diabetes study bulletin - mcmaster university · cardiac rehabilitation, heart failure service,...

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DIABETES STUDY BULLETIN THIRD EDITION | OCTOBER 2015 When McMaster University approached Kawartha Lakes as one of four potential sites for its diabetes intervention study, it was an opportunity to delve into the value of the diabetes care program for older adults with multiple health problems that was already in place. A chronic disease program - known as the Health First program - is based at Ross Memorial Hospital in Lindsay, Ontario and includes diabetes education, cardiac rehabilitation, heart failure service, cardio pulmonary rehabilitation and complex nutrition program. “We have team huddles every week where we share, and refer, patients, between programs,” said Jodi Dunn, program director, Continuing Care Program, Rehabilitation Therapies and Seniors Services, and Health First. “If we have a diabetes patient who is also in cardiac rehab, we try and align their appointments so that, when they come in, it is sort of one-stop shopping.” As well, the diabetes team visits the heart failure clinic and dialysis unit. It also has an outreach program which includes holding monthly clinics in different communities so patients with significant socio-economic challenges don’t need to travel, Dunn said. The Health First program features a shared documentation tool – a shared, paper- based chart with each patient’s history. “If a patient with diabetes is attending cardiac rehab or heart failure services, staff can see that information,” said Dunn. In many ways, initiatives already underway at the Kawartha Lakes site build on the intervention study that the Aging, Welcome all to the third edition of our Diabetes bulletin! We continue to be delighted with everyone’s involvement in this research study and value the relationships that have been established through this project. Final visits are underway in all four sites and we are right on track for completing the study by the end of 2015! Congratulations to all for your hard work. We truly could not do this without your support and continued hard work. Warm regards, Jenny Ploeg and Maureen Markle-Reid Co-Scientific Directors, Aging, Community and Health Research Unit, McMaster University Community and Health Research Unit (ACHRU) has underway. The intervention offers in-home visits by a registered nurse and registered dietitian along with monthly programs at the Kawartha Lakes Parks and Recreation centre where exercise, diabetes education and healthy eating are discussed. “With our diabetes program, we have always emphasized the value of exercise,” Dunn said. She added that past discussions have also included the importance of seeing patients with complex health problems in their own homes “because you can see what’s in their cupboard, sit down at their kitchen table, share conversation and easily review medication because everything is there.” A new initiative will get underway this fall when a member of the diabetes team (a dietitian, nurse or both) links with the GAIN (Geriatric Assessment and Intervention Network) team to visit complex geriatric patients in the community in their homes. “We have been delighted to be part of the intervention project with McMaster,” said Dunn, adding that results may provide good evidence which support the model which has been underway in Kawartha Lakes for some time. FOCUS ON KAWARTHA LAKES… Ross Memorial Hospital Jodi Dunn Program Director, Ross Memorial Hospital With our diabetes program, we have always emphasized the value of exercise.

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Page 1: DIABETES STUDY BULLETIN - McMaster University · cardiac rehabilitation, heart failure service, cardio pulmonary rehabilitation and complex nutrition program. “We have team huddles

DIABETES STUDY BULLETINT H I R D E D I T I O N | OCTOBER 2015

When McMaster University approached Kawartha Lakes as one of four potential sites for its diabetes intervention study, it was an opportunity to delve into the value of the diabetes care program for older adults with multiple health problems that was already in place.A chronic disease program - known as the Health First program - is based at Ross Memorial Hospital in Lindsay, Ontario and includes diabetes education, cardiac rehabilitation, heart failure service, cardio pulmonary rehabilitation and complex nutrition program.“We have team huddles every week where we share, and refer, patients, between programs,” said Jodi Dunn, program director, Continuing Care Program, Rehabilitation Therapies and Seniors Services, and Health First. “If we have a diabetes patient who is also in cardiac rehab, we try and align their appointments so that, when they come in, it is sort of one-stop shopping.”As well, the diabetes team visits the heart failure clinic and dialysis unit. It also has an outreach program which includes holding monthly clinics in different communities so patients with significant socio-economic challenges don’t need to travel, Dunn said.The Health First program features a shared documentation tool – a shared, paper-based chart with each patient’s history. “If a patient with diabetes is attending cardiac rehab or heart failure services, staff can see that information,” said Dunn.In many ways, initiatives already underway at the Kawartha Lakes site build on the intervention study that the Aging,

Welcome all to the third edition of our Diabetes bulletin!

We continue to be delighted with everyone’s involvement in this research study and value the relationships that have been established through this project. Final visits are underway in all four sites and we are right on track for completing the study by the end of 2015! Congratulations to all for your hard work. We truly could not do this without your support and continued hard work.

