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Improving Post-partum Screening for Diabetes with a Healthy Living after Gestational Diabetes Class
Can J Diabetes 41 (2017) S22–S83
Contents lists available at ScienceDirect
Canadian Journal of Diabetes journal homepage: w w w. c a n a d i a n j o u r n a l o f d i a b e t e s . c o m
POSTER PRESENTATION ABSTRACTS 55 Lived Experience as a Distinct Information Source: A Case Study to Improve e-Health Products for People with Diabetes JENNICA NICHOLS, STEPHANIE BOUTETTE*, KRISTA BANASIAK* Toronto, ON Objective: Better integration of patient experiences with clinical expertise has been called for in many areas of health, including clinical practice, research, program delivery, and policy development. We present a case study that demonstrates the value of patient engagement in producing e-health support tools: a series of online educational videos addressing insulin initiation for people living with diabetes (PwD). Methods: An original script was produced by health care professionals (HCPs) and professional script writers, and a prototype video was created. Three in-person focus groups (n=9) were held with PwD who have experience using insulin. Participants were shown the video and asked a series of semi-structured questions to facilitate discussion. Focus group were transcribed and analyzed thematically. Findings: PwD’s involvement highlighted the need to simplify language (use everyday as opposed to clinical terms), change the video’s narrative to provider a warmer and non-stigmatizing tone, add additional content that reflects information participants lacked when they initiated insulin, and increase the use of visuals to clarify areas of confusion and to enhance its relevance and effectiveness for endusers. The script was altered to reflect participants’ perspectives based on their lived experiences. Implications: This case study highlights patients as a distinct stakeholder group with unique knowledge and insights. Their lived experiences shed light on issues that HCPs would not otherwise have considered and led to the development of superior e-health support tools. We advocate for more patient engagement in policy creation, research, and the production of health care supports.
56 Improving Obesity Management Education and Training for Medical Residents DENISE L. CAMPBELL-SCHERER*,†, THEA LUIG, SONJA WICKLUM, DOUG KLEIN, RENA LAFRANCE, MELANIE HEATHERINGTON, SHUAI LI, ALISON CONNORS, KAREN MONIZ, ARYA M. SHARMA† Edmonton, AB Background: The prevention and management of chronic diseases, like diabetes and obesity, require a lifespan and interdisciplinary approach that primary care is well suited to provide. While effective medications and tools exist to support diabetes, residents and practicing physicians often feel ill-prepared to address obesity with patients. There is a need to create high quality, evidencebased training programs for medical residents so they can better support patients. Aim: We developed a comprehensive educational program for residents based on the 5As of Obesity Management™ (Ask, Assess,
Advise, Agree, Assist- 5As), a framework and suite of resources to improve knowledge and confidence in obesity counselling. Methods: The program combines lectures from content experts with experiential learning methods, including a bariatric suit experience, practice with standardized and in-clinic patients, and narrative reflections. We assessed changes using the NEW Attitudes Scale, and reports of self-confidence. Narrative reflections were analyzed thematically. Results: Evaluation of the program shows increases in residents’ understanding of the complexity and chronicity of obesity, and an uptake of the 5As framework and tools by residents to improve confidence and success in their obesity management practice. Experiential learning elements proved crucial in increasing residents’ ability to empathically engage with patients and critically reflect on implications for their practice. Conclusion: Results underscore the need for training programs for family medicine. Furthermore, findings reflect the utility of the 5As to improve residents’ confidence and competency in obesity management counselling across the age continuum.
57 Improving Post-partum Screening for Diabetes with a Healthy Living after Gestational Diabetes Class MARSHA FELDT*, ANNIE HOANG, LEIGH CAPLAN, ILANA HALPERIN† Toronto, ON Background: Women with gestational diabetes mellitus (GDM) are recommended to have an oral glucose tolerance test (OGTT) six weeks to six months postpartum Across Ontario completion rates are as low as 15%. At our institution baseline completion rates were 30%. With the addition of an email reminder, the completion rate increased to 44%, but did not reach the target of 60%. Purpose: 1) To further increase the proportion of women who complete postpartum diabetes screening, and 2) to offer early intervention through group education about prevention of diabetes. Method: Group education was introduced as another test of change under the Model for Improvement framework. Women with GDM received a postpartum lab requisition for an OGTT during their routine pregnancy care. They are then called between 4–6 months post-partum and reminded to complete the OGTT and invited to attend the class. OGTT completion rates were ascertained from our electronic medical record. Results: Of 251 women, 123 (49%) completed the postpartum OGTT. Of these, 92 (75%) attended postpartum group education, while 31 (25%) did not. Based on group education evaluations, women reported learning about: lab results, healthy eating, exercise, and goal setting. Conclusion: Offering the class did not significantly increase completion of the OGTT any further, however evaluation results indicated it increased awareness. Next steps will be to encourage all women to attend, regardless of OGTT completion, so more women can receive this important lifestyle education.
