Better Self-Management of Diabetes Project December 2009

Transcription

1 Better Self-Management of Diabetes Project December 2009 Joe LeMaster, MD, MPH Tamara Day, RN, BSN Brian Valentine Missouri Foundation for Health Funding for this project was provided in whole by the Missouri Foundation for Health. The Missouri Foundation for Health is a philanthropic organization whose vision is to improve the health of the people in the communities it serves.

2 Project Overview 5 practices (1 control) in 2 rural mid- Missouri counties, working with community advisory boards. Diabetes self-management support/promotion: Self-behavior goal-setting including health behavior changes (i.e., diet & exercise). Focus on low-income, uninsured, and minorities

3 Key Program Components Training for Providers & Care Teams Evidence-based practice treatment for diabetes. Self-management strategies for patients. Nutritional education. Motivational Interviewing as strategy for eliciting self-behavior changes.

4 Key Program Components Educational & Skills Training for Patients Community diabetes education classes. Nurses & community volunteers collaborate & hold monthly diabetes support groups. Case management to patients of participating clinics.

5 Key Program Components Collaboration with Community Partners Strong partnerships with community agencies, businesses and volunteer stakeholders. Increase providers & patients access to available SMS within the community. Collaborate with community advisory board to develop strategic plan. Address, plan & implement strategies for sustainability.

6 Key Program Components Follow up Care, Support & Communication Community advisory boards forming own committees to expand to other chronic care issues. Project team and community advisory boards work together to elicit participation and support of local business and government leaders. Project information presented at local, national and international meetings.

7 Other Key Components Qualitative interviews and participant observations with clinic providers/staff and taped/transcribed patient encounters. Help rural medical practices develop innovative ways to sustain services with little or no outside resources. Support Community Advisory Boards to assume leadership, build on current work and expand it into the future, based on their own unique needs.

8 Stand-Out Success Story #1 Challenges: Meaningful community participation. Minority & underserved buy-in. Plan: Identify root cause. Contacted community representatives Focus group conducted within target population. Key issues identified (misconceptions, expectations)

9 Success Story #1 (continued) Action: Subcommittee met to plan community canvassing. Target population and location identified. Promotional items wish list developed. Subcommittee worked with core team to ensure needs were met. Volunteer team recruited, duties outlined. Follow-up activity identified and planned.

10 Success Story #1 (continued) Results: Target community buy-in achieved. Increased participation in community activities. Increased representation/participation of minorities on community advisory board.

11 Stand-Out Success Story #2 Working on Wellness Project Collaborative between project & local grocer. Designed & implemented by team of nurses, dieticians, outreach coordinator & business owner. Six month contest aimed for contestants to make positive changes that improve overall health & build SMS. Focus placed on nutrition & exercise NOT weight loss. Length of contest chosen to strive for long-term, positive lifestyle changes.

12 Success Story #2 (continued) Contestants signed up in groups of 2-5 per team. Orientation and information packets were distributed. Each participant received a water bottle & t-shirt. All activities were held within the local grocery store. Grocery store provided $250/winning team + $250 for overall winner. Contest points were given for: Turning in required documents. Participating in nutritional & exercise education. Increase in fruits & vegetables and minutes of exercise each day was calculated to % of improvement.

13 Success Story #2 (continued) Results: 160 contestants joined, 128 remained throughout contest. Overall results: 68% increase in fruit and vegetable intake per day. 78% increase in minutes of exercise per day.

14 Steps for Sustainability Each county has taken over advisory boards, elected board members & created bylaws. County Advisory Boards continue to elicit local business & government leaders to support program. Each county has monthly support group meetings led by volunteers in collaboration with local healthcare providers. 3 participating clinics are training all nursing staff to assume SMS duties. 1 clinic is developing computerized program that will assess patient self-care needs and help identify target areas for goals.

15 Questions?