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Abstracts / Can J Diabetes 41 (2017) S22?S83
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58
A Grounded Theory Study Describing the Process of a Peerdelivered Telephone Coaching Program for Persons with
Type 2 Diabetes
PATRICK MCGOWAN, JULIETA GERBRANDT*, SHERRY LYNCH*,
FRAN HENSEN, SUZANNE HARMANDIAN, LEAH ALBRECHT
Delta, BC
Objective: This grounded theory qualitative study was part of a larger
pilot program that investigated the feasibility, viability and effectiveness of telephone-delivered peer coaching for persons with type
2 diabetes. Participants and coaches were located in the Fraser Health
Region of Vancouver, British Columbia, Canada.
Methods: Qualitative data was collected from 36 coaches (40 dyads)
during the course of the 6 month coaching period via bi-weekly telephone check-ins. Semi-structured in-depth telephone interviews
were also conducted with 29 participants following the 6-month
coaching period. Data collection and analysis were conducted using
the constant comparative analysis method.
Results: The coaches reported discussing several topics during the
coaching sessions including blood glucose, medication, foot care,
sleeping, weight concerns, self-care, relationships with healthcare professionals, life issues and other health issues. A description of the coaching role emerged through ?ve main themes: 1)
teaching Self-Management skills 2) maintaining focus, 3) providing encouragement 4) accessing community resources and 5) clarifying boundaries. These shaped the process of coaching and resulted
in participants reporting improved management and behaviour
changes. These included more consistent blood glucose testing,
healthier eating and food choices, increased physical activity,
improved stress management, better sleep practices and positive
change in attitude or outlook. Participants reported that the peer
coaching process was useful in assisting them learn to manage their
diabetes on a daily basis.
Practical Implications: Peer-delivered telephone coaching was
shown to be both a feasible, viable and effective intervention for
persons who need extended support and skills to manage their
condition.
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Glycemic Outcomes from Collaboration with a Community
Endocrinologist and a Diabetes Education Program
NAZLI PARAST, TINA LEECH, PHYLLIS J. HIERLIHY
Ottawa, ON
Background: Community Diabetes Education Program of Ottawa
(CDEPO) has been collaborating with a community endocrinologist by seeing clients in the endocrinologist?s o?ce one day a week.
The educators have had extensive training in glycemia management. The clients who are referred are mostly individuals who had
di?culty achieving target HbA1C due complexity of care.
Purpose: To assess and improve client?s glycemia in a collaborative practice between a community endocrinologist and CDEPO.
Methods: Retrospective analysis of clients who were seen by diabetes educators in a community endocrinology o?ce during a period
of 3 months between January?April 2017. The outcome was measured based on pre and post HbA1C results; The HbA1C results after
clients saw the diabetes educators were compared to the HbA1C
prior to being seen by diabetes educators. Some individuals did not
have pre and/or post HbA1C and some of these clients were seen
for the ?rst time but some have been followed for several visits.
Results: A total of 46 clients were seen during the three month
period and the HbA1C was improved for majority of the clients
except 3 individuals; due to low attendance rate and increased carbohydrate intake without changes in Antihyperglycemic Agent. The
mean HbA1Cimproved from 9.3% to 7.7% (Figure 1). These results
Figure 1. Percentage of HbA1C improvement assessed in individual clients during
one quarter.
demonstrate the importance of collaboration between an endocrinologist and diabetes educator to helping clients manage glycemia and improve glycemic outcomes.
60
Advanced Self-Care Program: Preliminary Results from a
6-Month Intervention for Patients with Chronically
Uncontrolled Diabetes
ALEXANDER ABITBOL, RUTH BROWN, DISHAY JIANDANI,
NAOMI ORZECH, ASHLEIGH WALKER*, RONNIE ARONSON
Toronto, ON, CA
Introduction: The DROP A1C study demonstrated that refractory
T2D patients (A1c>9.0 percent (%)) can achieve glycemic targets using
specialized barrier assessment tools and barrier-speci?c care paths
in a specialist-led setting. The Advanced Self-Care Program (ASCP)
incorporates these tools in a 6-month program that may be more
reproducible in typical healthcare settings and apply to a broader
population. The current study was designed to assess the impact
of the ASCP on self-management skills and clinical outcomes.
Methods: Patients with refractory T1 & T2D with persistent A1c
?8.0% were referred to the ASCP by endocrinologists and diabetes
educators. ASCP complements Clinical Practice Guidelines-led standard care with individualized counseling and small-group workshops based on speci?c assessments (LMC Barriers to Care Tool,
PHQ-9 Depression Screening, LMC Diabetes Skills, Con?dence & Preparedness Index) applied at baseline and 6 months.
Results: Among the 572 patients enrolled, the baseline A1c was
9.5�4%, with a mean age of 56.6�.9 years and a mean diabetes
duration of 16.0�8 years. 263 patients completed the ASCP showing
reduced A1C (?1.3�5, P<0.01), and an increase in skills (1.4�8,
P<0.01), con?dence (0.9�6, P<0.01) and preparedness (0.5�6,
P<0.01).
Conclusion: Patients completing a customized program for refractory T1D & T2D demonstrated signi?cant reductions in A1C and
increased self-management skills. ASCP provides a reproducible
intervention to improve outcomes in chronically poorly controlled diabetes patients.
