Podium Presentation Session A

Transcription

1 Podium Presentation Session A Disease Management and Disparities Through Interprofessional Relations #XUDisparitiesCollabs

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3 Join our social media discussions #XUDisparitiesCollabs #XUDisparitiesCollabs

4 Jessica Johnson, PharmD OPENING REMARKS #XUDisparitiesCollabs

5 Dietrich Taylor, RN SPEAKER #XUDisparitiesCollabs

6 Engaging People, Processes and Policies to Combat Inequities in Access to Diabetes Self- Management Education in Rural Mississippi Dietrich Taylor, RN, CDE, Director Diabetes Prevention and Control Program Mississippi State Department of Health

7 Background In 2012, Mississippi ranked 2 nd highest in U.S. for overall diabetes prevalence This is equivalent to 276,000 persons with a type 2 diabetes diagnosis Mississippi s prevalence: 12.5% National prevalence: 9.7% Number of DSME Accredited/Recognized programs: 37 Number of Certified Diabetes Educators (CDE): 133

8 Painting a Clear Picture of the Problem GIS mapping used to pinpoint potential hot spots to recruit diabetes education providers. Some of the county infrastructure variables considered were access to fruits/vegetables & physicians and health provider accessibility. < 10% % % >17% Diabetes Prevalence by County, 2010 Bolivar 13.9 III Sunflower 13.8 Washington 10.4 Sharkey 9.9. Coahoma 14.0 Humphreys 12.2 Tallahatchie 11.9 Leflore 14.6 De Soto 9.0 Tunica Tate Panola Quitman 21.8 I Carroll 8.6 Holmes 11.7 Yalobusha 17.4 Grenada 11.8 Marshall 13.8 Union 9.8 Lafayette 7.3 Lee Itawamba II 14.8 Pontotoc Mont - g omery 14.1 Attala 14.0 Calhoun Webster Benton 11.5 Choctaw 11.9 Chickasaw Monroe Clay Winston 13.2 Tippah 11.2 Oktibbeha Alcorn IV Prentiss Noxubee 11.1 Yazoo 12.1 Leake Issa - Neshoba Kemper quena Madison 8.1 Newton Warren Scott V 11.8 Lauderdale Rankin 12.4 Hinds 9.6 VI Smith Jasper Clarke Claiborne 11.0 Copiah Simpson Jefferson 14.5 Covington Jones Wayne Jefferson Adams Lincoln 12.5 Franklin Lawrence Davis Forrest Marion VIII VII Pike Lamar 10.0 Perry Greene Wilkinson 10.2 Amite Walthall Lowndes 12.0 Tisho - mingo 11.9 Issaquena not colored due to small sample size; rate may not be reliable. Pearl River 11.2 Hancock 10.1 Stone 15.4 Harrison 13.2 George 10.8 IX Jackson 11.4

9 DSME Accreditation/Recognition Collaborated with University of Mississippi Medical Center to recruit and assist safety-net providers in applying to become an accredited or recognized provider of Diabetes Self-Management Education (DSME). Onsite review and technical assistance provided Relationships fostered/established with national credentialing organizations Materials purchased to assist prospective organizations

10 Increasing Certified Diabetes Educators Collaborated with the American Diabetes Association to offer the Certified Diabetes Educators (CDE) Preparatory exam training locally for prospective CDEs. Collaborated with the Mississippi Affiliate of the American Association of Diabetes Educators (MS-AADE) to implement the National Credentialing Board for Diabetes Educators Mentoring Program.

11 Diabetes Coalition of Mississippi Revitalized the Diabetes Coalition of Mississippi (DCM) to create synergy among stakeholders on strategies to obtain third party reimbursement for diabetes self-management education. 3 Work Streams Diabetes Primary Prevention Disease Management Policy

12 The Business of DSME Partnered with MS-AADE, Gulf Coast Health Educators (GCHE) and the DCM to host a training on The Business Side of providing Diabetes Self-Management Education. Promoting the program to increase referrals Retaining current clients and increasing compliance with current plan of action Increase in Revenue $$$$$$$$$

13 Outcomes Two new safety-net providers were accredited in 2013, bringing total to 8 new programs in 3 years, with a potential to reach 15,590 people with diabetes. The total number of Certified Diabetes Educators is estimated to have increased from 117 in 2011 to 133 in The percentage increase is 13.7%.

