Improving glycemic control: can techniques used in a managed care setting be successfully adapted to a rural fee-for-service practice?

The objective of this work was to improve glycemic control using case management supported by electronic diabetes care monitoring. Information for patients with diagnosed diabetes in a rural community was maintained in the Diabetes Care Monitoring System. In September 1998, counseling and medication management for glycemic control was intensified during individual office visits. And, from September 1998 to February 1999, 2-hour cluster visits modeled after a successful urban program were offered for groups of patients with elevated HbA1c values. The median (and 75th percentile) HbA1c values for the patient population decreased from 8.7% (10.9%) in March 1998 (N = 173) to 7.5% (9.3%) in March 1999 (N = 182) and was maintained at 7.5% (9.1%) through March 2000 (N = 182). Case management, including cluster visits, can be accomplished in a rural physician's office with the support of an electronic diabetes care monitoring system. This intensified approach decreased and sustained the HbA1c level by more than a percentage point for the patient population.