelfSelf--Care:Care:
Q42. What is the best way to take
care of your feet?
3%
11%
11%
5%
70%
Look at and wash everyday
Massage with alcohol everyday
Soak for an hour everyday
Buy shoes a larger size
No answer
21%
20%
39%
12%
3% 5%
Poor
Fair
Good
Very good
Excellent
No answer
Satisfaction With Services:Satisfaction With Services:
Q37. How well does your diabetes
care provider keep you informed
about the next step to take in your
diabetes care?
63%
4%
6%
12% 15%
Kidney disease
Nerve disease
Eye disease
Liver disease
No answ er
19%
13%
2%
66%
Never
1 time
2-5 times
5+ times
Don't know
No answer
Funding by Alberta
Health and Wellness