Closing the GAP Diabetes Program

State: FL Type: Model Practice Year: 2006

Closing the GAP Diabetes Program targets low income, uninsured minorities in Manatee County and addresses the issue of diabetes prevention and management. The main objective of this project is to provide self-management skills to a minimum of 70 Manatee County minorities diagnosed with diabetes. The main goal is to provide these clients with a system of care through diabetes education and self-management training, which will enhance the quality of their life through prevention or reduction of disease complications. This objective is achieved using three main modes of teaching, including group classes, individual education sessions, and individual nutrition education with a registered dietician. An ongoing objective is to increase the number of diabetics who work to prevent complications by following the basic guidelines of the standard of care including at least twice a year measurement of their HgbA1c, lipid panel, an annual diabetic eye exam, an annual foot exam and an annual flu vaccine. The Manatee County Health Department (MCHD) facilitates this by partnering with the Eye Associates for free diabetic eye exams and free follow-up care for low income, uninsured diabetics as well as partnering with West Coast Podiatry for free diabetic foot exams. MCHD provides free HgbA1c and lipid panels for the low income uninsured participants. Flu clinics are held to ensure that diabetics have an opportunity to receive their annual flu shot. Another main objective is to provide diabetes prevention education to a minimum of 270 individuals in the target areas. This incorporates two other goals of establishing a Community Health Worker initiative and implementing the Body and Soul Program in African American Churches as well as doing outreach educational presentations. Since GAPs last renewal period on July 7, 2006; 56 diabetes self-management classes have been held, with participation of 48 Hispanic and 46 African Americans. A total of 91 dilated eye exams were performed by volunteer doctors from the Eye Associates. During this same period MCHD held one diabetic foot clinic and screened 10 participants. As part of MCHD’s flu initiative all participants not covered under Medicare were offered free flu vaccinations, courtesy of the Manatee County Immunization Coalition. A direct outcome of the education can be seen in the pre vs. post HgbA1c of the participants (9.53% vs. 6.95%).
The Closing the Gap program seeks to facilitate the improvement of health outcomes and the elimination of health disparities in the area of diabetes in Manatee County’s racial and ethnic populations. Current statistics gathered by the Florida Office of Vital Statistics shows the diabetes mortality rate per 100, 000 population (5 year age adjusted rates; 1999-2003) for Manatee County to be 50.7 to 62.7 non white compared to 9.0 to 18.0 white. The population of Manatee County is 264,000 (US Census 2000) of which approximately 19.1% are minority populations. Also according to the needs assessment done in 2004 for Hispanic farm workers, diabetes was listed as one of their top 5 health concerns. It is estimated that there are 18,000+ farm workers in Manatee County. The target areas chosen were those that had both the highest number of African Americans and Hispanics as well as the lowest median incomes. MCHD addressed this issue by applying for and obtaining a Closing the Gap grant from the State of Florida. MCHD's Closing the Gap program is a valuable resource to serve the minority populations who are diabetics or are at risk for diabetes. Without GAP services there are limited community resources for uninsured low income individuals to receive diabetes self-management education, prevention education and screenings. MCHD's Gap program helps to ensure that the low income, minority residents of Manatee County who are disproportionately affected by diabetes will have access to education to empower them to control or prevent diabetes, hypertension or dyslipidemia. For MCHD's objective on diabetes prevention the program chose to train African American and Hispanic Community Health Workers as one of the ways to educate the community in ways to prevent diabetes. Community Health Workers are community members who promote health among groups that have traditionally lacked access to adequate care. They come from the same neighborhoods or backgrounds and share the same cultural experiences as the people they serve, thus bridging the gap between healthcare agencies and local communities. CHWs were trained to give presentations on diabetes prevention using the NDEP’s African American and Hispanic flip charts The Road to Health: One Family’s Journey. To date the program has trained 5 Hispanics to be CHWs and have also trained 9 African American middle and high school students to do the same presentation to community groups. In addition, they will help to market the Body and Soul program in their churches. This program’s focus is to encourage church members to eat 5 to 9 servings of fruits and vegetables for better health and to prevent chronic diseases such as diabetes.
