Empowerment Program for Diabetes Patients
Transcript of Empowerment Program for Diabetes Patients
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Empowerment Program for Diabetes Patients
Sarita O Y CHAN
MSN / RN / Fellow (PHKAN) Advanced Practice Nurse / Department of M&G
Princess Margaret Hospital 19 May 2015
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Outline
• Introduction
• Impact of diabetes
• Chronic disease management
• Empowerment program
• Diabetes patient support group activity
• Take home message
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Diabetes is a Huge and Growing Problem…..
IDF Diabetes Atlas 6th Edition revision 2014
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Impact on Public Health Services
• service by an average of at least 2% every year
• 43% of the patients attending the GOPC of HA have either hypertension or diabetes
• Patients who are being treated for diabetes in HA will by 29% from 0.43M to 0.55M between 2012-2017
Hospital Authority Strategic Plan 2012-2017
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Diabetes is a chronic disease Require long term lifestyle modification and medical care
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Complex Interactions in People with Diabetes
Diabetes Mellitus
Hypoglycaemia
Compliance
Quality of life
Coronary Artery
Disease
Cerebral Vascular Disease
Peripheral Vascular Disease
Neuropathy Retinopathy Nephropathy
Cognitive Dysfunction
Depression Multi-Medications
Fall Adherence Physical disability
Mobility Mortality
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Paradigm Shift in Chronic Disease Management
Physician Centered
Care
Patient Centered
Care
Patient-Physician collaboration is fundamental to achieving optimal medical outcomes in chronic disease like DIABETES
Anderson et al, 2002; Von Korff et al, 1997; Funnel, 2004
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Health Care Delivery model
Provider-Centered Approach
• Paternalism
• Doctors knows Best
• Patient do not participate in medical decision- making
• Patients should do what they are told to do
Non-compliance
Patient-Centered Approach
• Autonomy
• Mutual respect
• Unique role & responsibility
• Define problems & set realistic goal
• Develop action plan & commit action
Trust & Rapport
Von Korff, 1997
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Concept of Empowerment
• Funnell (1991) “Patient empowerment is defined as helping patients to discover and develop the inherent capacity to be responsible for one‘s own life”.
• Funnell and Anderson (2004) "The choices that patients make each day as they care for diabetes have a greater impact on their outcomes than those made by health professionals”.
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Patient Empowerment Program in PMH
• Team approach
• Incorporate both group and individual experience
• Practical application to life: exercise, meal planning, and medication adjustment
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Objectives
• Build personal, therapeutic relationship with patients
• Identify & eliminate barriers to successfully managing diabetes
• Enhance patient’s ability to set realistic goal
• Improve ability to be self-motivated
• Develop and implement a individual diabetes management plan
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Self - Care Domains
Healthy Eating
Regular Exercise
Medication
Blood Glucose Monitoring
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Patient Selection
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DM Risk Assessment Report
Recruit patients whose HbA1c > 8.5% to Patient Empowerment Program
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Intervention
First Visit Second Visit Third Visit
Assessment: • Physical & Psychosocial •Dietary Compliance • Drug Compliance • Regular Exercise • Glucose Monitoring Identify Barrier Readiness to Change Set Realistic Goal Formulate Management Plan
Empowerment Diet: •Review meal diary •Carbohydrate counting •Food choice Exercise: •Exercise record Blood Glucose Record Refer other Health Care Professional
Empowerment Diet: •Review meal diary •Tips on eating out •Read food label Exercise: •Type, frequency & intensity Blood Glucose Record
Evaluation after 6 months
Telephone Follow Up
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Tools
SMBG
Meal Diary
Exercise Record
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Five-Step Empowerment Counseling Model
Explore the Problem
Clarify Feelings
Develop a Plan
Commit to Action
Experience and
Evaluation
Funnel, 2004
Goal Setting
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Learning Though Activities
Reading Food Label
Carbohydrate Counting
Food Choice
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Exercise
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Program Evaluation
HbA1c
LDL-Cholesterol
Patient Satisfactory Survey
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Results
Recruited 106 diabetic patients whose HbA1c > 8.5% from Jun-Sep 2014
Patient Demographics
Attend Program 74 (70%)
Not Attend Program 32 (30%)
Male 43 (58%) 15 (47%)
Female 31 (42%) 17 (53%)
Type 1 Diabetes 3 (4%) 2 (6%)
