Barriers to providing diabetes care in community health centers

OBJECTIVE- We aimed to identify barriers to improving care for individuals with diabetes in community health centers. These findings are important bec ause many such patients, as in most other practice settings, receive care t hat does not meet evidence-based standards. RESEARCH DESIGN AND METHODS- In 32 Midwestern health centers, we surveyed 3 89 health providers and administrators about the barriers they faced delive ring diabetes care. We report on home blood glucose monitoring, HbA(1c) tes ts, dilated eye examinations, loot examinations, diet, and exercise, all of which are a subset of the larger clinical practice recommendations of the American Diabetes Association (ADA). RESULTS- Among the 279 (72%) respondents, providers perceived that patients were significantly less likely than providers to believe that key processe s of care were important (overall mean on 30-point scale: providers 26.8, p atients 18.2, P = 0.0001). Providers were more confident in their ability t o instruct patients on diet and exercise than on their ability to help them make changes in these areas. Ratings of the importance of access to cam an d finances as barriers varied widely; however, >25% of the providers and ad ministrators agreed that significant barriers included affordability of hom e blood glucose monitoring, HbA(1c) testing, dilated eve examination, and s pecial diets; nonproximity of ophthalmologist; forgetting to order eve exam inations and to examine patients' feet; time required to teach home blood g lucose monitoring; and language or cultural barriers. CONCLUSIONS- Providers in health centers indicate a need to enhance behavio ral change in diabetic patients. In addition, better health care delivery s ystems and reforms that improve the affordability, accessibility, and effic iency of care are also likely to help health centers meet ADA standards of care.