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Collaborative Strategies of Education and Exercise in Diabetes and Chronic Disease Prevention or Management in a Rural Community Setting

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Title: Collaborative Strategies of Education and Exercise in Diabetes and Chronic Disease Prevention or Management in a Rural Community Setting


1
Collaborative Strategies of Education and
Exercise in Diabetes and Chronic Disease
Prevention or Management in a Rural Community
Setting
  • Paula Thompson, RD
  • Terese Hemmingsen, RN, BSN, CDE
  • Carla Theusch, MS

2
Saint Elizabeths Medical CenterMinistry
Diabetes Services-Wabasha
  • St. Elizabeths Medical Center, Wabasha, MN
  • Member of Ministry Health Care
  • Partner with the Mayo Clinic, Rochester Outreach
    clinics in Wabasha, Plainview, Lake City, and
    Alma, WI.
  • Service Area includes south-eastern Minnesota and
    western Wisconsin
  • Critical Care Assess Hospital
  • Offers both in-patient and out-patient services
  • Provider Referral Sources include Mid-level
    Providers and Family Practitioners

3
Saint Elizabeths Medical Center Ministry
Diabetes Services-Wabasha
  • Program initiated in 1997
  • Includes one-on-one combined with group education
  • Team includes a Registered Dietician and
    Registered Nurse/CDE
  • Provide out-patient and in-patient hospital
    consultation

4
Ministry Diabetes Services Referral to the
Program
5
Ministry Diabetes ServicesExercise Consult Added
  • Referral signed by PCP that they may participate
    in an exercise program.
  • Stress test strongly recommended.
  • RN schedules the Exercise Consult

6
Ministry Diabetes ServicesExercise Consult
Components
  • 1-on-1 consult with a member of the Wellness
    Center
  • Review of history
  • Education
  • Individualized exercise program developed

7
Ministry Diabetes ServicesNutrition Consultation
  • 2nd Visit with RD Nutrition Consultation
    (one-on-one visit)
  • Evaluate glucose records
  • Nutrition assessment
  • Develops a personalized meal plan
  • Education
  • Establish behavioral change goal
  • Schedule Group Classes

8
Group Education Classes
  • Sick Day Management
  • Long Term Complications
  • Exercise and Stress Management
  • Heart Healthy Eating

9
Ministry Diabetes ServicesSix-Month Follow-up
  • Six-Month Follow-up, RD
  • 1) Behavioral goals are reviewed
  • 2) Topics are variable depending on the patients
    needs
  • 3) Outcomes data obtained

10
Diabetes Self Management ProgramData
Improvement in A1c
11
Diabetes Self Management ProgramData HDL
12
Diabetes Self Management ProgramData LDL
13
Diabetes Self Management ProgramData Total
Cholesterol
14
Diabetes Self Management Program Data
Triglycerides
15
Ministry Diabetes Services Program Challenge
  • In 2005, Metabolic Syndrome and/or Pre-diabetes
    patients referred to Diabetes Self Management
    Program
  • Frustration No insurance coverage for such
    educational intervention!

16
Ministry Diabetes Services Program Challenges
  • Challenge
  • Develop an affordable out-of-pocket educational
    program
  • To update area providers about upcoming programs
    made available through the 2005 Flex Grant
  • Temporary Solution quarterly pre-diabetes class

17
Pre-Diabetes Education Class
  • What is pre-diabetes
  • Pre-diabetes statistics
  • Why is preventing diabetes important?
  • Statistics
  • Importance of increased physical activity
  • Development of individual exercise goals
  • Goal setting and tracking progress

18
Pre-Diabetes Class Continued
  • Risk Factors for Pre-Diabetes
  • Who should be screened
  • Tips on achieving a healthy weight
  • Comparing calories in food
  • Reading food labels
  • Review of carbohydrates effect on blood glucose
    levels
  • Protein, fat, and fiber

19
Pre-Diabetes Education Classes Continued
  • Overwhelming, retention was not adequate
  • More emotional/educational support was needed
  • A more structured exercise program was needed.

20
Ministry Diabetes Services Solution
  • Increase collaboration with Cardiac Rehab
    Department
  • Flex Grant received to initiate the Fresh Start
    Exercise and Education Program
  • 3) Patients with diagnosis of Pre-diabetes and
    Metabolic Syndrome referred to the Fresh Start
    Exercise and Education Program
  • 4) Share our solutions with area providers

21
Ministry Diabetes Services Diabetes Education
Event
  • Diabetes Awareness Banquet held.
  • Topics Diabetes Education, and Pre-diabetes.
  • 130 Providers, Pharmacists, and Nurses attended.

