Screening for Disparities to Promote Diabetic Control

Abstract

Incidence of type 2 diabetes is higher among minorities, those of low socioeconomic status, and those with lower education levels. Nearly half of the modifiable risk factors associated with diabetes are attributed to social determinants of health inequities. Social determinants of health (SDH) are the conditions in which we live and are highly influenced by the distribution of money, power, and resources. SDH disparities result in higher rates of hospitalization, suboptimal quality of life, and decreased life expectancy. The goal of this practice inquiry project is to improve the health of patients with diabetes by implementing a screening tool to identify SDH disparities in the primary care setting. There is growing evidence supporting primary care intervention to reduce SDH disparities. Without systematic screening, these barriers may never be revealed, resulting in care that is inappropriate and ineffective. This study consisted of 95 diabetic patients with an A1c of 8 or higher. Sixty-nine percent of participants had an A1c between 8-11.9 The remaining 31% had an A1c of 12 or higher. Baseline SDH screening revealed a total of 145 disparities at an average of 1.53 disparities per person. The prevalence of disparity was highest in those with an A1c 12 or above at an average of 1.9. Patients that screened positive for disparity were connected with community agencies to bridge gaps in care. Through systematic screening and follow up, the prevalence of disparity was reduced 24.13%. The total number of SDH disparities decreased from 145 to 110 and the average disparity prevalence went from 1.53 to 1.16 per person. A1c was reduced in 56% of the population that was retested during course of this study. Ten percent lowered their A1c below 8. Systematically screening for and addressing SDH disparities can be effectively incorporated into primary care practices, resulting in lower rates of disparity and improved A1c control.