7. Results
“… with [the educators] at our doctor’s in the same place, … we can
arrange our appointment the same time, right after our family
doctor, then we go right there and we get rid of it all at one time.”
(Pt 1)
“3 in 1, because you see the doctor, and after that you see the
nurse, and [after] the nurse you see the dietitian, 3 in 1, like what
else you want? ...yes, it's very convenient and it's very helpful for
any patient” (Pt 16)
Personalized
Care
Convenience
Collaboration
Preference
for One-on-
One Care
8. Results
“A partner, … not like a teacher or student. It was like a partnership”
(Pt 15)
“I think it is more collaborative. So... they look at my numbers, they
talk to me about them, they ask me why. I'll explain stuff and we
come up with a plan together. So it's not them telling me or me
telling...it's a kind of combination.” (Pt 13)
Personalized
Care
Convenience
Collaboration
Preference
for One-on-
One Care
9. Results
“Oh yeah, it keeps you motivated and you look forward to it, … when
they did it at the diabetic centre there were about 20, 30 people but
then a lot of people wouldn't … ask questions when there's so many
people . So here, one-on-one is good.” (Pt 14)
“Knowing what it actually does to your body, knowing ways to
change it, knowing ways that you could avoid things or reverse
things...that is more assessable on a one-to-one basis.” (Pt 17)
Personalized
Care
Convenience
Collaboration
Preference
for One-on-
One Care
10. Results
“… they didn’t treat me as somebody that was...stupid, not [like]
‘Ok, … why are you not looking after yourself?’ They … weren’t
degrading by any means. [more] ‘we’re here to help you’. …
they’re not judgemental” (Pt 6)
“I liked how they treated me.” (Pt 20)
“I found that they didn't judge, which was nice” (Pt 22)
Relationship
Building with
DE
Respect
Supportive
Interaction
Empowerment
11. Results
“Both of them were friendly… And … wanted to listen and … get me
… answers to the questions I had.” (Pt 8)
“They were very understanding and helped me sort of adjust to that
[diabetes]. So it seems more comfortable now than it did in the
beginning.” (Pt 10)
Relationship
Building with
DE
Respect
Supportive
Interaction
Empowerment
12. Results
“Because of what I have learned and my confidence in myself in being able to
manage my diabetes, I think that … other people should be doing this.” (Pt 20)
“I know what to do. I know everything about [diabetes] … blood sugar …
carbohydrates and glucose … insulin … when to take it. [what to do] if I am
low, or if I am high. … I check my blood sugar. … I look what I eat, … I
usually… make sure about carbohydrate[s]. … When I buy stuff … I read the
label. … I count the carbohydrate[s]. I like that.” (Pt 19)
Relationship
Building with
DE
Respect
Supportive
Interaction
Empowerment
17. References
1. Public Health Agency of Canada. Reducing health disparities related to diabetes: Lessons learned through the
Canadian Diabetes Strategy community-based program. 2011. ISBN: 978-1-100-18786-0.
2. Lau, David. Diabetes Management in primary care. Can J Diabetes. 2014, Vol. 38, pp. 157-8.
3. Canadian Diabetes Association. Diabetes: Canada at the tipping point: Charting a new path. 2011.
4. Canadian Diabetes Association. Global diabetes experts emphasize self-management to prevent fatal health
complications. Canadian Diabetes Association. [Online] October 12, 2012. [Cited: April 12, 2015.]
http://www.diabetes.ca/newsroom/search-news/global-diabetes-experts-emphasize-self-management.
5. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes
Association 2013 clinical practice guidelines for the prevention and management of diabetes in Canada. Can J
Diabetes. 2013, Vol. 37, suppl 1, pp. S1-S212.
6. International Diabetes Federation. Diabetes eudcation modules. International Diabetes Federation. [Online]
2011. [Cited: April 12, 2015.] http://www.idf.org/diabetes-education-modules.
7. Ridgeway, NA, et al. Improved control of type 2 diabetes mellitus: A practical education/behavior modification
program in a prinmcary care clinic. South Med J. 1999, Vol. 92, 7, pp. 667-72.
