The ARHI Diabetes Center Project Report Card for the Ohio Diabetes Prevention Control Program ODPCP

1. The ARHI Diabetes Center Project Report Card for the�Ohio Diabetes Prevention & Control Program (ODPCP) Frank L Schwartz, MD,FACE Assoc. Prof. of Endocrinology Director, ARHI Diabetes Center

2. An update of the project so far� Funded by� Ohio Department of Health (ODH) & Appalachian Rural Commission (ARC)

3. Objective of the ODH/ARC Project Develop a comprehensive program to improve diabetes awareness, increase diabetes screenings for earlier diagnosis, improved diabetes care, as well as, develop diabetes prevention projects in Appalachia (SE Ohio)

5. Why Focus on Appalachia?

6. Barriers to Comprehensive Diabetes Care Economic Geographic Cultural Educational Access

7. Objectives of ODH/ARC Project Expand original ARHI/ILGARD Survey to 7 additional counties in SE Ohio which increasing total counties surveyed to nearly � of all Appalachian counties in OH Create a database of diabetes health care providers, diabetes education programs, school personnel, county, & state professionals involved in diabetes care in SE OH

8. Objectives of this Project 3. Survey key community leaders within each county to identify barriers that they see which interfere with diabetes care, compile these observations, & use this information to improve infrastructure of diabetes care in region 4. Host a seminar on �Diabetes Management in 2006� for the FQHC�s & other health care professionals in SE Ohio

9. Objectives of this Project 5. Expand screening in at-risk rural communities for diabetes, hypertension, hyperlipidemia, & ASCVD via our OUCOM Community Outreach Program vans 6. Use this information for creation of the comprehensive program to improve diabetes care in Appalachia with the possible goal of developing a Diabetes Patient Navigator Program

10. Presenters Nancy Schell, BS -Supervisor of OUCOM Community Health Clinical Services Kathy Trace, RN, MSN -Director of OUCOM Community Health Clinical Services Sarah McGrew, BSN -Coordinator of Patient Services @ OUCOM Dept. of Social Medicine

11. Presenters Sara Boyd, MHA -Senior Project Manager, Voinovich Center @ OU Sharon Denham, DSN -Professor of Nursing @ OU Jane Hamel-Lambert, PhD -Director, Interdisciplinary Mental Health Education

12. Diabetes Education Program for Schools Nancy Schell BS, CHES OUCOM Community Service Programs

13. Diabetes Education Program for Schools Develop a survey for children with diabetes, their parents, and school personnel to the determine barriers to care of children with diabetes in schools and identify successful programs Survey has been developed and currently being reviewed by OU IRB committee

14. Diabetes Education Program for Schools Develop a data base regarding diabetes resources and school health resources for Athens County to serve as a model for other southeast Ohio counties Sara McGrew, RN is developing database School information will be added to this

15. Diabetes Education Program for Schools Develop a report summarizing what has been learned about diabetes and school health from the five districts in Athens County. Also collect and summarize procedures and policies in the schools regarding diabetes Data is being collected through AmeriCorps/ComCorps members & school nurses Survey will be administered via AHRI

16. Diabetes Education Program for Schools Develop a FAQ fact sheet and reference material for school staff -Working with Health and Human Service 345 School Health undergraduate class to develop material under the guidance of Ann Rathbun -Area school and health professionals are reviewing the material

17. Diabetes Education Program for Schools Provide conferences for school based individuals dealing with diabetic children Hands-on insulin pump training for Athens County School staff on March 28 in Grosvenor Hall 017/058 from 12:30 to 3:30 coordinated by Nancy Schell -AHEC is applying for CNE�s for the program Southeast Ohio School Nurse conference on diabetes coordinated by Sharon Denham on April 7, 2006

18. Diabetes Education Program for Schools Questions, Concerns or Contributions? Thank you! Nancy Schell BS, CHES 064 Grosvenor Hall OUCOM Community Service Programs 740-593-2293 schelln@ohio.edu

19. Community Outreach & Diabetes Screenings Kathy Trace, RN, MSN; Director of OUCOM Community Health Clinical Services

20. OHIO DIABETES PREVENTION & CONTROL PROGRAM Since January 01 2006 we have held 11 clinics. Four of those clinics have been held at Wal-Mart in Athens, Oh. We screen only for blood pressure and glucose at those clinics. 131 people have been screened so far at the store and we have 5 more clinics scheduled there through May 2006. Our other clinics have been held in Pike, Vinton, Perry, and Athens counties where we screened 195 people for cholesterol, glucose, and B/P. Our clinics have screened a total of 326 people this year. The Healthy Adult Project (HAP) has 23 more clinics scheduled through June 2006. Clinics are scheduled in each of the designated counties except Ross county, however we have contacted someone to schedule screenings and am waiting on a reply.

21. Melanie Moynan-Smith CNP, CDE and Community Service Programs has been providing DM education Goal: people with DM will better understand diabetes and the need and appreciation of self-management, for improved control and prevention of complications.

22. Community Outreach DM Education Utilize displays, power point presentations, visuals of food for the Plate Method, easy read hand-outs, simple explanations, blood glucose models, and tri-folds� Provide DM patient education bags

23. When: Once a week Sent out 70 letters and have been filling up our schedules. Will have AmeriCorps member follow up by phone.

