The goal of this study was to look at health care providers perspectives on what the nutritional barriers patients with diabetes faced and compare that with the patient\u27s perspectives. We also assessed patients knowledge on certain foods and if they have carbohydrates. We used this information to create a Notecard that could be given to patients.https://scholarworks.uvm.edu/fmclerk/1713/thumbnail.jp

Levine, Emma C

Marquis, Taylor D

English

ScholarWorks @ UVM

University of Vermont ScholarWorks @ UVM Family Medicine Clerkship Student Projects Family Medicine Community 2021 Nutritional Barriers for Patients with Diabetes: A quality improvement project Emma C. Levine Taylor D. Marquis Follow this and additional works at: https://scholarworks.uvm.edu/fmclerk  Part of the Medical Education Commons, and the Primary Care Commons Recommended Citation Levine, Emma C. and Marquis, Taylor D., "Nutritional Barriers for Patients with Diabetes: A quality improvement project" (2021). Family Medicine Clerkship Student Projects. 631. https://scholarworks.uvm.edu/fmclerk/631 This Book is brought to you for free and open access by the Family Medicine Community at ScholarWorks @ UVM. It has been accepted for inclusion in Family Medicine Clerkship Student Projects by an authorized administrator of ScholarWorks @ UVM. For more information, please contact donna.omalley@uvm.edu. NUTRITIONAL BARRIERS FOR PATIENTS WITH DIABETES:A QUALITY IMPROVEMENT PROJECTHinesburg Family Medicine Emma Levine and Taylor Marquis Dec 2020 – Jan 2021Project Mentor: Michelle CangianoProblem Identification• 8% of Vermont adults have diabetes• 6% of adults in Chittenden County• Among the most common chronic diseases in the state• Prevalence increases with advancing age & decreases with socioeconomic status• Prevalence is similar between white, non-Hispanic adults (8%) and adults of a racial or ethnic minority (9%)• 46% of adults with diabetes said they had attended diabetes self-management education.• Below the Healthy Vermonters 2020 target of 60%.Public Health Cost• Compared to those without diabetes, VT adults with diabetes are...• More than 2x more likely to be diagnosed with obesity, arthritis, cancer, and COPD• More than 4x more likely to be diagnosed with cardiovascular disease• More than 5x more likely to be diagnosed with chronic kidney disease• Diabetes-related mortality rate is on the rise in VT• 123.2 in 2019, up from 99.9 in 2009 (per 100,000)• Total direct diabetes-related medical expenses were estimated at $409 million in Vermont in 2012• Indirect costs due to lost productivity totaled $134 million• 1 in 7 healthcare dollars is spent treating diabetes and its complications, nationwide.Provider's Prospective on Nutritional BarriersFor Patients with Diabetes• We asked the providers at Hinesburg Family medicine the following questions:1. Do patients with diabetes have a good understanding of nutrition in a way that it impacts their diabetes?• “No and many patients aren’t willing to accept nutrition referrals”• “No”• “Depends on the patient. The vast majority do not.”• "Some do, particularly patients who were diagnosed a long time ago." 2. If you had to guess, how many of your patients have met with a nutritionist multiple times?• “10%”• “10% - a lot of people are too confident in their knowledge. The nutritionists also don’t meet people where they are at.”• “Very small percentage – some decline a referral right away, some make an appointment and don’t attend, some go to one appointment, etc.”• "Not very many."3. What are the biggest barriers to eating the foods that may help decrease their A1c?• “Patient’s like they way they are eating and don’t want to make the change.”• “Knowledge”• “Large portion is financial they can’t afford the fresh fruits and vegetables. Knowledge is the second biggest barrier.”• "Convenience. Habit. Lifestyle."Intervention + Methodology• We surveyed 10 patients on the following:• Have you met with a nutritionist? A diabetes nurse educator? If so, how many times?• A list of various foods, and whether patients believed each impacted blood glucose (BG)• Are there barriers that prevent you from eating the foods that help control your blood glucose/sugar? If so, what are those barriers?