- Email: [email protected]
Diabetes Pre-Clinic Patient Questionnaire.
360 I
CANADIAN JOURNAL OF DIABETES
POSTER PRESENTATIONS
227
I
A I C Outcome Measures to Evaluate the Efficacy of Individual Diabetes Education in a Part Time Diabetes Education Clinic. SYLVIE CHARPENTIER', MELANIE D ' AMOURS, Kapuskasing D iabetes Education Centre, Kapuskasing, On The Kapuskasing Diabetes Education Centre ( KDEC) is a part time diabetes program (2 dayslwk) , member of the Northern Diabetes Health Network. KDEC provides diabetes education services for individuals with prediabetes, diabetes, gestational. The objective of the study was to measure the effectiveness of the education provided by the Registered Nurse(RN), Registered Dietitian(RD) in the management of diabetes. The measurement used to evaluate the outcome was the Glycosylated Hemoglobin Level (A I C) at the basel ine in comparison with subsequent results. A chart review of the A I C results for the clients seen as new referred, re-referrals (not seen in the past 2 years) andlor follow up for the time period of July 2006 to July 2007 was performed. The criteria in the selection of the charts was to have the A I C results present. A total 305 charts met the criteria but 41 charts were rejected as there was only one A I C result available. A subdivision of the remaining charts was done. Group A : baseline A1C results above 7 % ; 99 charts met the criteria. Group B : baseline A I C results below 7 % ; 165 charts met the criteria. In both groups, a review of the A I C results looking at the improvement or the deterioration of the A1C from baseline to the latest A1C results was performed. For instance, if the Ale was above 7 % , remained above 7 %, but improved, went from 9 % to 8.2 % , it was counted as improved even though it was not yet in the target range below 7 %. Group A: initial A1C above 7%: 72 % of the individual's improved and 27 % deteriorated ( was higher then the baseline). Group B: initial A I C below 7 %: 91 % improved or remained below 7 % ; 9 % deteriorated: A I C was above 7 %. The overall 84 % improved thei r A I C level and 16 % deteriorated and were above 7 %.
Conclusion: The majority of the clientele receiving diabetes education with one on one individual counseling with the RN and the RD in a part time program improved their A I C baseline.
229
I
Diabetes Pre-Clinic Patient Questionnaire. N ICO LE DOLLlN*, CHRISTINE RI CHARDSON, GE)fEVIEVE PARENT, EDGAR BELANGER. De partment of Pediatrics. Children's Hosp ital of Eastern Ontario, Onawa, ON Meeting the nee ds of increasing numbers of patients and the increasing compl exity of diabetes care can be cha llenging wi thin the constraint s of fixed and Jimited clinic times and space. Our Pedia tric Diabetes T eam held a rerreat to discllss and develop an appro
228
I
'Look, I Draw'd a Picture of Diabetes!' Using Art to Assess Emotions and Leaming in Newly Diagnosed Children with Type 1 Diabetes. CRISTINA PEPE, Endocrinology and Diabetes Unit, BC Children 's Hospital, Vancouver, BC. Drawing is an intimate, child appropriate form of communication , linked to expression of personality, emotion and ideas. Most healthcare professionals consider children's drawing to be a nonnal extension of play and do not appreciate the value of art expression as a tool for assessment and evaluation . The developmental stages of children's drawings follow similar stages to cognitive and motor development. These include the scribble, pre-schematic, schematic, dawning realism stage and pseudorealism stages. Children may go back and forth between stages, and can show fluctuations in artistic development when under emotional stress. This project involved newly diagnosed children with type 1 diabetes aged 5-12, who came in to the BCCH diabetes education program for teaching with their families. They were asked to 'draw a picture of diabetes' at the start of education and again upon completion of the program. Looking at the before and after drawings revealed that they were useful for assessing emotions, and in many cases, were also a tool to evaluate learning. Often, even when a child appeared to nol be listening or paying attention, the drawings revealed that they were! Even in cases where no useful information was obtained, the children had so much fun drawing that the exercise was deemed useful. Children love to draw and will often keep drawing long after the requested artwori< is completed. Although there are standard emotional indicators for analyzing children's drawings, drawings are not diagnostic tools. They can, however, be a source of data. Based on this experience, the use of art as part of the education process for children with diabetes should be encouraged , and would be an interesting and innovative area for future research.
