Semester

Summer

Date of Graduation

2011

Document Type

Dissertation

Degree Type

PhD

College

School of Nursing

Department

Not Listed

Committee Chair

Cynthia Persily.

Abstract

Background. Rural populations with low socioeconomic status are at higher risk of late diabetes diagnosis, poor diabetes control, decreased self-management, and development of complications. Diabetes Group Medical Visits (DGMVs) have been used to improve outcomes for persons with diabetes. A gap in the literature exists related to the effectiveness of DGMVs for uninsured persons with diabetes.;Aims. The aims of the study were to describe the characteristics of uninsured persons with diabetes cared for in a free clinic, describe the biophysical outcomes of care, explore the differences in biophysical outcomes of care before and after attending DGMVs versus receiving usual care, and explore the impact of dose of DGMVs on biophysical outcomes of care.;Methods. This retrospective study was conducted at a free clinic in West Virginia, using chart review of a convenience sample of patients following approval of the WVU IRB. The inclusion criteria were: (1) age ≥ 18 years, (2) diagnosis of diabetes, (3) uninsured and received care at a free clinic between May 2007 and August 18, 2009. A total of 111 patients were studied. There were 53 participants who attended DGMVs and 58 participants who received usual care. Statistical Package of Social Sciences (SPSS), version 18 was used for analysis of the data.;Results. The majority of the patients were female, white, severely obese, had a high-school education or less, were age 50 or younger, had a mean of 5 co-morbid conditions other than diabetes, and drove long distances to receive care. The patients who attended DGMVs had a higher HgA1C, reported more pain, had increased depression levels and were more obese at baseline than those who received usual care. There was a statistically significant decrease in systolic blood pressure from time one to time two in patients who attended DGMVs. There was no significant impact on biophysical outcomes of care in patients who received usual care from time one to time two. Dose of DGMVs did not impact biophysical outcomes of care.;Conclusion. DGMV as an intervention is not enough to improve biophysical outcomes in this population. Interventions targeted to the unique characteristics of this population are needed to prevent devastating complications.

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