1. Introduction Nearly 26 million people are diagnosed with diabetes in the United States, roughly 8.5% of the total population (A.D.A. 2013). 2.1 million Americans are diagnosed with diabetes each year; by 2050, 1 in 3 adults will be diagnosed diabetic if current trends continue (A.D.A. 2013). $245 billion annually attributable to diagnosed diabetes; it’s the fifth leading cause of death in the Unites States, more deaths than AIDS and breast cancer combined (C.D.C. 2012). People with diagnosed diabetes have health care costs 2.3 times higher than what expenditures would be in the absence of diabetes. This equates to 1 in 5 health care dollars being spent caring for those diagnosed with diabetes (C.D.C. 2012). 95% of diagnosed cases are classified as Type II; this type of diabetes is highly preventable with proper diet, education and physical activity but is largely dependent on patient self-care (Ali 2012). High co-morbidity of diabetes presents an opportunity to improve health outcomes of many chronic conditions by focusing on the underlying factors that influence diabetic care and, in turn, drastically effecting health care expenditures. Understanding the barriers to self-care and how these can be overcome within the patient population is essential for developing individualized diabetic care plans that will increase patient health outcomes. Objectives Determine barriers to diabetes self-care within a patient population; what hinders nutrition and physical activity regimes Determine barriers to diabetes self-care within a patient population; what hinders nutrition and physical activity regimes Development of proper language to allow for meaningful patient- provider communication Development of proper language to allow for meaningful patient- provider communication Defining at-risk, potential target, groups within a patient population Defining at-risk, potential target, groups within a patient population Provide guidelines for future development of diabetic self-care plans Provide guidelines for future development of diabetic self-care plansObjectives Determine barriers to diabetes self-care within a patient population; what hinders nutrition and physical activity regimes Determine barriers to diabetes self-care within a patient population; what hinders nutrition and physical activity regimes Development of proper language to allow for meaningful patient- provider communication Development of proper language to allow for meaningful patient- provider communication Defining at-risk, potential target, groups within a patient population Defining at-risk, potential target, groups within a patient population Provide guidelines for future development of diabetic self-care plans Provide guidelines for future development of diabetic self-care plans Methods Identify Target Groups and Develop Individualized Care Plans Chart Review (n=387) Accepted Charts (n=352) Rejected Charts (n=35) Demographic Characteristics of Patient Population Phone Interviews (n=100) Open-ended Questions on Patient Perspective Developed Patient- centric Language and Areas of Concern Focus Groups (n=13) Group Discussion on Diabetes and Self-care Developed Topics of Interest for Survey and Patient Point of View Patient Survey (n=89) 60 Questions covering Social, Emotional and other barriers to Self-care Areas of Focus for PCP; need for comprehensive self- care plans Self assessment model Results Focus Group Executive Summary Respondents stated motivation for better self-care comes from family and the fear of debilitating outcomes or death. Disconnect from knowledge of disease to proper self-care and healthy behavior Chronic, slow progression of disease vs. day-to-day self-care Patient focus on acute outcomes instead of daily, healthy behaviors Daily good habits (diet, physical activity, medication and monitoring) not established Patients do not always recognize and/or report symptoms Benefits of diabetic education classes vs. “cost” of attendance Lacking knowledge of the affects of co-morbidities on overall disease progression and outcomes Reasons observed for potential disconnect from knowledge of disease to proper self-care and healthy behavior Lack of social support system (“blue-collar” attitude) Lack of concrete health-related goals and adequate motivation Comfort foods, traditional foods versus “expensive” health foods Extensive excuses for unhealthy behavior; guilt driven behaviors Results (cont’d.) Conclusions Patient to PCP disease-based language necessary for productive clinical dialogue Patient to PCP disease-based language necessary for productive clinical dialogue Need for comprehensive self-care plans including social support development, dietary regimes, physical activity and mental health support Need for comprehensive self-care plans including social support development, dietary regimes, physical activity and mental health support Establishment of individual motivation for proper self-care to improve health outcomes Establishment of individual motivation for proper self-care to improve health outcomes Increase awareness of day-to-day behavior that affects long-term progression of disease Increase awareness of day-to-day behavior that affects long-term progression of diseaseConclusions Patient to PCP disease-based language necessary for productive clinical dialogue Patient to PCP disease-based language necessary for productive clinical dialogue Need for comprehensive self-care plans including social support development, dietary regimes, physical activity and mental health support Need for comprehensive self-care plans including social support development, dietary regimes, physical activity and mental health support Establishment of individual motivation for proper self-care to improve health outcomes Establishment of individual motivation for proper self-care to improve health outcomes Increase awareness of day-to-day behavior that affects long-term progression of disease Increase awareness of day-to-day behavior that affects long-term progression of disease Current Research Comparative study analysis and latent factor analysis of survey responses Future Research Long-term effects of implemented individual self-care plans Behavioral modification studies to influence daily self-care Effects of specific diets and fitness regimes on diabetes health outcomes Implementation in Primary Care Setting Established target population(s) Comprehensive 6 and 12 month care plans Hiring of Health Coach and Fitness Trainer Increased role of Diabetic Health Educator Prescribed therapies Table 1: Co-morbidity statistics of chart reviewed patient population by gender. Acknowledgments I would like to thank Dr. Ronald Kalterider and Dr. Steve Jacob of York College of Pennsylvania for their guidance and support. A special thanks to Dr. Robert Nielsen, Dr. Erin Juliano, Kristen Mace, Adrienne Deswert and the staff at Annville Family Medicine. Additionally, I would like to thank the students of Dr. Jacob’s Applied Anthropology class for helping develop the patient survey. Lastly, a sincere thanks to the patients who allowed me the opportunity to develop this project through their participation and insight. Figure 1: Summary of chart review (n=352) for specific indicators separated by gender. BMI, current age, H1Ac and years diagnosed were selected as risk indicators to establish target groups within the patient population. Literature Cited American Diabetes Association (A.D.A.). 2013. Fast Facts: Data and Statistics about Diabetes (PDF). Available from: http://professional.diabetes.org/admin/UserFiles/0%20- %20Sean/FastFacts%20March%202013.pdf. Accessed 2014 March 03 Center for Disease Control (C.D.C.). 2013. Diabetes Report Card 2012. Available from: http://www.cdc.gov/diabetes/pubs/pdf/diabetesreportcard.pdf. Accessed 2014 February 25. Ali, Mohammed K., et al. Characteristics associated with poor glycemic control among adults with self-reported diagnosed diabetes—National Health and Nutrition Examination Survey, United States, 2007–2010. Morbidity and Mortality Weekly Report 61 (2012): 32-7.