1. CAPSTONE COLLEGE OF NURSING THE UNIVERSITY OF ALABAMA Improving Participation of Diabetics in Self-management Education Letrell Peoples, RN, MSN Dr. Roy Ann Sherrod, DSN, RN, CNE, CNL Faculty Advisor Capstone College of Nursing - The University of Alabama Mrs. Debrah Fisher, MSN, RN, CDE Clinical Advisor Manager, DCH Diabetes Education Center

2. STUDY OBJECTIVE  To identify factors to increase the participation of patients with diabetes at a regional medical facility in self-management education classes provided by the facility’s outpatient Diabetes Education Center.

3. BACKGROUND  Diabetes affects 8.3% of population  Direct and indirect care cost for diabetes averages $174 million per year  Medical expense for people with diabetes is more than 2X higher than those without diabetes (CDC, 2011)

4. DM STATISTICS  Alabama has a 12% prevalence rate  Tuscaloosa County has 12% prevalence rate  2012 medical center admissions:  30% had primary or secondary DX  20% readmissions had primary or secondary DX

5. OPPORTUNITY  1% of inpatients from medical center with diagnosis of DM attended classes at facility’s DIABETES EDUCATION CENTER (2012)

6. WHY EDUCATE?  Diabetes Self-Management Education (DSME) improves knowledge, constructive self-care behaviors, and better clinical outcomes for people with diabetes ( Norris, Lau, Smith, Schmid, & Engelgau, 2003).  Patients who have not received DSME :  Lack the skills to effectively care for themselves  Have a fourfold increased risk of major diabetes complications than those who do receive DSME Niccoluci et al. (as cited in Clark, 2008).

7. SAMPLE  Inpatients between the ages of 25-75  Primary or secondary diagnosis of diabetes  Able to participate in educational offerings  Able to comprehend and read the English language

8. DATA COLLECTION  Patient Education Survey  Demographic Data Collection Form

9. Sample Demographics  Gender:  Males (37%)  Females (63%)  Race:  Black (63.2%)  White (35.5%) Demographics  Age:  55-64 (42.1%)  Education Level:  HS or GED (40.8%)  Employment:  25% employed

10. Survey Results  Years with Diabetes:  <1 yr-10yrs: 59%  How are you managing:  Moderately well-56.6%  Will learning help:  Yes: 89.5%  Importance of learning:  Very or extremely important-92.2%

11. Survey Results  Know about Ed. Center:  N0 : 63.2%  Would you attend classes  Yes : 80.3%  Did staff ask about attending classes at Education Center:  No: 82.9%

12. Factors that would keep you from attending classes at the Diabetes Education Center

13. Conclusions  Major Issues Identified:  Transportation – 40%  Inability to pay-out-of-pocket – 30%

14. Possible Solutions  Increased marketing of Center  To staff and providers  To patients  Foundation support  Offering scholarships Fundraisers Apply for grants  Waiving payment (why?)

15. Limitations/Implications  Limitations  Sample size  No data from healthcare staff  Implications  EBP champion (Inpatient Diabetes Educator)  Longitudinal studies  Identify effectiveness of 2013 ADA Standards

16. Acknowledgments  Dr. Roy Ann Sherrod, DSN, RN, CNE, CNL  Mrs. Debrah Fisher, RN, MSN, CDE  Mrs. Lorraine Yehlen, RN, BSN, MA  Mrs. Shelia Bresnahan, RN, MSN  Unit RNs and staff

17. REFERENCES  American Diabetes Association. (2013). Third-party reimbursement for diabetes care, self-management education, and supplies. Diabetes Care, 36 (1), 598-599. doi: 10-2337/dc13-S098  American Diabetes Association. (2013). Standards of medical care in diabetes-2013. Diabetes Care, 36, S11-66. Retrieved from http://search.proquest.com/docview/1267207263?accountid=14472  Balamurugan, A, Ohsfeldt, R., Hughes, T, & Phillips, M. (2006). Diabetes self-management education program for Medicaid recipients: A continuous quality improvement process. Diabetes Educ ator, 32, 893– 900.  Clark, M. (2008). Diabetes self-management education: A review of published studies. Primary Care Diabetes, 2, 113–120.

18. REFERENCES  Fitzner, K., Greenwood, D., Payne, H., Thomson, J., Vukovljak, L., McCulloch, A., & Specker, J. E. (2008). An assessment of patient education and self-management in diabetes disease management—Two case studies. Population Health Management, 11 (6), 329-340. doi: 10.1089/pop.2008.0012  Gucciardi, E., DeMelo, M., Offenheim, A., Grace, S. L., & Stewart, D. E. (2007). Patient factors associated with attrition from a self-management education programme. Journal of Evaluation in Clinical Practice, 13 (6), 913-919. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=200 9721593&site=ehost-live  Gumbs, J. M. (2012). Relationship between diabetes self-management education and self-care behaviors among African American women with Type 2 diabetes. Journal of Cultural Diversity, 19 (1), 18-22.

19. REFERENCES  Karakurt, P. & Kasikci, M. K. (2012). The effect of education given to patients with type 2 diabetes mellitus on self-care. International Journal of Nursing Practice, 18, 170-179. doi.10.1111/j.1440.172X.2012.02013.x  Norris, S., Lau, J., Smith, S., Schmid, C, & Engelgau, M. (2002). Self-management education for adults with type 2 diabetes: A meta-analysis of the effects on glycémie control. Diabetes Care, 25(7), 1159-1171. doi:10.2337 / diacare.25.7.1159  U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. (2011). National Diabetes Fact Sheet: National Estimates and General Information on Diabetes and Prediabetes in the United States.