Community Screening & Outreach Project in the Big Sandy Area Development District Collaborators: Local Health Departments, Big Sandy Health Care, Kentucky College of Osteopathic Medicine, Appalachian College of Pharmacy, Kentucky Homeplace, KYNECT, Passport Health Plan, Anthem Blue Cross Blue Shield Medicaid, UK Markey Cancer Center, Local Housing Authority, AETNA Better Health of KY, Humana

Background Diabetes is at an epidemic rate in Southeastern Kentucky. “If the problem is in the community, the solution is in the community. –Dr. Gil Friedel” In Kentucky’s Appalachian counties, the Diabetes rate for adults is 13.6% while the rate in non-Appalachian counties is 9.5%. The national rate is 9.7%. (2015 Diabetes Report)

Background Picture taken from 2015 Diabetes Report

Project Setting / Population Pike, Floyd, Johnson, Martin and Magoffin are all benefitted from the project’s outcome data which will be shared within the five- county Big Sandy Diabetes Coalition. More specifically the elderly population with in these counties.

Project Aims Identify previously undiagnosed likely cases of diabetes and pre-diabetes through risk assessments and Hemoglobin A1c tests done at low income housing facilities, senior citizen centers, job fairs, and other opportunities for screening.

Project Aims Reduce the physical, emotional, and economic burden of diabetes through better awareness and utilization of local diabetes prevention and management resources. Measurably improve the health and quality of life in older adults.

Project Activities There will be a “Health Fair” that offers free height, weight, BMI, blood pressure, hemoglobin A1c screenings, and insurance assistance. This is the first screening event. There will be contact after one month for a follow-up. 6 months and a year later there will be additional screening events that will check the same data and compare it with the baseline data from the first screening event.

Project Activities Screenings will be set up in a Health Fair type of set-up. The room is going to be set up to have an efficient flow from one station to the next. There are 10 stations for the participants to flow through in a set pattern respectively: 1. Informed Consent & Registration, 2. Survey Station-SF12, 3. Height/Weight/BMI/Blood Pressure (Baseline Data) Station, 4. Diabetes Risk Assessment Station, 5. Diabetes Screening (A1c) Station, 6. Diabetes Self- Management Resource Station, 7. Diabetes Prevention & Healthy Lifestyle Resource Station, 8. Medical Home & Insurance Assistance Station, 9. Door Prize Entry Station, and 10. Snack Station. 

Evaluation Project aim I: Before receiving a diabetes risk assessment or A1c screening, each event participant will be given a survey to determine whether they have been diagnosed with diabetes or prediabetes. Results of this survey will give a baseline data to determine whether diabetes or prediabetes was identified in 10% of the population.

Evaluation Project aim II: To successfully connect at least 25% of participants identified as diabetic and 25% of participants identified as prediabetic with appropriate follow-up through referral resources within two months of initial screening event.

Evaluation Project aim III: To decrease blood pressure, BMI, or A1c of atleast 10% of participants who successfully followed-up on referrals/resources. To increase by atleast 10% the reported levels of wellness and quality of life among participants who successfully followed-up on referrals/resources.

Acknowledgement CLIK is a collaborative training program supported by the UK Center of Excellence in Rural Health, the Kentucky Office of Rural Health, and the UK Center for Clinical and Translational Science. The project described was supported by the National Center for Advancing Translational Sciences, UL1TR000117. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.  

Overall Data Report So far through these health fairs 661 people have been screened of which the following statistics are drawn: 24.6% “Diabetic” A1c zone with scores greater than 6.5, 24% “Prediabetic” A1c zone with scores between 5.7-6.4 51% “Normal” A1c zone with scores 5.6 and lower. Some participants had A1c’s of over 14 which is dangerously high and did not know they were in the diabetes range. Statistically 24.6% of the sample was diabetic and 24% was prediabetic—accounting for nearly 50% of the sample population. According to the CDC 2014 National Diabetes Report 9.3% of the US population have diabetes and in our sample the percentage was over double that number showing that diabetes is at an epidemic rate in Appalachia. November 2015