1. Implementation of the Diabetes State Plan: A collaborative academic and state partnership experience to improve diabetes care in South Dakota Cristina Lammers MD. MPH*; Nancy Fahrenwald PhD, RN*; Cheryl Sieverson MS, RN*; Haifa Samra PhD, RN*; Roxanne Boysen MS, RN*; Mary Minton PhD, RN*; Tom Stenvig PhD, MPH, RN, CNAA*; Marcie Kemnitz MS, RD, LN**; Kendra Kattelmann PhD, RD, LN*; Joan Clapper BS, MS* (*SDSU College of Nursing and Health Sciences; Nutrition, Food Science and Hospitality Dept. and **USD Dietetics. * *
South Dakota’s size and rural population results in significant challenges when seeking health care. Three fourths of SD counties are designated as health professional shortage areas, and 11% of residents lack health care coverage. Over 50,000 people have diabetes, a number that is projected to grow. The primary goal of the Diabetes State Plan is to improve diabetes health care by focusing on the essential services that are the foundation for public health practice. The University Partners in Health Promotion team worked with the state to address priority Diabetes State Plan objectives, engaging students and faculty in public health practice to improve the quality of life of SD residents. In , clinics, key-informants, and people with diabetes participated in personal or phone interviews, or completed self-report surveys. Results show that sustained collaboration and partnerships are needed to better understand diabetes care needs of South Dakotans with diabetes, and to assure access to quality diabetes health care in SD.
Obj. 5-6: Variables from the BRFSS and the Diabetes Link Survey data base linked to diabetes morbidity and mortality were used. Chi Square, Pearson correlation and Students’ t Tests were used as appropriate. Odds ratios (95% CI ) were calculated; logistic regression models were developed to identify morbidity and mortality risks. Both databases failed to address known risk factors such as pre-diabetes. Identified data gaps were: isolation, standards and quality of diabetes care, diabetes self care, lifestyle, exercise, diabetes program, and control method.
Obj. 1: Nursing students interviewed urban, and rural diabetics, health providers and health administrators in Southeastern SD. Major barriers reported were: lack of diabetes education, treatment compliance, transportation, health insurance, provider collaboration and lack of community resources. Proposed strategies: media communication, support groups , increase # of diabetes educators, and improve transportation.
1) Identify barriers to diabetes care, and strategies to lessen the barriers
2) Identify barriers to diabetes care and assess the needs of selected and high risk groups
3) Assess diabetes curricula for the health profession schools, compare to ADA standards, and propose diabetes curriculum recommendations
4) Monitor access, availability, and quality of diabetes care to plan for diabetes services
5-6) Identify morbidity and mortality diabetes indicators, analyze data sources to identify gaps in the indicators
Obj. 2: People with diabetes living in Hutterite colonies completed a survey in fall out of 55 SD colonies responded. Main diabetes related health issues identified were: nutrition and lack of physical activity (56% BMI >30%); deficient diabetes knowledge (54% obtain information from non-health professionals; 30% does no know about A1C); ineffective diabetes self management and high morbidity (72% had hypertension, 68% peripheral artery disease); and limited access to diabetes health services (35% travels >25miles) .
An assessment was conducted among parents of children with diabetes in Western SD. Emerging key issues were: need for improving communication among schools, parents and health providers, shortage of pediatric diabetes specialists, increase awareness of hypoglycemia and use of glucagon.
Obj.4: A secondary analysis of the Diabetes Link Survey data base was conducted. 47.5% (712 /1500 )diabetics in SD responded. Most were white, female, y.o, had health coverage, and lived in rural areas in the SE . 80% reported type 2 diabetes, more than half had hypertension and high cholesterol, and 30% or more had eye, foot and CV problems % did not receive key services (foot exam, kidney tests, DSM education, dental care of pneumonia vaccine), 67.3% never attended a support group, and 10% travel 50+ miles to see a dietitian or a diabetes educator. Major frustrations reported: lack of SDM education, diabetes knowledge, dietitians and diabetes educators. Interviewed diabetics in NE SD were of avg. age 61 and 75% American Indian. AI reported better access to diabetes care (provided by IHS) than whites. Community and private clinics, and IHS provide diabetes care, but eye, foot and dental exams, diabetes education and endocrinologist visits are not locally available requiring referrals to larger centers.
Obj.3: Nursing, nutrition, physician assistant and medical schools diabetes curricula were assessed and compared to ADA standards. Primary gaps identified were: diabetes self management education (DSM), information about exercising and diet, effect of stress, illness and trauma on diabetes, the importance of eyes, foot , and dental routine exams, psychosocial aspects of diabetes, diabetes complications, and diabetes care in different settings. Recommendations: incorporate DSM in all programs, stronger nutrition and physical activity information, and add a segment in managing diabetes in schools, correction, and other settings.