Fewer Primary-Care Physicians Refer All Patients with Diabetes to Diabetes Education Programs

Enza Gucciardi, a professor at Ryerson University’s School of Nutrition, is the lead author of a study that examined physician referral rates to diabetes education programs in southern Ontario. The study’s co-investigators are Mariella Fortugno, a recent Ryerson graduate from the School of Nutrition; Vivian Wing-Sheung Chan and Sobia Khan, University of Waterloo; Stacey Horodezny, Trillium Health Centre; and Susan Swartzack of the Mississauga Halton Local Health Integration Network.

“Since patients must be referred by their doctor to attend a diabetes education program, physicians are essentially the gatekeepers,” said Gucciardi. “Therefore, it is critically important that they are aware of these programs and provide referrals.”

Over nine million Canadians are living with diabetes or prediabetes, according to the Canadian Diabetes Association. If the disease is left untreated or improperly managed, over time, high blood glucose levels can cause a variety of potentially life-threatening complications including heart disease, stroke and nerve damage.

Diabetes self-management education has been proven to be effective in delaying the progression of complications from the disease. Patients who attend these education programs are encouraged to take oral medication, participate in insulin therapy, exercise, eat a balanced diet and monitor blood glucose levels. These activities improve their quality of life and can decrease health-care costs. The researchers surveyed 99 primary-care physicians in the Mississauga-Halton region about their referral patterns to diabetes education programs and the factors that influence their referral practices. They were also asked to identify barriers to attending diabetes education programs that their patients may face.

The researchers found that while the majority (96 per cent) of primary-care physicians referred some of their patients with diabetes to diabetes education programs, less than half (46 per cent) referred all of their diabetes patients.

“This is an important finding because the Canadian Diabetes Association Clinical Practice Guidelines recommend that all patients diagnosed with diabetes should receive multidisciplinary care from registered nurses, dietitians and other health-care professionals,” said Gucciardi. “However, we found that less than half of primary-care physicians are following the association’s recommended guidelines.”

When it comes to factors influencing referral, 74 per cent of physicians reported that their patients were unwilling to attend. Language barriers (28 per cent), waiting lists of more than two weeks (32 per cent), and a lack of evening or weekend programs (17 per cent) were common barriers. Twelve per cent of physicians reported they did not refer their patients because they could provide diabetes education themselves.

Looking to the future, the researchers recommend that diabetes education programs should increase primary-care physicians’ awareness of their programming, provide programs in more languages to serve their diverse communities, and shorten waiting lists. Fortugno added that some education programs have already started to offer evening and weekend programs and culturally specific resources and services. Streamlining the referral process for physicians by using the same forms and procedures for all education programs will also make it simpler and quicker for doctors to refer their patients.

“Strong partnerships between primary-care physicians and diabetes education program providers will encourage more dialogue regarding the types of services offered by the programs,” said Fortugno. “These partnerships, in turn, can encourage more patients to attend diabetes education programs, boost physician referral rates, and most importantly, lead to a better quality of life for people living with diabetes.”

The study, Primary Care Physician Referral Patterns to Diabetes Education Programs in Southern Ontario, will be published in the July issue of the Canadian Journal of Diabetes.

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