Community-Based Care for Persons Living with Type 2 Diabetes

The project consortium was led by Alcorn State University School of Nursing, which sponsored a nurse-managed family clinic that provides primary health care services to people living within 50 miles of the clinic. Field Memorial Community Hospital and the Jefferson Comprehensive Health Center sponsored diabetes clinics for residents of the four-county region. Together, these organizations provided case management, support groups, and continuing education opportunities for health care professionals from a variety of disciplines. All clients served were living with type 2 diabetes.

The project used certified family nurse practitioners placed at each clinic to provide case management services. The project initially used the prepackaged Life Skills for Diabetes Management model to help clients make health-positive behavior changes. Over time, this model had to be adapted so that it would meet the needs of clients, be more easily administrated by the certified family nurse practitioners, and track incoming clinical data.

The project sponsored health education sessions in support group settings throughout the four-county region. As a result, some participants stepped forward and expressed a willingness to facilitate group meetings. The nurse practitioners provided these self-appointed group leaders with guidance as needed and arranged for experts to come in to speak about special topics. For example, the chair of family medicine at the University of Mississippi Medical Center delivered a series of three presentations, one at each clinic site, on the American Diabetes Association’s 2003 standards of care for diabetes management.

The site provided onsite continuing education presentations on type 2 diabetes. In addition, during Diabetes Education Month (November) for each year of the grant, the project sponsored a Diabetes Education Day at the nursing school to educate people with diabetes, their family members, and area health care professionals about effective self-management.

One of the biggest challenges the project faced was the cost associated with providing hemoglobin (Hgb) A1c laboratory tests. Many patients couldn’t afford the test, so the project subcontracted with a local laboratory to perform these tests or used disposable test strips that were purchased in limited amounts. Eventually, the project decided that collecting HgbA1c data from participants on a quarterly basis was cost-prohibitive, so the project adjusted the intervals to suit patients’ ability to pay.

The project also sought to improve cultural competency in the delivery of diabetes-related services in the four-county region. During the 3 years of the project, 63 health professionals participated in continuing education presentations.

All three sites will continue to offer the diabetes clinics, although clients will have to pay for such services or meet eligibility requirements for Medicare or Medicaid reimbursement. The project is now expanding services to an additional local clinic and increasing opportunities for nurses and other health care professionals to learn more about diabetes self-management in rural settings. A new grant will support clinic services.

The project has established partnerships with medical equipment suppliers to provide glucometers and testing supplies to patients at reduced fees. In addition, pharmaceutical companies and local businesses have agreed to provide patients with needed medications. Meanwhile, the support groups continue to meet, and expert presenters continue to share their knowledge with participants on a volunteer basis.