Association of Health Literacy With Poor Diabetes Outcomes
The purpose of this session is to review the relationship between health literacy and health outcomes in patients with diabetes and discover what the potential interventions are to improve such outcomes.
Barriers for Achieving Glycemic Targets
Improved glycemic control in people with diabetes delays the onset and progression of severe microvascular complications of diabetes. Despite advances in pharmacotherapy and diabetes treatment devices and the emphasis placed on treatment adherence over the last decade, National Health and Nutrition Examination Survey (NHANES) data showed 45% of patients with diabetes did not achieve glycemic targets of <7%. Although some patients with diabetes may be undertreated (e.g., inappropriate treatment regimens, psychosocial issues that require adjustment in therapeutic targets), one reason for poor glycemic control is patients’ difficulty in following treatment prescriptions and recommendations for diabetes self-care. This collaborative addresses barriers for achieving glycemic targets and approaches and interventions that assist patients with managing diabetes.
Culturally Competent Care Learning Collaborative
To assist Health Centers in the adoption of the CLAS Standards and to equip providers with the competencies that will enable them to better treat the increasingly diverse population, NCHPH will be offering a 4-part learning collaborative. The interactive sessions will cover the fundamentals of cultural competency, language access, and building community partnerships through a combination of case studies and didactic learning.
Developing the Role of Community Health Workers and other Support Staff in Diabetes Prevention, Treatment, and Follow-Up
Community Health Workers (CHW) have been shown to be especially successful reaching hard to access populations such as agricultural workers and their families as well as the homeless and residents of public housing. In this session, participants and faculty explored the role of CHWs in the diabetes care team. Case studies and real-world discussion provided examples of both effective and ineffective integration of CHWs into the clinical care team. Participants discussed the scope of practice and most effective roles for CHWs within the diabetes care team as well as the role of clinical champions and leaders in effectively mobilizing the skills of CHWs and other team members.
Diabetes and Eye Exams in Primary Care
The American Academy of Ophthalmology recommends that anyone with diabetes should receive a retinal exam every year. Early detection can reduce the risk of severe vision loss by 90% and significantly reduce long-term healthcare costs. Unfortunately, fewer than 50% of patients with diabetes get a diabetic eye screening annually. During this session NCHPH explored ways to prevent and limit the extent of DR in public housing primary care settings.
Diabetes Continuum of Care: Using Behavioral Health and Substance Use Disorder Integration to Address Older Adults with Cognitive Impairments and Diabetes
This is the second webinar in the continuation of our Diabetes in Special & Vulnerable Populations: A National Learning Series. Diabetes affects more than 30 million people in the United States. Multi-tiered efforts to prevent, treat and manage diabetes are critical in reducing the burden of diabetes, particularly for medically underserved racial and ethnic minority populations. In addition to higher prevalence, ethnic and racial minority patients with diabetes have higher mortality and higher rates of diabetic complications.
Diabetes Continuum of Care: Impact of Health Literacy on Patients’ Diabetes Management and Self-Care
NCHPH partnered with members of the Special and Vulnerable Population Diabetes Task Force to provide a Learning Collaborative (LC) addressing critical issues to improve diabetes control in health centers nationally. NCHPH provided expertise in public housing primary care and provided a more in-depth exploration of strategies, tools, and resources needed to create positive change in diabetes control among health center patients. The LC sessions also provided in-depth knowledge and skills in order to address the unique needs of people experiencing homelessness, residents of public housing, migratory and seasonal agricultural workers, school-aged children, older adults, Asian Americans, Native Hawaiians and other Pacific Islanders, LGBT people, and other vulnerable populations.
Diabetes: Culturally and Linguistically Appropriate Services
Minority groups are affected by diabetes at significantly greater rates when compared to non-Hispanic white Americans for reasons that are multidimensional. Diabetes educators need be mindful of the cultural traditions and customs among all cultural and ethnic groups and to recognize socio-economic challenges that may exist. When diabetes education programs are delivered using culturally appropriate methods in diverse populations, they can result in improved patient health behavior, knowledge, health status, and self-efficacy. During this session, NCHPH explored strategies to provide culturally and linguistically appropriate services to diabetic patients.
Empowerment and Self-Management of Diabetes – The Pharmacist and Diabetes Care Learning Collaborative
The goal of this learning collaborative is to discuss with pharmacists how to integrate diabetes education and management into practice, so patients can make the best use of their medications and achieve the desired therapeutic outcomes.
