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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.