CAPSTONE COLLEGE OF NURSING

THE UNIVERSITY OF ALABAMA

Improving Participation ofDiabetics in Self-

management Education

Letrell Peoples, RN, MSNDr. Roy Ann Sherrod, DSN, RN, CNE, CNL Faculty

AdvisorCapstone College of Nursing - The University of Alabama

Mrs. Debrah Fisher, MSN, RN, CDE Clinical AdvisorManager, DCH Diabetes Education Center

STUDY OBJECTIVE

To identify factors to increase the participation of patients with diabetes at a regional medical facility in self-management education classes provided by the facility’s outpatient Diabetes Education Center.

BACKGROUND

Diabetes affects 8.3% of population Direct and indirect care cost for

diabetes averages $174 million per year

Medical expense for people with diabetes is more than 2X higher than those without diabetes (CDC, 2011)

DM STATISTICS

Alabama has a 12% prevalence rate Tuscaloosa County has 12% prevalence

rate 2012 medical center admissions:30% had primary or secondary DX20% readmissions had primary or

secondary DX

OPPORTUNITY

1% of inpatients from medical center with diagnosis of DM attended classes at facility’s

DIABETES EDUCATION CENTER (2012)

WHY EDUCATE?

Diabetes Self-Management Education (DSME) improves knowledge, constructive self-care behaviors, and better clinical outcomes for people with diabetes (Norris, Lau, Smith, Schmid, & Engelgau, 2003) .

Patients who have not received DSME :Lack the skills to effectively care for themselves Have a fourfold increased risk of major diabetes

complications than those who do receive DSME Niccoluci et al. (as cited in Clark, 2008) .

SAMPLE

Inpatients between the ages of 25-75 Primary or secondary diagnosis of

diabetes Able to participate in educational

offerings Able to comprehend and read the

English language

DATA COLLECTION

Patient Education Survey Demographic Data Collection Form

Sample

DemographicsGender: Males (37%) Females (63%)

Race: Black (63.2%) White (35.5%)

DemographicsAge: 55-64 (42.1%)

Education Level: HS or GED (40.8%)

Employment: 25% employed

Survey Results

Years with Diabetes:

<1 yr-10yrs: 59%

How are you managing:

Moderately well-56.6%

Will learning help: Yes: 89.5%

Importance of learning:

Very or extremely important-92.2%

Survey Results

Know about Ed. Center:

N0: 63.2%

Would you attend classes

Yes: 80.3%

Did staff ask about attending classes at

Education Center: No: 82.9%

Factors that would keep you from attending classes at the Diabetes Education Center

Transp

ortation

No Insu

rance

Unable to

Pay

Family

Issues

Limite

d Time

Info from else

whereOth

er0%

10%20%30%40%50%60%70%80%90%

100%

YesNo

Conclusions

Major Issues Identified:

Transportation – 40%

Inability to pay-out-of-pocket – 30%

Possible Solutions

Increased marketing of Center To staff and providers To patients

Foundation support Offering scholarships

FundraisersApply for grants

Waiving payment (why?)

Limitations/Implications

LimitationsSample sizeNo data from

healthcare staff

ImplicationsEBP champion

(Inpatient Diabetes Educator)

Longitudinal studiesIdentify

effectiveness of 2013 ADA Standards

Acknowledgments

Dr. Roy Ann Sherrod, DSN, RN, CNE, CNL

Mrs. Debrah Fisher, RN, MSN, CDE Mrs. Lorraine Yehlen, RN, BSN, MA Mrs. Shelia Bresnahan, RN, MSN Unit RNs and staff

REFERENCES American Diabetes Association. (2013). Third-party

reimbursement for diabetes care, self-management education, and supplies. Diabetes Care, 36 (1), 598-599. doi: 10-2337/dc13-S098

American Diabetes Association. (2013). Standards of medical care in diabetes-2013. Diabetes Care, 36, S11-66. Retrieved from http://search.proquest.com/docview/1267207263?accountid=14472

Balamurugan, A, Ohsfeldt, R., Hughes, T, & Phillips, M. (2006). Diabetes self-management education program for Medicaid recipients: A continuous quality improvement process. Diabetes Educator, 32, 893–900.

Clark, M. (2008). Diabetes self-management education: A review of published studies. Primary Care Diabetes, 2, 113–120.

REFERENCES Fitzner, K., Greenwood, D., Payne, H., Thomson, J., Vukovljak, L.,

McCulloch, A., & Specker, J. E. (2008). An assessment of patient education and self-management in diabetes disease management—Two case studies. Population Health Management, 11(6), 329-340. doi: 10.1089/pop.2008.0012

Gucciardi, E., DeMelo, M., Offenheim, A., Grace, S. L., & Stewart, D. E. (2007). Patient factors associated with attrition from a self-management education programme. Journal of Evaluation in Clinical Practice, 13(6), 913-919. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2009721593&site=ehost-live

Gumbs, J. M. (2012). Relationship between diabetes self-management education and self-care behaviors among African American women with Type 2 diabetes. Journal of Cultural Diversity, 19(1), 18-22.

REFERENCES

Karakurt, P. & Kasikci, M. K. (2012). The effect of education given to patients with type 2 diabetes mellitus on self-care. International Journal of Nursing Practice, 18, 170-179. doi.10.1111/j.1440.172X.2012.02013.x

Norris, S., Lau, J., Smith, S., Schmid, C, & Engelgau, M. (2002). Self-management education for adults with type 2 diabetes: A meta-analysis of the effects on glycémie control. Diabetes Care, 25(7), 1159-1171. doi:10.2337 / diacare.25.7.1159

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. (2011). National Diabetes Fact Sheet: National Estimates and General Information on Diabetes and Prediabetes in the United States.