An Integrated Model of Diabetes Care Addressing Emotional Distress Liz Bongetti Registered Nurse, Credentialled Diabetes Educator
Overview Outline of IDEAS at Whitehorse Community Health Service (WCHS) Examine the problem of diabetes related emotional distress Discuss the early experience using the PAID-5 as part of the IDEAS assessment Consider future opportunities
What is the Integrated Diabetes Education and Assessment Service (IDEAS)? Partnership with Eastern Health Other sites: Knox CHS & Ranges CHS For people with type 2 diabetes Community-based Collaborative, multidisciplinary team
Our aim To support diabetes self management and minimise the risk of diabetes complications by providing an integrated approach to care
IDEAS Initial Assessment Person with Type 2 diabetes is referred via GP, to Box Hill Hospital Endocrinology or IDEAS, WCHS Triaged to IDEAS Person is registered and appointment booked by WCHS staff Comprehensive initial assessment by WCHS IDEAS Team Member and Endocrinologist or Endocrinology Registrar. Client goals identified and treatment plan is completed. Copy given to client and posted to GP. Review appointment booked. Documentation in WCHS and Box Hill Hospital electronic health records Referral to the Good Life Club, external services Diabetes Educator, Dietitian, Podiatrist, Health Psychologist, Health Coaching, Quit Smoking, Good Life Gym, Diabetes Course, Heart Health Program, Dental Services
PAID-5 Problem Areas in Diabetes - 5 item short form. (Author B.E. McGuire et al.) Difficulty coping with the daily regime and worries about complications Five point response option (0 4 representing Not a problem through to Serious problem. Score. Range 0-20. Higher scores, greater emotional distress High distress, score 8
PAID-5 Questions 1.Feeling scared when you think about living with diabetes? 2.Feeling depressed when you think about living with diabetes? 3.Worrying about the future and the possibility of serious complications? 4.Feeling that your diabetes is taking up too much of your physical and mental energy every day? 5.Coping with the complications of diabetes?
Diabetes-related emotional distress 22% of people with Type 2 diabetes experience severe diabetes related distress (Speight J. et al. Diabetes MILES Australia 2011) Depressive symptoms were measured in 23% people with Type 2 diabetes and 35% of people with Type 2 diabetes using insulin (Speight J et al. 2011) High levels of distress are significantly associated with poor glycaemic control, poor self care and poor quality of life, even after controlling for clinical depression. (Fisher et al. 2012)
Diabetes-related emotional distress The prevalence of depression and anxiety is higher in females with diabetes (23.8%) compared with males (12.8%). (Clarke, D. & Currie, K, 2009) Psychological distress is not only burdensome itself, but can impede self-care behaviours International guidelines advocate routine screening for psychological problems (McGuire, B. et al. 2010).
PAID Project Summary of PAID-5 scores for 5 months from May to October 2011 36 people. 21 males,15 females 34 people with type 2 diabetes and 2 with type 1
Number of people completing the PAID-5 by age group. Number of people 9 8 7 6 5 4 3 2 1 0 21-30 31-40 41-50 51-60 61-70 71-80 81+ Age in years
Number of people vs. PAID-5 score 12 10 8 No of people 6 4 2 0 0-1 2-3 4-5 6-7 8-9 10-11 12-13 14+ PAID score
Outcomes for clients with high distress Three females, were referred to the WCHS Health Psychologist One male was already receiving counselling Two females said their GPs support would be sufficient. 1 was taking antidepressant medications One female was receiving drug and alcohol counselling One male declined counselling but accepted other clinical services
Health Psychologist Referrals were appropriate Reassessment with K10, DASS 21 scale at first contact and subsequently Feedback for clients about their progress Feedback to GPs Counselling including Cognitive Behavioural Therapy (CBT) and Acceptance and Commitment Therapy (ACT)
PAID Project Outcomes The capacity to identify and respond to diabetes-related emotional distress has became an integrated part of IDEAS Ensures acknowledgement Various support options offered PAID score was highlighted to the GP Other sites offering the IDEAS service may use the PAID tool in future
Future opportunities Commencement of repeat assessment with PAID in IDEAS at 1 st review and subsequently Reflect on the PAID questions scored highly with clients Investigate the impact of psychological interventions on emotional distress in people with diabetes Development of new Group Programs
Acknowledgements Austin Health HARP. Dr Nicki Gazis Current IDEAS Team Members Tania Apenianeski Cathy Canny Sam Cattley Julie Temelli Dr Anuradha Sakthivel Janine Scott Dr Shilpa Verma Fiona Wallace Janelle Watson Former IDEAS Team Members Tina Asker Dr Jason Galanos Dr Sarah Price PAID Project Educational Grant 2011. Novo Nordisk.
References Ali S, Stone M.A, Peters J,I et al. The Prevalence of Co morbid Depression in People with Type 2 Diabetes: A Systematic Review and Meta-analysis. Diabetes Medicine 23,1165-1173, 2006 Australian Institute of Health and Welfare. Diabetes and Poor Mental Health and Wellbeing: An Exploratory Analysis. June 2011 www.aihw.gov.au/publication-detail?id=10737419262 Clarke D.M, Currie,K.C Depression, anxiety and their relationship with chronic diseases: a review of the epidemiology, risk and treatment evidence. Medical Journal of Australia 190, (7) S54-S60, 2009 Lovibond,S.H & Lovibond, P.F. (1995) Manual for the Depression Anxiety Stress Scales (2 nd Ed.) Sydney Psychology Foundation. McGuire B.E et al. Short-form measures of diabetes-related emotional distress: the Problem Areas in Diabetes Scale (PAID)-5 and PAID-1. Diabetologia 53,66-69,2010 Fisher L, et al. When Is Diabetes Distress Clinically Meaningful? Establishing cut points for the Diabetes Distress Scale. Diabetes Care Vol 35.No 2.259-264. Speight J. Browne J.L. et al. Diabetes MILES-Australia 2011 Survey Report. Diabetes Australia: Canberra.