Agency Community RolesClosing the Gap was introduced to Manatee County in February 2000. Partnerships were solidified and programs were developed when the grant was rewarded. Some partners were long standing in other health areas, such as the relationship between Manatee County Rural Health Services and Manatee County Health Department. Other relationships were more informal, but became more formalized with this project. These included relationships with the NAACP and We Care, Inc. In June 2003 Education Consultants Consortium, Inc became a partner. The Manatee County Health Department’s role in this program is to apply for the grant and coordinate its implementation with program staff as well as with partners. Other community partners that participate in our diabetes program are The Bradenton Front Porch Community, Healthy Start Coalition, AHEC, Manatee Opportunity Council and the Manatee School System. Doctors from the Eye Associates and West Coast Podiatry volunteer their services. The program has monthly partners meeting that allow all of the partners the opportunity to update the group on accomplishments and to brainstorm on ways to improve the program. Since 1912, the Manatee County Health Department has played a critical leadership role in providing a wide range of health and wellness services to residents of Manatee County. The MCHD draws on and incorporates the strengths of the community through partnership development. These joint enterprises enhance the programs and skill levels of all involved and have resulted in increased visibility and more direct outreach services for our diabetes.  Costs and ExpendituresThe 2006-2007 budget for the program is $114,596. $75,000 is from the Closing the Gap grant from the Florida Department of Health. $39,596 is in kind from the Manatee County Health Department. The primary program services are provided by a MCHD Senior Community Health Nurse, a MCHD Registered Dietician, a Project Manager and clerical support. MCHD sub-contracts with We Care Manatee, Inc to provide education on diabetes prevention and control to the migrants who are seen at their clinic and with Education Consultants Consortium who help with the Community Health Worker Program and Body and Soul Program.   ImplementationTo achieve the goal of educating a minimum of 100 Manatee County minorities diagnosed with diabetes three different modes of teaching are used including group classes, individual education sessions and individual nutrition consults with a registered dietitian. The first mode consists of nine consecutive group classes on different aspects of diabetes self-management (classes in English and Spanish) at MCHD, MCRHS and community sites in our target area. The second mode is individual education classes for those unable to attend group classes or who need additional help. The third mode is administered by a registered dietitian and consists of individual nutrition education. Each participant will be seen bi-monthly for a one hour nutrition education session for a six month period. To increase the number of diabetics who work to prevent complications by following the basic guidelines for standard of care including at least twice a year measurement of their Hemoglobin A1C, an annual dilated eye exam, an annual foot exam and an annual vaccination against influenza the program has developed a system. There are 8 to 9 free diabetic eye clinics per year for low income uninsured diabetics as well as free follow up exams and treatments as needed. The eye clinics are run by Doctors from the Eye Associates who volunteer their services. We have just implemented a free diabetic foot clinic. Doctors from West Coast Podiatry donate their services. MCHD provides free HgbA1c and lipid panels for our low income, uninsured participants. These labs also provide data to gauge the success of our program. For example for the period 7/05 to 6/06 the average pre-class HgbA1c was 9.53% and the average post-class HgbA1c was 6.95%. To provide diabetes education to a minimum of 270 individuals in our target areas we will utilize 4 modes of teaching. The first objective will be to utilize the Community Health Workers that were trained by GAP to do presentations on diabetes prevention. They will utilize the African American and Hispanic flipcharts on The Road to Health: One Family’s Journey. A follow up presentation on nutrition will also be conducted by these Community Health Workers. The second mode will be implementing the Body and Soul Program in African American Churches. The third mode is outreach with the MCHD van. The fourth mode is healthy lifestyle classes at community sites.
Objective 1: Continuous series of 9 class course on diabetes self-management topics using the Life with Diabetes Curriculum. Performance Measures: Number of participants who attended classes and number who completed the class series. Objective 2: Individual diabetes education sessions. Performance Measures: Achievement of session learning objective. Objective 3: One hour individual nutrition consults bimonthly for 6 months.  Performance Measures: Verbalized understanding of carbohydrate counting, portion sizes, and meal timing.
Sustainability Through the GAP project a heightened community awareness of the health issue of diabetes was achieved using educational and media presentations and participation in community events. In the event of suspension of state awarded funds, the existing community resources identified and data collected will provide a basis for seeking local funding. Partnerships are also being developed that would allow for in-kind support of services and classes.   Lessons learned include: More participants attended the nutrition classes; therefore, it is important to include some nutrition education in every class, When clients are anxious regarding diagnosis, it is difficult for them to concentrate on instruction; therefore, there is a need to repeat material at different times, and Nutrition for diabetes control is a difficult concept to understand; therefore, knowledge needs to be frequently reviewed.