Health in Public Housing Advisory Group Call October 2019
In this call, NCHPH and the Advisory Group discussed HRSA priorities, increasing access to care and other important topics for Public Housing Primary Care.
Identifying and Treating People with Prediabetes
Prediabetes is a serious health condition where blood sugar levels are higher than normal, but not high enough yet to be diagnosed as type 2 diabetes. According to the Center for Disease Control and Prevention (CDC), approximately 84 million American adults—more than 1 out of 3—have prediabetes. Of those with prediabetes, 90% don’t know they have it. In this session participants discussed statistics of prediabetes and conversion rates from prediabetes to diabetes, identify patients at risk for diabetes, resources to screen and test for prediabetes and the use of EHRs to identify people with prediabetes.
Implementing Smoking Cessation Programs in Health Center Settings 2020
This Learning Collaborative aimed to identify barriers to implementation of and strategies to establish smoking cessation programs in primary care settings through a series of four sessions: a didactic webinar, covering the behavioral aspects of cessation counseling, the FDA approved medications for cessation and some basic motivational interviewing techniques, and a subsequent three learning collaborative sessions, detailing how to conduct each counseling session whether they are individual or group. NCHPH provided a written protocol booklet to be used as a guide during actual sessions.
Implementing Smoking Cessation Programs in Health Center Settings 2021
This learning collaborative discussed group and individual strategies and best practices to help health center patients to quit smoking. Topics such as stress management, relapse, and quitting strategies for people with substance use disorders and behavioral health issues were addressed.
Improving Public Housing Health Center Service Delivery Through Cultural Competence and Health Literacy Learning Collaborative
Research on health literacy from the Institute of Medicine (IOM) states that over 90 million U.S. adults do not have needed literary skills to access and navigate U.S. health systems (Rudd & Anderson, 2006). As a result, patients disengage from the health system until they have no choice, thus ignoring their care and seeking alternative remedies or ways of coping.
Improving Cultural Competency for Behavioral Health Professionals Serving Residents of Public Housing
Behavioral health services form a crucial part in providing quality health care services, particularly to populations of diverse cultural backgrounds living in public housing. Behavioral health services that adhere to cultural competency have shown to engender more positive health outcomes such as better adherence to medications and treatments, building trust between healthcare providers and their patients, and has contributed to the creation of more sustainable ways of providing care to patients overall.
To assist Public Housing Primary Care (PHPC) Health Centers grantees in increasing their capacity to provide quality behavioral health services to patients from diverse cultural backgrounds, NCHPH will be conducting a 5-part learning collaborative. This learning collaborative will focus in helping behavioral health professionals increase cultural and linguistic competency.
Management, Education and Support, Nutrition, Physical Activity, Smoking Cessation, and Psychosocial Issues
Residents of public housing are particularly at risk of developing diabetes and diabetes-related complications due to the many social factors that impact their health. A recent HUD publication indicates that HUD-assisted adults have the highest prevalence of diabetes diagnosis, with 17.6% reporting ever having been told they had diabetes. During this session NCHPH explored ways to manage diabetes through programs that address education and support, nutrition, physical activity, smoking cessation, and psychosocial issues.
Microvascular Complications and Foot Care
The importance of protecting the body from hyperglycemia cannot be overstated; the direct and indirect effects on the human vascular tree are the major source of morbidity and mortality in both type 1 and type 2 diabetes. Diabetes complications are divided into microvascular (due to damage to small blood vessels) and macrovascular (due to damage to larger blood vessels). In this session, we discuss diabetes barriers to care and best practices to address microvascular complications among diabetic patients.
Nonadherence and Behavior Change: How Are You Helping your Patients?
Research studies indicate that diabetes affects around 9% of the U.S. population, and it is a leading cause of heart disease, stroke, kidney failure, lower limb amputations, and blindness among U.S. adults. A recent CDC publication estimated direct medical costs attributable to this disease were $116 billion, and the number of patients with diabetes will more than double by 2050. Thus, diabetes is a highly prevalent disease that is important for both public health and public policy reasons.
