A Multi-disciplinary approach to Diabetes Management: Empowerment by learning how to use the Tools.

Abstract

LEARNING OUTCOME: To evaluate the impact of group cluster intervention in achieving increased self-efficacy in using diabetes management tools, e.g., blood glucose monitoring, food, stress triggers, and exercise logs.Purpose:In one northern California region health medical organization diabetes registry, there are 90,000 members with diabetes accounting for 13% of all outpatient visits and 13% of all inpatient admissions. A multi-disciplinary interactive program may prove to decrease additional utilization of health care resources. Preliminary data indicate high patient satisfaction, increased self-efficacy, and improved glycosylated hemoglobin A 1C (HgbAlC) lab values with the Diabetes Cooperative Care Clinic program. Setting/Characteristics: A model of delivery of care is developed for adult members with diabetes who are taking insulin and/or oral agents. The criterion for inclusion is a HgbAlC of 8.5% or greater within the last two months. The team is composed of an internist, podiatrist, diabetes nurse educator, registered dietitian diabetes educator, psychologist, research assistant-certified medical assistant, exercise physiologist, and pharmacist The delivery of care is provided by six monthly group sessions with telephone and individual follow-up. The two hour group sessions, consisting of 15 -20 members, incorporates division of the group to clusters for specified interests and needs, e.g., foot exams, food log/blood sugar/medication review, and blood pressure monitoring. The database programmed for this type of setting includes labs, weight, medication, and action plan. In establishing topics during the first clinic, nutrition information has been in high demand. Dining out, exercise, shopping, label reading, and meal planning are popular topics. Dietary changes have included the following: adding just a one fruit or vegetable, less refined flour products, and less fat and fast food intake. The psychologist provides tips on assertiveness and goal setting strategies. The nurse reviews blood sugar and medication interaction and recommends changes. Concerns of the members are addressed and participants are empowered to improve their individual glycemic control. Evaluation: Previous to the first clinic and repeated before the final clinic, patients completed a health questionnaire (Diabetes 2.1 form, self-efficacy, diabetes health care practices assessment, modified Gladys Block food frequency questionnaire), HgbAlC, fructosamine, utilization data (emergency visits, urgent care visit and hospitalization), and patient and provider satisfaction.