Individuals with diabetes face many multifaceted issues when integrating their plan of care into their daily lives, which can become burdensome and lead to inadequate diabetes control. Due to the persistent demands of diabetes management, screening for psychosocial factors that can impact control, such as depression, anxiety, and diabetes-related distress (DRD) should occur routinely (American Diabetes Association [ADA], 2017). DRD is distinctly different from depression in that the focus is on the burden experienced due to the rigorous treatment regimen associated with diabetes. DRD focuses on the self-management demands, complications, comorbidities, and lack of perceived social support (ADA, 2019). DRD can affect treatment compliance and lead to negative health outcomes, including more frequent hospitalizations and higher healthcare costs. Therefore, early screening and detection of psychosocial factors influencing management is essential to prevent health complications and deterioration. The purpose of this practice improvement project was to implement DRD screening in a rural North Dakota clinic. Rural providers were educated on DRD and the use of an evidenced-based screening tool called the Problems Areas in Diabetes (PAID) scale. This self-report scale allows providers to make appropriate referrals to diabetes educators, dieticians, and mental health professionals, which may result in individualized treatment plans and improved outcomes. The project implementation was comprised of an educational session focused on DRD that included a pre- and post-test, as well as return skill demonstration where attendees were asked to score a mock patient’s PAID scale. Following the educational session, the PAID scale was implemented at diabetic appointments for a three-month period. Positive PAID scale results were monitored to determine if the positive screenings resulted in a referral or additional resources. Twenty-four scales were completed by patients during the project, resulting in 30 referrals for additional support. Additionally, an increase in healthcare provider knowledge related to DRD evaluation and management was identified. The provision of DRD education and implementation of the PAID scale in this rural primary care clinic enabled patients within the community to receive evidence-based, individualized care, which may potentially reduce complications, as well as improve diabetes control and overall patient health.

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