Poster Presentation
Wednesday, 19 July 2006
9:30 AM - 10:00 AM
Wednesday, 19 July 2006
2:30 PM - 3:00 PM
Impact of Individual Monthly Contact on Patients with Elevated A1C's
Lori D. Fox, APNP, MN, BS, RN, Menomonie office, Community Health Partnership, Menomonie, WI, USA
| Learning Objective #1: articulate three strategies to encourage patient self monitoring and improved glycemic control. |
| Learning Objective #2: to understand the need some patients have for close contact to help them to deal with their diabetes. |
There are well over 18.2 million diagnosed diabetics in the US today. Less than 12 % of them meet the ADA treatment guidelines. (1,2) Treatment for the diabetic patient has become complex and multilevel. Part of the treatment problem is the relationship, or lack of, for patients and providers and the need for patients to manage their own care. (3) But data suggests that there is not adequate time in a primary providers day to deal with all of the issues associated with a chronic illness. (4) Confounding the issue are Health Plans limiting access to resources. (5) Following all of the established guidelines for each chronic illness creates further complications for frail elders with multiple co-morbidities. (6) Add to that the time lag before a benefit is perceived and polypharmacy (7) and you have created a climate for disaster.
Community Health Partnership Inc, a Wisconsin Partnership Program in three predominately rural midwestern Wisconsin counties has looked at this issue utilizing a rapid change process called “Plan, Do, Study and Act,” (PDSA). One part of the problem, the relationship with the provider, was chosen to see if an intervention would have an impact. Patients having an A1C greater then 8.3 are placed in a high-risk population subset. The intervention, a monthly one-on-one meeting with the member, provides education and assessment to determine what other resources could be offered to fine tune control. This contact alternates between a Nurse Practitioner one month and a Registered Nurse the next month. If the A1c is less then 8.3 in two consecutive three-month intervals than the member is removed from the intensive management group. Overall, results have been gratifying with improved A1C’s and patients reporting increased satisfaction with their control and overall health.
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