Date of Final Presentation
Dr. Sara Ahten, DNP
Dr. Pamela Strohfus, DNP, RN, CNE
Abstract/ Executive Summary
Problem Description: Patients of one internal medicine clinic were found to have nearly twice the rate of diagnosed diabetes and poor glycemic control, when compared with national rates. Given this, certain aspects of the patient-provider dyad system, such as inadequate provider time, knowledge, and resources; may have contributed to the ability of some patients to adapt to a lifestyle with consistent diabetes self-care.
Intervention: An evidence-based diabetes protocol was developed, a diabetes self-management training (DSMT) curriculum was adapted to local context, and three cycles of patient-centered DSMT classes were delivered to provide individual and group-based support to participants. Completion of the DSMT series was expected to improve diabetes empowerment, performance of self-care behaviors, and A1C levels from baseline; and result in positive program satisfaction. Draft documents were also developed to fulfill accreditation standards toward application as a Diabetes Education Center, which would allow clinic providers to receive third-party reimbursement for DSMT services.
Results: During the pilot project, 16 patient referrals were received, 10 patients attended DSMT classes, and nine patients completed the 4-class series. Afterward, participants self-reported slightly increased diabetes empowerment and performance of self-care behaviors, and positive program satisfaction.
Interpretation: Upon conclusion of the pilot project, it was determined that poor glycemic control did not always indicate inability to adapt to a lifestyle with diabetes; and all participants benefitted from receiving DSMT. Three-month findings were somewhat comparable to the diabetes literature at 3 and 6 months, with differences most likely due to the short series duration and 1-week interval between some DSMT classes. Positive impact for participants involved receiving evidence-based support in diabetes self-management. At 3 months, 89% of participants self-reported daily performance of SMBG and foot care; and available A1C results demonstrated reductions for 83% of participants. Positive impact for the clinic was demonstrated by the medical director stating that she would refer all of her patients with diabetes for DSMT. Implications for policy development included the clinic becoming certified as a Diabetes Education Center, and third-party payers adequately reimbursing DSMT and reducing costs for copays and supplies for diabetes self-care.
Conclusions: Sustainability of the pilot project will be reached if the clinic becomes a Diabetes Education Center, assists other practices to pursue certification, and develops similar models to support patients with other chronic illnesses. Implications for further study include determining cost-effective methods to deliver DSMT classes that will result in long-term behavior change. Next steps include disseminating findings through the Boise State University Executive Session and ScholarWorks, researching smart phone apps to reinforce diabetes self-care, and starting a diabetes support group in the local area.
Clark, Bonnie M., "Improving Care for Adult Clinic Patients with a History of Poor Glycemic Control" (2018). Doctor of Nursing Practice. 21.