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Diabetes Program Enters Second Year

Partners Home Care's Diabetes Program has celebrated its second anniversary, and preliminary results show success on many different levels.  "Almost fifty percent of all home care patients suffer from diabetes," says Lynn White, RNC, MS, FNP, CDE, Diabetes Management Team Coordinator.  "We needed to develop a specialized program that would optimize the management of this disease within the agency."

One of the first accomplishments of the program was to develop a teaching package for both nurses and patients that provided consistent information on diabetes management. A seventeen-member interdisciplinary team of nurses - including four certified diabetes educators, physical and occupational therapists and a nutritionist - was created. Their responsibility was to improve the expertise of the clinical staff as it related to diabetes and to assist in evaluating and making recommendations. The certified diabetes educators also followed more difficult patients. These components allowed the agency to focus on diabetes education and care. And, with the resources and education offered through the certified diabetes educators, staff competency increased significantly.

"Our staff have improved assessment skills and are more knowledgeable on the newest treatments for diabetes," says White. "Our patient satisfaction surveys indicate that our diabetes patients really value the more focused education and care."

In addition to patient satisfaction, physicians have also expressed their appreciation of the nurses' higher level of understanding of diabetes care. Many have requested that they be added to the mailing list for the Diabetes Support Group. Although initially developed in the South Region Branch of PHC, plans are underway to add additional support groups in other regions of the PHC service area within the next few months.  Blue Cross/Blue Shield, the Massachusetts Department of Public Health and JACHO have all requested home care agencies to become more focused on diabetes education and chronic disease management programs.

Data on the effectiveness of the program is being compiled, and the results will be completed by the spring, but recent outcomes have shown patients to have greater independence with medication and a shorter time on caseload. "As far as home care agencies, we are definitely unique in our approach to diabetes care and clearly ahead of the curve," concludes White.

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