8. Hornsten, Asa, et al. Patient satisfaction with diabetes care. Journal of Advanced Nursing. 2005, Vol. 51, 6, pp.
609-17.
18. References con’t
9. Wu, Shu-Fang Vivienne, et al. Differences in the perceptions of self-care, health education barriers and
educational needs between diabetes patients and nurses. Contemporary Nurse. 2014, Vol. 46, 2.
10. Cauch-Dudek, K, et al. Disparities in attendance at diabetes self-management education programs after
diagnosis in Ontario, Canada: A cohort study. BMC Public Health. 2013, Vol. 13, p. 85.
11. Coonrod, BA, Betschart, J and Harris, MI. Requency and determinants of diabetes patient education among
adults in the U.S. population. Diabetes Care. 1994, Vol. 17, pp. 852-8.
12. Ruppert, Kristine, Uhler, Amy and Siminerio, Linda. Comorbid conditions, participation, and physician referrasl
to a rural diabetes self-management education program. The Diabetes Educator. 2010, Vol. 36, 4.
13. Shah, BR and Booth, GL. Predictors and effectiveness of diabetes self-management education in clincial
practice. Patient Educ Couns. 2009, Vol. 74, pp. 19-22.
14. Cancer Care Ontario. Improving Ontario's health system through patient and gamily engagement.
15. Imran, S Ali, Tuygwell, Barna and Harris, Stewart. Diabetes in Primary Care: Back to Basics. Can J Diabetes.
2014, Vol. 38, pp. 155-6.
Editor's Notes
2 mil currently living with DM, 6 mil at risk of diagnosis
Complications account for 80% of cost
50% can be prevented/delayed
Reduce complications & mortality by 60%
Can be managed effectively via self-management
Proper education improve self management improve control and reduced complications
25% being referred to DEC (83% referred attend)
1/3 go to education class
Diabetes educator teams travelled to various primary care facilities (8 FHT, 1 solo DR office, 2 family DR group office)
Provided DSME to pts referred by DR
1 year post intervention
Secondary data analysis
Original codes were reviewed, excel matrix created summarizing the content of the interview under each original code
Matrix was used to determine emergent themes, develop subthemes and overarching themes
PCC is being used at a theoretical lens
Patient-centred care recommended by IOM & IDF. Person-centred care goes deeper.
CCO PCC model chosen as a framework because it serves to involve the patient as an active participant in their care rather than a passive one. Unlike cancer, diabetes can be successfully managed by lifestyle modification and appropriate self-management
Comfortable with staff
Familiarity
Closet to the location (work or home)
Access to RD, RN, MD change meds as needed
Bloodwork prior to apt
Familiar with wait times, etc
Team process involving the pt
Goal setting
Making decisions together
Tailoring interventions to suit pt
Created a working partnership
Positive exchange
Group vs 1-on-1 care
Group
Confusing
Generalized
1 person dominated
1-on-1
Specific
Spend more time on areas that are not clear
Tailored recommendations
Open to ask any questions (comfortability)
tailored
Respected time, thoughts, fears, choices
Worked with pts and their eating patterns whether it was d/t medical reasons, cultural, etc
Treatment
Non judgemental
Helpful
Working together in positive manner
Accessible
listening
Approachable
Receptive
Increased awareness
Increased knowledge/skills led to increased confidence
Increased self-efficacy
Knowing how to handle different situations
Managing medications
Positive responses from all participants
Several aspects of intervention aligned with PCC
Respect
Individualized or tailored interventions
Team work/partnership with patient
Building trusting relationships
Feelings of empowerment
Interdisciplinary approach (access to different HCP as needed)
Participants expressed increased motivation and engagement following sessions
Encourage patient engagement/activation
Improves consistency in self-management
Increases confidence/self-efficacy
Become active participants
80% of diabetes care occurs in primary care, so ongoing education should also occur in primary care
Increase convenience
Existing relationships
d/t number of new diagnosed and possible newly diagnosed pts
Group general, overall information that would be same/similar for everyone
1-on-1 specifics, tailor interventions, answer pt questions
Using PCC DSME in primary care may reduce barriers to attending DECs
Having a travelling team would benefit primary care sites that may not need full time support
- Visit locations where attending a DEC would be a hardship d/t rural
