Social, medical intervention improved glycemic control in rural patients with diabetes

A population health team assessed patients' medical, behavioral, and social needs with annual health risk assessments and partnered with community organizations to improve their access to food, transportation, and medicine.

A medical-social intervention for rural patients with type 2 diabetes improved HbA1c levels among those with less well-controlled disease, a study found.

The intervention integrated medical and social care to improve clinical outcomes in a resource-constrained area. The cohort study included 1,764 patients with type 2 diabetes treated by a health care system in frontier Idaho, a sparsely populated area geographically isolated from population centers and services, from September 2017 to December 2021.

A population health team used annual health risk assessments to evaluate patients' medical, behavioral, and social needs. Patients were provided with diabetes self-management education, chronic care management, integrated behavioral health, medical nutritional therapy, and community health worker navigation. The intervention team also partnered with community organizations to address access to food, transportation, and medication, as well as needs specific to older patients, such as grab bars and wheelchair-accessible ramps. Results were published by the Journal of General Internal Medicine on March 2.

Patients were categorized by whether they had two or more encounters with the intervention team, one encounter, or no encounters. The intervention patients had more chronic conditions and higher medical complexity. All of the patients had a reduction in mean HbA1c levels at six months, but the group with no encounters did not sustain the reduction over time. The group with multiple encounters, however, had a significant decrease in mean HbA1c level from baseline to 12 months (7.9% to 7.6%; P<0.01) and sustained reductions at 18 months, 24 months, 30 months, and 36 months. The HbA1c levels of patients with only one encounter decreased from baseline to 12 months (7.7% to 7.3%; P<0.05), but no significant decreases were observed after 12 months.

The study “illustrates how health systems may build a model to improve population health and assess and address social needs as part of standard medical care provided to all patients,” said the authors, although they noted that rural hospitals “must walk a critical line between offering comprehensive services to address both medical and social needs and remaining financially solvent in the current fee-for-service healthcare delivery and financing environment.”

The study was one of several reporting on a recent initiative to reduce diabetes care disparities, and an associated editorial called for a fundamental paradigm shift in health care financing and delivery to create health equity. “Too often we require that healthcare interventions for marginalized populations save costs or be cost neutral, rather than increase value,” it stated. “We should invest more in health promotion, public health, primary care, and social care. Our current healthcare delivery and financing system undervalues the time and resources required to address the medical and social needs of patients experiencing health inequities.”