230
I
Cardston and Building Healthy Lifestyles (BHL) - Service Agreement in the Making. BARBARA LOCKHART, SHANTEL ROEST, SCHARI HEATHER, LESLIE MCKENZIE, LLOYD CLARKE, Cardston, AB Context - Service agreements are an important and intergral part of Primary Care Reform. Service Agreements are important as they: • Define relationships between primary care (PC) and specialty care • I mprove referral process • Decrease delay in care • Reduce backlog • Reduce demand for vis its Objective - The vis ion of the service agreement is "there will be a planned care approach for patients with diabetes who receive primary care from their physicians and PC teams at the Cardston Medical Clinic. This care will be based on the use of clinical guides for vascular protection , access to specialty care when required and the consistent exchange of information between primary care and BHL that will support the positive o utcomes for those patients." Method - The process for the development of the Service Agreement included: regular monthly meetings, flow mapping of process and the evaluation of the service agreement. The evaluation component needs to review both process steps identified as we ll as the clinical indicators. Results - Eva luation of the service agreement isjust beginning. One of the key decisions surrounding the evaluation process was not to significanltly increase the co ll ection of indicators already being coll ected. But what needed to be added were indicators that evaluated the proceses that had been agreed upon between both groups. Access and delay measures were already being coll ected by both groups. Concl usion - To date, the most significant finding has been the importance of the process needed to develop the service agreement. Spending the needed time on the flow mapping, clearly identifing what is the work, defining what information needs to be sent and what information needs to be returned has provided the most benefit to both parties.
CANADIAN JOURNAL OF DIABETES
POSTER PRESENTATIONS
227
I
A I C Outcome Measures to Evaluate the Efficacy of Individual Diabetes Education in a Part Time Diabetes Education Clinic. SYLVIE CHARPENTIER', MELANIE D ' AMOURS, Kapuskasing D iabetes Education Centre, Kapuskasing, On The Kapuskasing Diabetes Education Centre ( KDEC) is a part time diabetes program (2 dayslwk) , member of the Northern Diabetes Health Network. KDEC provides diabetes education services for individuals with prediabetes, diabetes, gestational. The objective of the study was to measure the effectiveness of the education provided by the Registered Nurse(RN), Registered Dietitian(RD) in the management of diabetes. The measurement used to evaluate the outcome was the Glycosylated Hemoglobin Level (A I C) at the basel ine in comparison with subsequent results. A chart review of the A I C results for the clients seen as new referred, re-referrals (not seen in the past 2 years) andlor follow up for the time period of July 2006 to July 2007 was performed. The criteria in the selection of the charts was to have the A I C results present. A total 305 charts met the criteria but 41 charts were rejected as there was only one A I C result available. A subdivision of the remaining charts was done. Group A : baseline A1C results above 7 % ; 99 charts met the criteria. Group B : baseline A I C results below 7 % ; 165 charts met the criteria. In both groups, a review of the A I C results looking at the improvement or the deterioration of the A1C from baseline to the latest A1C results was performed. For instance, if the Ale was above 7 % , remained above 7 %, but improved, went from 9 % to 8.2 % , it was counted as improved even though it was not yet in the target range below 7 %. Group A: initial A1C above 7%: 72 % of the individual's improved and 27 % deteriorated ( was higher then the baseline). Group B: initial A I C below 7 %: 91 % improved or remained below 7 % ; 9 % deteriorated: A I C was above 7 %. The overall 84 % improved thei r A I C level and 16 % deteriorated and were above 7 %.
