Key points
Though benefits are well known, a very small percentage of people with diabetes participate in DSMES services. Identifying and addressing barriers at all levels is key to increasing participation.
Overview
Of people with diabetes, less than 5% of Medicare beneficiaries and 6.8% of privately insured people participate in DSMES within the first year of diagnosis. Barriers to participation occur at several levels, including:
- Programmatic barriers to starting or sustaining DSMES services.
- Provider barriers to referral.
- Individual barriers to access and participation.
Programmatic barriers
Programmatic barriers to starting and sustaining a DSMES service include:
- Few clinical professionals in the area.
- Difficulty attracting and retaining enough participants, such as with rural populations.
- Participants with limited financial resources.
- Limited or low reimbursement rates.
- Administrative or resource challenges with American Diabetes Association recognition or Association of Diabetes Care & Education Specialists accreditation.
- Lack of reimbursement for community health workers helping with DSMES.
- Limited resources for administration and marketing.
- Lack of support among health care administrators.
- Unknowns associated with health care policy.
For tools and resources that can help address these barriers, see Building the Business Case for DSMES and Reimbursement and Sustainability.
Provider barriers
Provider barriers to referral include:
Awareness
- Lack of knowledge and awareness about DSMES.
- Lack of perceived need (diabetes education offered in a provider's practice).
Referral process
- Confusion about referrals.
- Complicated referral forms and paperwork.
- Previous negative experiences with referring to DSMES services.
- Lack of relationships between hospitals and community DSMES services.
Reimbursement
- Lack of provider reimbursement for counseling and interventions.
- Lack of provider understanding of reimbursement procedures.
- Concerns about insurance issues or cost to the person with diabetes.
Tools and resources
Technology, such as electronic health records (EHRs), can help health care providers identify patients with diabetes and increase referrals to DSMES. EHRs can be used to:
- Generate and track referrals.
- Identify people with diabetes who need additional follow-up.
- Close referral loops between providers and DSMES services.
- Strengthen provider buy-in by streamlining the referral process.
The following resources can help address provider barriers and develop a clear, efficient referral process. For additional resources, see Educating Providers and Establishing a Referral Network.
Approaches to Increasing Access and Participation in DSMES
Diabetes Self-management Education and Support in Adults With Type 2 Diabetes: A Consensus Report
Diabetes Self-Management Training (DSMT) Accreditation Program
Individual barriers
Individual barriers to access and participation include:
- Lack of:
- Knowledge about DSMES services and its benefits.
- Access to DSMES services, especially in rural areas.
- Transportation or childcare.
- Insurance or high insurance costs/copayments.
- Family support.
- Evening or weekend classes.
- Inconvenient DSMES service times or locations.
- Unwillingness to participate in group classes.
- Competing demands for time and attention.
Diabetes care and education specialists can address individual barriers and increase DSMES participation using these strategies:
- Offer classes on various days of the week and at convenient times.
- Offer classes in different formats and lengths (multiple sessions, all-day services).
- Increase frequency of class offerings.
- Follow up by phone call, text, or email with participants who don't attend or miss appointments.