Effectiveness of a rural pediatric diabetes management program.
BACKGROUND: Children with type 1 diabetes living in rural areas may have limited access to specialty diabetes care compared to children living in urban areas. To address this issue, providers have developed outreach services in which specialists travel periodically to rural communities. OBJECTIVE: To determine whether the care of children with type 1 diabetes treated by pediatric endocrinologists in a rural outpatient clinic is comparable to the care of children treated in an urban medical center by the same diabetes team. METHODS: We carried out a retrospective cohort study comparing the number of patient visits with physicians, behavioral specialists, and dietitians and the frequency of hemoglobin A1c (HbA1c) measurements over a 12-month period treated in a rural clinic with a matched group treated in an urban children's hospital clinic. RESULTS: We found that urban patients (n = 38) were more likely to complete four visits per year compared to a matched group (n = 19) at the rural clinic (55.3% vs. 15.8%; p < 0.004), were significantly more likely than those in the rural clinic to have had four HbA1c measurements per year (55.3% vs. 21.1%; p < 0.014), and more likely to have had an assessment by a behavioral specialist (31.6% vs. 0%). Children at the rural clinic site were more likely to have had a visit with a nutritionist during the year (89.5% vs. 36.8%; p < 0.005). CONCLUSION: We conclude that diabetes care provided using a rural outreach model closely approximates, but does not entirely duplicate, care provided in the urban setting.