Accessibility and outcomes from a rural diabetes nurse-educator led self-management program

Objective To investigate factors associated with access to, and health outcomes of, a diabetes nurse-educator led self-management program for rural Australians with diabetes. 

Design Retrospective cohort study 

Setting A rural community-health service with a dispersed catchment of 10,000 population. 

Subjects Clients diagnosed with type 2 diabetes mellitus and referred to the program between April 2008 and December 2012. 

Intervention A diabetes self-management program comprising an initial assessment, a group education session, and 3, 6, and 12 month clinical reviews. 

Main outcome measures Program attendance after referral; and achievement of management goals for HbA1c, BMI, total cholesterol, quality of life and psychological distress. 

Results Ninety-four percent (n=219/232) of referred clients attended at least once. Multivariate logistic regression showed that attending at least once was significantly associated with living within 25km of the service. Non-smokers/former smokers, general practitioner-referred clients and those with diabetes management plans were significantly more likely to attend three or more sessions. At 12 months clients showed significant improvements in cholesterol, BMI, quality of life and psychological distress. 

Conclusion This study demonstrates that diabetes nurse-educator led self-management programs which adapt to their rural contexts – including geographically dispersed catchment populations and resource constraints – provide highly accessible services meeting the needs of most. Nevertheless, some groups (cigarette smokers, those living furthest from the service) may remain marginalised and less able to access services. Improvements in health outcomes for these clients may require further adaptation of models of care to better target their health care needs.