14 Outcomes (continued) Enrollment in the Certified Diabetes Educators Preparatory Exam course has increased from 25 in 2011 to over 60 in The DCM coalition has received training on the policy planning process. Medicaid reimbursement for pre-diabetes screening and diabetes self-management education are priority items on their policy agenda.

15 Challenges to Success Insufficient staff time and resources Lack of awareness of DSME programs by providers Programmatic costs can be a barrier to DSME sustainability DSME reimbursement restrictions Difficult to meet requirements to sit for the CDE exam

16 Conclusions Engaging people, processes and policies to improve access to diabetes self-management education is working in Mississippi. This strategy has: increased access to accredited DSME sites and CDEs increased training and other resources for DSME providers resulted in the emergence of a unified voice to advocate for reimbursement policies.

17 A Unified Voice for Diabetes

18 Acknowledgements Mississippi State Department of Health Office of Health Promotion/Equity Evelyn Walker, MD, MPH OPH Leadership Victor Sutton, PhD, MPPA Cassandra Dove, MPH Anthony Fox, MS DPCP Team Dietrich Taylor, RN, CDE Bettye Daniel, MSHyg, MPM Latonya Lott, MS, MPH Amel Mohamed, MPH University of Mississippi Medical Center Office of the Vice Chancellor Michael Jones, RN, MSN, MBA

19 QUESTIONS? THANK YOU!!!!

20 Akiko Komura, MS SPEAKER #XUDisparitiesCollabs

21 AN INTERDISCIPLINARY APPROACH TO IMPROVING PATIENT ADHERENCE A Komura; KM Mellion; KE Smythe; JB Whitner; MG Holiday-Goodman College of Pharmacy and Pharmaceutical Sciences (JBW; MGH), College of Medicine and Life Sciences (AK; KMM; KES), The University of Toledo (IRB #107970, 09/18/12, "Interprofessional Student Research Award, JCCTR Foundation: # ) Aim 1: Student Education Objective: To improve knowledge and self-efficacy of health professional students in addressing medication adherence Methods: Educational program face-to-face lectures small group discussions

22 Aim 1 Student Education Results Table 1: Discipline of health professional students enrolled Health Professional Students Medicine 13 Pharmacy 6 Physician Assistant 1 Total 20 Table 2: Knowledge level before and after 4 week lecture course Pre Post P-value Mean assessment test score (max. 50 pts) * Table 3: Self-reported efficacy level before and after 4 week lecture course Mean self-reported efficacy score (max. 60 pts) Knowledge level increased Self-reported efficacy decreased Pre Post P-value P < 0.001* *Related-samples Wilcoxon Signed Rank test was used for all mean comparisons.

23 Aim 2 Patient Counseling Objective To assess and enhance patient adherence and medical outcome with medication adherence counseling Methods: Personal education sessions for the patients by trained students from Aim 1 at a local free clinic to target underserved population Patients with HTN and/or T2DM < 5 min per session

24 Aim 2 Patient Counseling Results Table 4: Gender and age of patients enrolled in study Gender Male 9 Female 8 Table 5: Disease state of patients Patients HTN T2DM HTN + T2DM Total enrolled Table 6: Adherence and Clinical values pre and post intervention Adherence and clinical values Pre Post P-value Adherence 5.58 (SD = 2.09) 6.93 (SD = 1.30) 0.042* BP (n = 13) 141.8/ /88.6 NS Glu (n = 3) NS Patient adherence: improved Clinical outcome: no significant change Adherence: Morisky Medication Adherence Scale (MMAS-8-Item), MMAS-8

25 Conclusions The new interprofessional education course is effective in improving students knowledge Patient counseling is effective in encouraging skills to improve adherence This approach is applicable in clinics for underserved patients Study Limitations Limited access to medications Lifestyle Inconsistent follow-up Complex drug regimens of HTN and T2DM Clinical outcome measurements Use of the MMAS is protected by US copyright laws. Permission for use is required. A license agreement is available from: Donald E. Morisky, ScD, ScM, MSPH, Professor, Department of Community Health Sciences, UCLA School of Public Health, 650 Charles E. Young Drive South, Los Angeles, CA

26 Questions & Answers #XUDisparitiesCollabs

27 Closing Remarks #XUDisparitiesCollabs