22
Physician Breakfast
  • Physicians invited to breakfast information
    meeting
  • Introduced Fresh Start Program
  • Reviewed referral process
  • Questions and Answers

23
Fresh Start Exercise and Education Program
  • Determined need for a primary prevention program
  • GAINED ADMINISTRATIVE SUPPORT!!!
  • GAINED PHYSICIAN SUPPORT!!!
  • Developed in 2005
  • From Cardiac Rehab to Wellness Center

24
Maintenance Program 2-3 d/wk indefinitely
25
Fresh Start Exercise and Education Program
  • Orientation
  • Seven-weekly education classes
  • 24 supervised exercise classes (3 days/wk) to be
    completed in 8-10 wks

26
Fresh Start Exercise and Education Program
  • Initial Exercise Session
  • Individualized exercise program developed
  • Monitored pre-, peri-, and post-exercise
  • Physician

27
Fresh Start Exercise and Education Program
  • Weekly Education Classes
  • Introduction to Pre-Diabetes and Metabolic
    Syndrome
  • Carbohydrate Counting
  • Your Heart and How it Works
  • Take Charge! Identify and Modify Your Risk
    Factors
  • Exercise and Your Heart a personalized home
    Exercise Rx
  • Relax and Unwind
  • Medications
  • Nutrition Care of the Heart/Healthy Meal Planning
  • The Maze of Reading a Food Label

28
Frustration with Reimbursement in Primary
Prevention Programs
  • Trips to the Capitol
  • Several conference calls/meetings with other key
    players BCBS MN, Health Partners, AHA, South
    Country etc.
  • Restated the need for Primary Prevention Programs

29
Community and Employee Initiatives
  • Annual Employee Screenings
  • Annual community screenings
  • Hi Ho Hi Ho
  • Riverboat Days Walk/Run
  • Ring Around Wabasha
  • Wabasha Walks the MI River
  • Fit City Seniors
  • L.E.A.R.N. Program
  • Bike Club, Swimming Pool, Walk paths
  • DM Ed. Event for Medical Prof.

30
Frustration with Reimbursement in Primary
Prevention Programs
  • We gained their support!!!!!
  • Requested data to support our initiative.

31
Wabasha named First Fit City of Minnesota!
32
Metabolic Syndrome Pilot Study
  • Funding still problematic due to reimbursement
    issues
  • Applied for 2 grants and received 30K in funding
  • Developed a team to initiate plan of action

33
Metabolic Syndrome Pilot Study Commitment
  • Sent out approx. 2,000 letters
  • 85 participants committed to
  • 3 5-part screening process (labs, girth, BP, and
    6 min. walk test) at pre-start, 3mths, and 6mths
  • 24 exercise sessions in 8-10 weeks
  • 7 wkly education classes in 8-10 weeks
  • Read wellness center guidelines and informed
    consent
  • Non-refundable 110 commitment fee

34
Metabolic Syndrome Pilot Study Inclusion Criteria
35
Metabolic Syndrome Pilot Study Participants
  • 25-83 yo
  • Mean age of 59yo
  • 37 Males 48 Females
  • 60 MN 25 WI
  • 11 Drop outs
  • 7 non-medical
  • 3 medical
  • 1 both

36
Metabolic Syndrome Pilot Study Case Study 1
  • 61 year old female with diagnosis of
    hypertension, hyperlipidemia, girth inactivity.
  • Completed 24 sessions of exercise in 8 weeks and
    attended all 7 education classes.
  • Initial Data 6 Month Data
  • Resting BP 144/94 Resting BP 108/68
  • TC 158 TC 144
  • HDL 31 HDL 37
  • LDL 84 LDL 83
  • TG 217 TG 122
  • BS 95 BS 85
  • Weight 234.5 (BMI 37) Weight 190 (BMI 30)
  • Girth 52 inches Girth 45 inches
  • In conclusion Blood pressure better controlled.
    TC, LDL, TG decreased. HDL increased. BS
    decreased. Lost 44.5 pounds and lost 7 inches at
    the waist.
  • Participant continues in the maintenance program
    3 days/week. Has lost further weight (50 pounds
    total from initial) and has cut two blood
    pressure medications half post study.

37
Metabolic Syndrome Pilot Study Compliance
38
Metabolic Syndrome Pilot Study
39
Metabolic Syndrome Pilot StudyExercise
Compliance at 6 Months
40
Metabolic Syndrome Pilot Study
41
Metabolic Syndrome Pilot Study
42
Metabolic Syndrome Pilot Study
  • At 6 months
  • 35
  • no longer meet the diagnostic criteria
  • for
  • Metabolic Syndrome!!!!

43
Whats Next?
  • Take final results to insurers to prove need for
    primary prevention reimbursement.
  • Part II of Metabolic Syndrome Pilot Program
  • 12 and 18 month reassessments
  • Bimonthly support groups and educational
    offerings.
  • Share our success with others.

44
Thank you!
  • 1200 Grant Blvd. W.
  • Wabasha, MN 55981
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