Warm regards,

Jenny Ploeg and Maureen Markle-Reid

Co-Scientific Directors, Aging, Community and Health Research Unit, McMaster University

Community and Health Research Unit (ACHRU) has underway. The intervention offers in-home visits by a registered nurse and registered dietitian along with monthly programs at the Kawartha Lakes

Parks and Recreation centre where exercise, diabetes education and healthy eating are discussed. “With our diabetes program, we have always emphasized the value of exercise,” Dunn said.She added that past discussions have also included the importance of seeing patients with complex health problems in their own homes “because you can see what’s in their cupboard, sit down at their kitchen table, share conversation and easily review medication because everything is there.”A new initiative will

get underway this fall when a member of the diabetes team (a dietitian, nurse or both) links with the GAIN (Geriatric Assessment and Intervention Network) team to visit complex geriatric patients in the community in their homes.“We have been delighted to be part of the intervention project with McMaster,” said Dunn, adding that results may provide good evidence which support the model which has been underway in Kawartha Lakes for some time.

FOCUS ON KAWARTHA LAKES…

Ross Memorial HospitalJodi Dunn Program Director, Ross Memorial Hospital

“With our diabetes program, we have always emphasized the value of exercise.

Page 2: DIABETES STUDY BULLETIN - McMaster University · cardiac rehabilitation, heart failure service, cardio pulmonary rehabilitation and complex nutrition program. “We have team huddles

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Pat Ainsworth Ross Memorial Hospital Pat Ainsworth’s varied background put her in good stead for her job as recruiter for the Kawartha Lakes site of McMaster University’s diabetes intervention study. She has had multiple roles including; operating room data administrator collecting information on wait time strategies; dietetic technician helping dietitians plan nutritional patient meals; nursing home supervisor doing everything from ordering food and supplies to hiring staff; and for the last five years, administrative assistant in the diabetes education program at Ross Memorial Hospital.Her business background proved to be a valuable asset, teaching her short-cuts that helped her avoid, making fruitless calls to potential patient volunteers. Instead, her initial step was to check patients with two or more existing health problems. And she was a familiar face to patients coming to the hospital’s Diabetes Education Program and as first contact for referral patients she said “it was quite easy for me to do the recruitment.”Like other recruiters, she hit some snags. “Some diabetic patients only signed up for the study because they thought they would get home visits,” she said. Ainsworth made it clear they had a 50-50 chance of being in the intervention arm of the study which includes usual diabetes care plus home visits and group sessions.

“A lot of elderly people live in our area and find it difficult getting to their appointments. They really wanted the home visit and, to them, the most attractive thing about volunteering for the study was the home visit,” she said.Her biggest challenge was when a few patients dropped out just as she reached her full complement of study participants.

“I don’t know why that happened. It was the last few patients that I recruited and it was very challenging.”Ainsworth also found it was most difficult to recruit younger seniors in the 65 – 75 age group because they continue to live active lives. One man declined because he wanted to play golf. Seniors in their 90s showed little interest in volunteering as well. Many others were too busy with multiple medical appointments. “I had way more uptake from women than men,” she said.From her perspective, she came to see how valuable home visits are for

many people, and not just those requiring diabetes education from a nurse and dietitian. “We have seen some of these patients for years and years and they are getting frail. Many are caregivers for a spouse and can’t leave their spouse, who may have Alzheimer’s, alone. It sounded like they didn’t have any respite so they didn’t want to participate at all in the study.”Ainsworth said she “really enjoyed” her job as recruiter. “It was an amazing opportunity.”

P R O F I L E | ROSS MEMORIAL HOSPITAL | CITY OF KAWARTHA LAKES PARKS AND RECREATIONDIABETES STUDY BULLETIN | THIRD EDITION | OCTOBER 2015

“A lot of elderly people live in our area and find it difficult getting to their appointments. They really wanted the home visit and, to them, the most attractive thing about volunteering for the study was the home visit.

Page 3: DIABETES STUDY BULLETIN - McMaster University · cardiac rehabilitation, heart failure service, cardio pulmonary rehabilitation and complex nutrition program. “We have team huddles

P R O F I L E | ROSS MEMORIAL HOSPITAL | CITY OF KAWARTHA LAKES PARKS AND RECREATION

Claire Doble Ross Memorial HospitalIt’s a 30-50 minute drive but dietitian Claire Doble gets a lot of pleasure from her home visits with diabetic seniors who are coping with multiple chronic health conditions.

Her role as an interventionist in the ACHRU diabetes self-management study is to complete home visits and also provide group education and support for the study’s intervention group.“It’s going well and patients enjoy having us come to their homes,” said Doble, a registered

dietitian for five years, four year of which have been spent in diabetic education as a certified diabetes educator.

