Post written by Gwenyth Wagner, DNP, APRN, Adult Nurse Practitioner, Health Partnership Clinic
In response to a challenge from Health Resources and Services Administration (HRSA) to create a quality improvement plan to address the number of patients with uncontrolled diabetes, HPC started a focused High-Risk Diabetes Clinic (HRDC) in August 2018. It takes place on Mondays and is open to any patient with an A1C greater than or equal to nine. An A1C is sometimes referred to as the “three-month blood sugar” as it reflects the average blood sugar the patient has had over the past three months. The goal for a person with diabetes per the American Diabetes Association (ADA) is to have an A1C of seven or lower. At present there are 100 patients participating in the HRDC.
There are three goals of the HRDC:
- To improve patients understanding of effective lifestyle change and to assess and address psycho-social barriers to diabetes care.
- To provide additional education and support for diabetes self-care especially with regards to insulin administration.
- To remove financial barriers to obtaining insulin for self-administration and diabetes treatment.
Helping patients control their diabetes is not as simple as just providing medication or telling someone not to eat sugary foods. Diabetes can be a complex and multifaceted disease and patients need not only medication but education, counseling, support and self-management tools so that they can become experts in controlling their own blood sugars.
At HPC, we recognized the need for more comprehensive care and started the HRDC for those patients with uncontrolled blood sugars.
In the HRDC, we focus on education, counseling, mental and behavioral support along with medication management. This provides patients with comprehensive diabetes care and ultimately helps improve their quality of life. Lifestyle management is a fundamental aspect of diabetes care, and we focus on helping patients address risk factors and implement dietary and physical activity changes.
Diabetes self-management education focuses on providing individuals with the knowledge and tools they need to improve their control of diabetes. Patients are encouraged to check daily blood sugars, learn to recognize the signs of blood sugars that are too high or low and then learn how to manage those situations. They are taught how to take their medications safely, particularly insulin and even how to adjust insulin doses at home. Information about foot care and a variety of other topics are also addressed. Lastly, during clinic time a medical provider will perform necessary physical assessments and provide medication management tailored to the individual’s needs.
Medications for diabetes can be very expensive for those both with and without insurance. However, several medications prescribed are made affordable through an assistance program called the 340 B plan and through our association with AuBurn Pharmacy in Olathe. We also have been able to assist patients to obtain insulin when necessary for blood sugar control.
Since starting the clinic, over half of our patients have A1Cs that have now fallen below nine percent, with an average individual decrease in A1C of approximately two percent. Our overall percentage of patients with diabetes who are considered “uncontrolled” (an A1C greater than nine) has dropped from 43 percent to 33 percent since the clinic began.
We hope to continue to support our patients with diabetes with the tools and resources they need to improve control of their diabetes and as a result, improve the quality of their lives.