| Description |
This Doctor of Nursing Practice Scholarly Project addressed provider and healthcare team support for a diabetes self-management support (DSMS) program in a community health clinic system. The clinic is currently participating in a National Institute of Health (NIH) study and anticipates clinic-wide implementation of the Connection-to-Health (CTH) DSMS program following completion of the study. The standard of care recommends that all patients should be involved in a DSMS program. However, not all patients receive DSMS due to barriers in program implementation. The purpose of this project was to develop and present a successful learning session intervention for implementing the CTH-DSMS study specifically targeting team support in the clinic and to evaluate learning session effectiveness. Objectives included: 1. Identifying team perceptions of barriers and willingness to support a patient DSMS study and subsequent program implementation using a "Diabetes-Self Management Perception" questionnaire, 2. Decrease perceived barriers and promote willingness to support the study and its implementation through creation and presentation of a learning session for clinic team and, 3. Dissemination of findings to clinic administration and the NIH research team. A literature review revealed the increasing prevalence of diabetes, associated detriment to quality of life, and rapidly increasing cost to clinics and the nation. However, multiple studies show DSMS programs improve disease knowledge, lower hemoglobin A1C levels, improve quality of life, and decrease cost. Despite these findings, clinics are not implementing DSMS programs. Patients cannot benefit from evidence-based practices they do not receive, thus creating an evidence-to-practice gap. Barriers to use of DSMS include provider lack of time and competing demands, lack of knowledge, provider attitudes toward diabetes management, and patient noncompliance. Literature findings indicated that strengthening the healthcare team, by identifying and removing implementation barriers through the use of learning sessions, leads to improvements in DSMS and delivery. Implementation included development and presentation of a learning session designed to promote interest and willingness to support both the study and DSMS in clinic practice. The session delineated the role and responsibility of each member of the health care team for successful use of the DSMS-CTH program. Evaluation was based on both qualitative and quantitative descriptive data identifying perceived barriers of patient non-compliance, lack of provider time and lack of patient understanding of disease. Following the learning session, providers were more willing to refer patients to the clinic health educator for diabetes education. There was no change in provider perception as to whether a DSMS program could benefit their patients, but they were more willing to support DSMS. Successful implementation of evidence-based programs can depend upon healthcare team ability to support change in busy family practice clinics. Training of all members of the team in coordination with identification of implementation barriers increases team buy-in to evidence-based programs required in an ever changing health care system. |