24. Where: (6) Wal Mart-3 foot screens 62 DM education OUCOM-Feb.2 & 24-16 DM education Perry Co. HD-28 DM education TOTAL: 109 DM direct patient education

25. Pending: April 11-Meigs Seniors May 1-Pike Co. Diabetes Coalition May 9-Glouster library May 16-Coolville library May 18-Perry Co. May 25-Belpre Seniors June 2-Carbondale

26. Goals to present in all counties at least twice before June 30, 2006. To provide 20 presentations Working to reach Ross County. Did meet with Community Outreach Director at Adena Health Systems. CSP is working out specifics. Reach as many of the 70 sites as possible

27. Wal-Mart Project Working with the pharmacist and pharmacy intern Why To reach multiple people/good access point for screenings and education Future: The pharmacist would like to eventually submit a proposal for employee wellness

28. Also to begin laying the foundation for an indigent program for patients that can not buy strips and incentives for people that are compliant with meds etc. Collect surveys regarding pre diabetes and diabetes Outreach: CSP provides screenings and education also collaborates with dietician and diabetic education for food tour and education

29. Creation of Community Diabetes Resources Database Sarah McGrew, BSN; Coordinator of Patient Services @ OUCOM Dept. of Social Medicine

30. Seven County Prevalence Survey Sara Boyd, MHA Senior Project Manager Voinovich Center @ OU

31. GVC Health Needs Assessment Study Examination of the status of chronic disease and risk factors for chronic disease in 7 counties. Specific emphasis on diabetes and risk factors for diabetes

32. Two Study Branches Compilation and analysis of existing data Household telephone survey measuring chronic conditions and risk factors for these in nine counties

33. Existing Data Published State and National Data Death Rates E.g. Vital Statistics, CDC Prevalence and Incidence E.g. BRFSS, NHIS Risk Factors E.g. BRFSS, Ohio Family Health Survey

34. Existing Data Unpublished Databases Available Local Data and Information Diabetes Screening Data School Data

35. Household Survey Survey designed to be comparable to 2004 BRFSS 2,271 surveys collected in 7 counties in January, 2006 Jackson, Meigs, Morgan, Perry, Ross, Scioto, Washington

36. Preliminary Survey Findings: Diabetes Survey findings compared to 2004 BRFSS- Ohio and USA

37. General Health Assessment How do you feel you general health status is?

39. Diabetes Query Have you been told by a doctor other health care professional that you have problems with sugar or have diabetes or blood sugar?

40. It goes up and up and up CDC website is great source of information on this topic Survey is in home survey conducted with approximately 7,000 individuals. 5,000 do the health component (examination).It goes up and up and up CDC website is great source of information on this topic Survey is in home survey conducted with approximately 7,000 individuals. 5,000 do the health component (examination).

41. �Not to worry-it�s just a little sugar�

42. The diabetes rate obtained in the ARHI 2006 survey is higher than the Ohio BRFSS 2004 rate The confidence interval for this result is outside that of the Ohio BRFSS results

43. How old where you when you were first told that you had problems with high blood sugar, or that you have diabetes or sugar?

45. About how many times in the past 12 months have you seen a doctor, nurse or other health care professional for our diabetes, high blood sugar, or sugar?

47. Body Mass Index How tall are you without shoes? How much do you weigh without shoes?

49. My weight and height? 6 feet 2 inches and 175 lbs

50. A Community Kit for Diabetes: A Toolkit for Appalachia Sharon A. Denham, DSN, RN Primary Investigator

51. PROJECT AIMS: Identify gaps in diabetes services and education Consider culture and health literacy knowledge Develop culturally appropriate prevention and educational information (consumers, lay visitors, health professionals)

52. MULTI-PHASE PROJECT Interdisciplinary and inter-professional involvement Project theme: Diabetes: A Family Disease Concerns: Cultural sensitivity, health literacy, and community-focused Narrative discourse, story-telling, qualitative and quantitative research, photographs, filming, etc.

53. Phase I (Fall 2005 - Summer 2006) Advisory Board (met February 17, 2006) Hire Graduate Assistants Create databases Institutional Review Board (approved March 1, 2006) Environmental Survey (services and practices of health providers)

54. Phase I (Fall 2005 - Summer 2006) Diabetes Educator Surveys (education and service practices) Collect Educational Materials from the Appalachian region (assess for cultural & health literacy) Diabetes Coalition Surveys (community ideas about diabetes care) Transcribe diabetes radio programs (Whitesburg, KY)

55. Phase I (Fall 2005 - Summer 2006) Story-telling workshop (April 13, 2006) Photography (Living with Diabetes) Begin work on website Prototype Brochure (Diabetes a Family Disease) Family interviews (Living with Diabetes)

56. Phase I (Fall 2005 - Summer 2006) Test educational materials for readability Data analysis (spring/summer) Identify existing epidemiological data from Appalachia about diabetes and risk factors Collect information about successful community diabetes education programs Identify potential funding sources

57. Phase II (Fall 2006- Summer 2007) Advisory Board (Fall 2006) Complete data analysis Plan community campaign Develop educational curricula Develop media prototypes Begin testing materials Disseminate study findings

58. Update on Development of Patient Navigator Program Jane Hamel-Lambert, PhD Director, Interdisciplinary Mental Health Education

59. Questions?

60. Special thanks to the ODH & ARC for funding of these projects!!