Integrated Care for Rural Diabetic Patients Grant uri icon

abstract

  • Problem Statement: Diabetes mellitus is one of the five leading contributors to mortality rates of Pitt and Greene county residents. Eastern North Carolina exceeds the rest of the state by 28% in the years of life lost (before the age of75) due to premature deaths caused by diabetes. The 2003 diabetes mortality rate for Pitt county was 34.3 and for Greene county was 80.5 compared to 28.3 for the entire state. The rate of diagnosis of diabetes mellitus has increased 50% in Pitt county alone from 1991-2000. Since diabetes and depression tend to co-exist (V on Korff et al., 1998), mental health services are a critical resource for this population. We propose to implement medical family therapy (MedFT) services to improve patient outcomes for individuals who do not maintain good glycemic control (HbAlc at 9 or higher) and for those who are newly diagnosed during the project period. Objectives: Specific objectives of MedFT include enhanced daily functioning for the patient and family, improved coping with chronic and acute symptoms, decreased conflict about treatment, improved communication with healthcare providers, increased acceptance of a health problem that cannot be cured, addressing barriers to treatment compliance and increased ability to make necessary lifestyle changes, such as diet and exercise. The overarching goals of MedFT are to increase the patient and family's sense of effectiveness in managing the illness and other aspects of their lives and to decrease social isolation, which has significant health consequences both in terms of onset of disease and in treatment. Collaboration among providers is an anchor for its success. Method: The MedFT sessions will average six per patient per year, with the initial session lasting up to 90 minutes and subsequent visits under an hour a piece, depending on patient need and availability. Each of the three MedFT students will work onsite for 20 hours per week ~ 12 months, through a paid assistantship contract, totaling 60 hours each week at GCHC delivery sites. The doctoral level MedFT student will treat 104 patients each year and each master's level (second year) student will treat 60 patients each year, for a total of 224 diabetic patients expected to receive Medical Family Therapy each project year. If demand warrants in project years 2 and 3, additional MedFT students will provide care onsite through the internship program, which offers clinical placements of 15 hours each week at no cost to the placement institution (We prefer using the assistantship students because their hours are established by the placement institution, thus giving the patients stability and predictability of therapists.). This is especially important because researchers indicate that interdisciplinary care is extremely effective for diabetics (Beneditti, Flock, Pederson, Ahem, 2004), especially during the initial and subsequent medical appointments. The MedFT appointments for diabetic patients will occur immediately before, after, or integrated with diabetic patient medical appointments, depending on the nature of the appointment and other patient demands. A depression scale will be administered for all patients during the initial Medical Family Therapy session with re-testing done at the conclusion of the therapy sessions, in order to determine any improvements or need for further treatment of depression. MedFT students will assess the social supports available to the patient and refer those without effective support to Lay Health Worker/Promotora staff.

date/time interval

  • August 2006 - July 2009