Date of Award

Summer 2001

Document Type


Degree Name

Doctor of Philosophy (PhD)


Urban Services--Health Services

Committee Director

Stacey Plichta

Committee Member

Robert McIntyre

Committee Member

Betty Alexy


The healthcare system is faced with overwhelming demands as a result of the growing elderly population, especially those with chronic illnesses. One disease that significantly impacts the morbidity and mortality of the elderly population, especially the minority and poor population, is type 2 diabetes. This population often lacks access to resources and quality healthcare that may be due to inadequate knowledge by the patients and their healthcare providers regarding available services. Current models of healthcare have not been effective in meeting the healthcare demands of this population. The purpose of this study was to evaluate the effectiveness of the Enhanced Primary Care Model as a theoretical framework for designing a program aimed at training providers to care for elderly patients with type 2 diabetes.

A quasi-experimental design was used to assess the effectiveness of the Enhanced Primary Care Model. Two family practice residency clinical sites, an intervention site and a comparison site, participated in this study. An interdisciplinary diabetes team was created at the intervention site. The team developed and implemented programs to train the physicians at this site to provide team-based care for elderly patients with type 2 diabetes. The interdisciplinary diabetes team consisted of a family physician, a nurse practitioner, a nutritionist, a psychologist, a chaplain, a research nurse practitioner, and a database manager. The team developed and implemented didactic sessions on diabetes, a diabetes newsletter, a resource directory, a diabetes flow sheet, a patient education file, and patient education classes. The patients and the providers at both sites were assessed before the intervention programs began and then 12 months later after the intervention. The providers were assessed on attitudes towards the elderly, attitudes towards other disciplines. referrals, and adherence to diabetes guidelines. The patients were assessed on satisfaction with the doctor-patient interaction, quality of life, and health outcomes. The only area where there was a significant difference between or within the two sites was in the area of patient satisfaction. The results of this study do not support the use of the Enhanced Primary Care Model as a theoretical framework for improving provider or patient outcomes.