Peers for Progress STFM AAFP Conference December 2010 Michelle Henry, MSN, RN, VP, Clinical Program Administration Margie Gomez, BSN, RN Clinical Program Manager Robin Eickhoff, M.D., M.P.H

Objectives – On completion of this session: – Participants will have the tools needed to determine if peer-to-peer mentoring is right for their clinic/community – Participants will know what will be needed to bring a peer-to-peer mentoring program into their clinic/community. – Participants will know how peer-to-peer mentoring might affect patient outcomes. – Participants will know how each individual involved plays an integral roll in a peer-to-peer mentoring program.

Agenda – Company Overview – Peers for Progress Program Implementation – Lessons Learned – Testimonials – Preliminary Results – Q & A

WellMed Overview Founded in 1990 in San Antonio, Texas by George Rapier, MD Founded in 1990 in San Antonio, Texas by George Rapier, MD Specializing in managing medical services for SENIORS Specializing in managing medical services for SENIORS Primary Care, Physician-Centric Primary Care, Physician-Centric – 30 Clinics in San Antonio, Austin, Rio Grande Valley and Florida and Florida – Serve more than 70,000 patients

WellMed Overview Patient-Centered Medical Home Approach Patient-Centered Medical Home Approach – Disease Management (DM, COPD, CAD, CHF) – Care Coordination (Providers, Health Coaches, MAs, RN Case Managers, etc…) – Group Education Classes (Diabetes 101) WellMed is innovative, progressive and a leader in managing chronic disease WellMed is innovative, progressive and a leader in managing chronic disease

Peers for Progress Opportunity to enhance current Patient- Centered Medical Home model Opportunity to enhance current Patient- Centered Medical Home model Opportunity to reinforce our self- management support efforts Opportunity to reinforce our self- management support efforts Partners Partners – American Academy of Family Physicians – Latino Health Access (Orange County, CA) – Modeling Dr. America Bracho’s Carpeta Roja Program in our Senior population

Peers for Progress WellMed is one of 14 grantees* in 6 continents - to evaluate the contribution of peer support in diabetes and, - to evaluate the contribution of peer support in diabetes and, - to provide a model for peer support programs around the world - to provide a model for peer support programs around the world *Supported by the AAFP Foundation and the Eli Lilly and Company Foundation Inc. -

Peers for Progress PROGRAM PURPOSE: PROGRAM PURPOSE: – Seeks to empower patients to become “managers of their own health and health care” Volunteers, also diabetics, meet with patient partners for mentoring/support

Why is Self-Management Support Important? Emphasizes the patient’s role and collaborative decision-making for health Emphasizes the patient’s role and collaborative decision-making for health Professionals are experts about diseases, but… Professionals are experts about diseases, but… Patients are experts about their own LIVES! Patients are experts about their own LIVES!

The Time Pyramid Family/community Peer mentors MAs Health coaches & RNS MD Amount of time spent w/ patient

Getting Started Included clinic administration, staff in planning process Included clinic administration, staff in planning process Integrated program within familiar processes (group classes, Integrated program within familiar processes (group classes, health coach identification, clinic Volunteer Program) health coach identification, clinic Volunteer Program) Initiated physician and staff “roll-out” meetings Initiated physician and staff “roll-out” meetings Added physician and staff dinner meetings with provider Added physician and staff dinner meetings with provider and patient testimonials and Dr. Bracho from Latino Health and patient testimonials and Dr. Bracho from Latino Health Access Access

Implementation Offered Diabetes 101 Classes – 8-week course conducted by Offered Diabetes 101 Classes – 8-week course conducted by diabetes educators diabetes educators Class participants were referred by provider and clinic staff Class participants were referred by provider and clinic staff Class participants shared successes and challenges Class participants shared successes and challenges Support network evolved Support network evolved Mentors within the group were identified by the educators Mentors within the group were identified by the educators

Diabetes 101 Curriculum - Developed as a combination of LHA’s Carpeta Roja curriculum and the WellMed Disease Management curriculum for diabetes Week 1 – Week 1 – What is Diabetes & Stages of Change Week 2 – Week 2 – Blood Glucose Monitoring Week 3 – Week 3 – Healthy Eating Week 4 – Week 4 – Meal Planning Week 5 – Week 5 – Medication Week 6 – Week 6 – Get up and Move – Physical Activity Week 7 – Week 7 – Diabetes Complications Week 8 – Week 8 – Coping and Living with Diabetes

