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A Grounded Theory Study Describing the Process of a Peer-delivered Telephone Coaching Program for Persons with Type 2 Diabetes
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 five 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 office one day a week. The educators have had extensive training in glycemia management. The clients who are referred are mostly individuals who had difficulty 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 office 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 first 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-specific 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 specific assessments (LMC Barriers to Care Tool, PHQ-9 Depression Screening, LMC Diabetes Skills, Confidence & Preparedness Index) applied at baseline and 6 months. Results: Among the 572 patients enrolled, the baseline A1c was 9.5±1.4%, with a mean age of 56.6±12.9 years and a mean diabetes duration of 16.0±8.8 years. 263 patients completed the ASCP showing reduced A1C (−1.3±1.5, P<0.01), and an increase in skills (1.4±1.8, P<0.01), confidence (0.9±1.6, P<0.01) and preparedness (0.5±1.6, P<0.01). Conclusion: Patients completing a customized program for refractory T1D & T2D demonstrated significant 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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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 five 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 office one day a week. The educators have had extensive training in glycemia management. The clients who are referred are mostly individuals who had difficulty 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 office 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 first 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-specific 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 specific assessments (LMC Barriers to Care Tool, PHQ-9 Depression Screening, LMC Diabetes Skills, Confidence & Preparedness Index) applied at baseline and 6 months. Results: Among the 572 patients enrolled, the baseline A1c was 9.5±1.4%, with a mean age of 56.6±12.9 years and a mean diabetes duration of 16.0±8.8 years. 263 patients completed the ASCP showing reduced A1C (−1.3±1.5, P<0.01), and an increase in skills (1.4±1.8, P<0.01), confidence (0.9±1.6, P<0.01) and preparedness (0.5±1.6, P<0.01). Conclusion: Patients completing a customized program for refractory T1D & T2D demonstrated significant 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