Conclusion: The majority of the clientele receiving diabetes education with one on one individual counseling with the RN and the RD in a part time program improved their A I C baseline.
229
I
Diabetes Pre-Clinic Patient Questionnaire. N ICO LE DOLLlN*, CHRISTINE RI CHARDSON, GE)fEVIEVE PARENT, EDGAR BELANGER. De partment of Pediatrics. Children's Hosp ital of Eastern Ontario, Onawa, ON Meeting the nee ds of increasing numbers of patients and the increasing compl exity of diabetes care can be cha llenging wi thin the constraint s of fixed and Jimited clinic times and space. Our Pedia tric Diabetes T eam held a rerreat to discllss and develop an appro
228
I
'Look, I Draw'd a Picture of Diabetes!' Using Art to Assess Emotions and Leaming in Newly Diagnosed Children with Type 1 Diabetes. CRISTINA PEPE, Endocrinology and Diabetes Unit, BC Children 's Hospital, Vancouver, BC. Drawing is an intimate, child appropriate form of communication , linked to expression of personality, emotion and ideas. Most healthcare professionals consider children's drawing to be a nonnal extension of play and do not appreciate the value of art expression as a tool for assessment and evaluation . The developmental stages of children's drawings follow similar stages to cognitive and motor development. These include the scribble, pre-schematic, schematic, dawning realism stage and pseudorealism stages. Children may go back and forth between stages, and can show fluctuations in artistic development when under emotional stress. This project involved newly diagnosed children with type 1 diabetes aged 5-12, who came in to the BCCH diabetes education program for teaching with their families. They were asked to 'draw a picture of diabetes' at the start of education and again upon completion of the program. Looking at the before and after drawings revealed that they were useful for assessing emotions, and in many cases, were also a tool to evaluate learning. Often, even when a child appeared to nol be listening or paying attention, the drawings revealed that they were! Even in cases where no useful information was obtained, the children had so much fun drawing that the exercise was deemed useful. Children love to draw and will often keep drawing long after the requested artwori< is completed. Although there are standard emotional indicators for analyzing children's drawings, drawings are not diagnostic tools. They can, however, be a source of data. Based on this experience, the use of art as part of the education process for children with diabetes should be encouraged , and would be an interesting and innovative area for future research.
230
I
Cardston and Building Healthy Lifestyles (BHL) - Service Agreement in the Making. BARBARA LOCKHART, SHANTEL ROEST, SCHARI HEATHER, LESLIE MCKENZIE, LLOYD CLARKE, Cardston, AB Context - Service agreements are an important and intergral part of Primary Care Reform. Service Agreements are important as they: • Define relationships between primary care (PC) and specialty care • I mprove referral process • Decrease delay in care • Reduce backlog • Reduce demand for vis its Objective - The vis ion of the service agreement is "there will be a planned care approach for patients with diabetes who receive primary care from their physicians and PC teams at the Cardston Medical Clinic. This care will be based on the use of clinical guides for vascular protection , access to specialty care when required and the consistent exchange of information between primary care and BHL that will support the positive o utcomes for those patients." Method - The process for the development of the Service Agreement included: regular monthly meetings, flow mapping of process and the evaluation of the service agreement. The evaluation component needs to review both process steps identified as we ll as the clinical indicators. Results - Eva luation of the service agreement isjust beginning. One of the key decisions surrounding the evaluation process was not to significanltly increase the co ll ection of indicators already being coll ected. But what needed to be added were indicators that evaluated the proceses that had been agreed upon between both groups. Access and delay measures were already being coll ected by both groups. Concl usion - To date, the most significant finding has been the importance of the process needed to develop the service agreement. Spending the needed time on the flow mapping, clearly identifing what is the work, defining what information needs to be sent and what information needs to be returned has provided the most benefit to both parties.