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Patient Perspectives of Integrating Diabetes Education Teams into Primary CareA Person-Centred Care Analysis
Barbara GrohmannRD, MHSc(c)
Background
• Diabetes in Canada1,2
– 2 million– 6 million
• Cost3,4
– $11.7 billion & ↑– Complications
Diabetes Education
• CDA & IDF5,6
– Group & individual classes– Collaborative & Interdisciplinary
• Improve glycemic control & Reduce complication7-
9
• 1/3 attending DEC10-13
Methodology
• RN & RD – CDE
• 23 patients– Semi-structured interviews
• 2nd data analysis emergent themes• Person-centred care
– Theoretical lens
ResultsPersonalized
Care
Convenience
Collaboration
Preference for One-on-One
Care
Relationship Building with
DE
Respect
Supportive Interaction
Empowerment
Results
“… with [the educators] at our doctor’s in the same place, … we can
arrange our appointment the same time, right after our family
doctor, then we go right there and we get rid of it all at one time.”
(Pt 1)
“3 in 1, because you see the doctor, and after that you see the nurse,
and [after] the nurse you see the dietitian, 3 in 1, like what else you
want? ...yes, it's very convenient and it's very helpful for any
patient” (Pt 16)
Personalized Care
Convenience
Collaboration
Preference for One-on-
One Care
Results
“A partner, … not like a teacher or student. It was like a partnership”
(Pt 15)
“I think it is more collaborative. So... they look at my numbers, they
talk to me about them, they ask me why. I'll explain stuff and we
come up with a plan together. So it's not them telling me or me
telling...it's a kind of combination.” (Pt 13)
Personalized Care
Convenience
Collaboration
Preference for One-on-
One Care
Results
“Oh yeah, it keeps you motivated and you look forward to it, … when
they did it at the diabetic centre there were about 20, 30 people but
then a lot of people wouldn't … ask questions when there's so many
people . So here, one-on-one is good.” (Pt 14)
“Knowing what it actually does to your body, knowing ways to
change it, knowing ways that you could avoid things or reverse
things...that is more assessable on a one-to-one basis.” (Pt 17)
Personalized Care
Convenience
Collaboration
Preference for One-on-
One Care
Results
“… they didn’t treat me as somebody that was...stupid, not [like] ‘Ok, … why are you not looking after yourself?’ They … weren’t degrading by any means. [more] ‘we’re here to help you’. … they’re not judgemental” (Pt 6)
“I liked how they treated me.” (Pt 20)
“I found that they didn't judge, which was nice” (Pt 22)
Relationship Building with
DE
Respect
Supportive Interaction
Empowerment
Results
“Both of them were friendly… And … wanted to listen and … get me
… answers to the questions I had.” (Pt 8)
“They were very understanding and helped me sort of adjust to that
[diabetes]. So it seems more comfortable now than it did in the
beginning.” (Pt 10)
Relationship Building with
DE
Respect
Supportive Interaction
Empowerment
Results
“Because of what I have learned and my confidence in myself in being able to
manage my diabetes, I think that … other people should be doing this.” (Pt 20)
“I know what to do. I know everything about [diabetes] … blood sugar …
carbohydrates and glucose … insulin … when to take it. [what to do] if I am
low, or if I am high. … I check my blood sugar. … I look what I eat, … I usually…
make sure about carbohydrate[s]. … When I buy stuff … I read the label. … I
count the carbohydrate[s]. I like that.” (Pt 19)
Relationship Building with
DE
Respect
Supportive Interaction
Empowerment
Discussion
• Overall positive• Closely aligns with PCC • Engage patients in self-care• Importance in primary care15
Conclusions
• Diabetes self-management education– Group– 1-on-1
• Reduce barriers to attending• Mobile team
Acknowledgment
• Enza Guccairdi, PhD, RD• Sherry Espin, PhD, RN• Sharon Wong, PhD, RD• MHSc Nutrition Communication program @
Ryerson University
References1. Public Health Agency of Canada. Reducing health disparities related to diabetes: Lessons learned through the
Canadian Diabetes Strategy community-based program. 2011. ISBN: 978-1-100-18786-0.2. Lau, David. Diabetes Management in primary care. Can J Diabetes. 2014, Vol. 38, pp. 157-8.3. Canadian Diabetes Association. Diabetes: Canada at the tipping point: Charting a new path. 2011.4. Canadian Diabetes Association. Global diabetes experts emphasize self-management to prevent fatal health
complications. Canadian Diabetes Association. [Online] October 12, 2012. [Cited: April 12, 2015.] http://www.diabetes.ca/newsroom/search-news/global-diabetes-experts-emphasize-self-management.
5. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2013 clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes. 2013, Vol. 37, suppl 1, pp. S1-S212.
6. International Diabetes Federation. Diabetes eudcation modules. International Diabetes Federation. [Online] 2011. [Cited: April 12, 2015.] http://www.idf.org/diabetes-education-modules.
7. Ridgeway, NA, et al. Improved control of type 2 diabetes mellitus: A practical education/behavior modification program in a prinmcary care clinic. South Med J. 1999, Vol. 92, 7, pp. 667-72.
8. Hornsten, Asa, et al. Patient satisfaction with diabetes care. Journal of Advanced Nursing. 2005, Vol. 51, 6, pp. 609-17.
References con’t9. Wu, Shu-Fang Vivienne, et al. Differences in the perceptions of self-care, health education barriers and
educational needs between diabetes patients and nurses. Contemporary Nurse. 2014, Vol. 46, 2.10. Cauch-Dudek, K, et al. Disparities in attendance at diabetes self-management education programs after
diagnosis in Ontario, Canada: A cohort study. BMC Public Health. 2013, Vol. 13, p. 85.11. Coonrod, BA, Betschart, J and Harris, MI. Requency and determinants of diabetes patient education among
adults in the U.S. population. Diabetes Care. 1994, Vol. 17, pp. 852-8.12. Ruppert, Kristine, Uhler, Amy and Siminerio, Linda. Comorbid conditions, participation, and physician referrasl
to a rural diabetes self-management education program. The Diabetes Educator. 2010, Vol. 36, 4.13. Shah, BR and Booth, GL. Predictors and effectiveness of diabetes self-management education in clincial
practice. Patient Educ Couns. 2009, Vol. 74, pp. 19-22.14. Cancer Care Ontario. Improving Ontario's health system through patient and gamily engagement.15. Imran, S Ali, Tuygwell, Barna and Harris, Stewart. Diabetes in Primary Care: Back to Basics. Can J Diabetes.
2014, Vol. 38, pp. 155-6.