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Diabetes Educ. 2005 Nov-Dec;31(6):890-9.

Barriers associated with the delivery of Medicare-reimbursed diabetes self-management education.

Author information

The University of Alabama at Birmingham, Department of Health Services Administration (Dr Powell)
Birmingham VA Medical Center, Deep South Center on Effectiveness, Birmingham, Alabama (Dr Powell)
South Carolina Rural Health Research Center, Columbia (Dr Glover, Dr Probst, Dr Laditka)
The University of South Carolina, Department of Health Services Policy and Management, Columbia (Dr Glover, Dr Probst, Dr Laditka).



The purpose of this study was to explore the barriers that practitioners face in providing diabetes self-management education (DSME) to Medicare beneficiaries, with a special focus on barriers faced by rural providers.


Using an e-mail survey, Diabetes Control Program Coordinators (DCPCs) in all US states were asked 3 open-ended questions to understand problems with obtaining American Diabetes Association (ADA) recognition for Medicare reimbursement, differences in obtaining ADA recognition by rural and urban facilities, and facility-level barriers to providing DSME to Medicare patients. Using a mail survey administered to half of ADA-recognized diabetes education centers (DECs), information was collected about perceived barriers to providing DSME in all areas and rural areas.


Most DCPCs believed it was more difficult for rural providers to obtain ADA recognition than for urban providers; the largest barriers were costs and reporting requirements. The top barriers for rural providers mentioned by DCPCs were the shortage of designated specialists, fewer resources, and high application fees for ADA recognition. Barriers identified by DEC respondents facing rural providers include staffing/institutional support, amount of Medicare reimbursement, lack of hours covered, and transportation. DEC respondents providing care in urban areas only were more likely to perceive barriers to providing diabetes education in rural areas than were rural providers.


Barriers to DSME are perceived to be higher for rural providers than urban providers. Urban providers perceived that many barriers to DSME are greater for rural providers. The ADA application process is perceived as expensive and laborious. Most respondents perceived Medicare reimbursement for DSME as inadequate.

[Indexed for MEDLINE]

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