Abstracts / Can J Diabetes 41 (2017) S22?S83 S23 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. 59 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 S24 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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