Throughout the six-month study, Doble is noticing changes in seniors. “By increasing their comfort level, we are able to see good changes in their lifestyle as they add more fruits and vegetables to their diet and reduce their snack and treat foods.”A home exercise program is a very valuable component of the study, she said. Seniors are taught 10 different exercises, half that can be done seated and half standing, where no equipment is necessary. “This helps with fall prevention and helps to increase their self-confidence,” said Doble.Groups sessions, she said, are an important part of the intervention program. “One thing that is so beneficial for patients is for them to see how they can interact with each other. They chit chat in class and this means a lot to those patients who don’t know anyone with diabetes and are alone.”

The intervention is quite successful, so far, said Doble, although some people are facing significant challenges, such as limited financial resources. “It’s been a really positive experience and we enjoy participating and seeing the seniors succeed.”

Della Hare Ross Memorial Hospital As a hospital-based nurse for more than 30 years, Della Hare found McMaster University’s diabetes self-management study gave her the opportunity “to see the other side of the world” – community-based nursing.

Trained initially as a registered nursing assistant (RNA), Hare has worked in the emergency department, spent the last six years in diabetes education and, most recently, completed the nurse practitioner (NP) program. With insights from a nursing career that spans several decades, she believes that the diabetes self-management

study led by ACHRU will result in improved health for seniors.“The concept of the McMaster study is certainly the way of the future,” she said. “Our patients absolutely love it.”Personally, Hare said she gains a lot of self-satisfaction from the home visits she makes to diabetic seniors as part of the study’s intervention. “I can help individuals with their daily lives, their disease and to have a better life,” she said. “In the community, in their home, you see a much different side of people. They are more revealing and talk about their children and grandchildren.”She has also found home visits give seniors a better sense of who nurses are as educators in their diabetes care. “In the office, everything is kept professional,” she said. “They feel

they can ask all the questions that they can’t ask physicians. We show up and we can answer their questions.”Hare has also seen how beneficial the group component of the intervention is to diabetic seniors. After one meeting, a participant told her how much she had learned and how that had empowered her.

“By increasing their comfort level, we are able to see good changes in their lifestyle as they add more fruits and vegetables to their diet and reduce their snack and treat foods.

“The concept of the McMaster study is certainly the way of the future. Our patients absolutely love it.

Page 4: DIABETES STUDY BULLETIN - McMaster University · cardiac rehabilitation, heart failure service, cardio pulmonary rehabilitation and complex nutrition program. “We have team huddles

P R O F I L E | ROSS MEMORIAL HOSPITAL | CITY OF KAWARTHA LAKES PARKS AND RECREATION

Our Partners• St. Joseph’s Health Care London

• YMCA of Western Ontario

• Peterborough Regional Health Centre

• YMCA of Central East Ontario

• Port Hope Community Health Centre

• Northumberland YMCA

• Ross Memorial Hospital

• Recreation Department – City of Kawartha Lakes

Amy BartholomewResearch CoordinatorAging, Community and Health Research Unit School of Nursing, McMaster University 905.525.9140, ext. 20294w: achru.mcmaster.ca

Follow us on Aging, Community and Health Research Unit | Follow @achru_mcmaster

The City of Kawartha Lakes is a vast, mostly rural area and growing numbers of its 74,000 residents are seniors who find it a challenge to travel any distance from home.Yet, distance isn’t proving to be a barrier for many seniors with multiple chronic conditions (MCC) who are participating in an exercise program that’s almost an hour from home. The exercise program is part of an intervention in the diabetes self-management study led by McMaster University’s Aging, Community and Health Services Research Unit.“People say that normally they wouldn’t make the effort to come out. But, a lot say not only are they happy to come but they feel better for it. That’s music to my ears,” said Tracey Cooper, Fitness and Membership Coordinator for the City of Kawartha Lakes.Cooper believes part of their enthusiasm is due to the psychosocial aspect of the program and their chance of being around other older adults facing diabetes and share their worries. “A lot haven’t socialized for a long time because their health issues isolated them. Others are enjoying the home exercises and feeling great.”This is exciting for Cooper. During her 30 years in the fitness industry as a certified fitness instructor and personal trainer, her passion has been helping people stay active. Contact Information for this study:

Most recently, the focus of her work has centred on helping Ross Memorial Hospital with its rehabilitation program. Cooper admits exercise is much more difficult for those with chronic health problems but being around seniors with similar problems is a good way to cushion that. Participants also have the opportunity to discuss topics important to them and

ask questions. “For example, when someone finds exercise daunting, we ask them what they can do to not make it so daunting. And we found our group is really good at doing their exercises at home,” she said.In her 10 years with (the city’s) fitness program Cooper said there has been a 10 fold increase in need for fitness programs for seniors. Not only are seniors more aware of the

importance of fitness they also have a desire to be more active, she said, adding they’re looking for exercise because of health issues, not to be athletic.

“When someone finds exercise daunting, we ask them what they can do to not make it so daunting

Tracey Cooper City of Kawartha Lakes Parks and Recreation