5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
5 13-10 reach sea-ceed final
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5 13-10 reach sea-ceed final

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  • Thank you. It is an honor to share our work in decreasing disparities and health care costs for African Americans with diabetes.
  • Multiple partners worked together to identify differences or disparities in diabetes self-management, health care, and outcomes. Our community is composed of 2 counties and covers about 1600 square miles. The population of African Americans in the two counties is >300,000 and more than 20% report that they have been diagnosed with diabetes.
  • During the planning year (1999-2000), many health disparities were identified. We used qualitative and quantitative approaches and CBPR to identify the disparities.
  • In the Year 1 planning period, we developed the coalition and enhanced our understanding of context, causes, and solutions for health disparities. Additionally, we built capacity for planning and developing our community action plan. As our targeted actions and existing activities are implemented, we examine community and systems change and change agents change, as well as changes in risk and protective behaviors. We examine changes in disparities as well as other outcomes in the context of the environment and external influences. Recently, we are examining the SDOH in our communities. In addition to the REACH model, we are using RE-AIM as an evaluation framework.
  • The HADME program provided the preliminary data for obtaining CDC finding for our REACH Program to decrease disparities for African Americans with diabetes.
  • We have several different aims focused on eliminating disparities for more than 1300 AA with diabetes. The two I will talk about today are focused on improving foot care and decreasing amputations.
  • REACH activities were focused on: **Community skill-building **Health professionals training and education, and health systems change **Coalition building and policy change.
  • REACH activities were focused on: **Community skill-building **Health professionals training and education, and health systems change **Coalition building and policy change.
  • Lets look briefly at some of our methods and interventions.
  • Our focus has been on community skill-building rather than importing others to do the work in communities. Thus, a major focus has been on training community members based on their identified needs.
  • Nurses, especially those interested persons from the Tri-County Black Nurses Association, have participated in the Foot and Nail Care Review Course. The course is currently on DVD but was originally offered on site by the College of Nursing and Dr. Teresa Kelechi. There was actually a practice component in the course. One of the REACH nurses actually works collaboratively with those trained.
  • We developed a lesson plan on Feet. The plan is available on the community table. It is divided into specific activities so the lesson can be done as a whole or one activity can be selected and offered in the community. Over 100 persons have been trained to deliver the lesson.
  • The lesson objectives are listed here.
  • One of the components is testing for loss of feeling and over 6,000 monofilaments have been distributed by pharmacies, other groups, and volunteers in the communities. Many persons with diabetes have done a return demonstration.
  • The CHAs and volunteers provide outreach to the communities. The volunteers are the “Heart of the Community” and are so vital to the success of this program.
  • Additionally, we have offered foot checks and ongoing DSMT classes in the community. On both a positive and negative side, the shoe sales persons have marketed special shoes, ALTHOUGH we teach that most can select regular shoes with care. We have expanded access to medications but find access to strips for monitoring is a major challenge.
  • Together, we have developed MGTSD and a card for tracking diabetes care. Many health professionals scientists did not want to include sugar but about 45-50% still say “I got sugar.” so we use both terms but say if your HCP says you have sugar, then you have diabetes. In next month, we will have a new updated version of My Guide available on our website.
  • Here are a few of our activities: Skill building activities such as learning about foot care and then teaching foot care to others. Neighborhood activity groups where we “walk and talk” are most popular. Many do not like to sit in a class Volunteer networks are growing and we now have Volunteer Health Ministers for Diabetes who work with hospitalized patients after discharge. Group and individual education sessions are becoming more popular, and Media messages are expanding our reach. This month we have messages on the area buses.
  • And we focus on health systems changes using CQI.
  • We have two active diabetes coalitions, one in each county that also work to improve diabetes. Their major activities are listed here. They raise funds to help with supplies for those unable to afford them.
  • And we work with political and government systems to change health policies. In the past years we have linked reimbursement for diabetes education to minimal standards of care in South Carolina and we have a state funded diabetes initiative. This year our Health Department received several million to decrease disparities for diabetes.
  • Lets look briefly at some of our data.
  • For example, today Ms. Dilligard is 76 years old. She was a patient in a community hospital and her leg was to be amputated. A family member attended one of the foot care classes offered by a REACH community health advisor, and requested a second opinion from an MUSC physician, who “saved her leg.” She says, “I’ll show my leg to anybody.” She has scars, but she has her leg. She walks without assistance, and has a quality of life she almost lost… She got a referral…she got hope…she got quality care. Health information and advocacy, along with quality care, work well together.
  • Yes, this is not a randomized control trial and it has many limitations, but there is no question. Our communities have changed.
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