61
Glycemic Outcomes from Collaboration Between a Primary
Care Practice and a Diabetes Education Program
NAZLI PARAST, HEATHER WILLIAMS*, CHRISTELLE P.-CLEROUX,
TINA LEECH
Ottawa, ON
Background: Collaboration between the client, diabetes educator
and primary care provider (PCP) is an integral part of diabetes management. It is shown that around 80% of people have their diabetes managed in a primary care setting. Two educators from
Community Diabetes Education Program of Ottawa (CDEPO) provide
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Abstracts / Can J Diabetes 41 (2017) S22?S83
Figure 1. Referral Percentage of Type 2 Diabetes, Prediabetes, Undiagnosed but at
risk.
diabetes care professionals may be positioned to be leaders in
advancing PA promotion in the disease management ?space? within
the current health care context. The purpose of the study was to
examine differences in PA con?dence, barriers, and counseling across
area of practice. Nurse, nurse practitioners and dietitians from Nova
Scotia (n=177) completed measures of con?dence in, barriers to,
and counseling behaviours around PA. The sample was split into
those who reported diabetes as their primary are of work (n=51),
and those who reported working primarily with other chronic
disease populations or in general practice (n=126). MANOVA revealed
that those working in diabetes care, more frequently discussed PA
(70% vs 40% of sessions), assessed both PA (83% vs 43%), and PA readiness (69% vs 37%), recorded PA (87% vs 52%) and provided PA prescriptions (22% vs 11%). A separate MANOVA revealed no differences
on overall con?dence or barrier impact; however, individual item
means suggested that those working in diabetes were more con?dent in their ability to provide PA information, assess readiness,
and answer questions about PA. These ?ndings suggest that those
working in diabetes care could be looked to as leaders in moving
the PA counseling agenda forward in chronic disease management.
63
The Impact of an Interdisciplinary, Case-Managed Diabetes
Team on Diabetes Self-Management, Diabetes-Related
Hospitalizations and Emergency Department Visits
KRISTEN IMFELD, JUSTINE CHAN, MARGARET CHEUNG,
STACEY HORODEZNY
Mississauga, ON
Figure 2. Percentage of Glycemia Improvement.
client care alongside PCPs in the Carlington Community Health
Centre (CCHC) primary care setting one day per week.
Antihyperglycemic agent recommendations are made to PCPs when
glycemic targets are not being met.
Purpose: To assess and improve clients? glycemia in a collaborative practice between PCP of CCHC and CDEPO.
Methods: Retrospective evaluation of referrals from CCHC to CDEPO.
The outcome was measured based on blood glucose and HbA1C
improvements. A period of 6 months was analyzed: April 1? September 30, 2016.
Results: 57 clients were referred for diabetes education; 91% had
type 2 diabetes 7% had prediabetes; 2% were high risk but not diagnosed (Figure 1). Among the 91% with diabetes, 37% showed
improved glycemia, 47% could not be properly assessed and 7% maintained their glycemic control. Glycemia declined in 9%, mainly due
to other comorbidities (Figure 2). Out of the 47% whose glycemia
could not be assessed, the main cause was lack of follow-up. These
results identi?ed the need for emphasis on client follow-up. It is
important to note that CCHC has a high rate of clients with complex
mental health issues.
Objective: Trillium Health Partners? Centre for Complex Diabetes
Care (CCDC) clinic is a short-term case-management program that
addresses the needs of patients with poorly controlled diabetes and
multiple comorbidities. The rise of the diabetes epidemic in Canada
has led to increased hospital admissions and emergency visits. We
propose that an interdisciplinary, case-managed diabetes team will
have a positive impact on patients? usage of emergency departments and hospital admissions, health outcomes, and Quality of Life
Index (QLI).
Methods: Retrospective chart analysis examining all patients admitted to CCDC and discharged on or before June 30, 2015.
Results: Mean age was 57.2 years (�.9) and 55.3% were male. On
average, patients were admitted for 10.7 months (�8) and excluding diabetes, had multiple comorbidities (4.2�1). Monthly
weighted-average hospital and emergency visits prior to CCDC
admission were reduced during admission to the program (Z=7,835
p<0.0005; Z=17,592 p<0.0005 respectively). Wilcoxon Signed Rank
Test comparing A1C on admission (10�5) and discharge (7.4�3)
was found to be signi?cant (Z=10 344, p<0.0005). Signi?cant
improvement in QLI was noted at discharge (0.78�vs. 2.11�2;
t(621)=23.88, p<0.0005). The mean overall score on the Patient
Assessment of Chronic Illness Care survey was 3.9 of a possible 5,
indicating a high level of satisfaction with the care patients received.
Conclusion: CCDC, an interdisciplinary, case-managed diabetes team,
had a positive impact on patients? emergency and hospital admissions, health outcomes, and Quality of Life Index.
64
62
?Stepping-Up? to the Challenge: Diabetes Care Professionals
Promoting Physical Activity
MYLES O?BRIEN, CHRISTOPHER SHIELDS*, JONATHON FOWLES
Wolfville, NS
Story-Based Interventions: Functions Of Storytelling That Can
Promote Disease Self-Management Among Those Living With
Diabetes
ENZA GUCCIARDI
Toronto, ON
Physical activity (PA) is recognized as key in the prevention and management of numerous chronic diseases. Diabetes management is
an area where PA has been a priority over the last decade. As such,
Objective: Storytelling is a form of communication that conveys a
persons? narrative and experiences and is emerging as a strategy
in chronic disease self-management. The purpose of this study was
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