Diabetes 101 Curriculum Self-care, manager of care concepts emphasized throughout Diabetes 101 classes Self-care, manager of care concepts emphasized throughout Diabetes 101 classes Goal-Setting Goal-Setting Identified Mentors for additional training Identified Mentors for additional training Identified potential Mentees Identified potential Mentees

Group “Reunion” Meetings After Diabetes 101 class, patients wanted to continue meeting After Diabetes 101 class, patients wanted to continue meeting “Reunion” meetings developed “Reunion” meetings developed Progressed to monthly meetings Progressed to monthly meetings Opportunity for Mentor and Mentee Interaction Opportunity for Mentor and Mentee Interaction

Mentor and Mentee Interaction Ongoing monthly support meetings Ongoing monthly support meetings Minimum contact 4 hours per month by mentor Minimum contact 4 hours per month by mentor Encounters between mentor and mentee are documented and tracked in addition to community and family members Encounters between mentor and mentee are documented and tracked in addition to community and family members Encounters focus on healthy eating, monitoring, reducing risk, problem solving, physical activity, goal setting, emotional support, encouragement and motivation Encounters focus on healthy eating, monitoring, reducing risk, problem solving, physical activity, goal setting, emotional support, encouragement and motivation

Lessons Learned Provider and Clinic Administration buy-in Provider and Clinic Administration buy-in Feedback from patients for class improvements Feedback from patients for class improvements Direct referrals from providers and clinic staff Direct referrals from providers and clinic staff

Why It Works Support from peers address daily struggles Support from peers address daily struggles Real-life examples based on common experiences Real-life examples based on common experiences Social and emotional issues discussed in deeper way Social and emotional issues discussed in deeper way Peers are accountable to each other Peers are accountable to each other Peers advocate and encourage each other Peers advocate and encourage each other

Preliminary Results – Numbers at a Glance Demographics – 15 clinics 9297 Patients with Diabetes 371 enrolled in D completed D101(6/8 classes) 41 Mentors (Program Goal: 45) 113 Mentees (Program Goal: 200)

Preliminary Results – Health Questionnaire Average number of days blood sugar tested in previous 7 Baseline4.44 (2.90 SD) Post D (1.85 SD)* when compared to baseline 6mosPost Mentee Mentor No Support After 101 * P = < (2.07 SD)* when compared to baseline 6.48 (1.12)* when compared to ‘No Support’ and “Mentor” 5.20 (2.04) 5.23 (2.58)

Preliminary Results – Health Questionnaire Know what A1C is Know what individual A1C value is Improvement in A1C after 101? (self-reported on post surveys) Baseline36.4%25.5% Post92.7%78.2% Yes: 27.3% No: 7.3% Waiting for lab: 54.5% 6mosPost92.7%81.8% Yes: 61.8% No: 18.2% Waiting for lab: 12.7%

Preliminary Results – Health Questionnaire Days of high fat in last 7 days Days of five servings of fruit and vegetable in last 7 days Days of 30 minutes of physical activity in the last 7 days Days of planned exercise in the last 7 days Days checking feet in last 7 days Baseline3.08 (1.82 SD)4.88 (1.90 SD)3.36 (2.56 SD)2.80 (2.60 SD)6.00 (1.67 SD) Post2.70 (1.74 SD)5.25 (1.69 SD)4.18 (2.25 SD)3.19 (2.50 SD)6.17 (1.77 SD) 6mos Post Mentee Mentor NS 2.70 (1.42) 3.14 (1.28) 2.10 (1.10) 2.52 (1.53) 5.21 (1.62) 5.68 (1.32) 5.10 (2.03) 4.91 (1.65) 3.92 (2.06) 4.45 (1.97) 4.00 (2.31) 3.57 (2.04) 2.87 (2.44) 2.86 (2.61) 3.40 (2.12) 2.82 (2.54) 6.04 (1.65) 5.77 (1.78) 6.40 (0.97) 6.00 (1.93)

For the Future As the project comes to an end and the sample size gets larger we will also be analyzing: Pre-post A1c, lipids, weight and blood pressure values Pre-post Diabetic Distress Scale (Fisher 2005) values Pre-post medication information Pre-post information on Quality of Life, Self Care Activities, Support and Behavioral/Medication adherence Process evaluation information from mentees Program cost-effectiveness

THANK YOU! Discussion/Questions