Type 2 Diabetes 71 (96%) 30 (94%)
Mean Age (Years) 63.3 60.3
Mean Duration of Diabetes (Years)
17.1 17.5
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HbA1c Change Over 6 Months Attended the Program (N=74) Not Attend the Program (N=32)
56(76%) patients had improvement and 10(14%) remained unchanged in HbA1c Mean HbA1c dropped from 9.7% to 8.9%
8.40%
8.60%
8.80%
9.00%
9.20%
9.40%
9.60%
9.80%
Pre Post
9.70%
8.90%
Pre Post
0%
20%
40%
60%
80%
100%
Pre Post
9.7 9.8
Pre Post
8(25%) patients had deterioration and 10(31%) remained unchanged in HbA1c Mean HbA1c increased from 9.7% to 9.8%
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LDL Cholesterol Change Over 6 Months
2
2.5
3
Pre Post
2.5 2.4
Pre Post
mmol/L
24(32%) patients had improvement in LDL-C post-empowerment program Mean LDL-C dropped from 2.5mmol/L to 2.4mmol/L
N=74
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Patient Satisfaction Survey
The Overall Satisfactory Rate is 82%
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Further Study
Reason of defaulted Fu:
? Social Background
? Age Related
? Disease Related
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Patient Support Group Activities
PMH Diabetes Club Found in 1994
Year Activities
2008 糖尿病與牙齒之口腔護理
2008 九龍西糖尿同樂日
2010 烹飪班 : 製作桂花糕
2010 糖尿病患者的足部護理
2011 糖尿同路人Fun Fun日
2012 糖尿知心友同樂日
2012 <胰家齊控糖> 齊創健力士世界紀錄
2013 香港糖尿病患者研討會 “關顧糖尿 .愛未來”
2013 健康糖尿同樂日
2014 [腦]友記同樂日
2015 糖尿運動日 –‘Fing’走脂肪,舞動健康
Sharing with Newly Diagnosed DM Patients
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DM Fun Day 2015–‘Fing’走脂肪,舞動健康
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Pre and Post Exercise Blood Glucose Comparison
9
9.2
9.4
9.6
9.8
10
10.2
10.4
Pre-Exercise Post-Exercise
10.3 mmol/L
9.5mmol/L
Pre-Exercise Post-Exercise
mmol/L
47(87%) patients had improvement in post-exercise blood glucose Mean capillary blood glucose dropped from 10.3 to 9.5 mmol/L
N=54
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Patient Satisfaction Survey
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Summary
• Diabetes is a chronic disease with serious short term and long term complications
• Advance in research and treatment technology have provided patients, families and the health care team with many tools
• Comprehensive professional knowledge from multidisciplinary approach would enhance patients on diabetes management
• However, patients involvement and empowerment would make their own choices to control the disease and lead to successfully diabetes management
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Take Home Message
• Listening to patients’ concern, life situation and difficulties
• Building a trust relationship that actively engages the patient
• Use collaborative patient-centered approach
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Acknowledgement
Senior Management:
• Mr. Philip Choi (CGMN / KWC & GMN / PMH & NLTH)
• Dr. Law Chun Bon (COS / M&G / PMH & NLTH)
• Ms. Candic Tang (DOM / M&G / PMH)
Endocrine and Diabetes Team / PMH
• Dr. KW Chan (Team Head / Endocrine & Diabetes Team / PMH)
• Dr. Victor Hung (AC / M&G / PMH)
• Dr. C H Chung (AC / M&G / PMH)
• Dr. Vivian Chow (MO / M&G / PMH)
**And All Staff of Diabetes Care Center / PMH
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References • American Diabetes Association. Management of hyperglycaemia in type 2 diabetes: A patient –centered
approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2012 ; 35 (6): 1364-1379
• Anderson R M. Patient Empowerment and the traditional medical model: A case irreconcilable difference? Diabetes Care 1995 ; 18 (3): 412-415
• Anderson RM, Funnel M M, Butler PM, Fitzgerald JT & Feste CC: Patient Empowerment: Results of a randomized controlled trial . Diabetes Care 1995 18 (7): 943-949
• Centre for Health Protection. Census and Statistics Department: http://www.chp.gov.hk/en/content/9/25/59.html
• Funnell MM, Anderson RM: The Problem With Compliance in Diabetes .JAMA. 2000;284(13):1709
• Funnell MM, Anderson RM, Arnold MS, et al. Empowerment: an idea whose time has come in diabetes education. Diabetes Educ 1991;17: 37-41.
• Funnell MM, Anderson RM: Empowerment and self-management of diabetes. Clinical Diabetes 2004; 22(3): 123-127.)
• Funnell MM, Anderson RM, Arnold MS, Barr PA, Donnelly M, Johnson PD, Taylor-Moon D, While NH: Empowerment: an idea whose time has come in diabetes education. Diabetes Educ 1991; 17:37–41, 1991
• International Diabetes Federation. IDF Diabetes Atlas -6th Edition revision 2014: http://www.idf.org/diabetesatlas
• Jones PS, Meleis AI. Health is empowerment. ANS Adv Nurs Sci 1993; 15:1-14.
• Lau D H. Patient empowerment-a patient-centred approach to improve care. Hong Kong Medical J 2002; 8 (5): 372-374
• Padgett D, Mumford E, Hynes M, Carter R. Meta-analysis of the effects of educational and psychosocial interventions on management of diabetes mellitus Journal of Clinical Epidemiology,. 198841 (10): 1007-1030
• Korff M V et al. Collaborative Management of Chronic disease. Ann Intern Med. 1997: 127(12):1097-1102
• World Health Organization. Health promotion glossary. Geneva. 1988.
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