• Providers wrote down patient's last A1c on survey• Meeting with Rachel Kring, Executive Director of the Hinesburg Community Resource Center• Provided Center with Notecard that includes lower-carb alternatives to favorite foods, which we identifiedSurvey Results• 70% of the patients had Type II diabetes• 60% had seen a nutritionist• 40% had seen a diabetes nurse educator• 60% correctly identified that carbohydratesare the most important thing to look at on a nutrition lab when weighing impact on BG• Only 30% of patients thought there was a nutritional barrier to controlling their BG• (Of those 0% said there was a financial OR education barrier)• 40% of patients had an A1c ≥7• Do these foods impact BG?o Pasta (yes) - 90% answered correctlyo Meat (no) - 90% answered correctlyo Bananas (yes) - 50% answered correctlyo Rice (yes) - 80% answered correctlyo Celery (no) - 100% answered correctlyo Potatoes (yes) - 90% answered correctlyo Cheese (no) - 60% answered correctlyo Regular soda (yes) - 100% answered correctlyo Diet soda (no) - 40% answered correctly• On average, patients who have met with a nutritionist answered 80% correctly, while those who have not met with a nutritionist answered 67% correctly.• On average, patients with an A1c ≥7 answered 83% correctly, while those with an A1c <7 answered 69% correctly.Response: Community Engagement• Hinesburg Community Resource Center, (aka Hinesburg Food Shelf):• Will add educational information to their newsletters about "carb smart" options• Further measures may be implemented when community members can shop, again• Providing alternatives to high carb foods at the HCRC• Notecard / educational handout• To be provided to patients and/ or customers at HCRCEvaluation of Effectiveness and Limitations• Limitations• Small sample size (10 patients completed the survey)• Association between A1c and nutritional knowledge may be impacted by confounding variables (medication management, exercise, time since diagnosis, etc.)• It was unexpected that patients with higher A1c's scored higher (more correct answers) on the food quiz• Have these patients received more diabetes and nutrition education because their diabetes is not as well-controlled?• Other things to consider:• A1c aside, does diabetes education result in clinically significant outcomes?• Fewer amputations? Longer life expectancy?• What is the role of language when encouraging lower carb choices for people with diabetes?• "Low-sugar" vs "low-carb"• Bananas as an example of a high carb (~30g) fresh fruitFuture Interventions / Projects• Increasing sample size, power• Discuss project with future students, who can survey more patients• Use results to draw stronger conclusions and associations• Hinesburg Family Medicine• Working to improve patient diabetes education with data-driven strategies• Working to bridge knowledge gaps between patients and providers• Hinesburg Community Resource Center• Offering “Carb Smart Options” for customers• Continuing to offer nutrition educational notecardsReferences1. HS_1305_Data_Pages_081816.pdf. Accessed January 14, 2021. https://www.healthvermont.gov/sites/default/files/documents/pdf/HS_1305_Data_Pages_081816.pdf2. vermont.pdf. Accessed January 14, 2021. http://main.diabetes.org/dorg/PDFs/Advocacy/burden-of-diabetes/vermont.pdf3. The Cost of Diabetes | ADA. Accessed January 14, 2021. https://www.diabetes.org/resources/statistics/cost-diabetes4. SnoozeAlpha. (2019). Palmini Nutrition Label. Retried January 6 2021. https://commons.wikimedia.org/wiki/File:Palmini_Nutrition_Label.jpgInterview ConsentThank you for agreeing to be interviewed. This project is a requirement for the Family Medicine clerkship. It will be stored on the Dana Library ScholarWorkswebsite. Your name will be attached to your interview and you may be cited directly or indirectly in subsequent unpublished or published work. The interviewer affirms that he/she has explained the nature and purpose of this project. The interviewee affirms that he/she has consented to this interview.

Nutritional Barriers for Patients with Diabetes: A quality improvement project

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Nutritional Barriers for Patients with Diabetes: A quality improvement project

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