1499-2671 The Canadian Diabetes Association is the registered owner of the name Diabetes Canada. https://doi.org/10.1016/j.jcjd.2017.08.066
Contents lists available at ScienceDirect
Canadian Journal of Diabetes journal homepage: w w w. c a n a d i a n j o u r n a l o f d i a b e t e s . c o m
POSTER PRESENTATION ABSTRACTS 55 Lived Experience as a Distinct Information Source: A Case Study to Improve e-Health Products for People with Diabetes JENNICA NICHOLS, STEPHANIE BOUTETTE*, KRISTA BANASIAK* Toronto, ON Objective: Better integration of patient experiences with clinical expertise has been called for in many areas of health, including clinical practice, research, program delivery, and policy development. We present a case study that demonstrates the value of patient engagement in producing e-health support tools: a series of online educational videos addressing insulin initiation for people living with diabetes (PwD). Methods: An original script was produced by health care professionals (HCPs) and professional script writers, and a prototype video was created. Three in-person focus groups (n=9) were held with PwD who have experience using insulin. Participants were shown the video and asked a series of semi-structured questions to facilitate discussion. Focus group were transcribed and analyzed thematically. Findings: PwD’s involvement highlighted the need to simplify language (use everyday as opposed to clinical terms), change the video’s narrative to provider a warmer and non-stigmatizing tone, add additional content that reflects information participants lacked when they initiated insulin, and increase the use of visuals to clarify areas of confusion and to enhance its relevance and effectiveness for endusers. The script was altered to reflect participants’ perspectives based on their lived experiences. Implications: This case study highlights patients as a distinct stakeholder group with unique knowledge and insights. Their lived experiences shed light on issues that HCPs would not otherwise have considered and led to the development of superior e-health support tools. We advocate for more patient engagement in policy creation, research, and the production of health care supports.
56 Improving Obesity Management Education and Training for Medical Residents DENISE L. CAMPBELL-SCHERER*,†, THEA LUIG, SONJA WICKLUM, DOUG KLEIN, RENA LAFRANCE, MELANIE HEATHERINGTON, SHUAI LI, ALISON CONNORS, KAREN MONIZ, ARYA M. SHARMA† Edmonton, AB Background: The prevention and management of chronic diseases, like diabetes and obesity, require a lifespan and interdisciplinary approach that primary care is well suited to provide. While effective medications and tools exist to support diabetes, residents and practicing physicians often feel ill-prepared to address obesity with patients. There is a need to create high quality, evidencebased training programs for medical residents so they can better support patients. Aim: We developed a comprehensive educational program for residents based on the 5As of Obesity Management™ (Ask, Assess,
Advise, Agree, Assist- 5As), a framework and suite of resources to improve knowledge and confidence in obesity counselling. Methods: The program combines lectures from content experts with experiential learning methods, including a bariatric suit experience, practice with standardized and in-clinic patients, and narrative reflections. We assessed changes using the NEW Attitudes Scale, and reports of self-confidence. Narrative reflections were analyzed thematically. Results: Evaluation of the program shows increases in residents’ understanding of the complexity and chronicity of obesity, and an uptake of the 5As framework and tools by residents to improve confidence and success in their obesity management practice. Experiential learning elements proved crucial in increasing residents’ ability to empathically engage with patients and critically reflect on implications for their practice. Conclusion: Results underscore the need for training programs for family medicine. Furthermore, findings reflect the utility of the 5As to improve residents’ confidence and competency in obesity management counselling across the age continuum.
57 Improving Post-partum Screening for Diabetes with a Healthy Living after Gestational Diabetes Class MARSHA FELDT*, ANNIE HOANG, LEIGH CAPLAN, ILANA HALPERIN† Toronto, ON Background: Women with gestational diabetes mellitus (GDM) are recommended to have an oral glucose tolerance test (OGTT) six weeks to six months postpartum Across Ontario completion rates are as low as 15%. At our institution baseline completion rates were 30%. With the addition of an email reminder, the completion rate increased to 44%, but did not reach the target of 60%. Purpose: 1) To further increase the proportion of women who complete postpartum diabetes screening, and 2) to offer early intervention through group education about prevention of diabetes. Method: Group education was introduced as another test of change under the Model for Improvement framework. Women with GDM received a postpartum lab requisition for an OGTT during their routine pregnancy care. They are then called between 4–6 months post-partum and reminded to complete the OGTT and invited to attend the class. OGTT completion rates were ascertained from our electronic medical record. Results: Of 251 women, 123 (49%) completed the postpartum OGTT. Of these, 92 (75%) attended postpartum group education, while 31 (25%) did not. Based on group education evaluations, women reported learning about: lab results, healthy eating, exercise, and goal setting. Conclusion: Offering the class did not significantly increase completion of the OGTT any further, however evaluation results indicated it increased awareness. Next steps will be to encourage all women to attend, regardless of OGTT completion, so more women can receive this important lifestyle education.
1499-2671 The Canadian Diabetes Association is the registered owner of the name Diabetes Canada. https://doi.org/10.1016/j.jcjd.2017.08.066