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

Person-Centred Care

• CCO14

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

Thank You

• Questions?• Comments?

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.

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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

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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.

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