Patient Engagement Strategies for the Collaborative Care Team: Group-Visits
Pre-visit planning includes scheduling patients for future appointments at the conclusion of each visit, arranging for pre-visit lab testing, gathering the necessary information for upcoming visits and spending a few minutes to huddle and handoff patients. This can be particularly challenging for vulnerable populations such as agricultural workers, the homeless and residents of public housing. This session will explored strategies and tools for diabetes pre-visit planning that can be successful for vulnerable populations. Participants and faculty brought case studies and real life scenarios to the discussion in order to facilitate problem-solving conversations about how to address challenging scenarios. The session also addressed how to best incorporate pre-visit planning into a team-based setting that includes CHWs.
Patient Intervention Strategies for the Collaborative Care Team: Pre-Visit Planning
Group visits have been shown to be an effective strategy to address diabetes management in a number of health settings. During group visits, participants have a greater opportunity to ask questions, run the discussion and provide one another with peer support. CHWs can be particularly effective in setting up and helping run group visits at health centers. During this session, participants discussed different models for group visit and explored best practices used in health centers. The session relied on case studies and real-life scenarios to discuss challenges and successes using group visits with vulnerable populations.
Phases of Diabetes Care
Diabetes care can be organized into three phases: pre-visit, intra-visit, and post-visit. Opportunities exist during each phase to introduce practice changes that can help engage and support patients in their diabetes care and management. Health care teams can optimize diabetes encounters by taking a planned, continuous improvement approach to visits, which includes pre-visit preparation (by both patients and practices), intra-visit coordination (among practice team members), and post-visit follow-up (among the practice team and with patients).
Social Determinants of Health Screening Tools for Public Housing Residents
In this learning collaborative, NCHPH guided participants through the practical aspects of identifying and implementing an SDOH screening process at their health center. The series went beyond the basics by covering issues such as:
• building trust while assessing social risks;
• integrating data to improve patient engagement;
• evaluating impact on patient outcomes and health center procedures;
• understanding the variability and utilization of specific screening tools that are dependent on the context of health issues;
• reimbursement and funding strategies to pay for SDOH screening and referrals.
Each session included insight and promising practices from an expert in the health care field.
Strategies for Diabetes Awareness, Prevention and Control: Focusing on Prediabetes
Increasing awareness and risk stratification of individuals with prediabetes may help physicians understand potential interventions that my help decrease the percentage of patients in their communities in whom diabetes develops. During this session NCHPH discussed strategies for diabetes awareness, prevention and control with a focus on prediabetes.
Supporting Implementation of Smoking Cessation Programs in Public Housing Primary Care Settings 2020
This Learning Collaborative aimed to identify barriers to implementation of and strategies to establish smoking cessation programs in primary care settings through a series of four sessions: a didactic webinar, covering the behavioral aspects of cessation counseling, the FDA approved medications for cessation and some basic motivational interviewing techniques, and a subsequent three learning collaborative sessions, detailing how to conduct each counseling session whether they are individual or group. NCHPH provided a written protocol booklet to be used as a guide during actual sessions.
Supporting Implementation of Smoking Cessation Programs in Public Housing Primary Care Settings 2021
This NCHPH Learning Collaborative discussed ways to debunk the myth that smoking is an effective way to deal with stress, enumerated various proven stress management techniques, in depth, that can be used to maintain a quit, and discussed how to successfully teach these techniques to patients.
The Impact of Nutrition on Diabetes Prevention and Diabetes Management
This presentation will cover best practices for nutrition care, top eating patterns for people with diabetes, and ADA resources that can be used in practice.
The Use of CHWs in the Prevention of Teen Pregnancy and HPV Vaccine Promotion in Hispanic Adolescent Girls Living in Public Housing
Teen pregnancy and HPV vaccination continue to be a pressing issue for low-income populations. Human papillomavirus (HPV) is a common sexually transmitted infection which is the cause of several cancers, including cervical cancer, and genital warts. Although cervical cancer can be prevented through screening, this cancer persists in the US. More recently, HPV vaccination has the potential to decrease the burden of HPV-related disease among young HPV-unexposed adolescents. This learning collaborative will explore the role of community health workers in teen pregnancy prevention and HPV vaccine promotion in teenage girls living in public housing.
Using Information Systems and Technology to Enhance Diabetes Care
Patients and physicians require new tools to manage the growing burden of chronic illness. For providers responsible for the care of diabetic patients, developments in information management, real-time health education and feedback, and new approaches to self-monitoring and insulin delivery hold great promise to improve the quality and safety of diabetes care. In this call, NCHPH and Health Centers participants shared some of the major developments in the field, and the ways these technologies can be integrated into a typical practice.