Idea Transcript
8/7/2017
Linda M. Siminerio, RN, PhD, CDE Professor of Medicine Professor of Nursing and Community Health University of Pittsburgh Pittsburgh, PA
Disclosure • Advisory Panel, Becton Dickinson
This material is based on research sponsored by the Air Force Surgeon General’s Office under agreement number FA7014-10-2-0005. The U.S. Government is authorized to reproduce and distribute reports for Governmental purposes notwithstanding any copyright notation thereon.The views and conclusions conta ined herein are those of the authors and should not be interpreted as necessarily representing the official policies or endorsements, ei ther expressed or implied, of the Air Force Surgeon General’s Office or the U.S. Government.
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(Program Reinforcement Impacts Self-Management)
Background Diabetes Self-Management (DSMES) DSMES is the cornerstone of care for all individuals with diabetes who want to achieve successful health-related outcomes Patients who receive DSMES are provided with the knowledge and tools needed to effectively manage their diabetes Research has shown DSMES can have a significant impact on patient outcomes short-term
The Evidence for DSMES •Dramatic decline in A1C (0.76%) •Effectiveness directly correlated to the amount of time spent with the educator •Benefits of the education decrease 1-3 mos. •Sustained improvement requires follow up.
Norris SL, et al. Effectiveness of self-management training on type 2 diabetes: a systematic review of randomized controlled trials. Diabetes Care. 2001. Brown AS. Interventions to promote diabetes selfmanagement: state of the science. Diabetes Educator 1999.
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DSMES Diabetes SelfManagement Education (DSME) Lays foundation •Provided by health professional •Provides and links clinical advice •Develop goals
Self-management support (SMS) •Ongoing •Supports follow-up •Can be provided by community, health workers and peers • Advocacy, community connections, support behavior and goals
Self-Management Support Current approach to DSME is usually based on a short-term program with or without some degree of follow-up Without sound follow up patient not be able to effectively manage their diabetes throughout their lifetime Suggested mechanisms for support:
DSME Follow-Up Studies • ADA DSME Standards require SMS • Several studies have been published examining peer interventions • However, there is limited evidence to support which type of intervention is most effective
Patient Centered Medical
Home
Community workers Office staff within community sites (PCP offices, wellness clinics) Peers with diabetes
Currently, no study demonstrates which mechanism is most effective in helping patients maintain/improve outcomes
Who can best provide support? •Diabetes Educators •Peers with diabetes •Office staff from primary care (the Patient Centered Medical Home)
Hypothesis Patients who receive Diabetes SelfManagement Education (DSME) who are enrolled in a specific Self-Management Support (SMS) follow up program will maintain and/or improve behavioral and clinical outcomes at 6 months and be more satisfied as compared to those in the other SMS program interventions
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Objectives/Tasks Study Intervention
Study Design Setting
1. Train primary care office staff, research staff and peer participants on SMS interventions 2. Deliver DSME to patients enrolled in the PRISM study 3. Implement SMS interventions following DSME 4. Compare patient clinical, psychosocial and behavioral outcomes and satisfaction between SMS interventions to determine the most effective SMS support mechanism 5. Assess primary care office staff and peer participant satisfaction
Three Community Sites:
UPMC Community Medicine, Inc. (Pittsburgh, PA) Centerville Clinics, Inc. (Washington, PA) Penn State Hershey Medical Center (State College, PA)
Project Timeline
Study Design
+6 Week Visit (DSME complete)
+ 3 months
3 Progra m Sites + 6 months
Baseline
Recruitment 40 s ubjects per site (N=120)
DSME
DSME Intervention
Ra ndomization
Educator SMS 6 week visit (30 Subjects)
Peer SMS 6 week visit (30 Subjects)
PCP SMS 6 week visit (30 Subjects)
Us ual Care SMS 6 week visit (30 Subjects)
3 Month Visit
3 Month Visit
3 Month Visit
3 Month Visit
6 Month Visit
6 Month Visit
6 Month Visit
6 Month Visit
SMS Follow Up (Monthly Phone Calls)
Patients receive DSME between baseline and 6 week visit SMS follow up occurs between 6 weeks and 3 months, 3 months and 6 months SMS Follow Up: Peer SMS - call patients monthly, use phone scripts to interact with patient Educator SMS - call patients monthly PCP SMS - staff instructed on self-management; staff determine frequency of phone calls Usual Care SMS – Educator/PCP staff contact patient 2-3 months following DSME
Survey Tools
Measures Patient: A1c Lipids Blood Pressure Weight Additional surveys (empowerment, self-care behaviors, diabetes specific distress) Satisfaction Peer, Educators and PCP Office Staff: Satisfaction
SMS Follow Up (Monthly Phone Calls)
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•Self-care behaviors (Glasgow) •Emotional Distress (PAID - Problem Areas in 2 Diabetes) 3 •Quality of Life (SF-12 Health Survey) •Empowerment (DES-SF -Diabetes Empowerment 4 Short-Scale Form) •Peers, Educators and Office Staff satisfaction surveys 1Toobert,
et al.;2Welch, et al. 3Quality Metric, Inc.; 4University of Michigan Diabetes Research and Training Center
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Current Status
PRISM Participant Characteristics
Study Enrollment Site
Participants Enrolled
Penn State Hershey Clinics
44
Centerville Clinics, Inc.
41
Community Medicine, Inc.
56
Total
141
Age Duration BMI A1C Total Cho. HDL LDL Trig. BP
N
Mean
S.D
97 90 93 95 92 87 90 90 95
60.44 8.511 34.16 * 8.48 * 176.6 44.76 98.40 178.37 133/78
11.44 10.04 7.26 1.96 36.18 13.75 34.19 96.65
Current Status
Study Follow Up 111 participants have completed a 6-week study visit
RESULTS
27 participants have completed a 3-month study visit 12 participants have been lost to follow up
DSME Was Effective Improvements at 6 wks in: •A1C (0.9) •Diabetes empowerment (DES-SF) •Quality of life (SF-12) •Self- Care (Glasgow scale) •Freq. glucose monitoring •Foot score •General Diet (All p