Quality of care in rural youth with type 1 diabetes: a cross-sectional pilot assessment

Abstract

BackgroundType 1 diabetes mellitus (T1DM) presents a significant health burden for patients and families. The quality of care (QOC) among those living in rural communities is thought to be subpar compared with those in urban communities; however, little data exist to reflect this, especially in pediatric diabetes.ObjectiveThe purpose of this pilot study was to investigate diabetes QOC among families living in rural versus urban areas. 6 QOC markers were used to compare youth with T1DM: appointment adherence, patient–provider communication, diabetes education during clinic visit, congruency with diabetes standards of care, diabetes self-management behaviors, and diabetes-related hospitalizations.Research design and methodsParticipants were rural or urban adult caregivers of youth ages 2–18 with ≥10-month history of T1DM receiving treatment at Seattle Children's Hospital, USA. Participants were from rural areas of central Washington, or urban areas of western Washington. Caregivers completed a 26-item survey pertaining to the 6 QOC markers. The 6 QOC markers were compared across 61 participants (34 rural, 27 urban), to determine how diabetes care quality and experiences differed. Data were collected over 12 months. Groups were compared using t-tests and χ2 tests, as appropriate.ResultsCompared with urban families, rural families reported significantly lower income and a 4-fold greater usage of public insurance. Among the QOC measures, rural participants were significantly worse off in the appointment adherence, patient–provider communication, and hospitalizations categories. Congruence with diabetes standards of care (foot care only) was also significantly poorer in rural participants.ConclusionsThe burden of travel in conjunction with the lack of resources in this rural population of families with T1DM youth is cause for concern and warrants further research.

<p>Implementation of Electronic Medical Record Template Improves Screening for Complications in Children with Type 1 Diabetes Mellitus</p>

“…10 A study by Stumetz et al revealed that participants from rural environments were less adherent to appointments and provider communication than participants from urban environments. 11 Ethnicity and socioeconomic indicators also demonstrate a role in compliance with screening, as one study showed the odds of screening for diabetic retinopathy being lower in black children and in those with poorer diabetes control. 12 Medical provider compliance in adhering to screening guidelines is essential to reduce the acute and chronic complications associated with T1DM.…”

Socio-demographic and clinical characteristics of diabetes mellitus in rural Rwanda: Time to contextualize the interventions? A cross-sectional study

“…Although our study population was uniformly well covered by medical insurance, more rural individuals than urban participants reported severe hyperglycaemia at diagnosis and use of herbal medicine, and their diabetes was less well controlled. Limited access to diabetes care, easy accessibility to traditional healers, lack of resources and frequent lack of stock of modern diabetes drugs have been reported to be the reasons for herbal medicine use and poor quality of diabetes care in LMICs [47,48]. There is a need to identify other barriers to quality diabetes care in the setting in which universal medical coverage is maximized and diabetes care decentralization to lower levels of the health system is established to improve equitable access to care.…”

Socio-demographic and clinical characteristics of diabetes mellitus in rural Rwanda: Time to contextualize the interventions? A cross-sectional study

“…where Type 1 and type 2 diabetes have been reported to be equally common [46] Although our study population was uniformly well covered by medical insurance, more rural individuals than urban participants reported severe hyperglycaemia at diagnosis and use of herbal medicine, and their diabetes was less well controlled. Limited access to diabetes care, easy accessibility to traditional healers, lack of resources and frequent lack of stock of modern diabetes drugs have been reported to be the reasons for herbal medicine use and poor quality of diabetes care in LMICs [47,48]. There is a need to identify other barriers to quality diabetes care in the setting in which universal medical coverage is maximized and diabetes care decentralization to lower levels of Further studies are required to assess risk factors for sub-types of diabetes and their aetio-pathology in rural and low-income settings and to identify effective interventions to inform guidelines to prevent and treat all forms of diabetes in LMICs.…”