problem solving assessment flow chart diabetes activecare
TRANSCRIPT
H11-01076-01_12 01/12 ©2012 OptumRx, Inc.
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Source: Adapted from The Art and Science of Diabetes Self-Management Education, American Association of Diabetes Educators, 2010.
Problem Solving Assessment Flow Chart Diabetes ActiveCare
• Recurrent DKA
• Frequent hyperglycemia
• Frequent hypoglycemia
• A1C > 9%
Level 1: Referral ProblemClinical Markers and Emergencies:FIRST
Identify the reason the patient has been referred.
• Unhealthy eating
• Physical inactivity
• Difficulty taking medications
• Not monitoring as prescribed
Level 2: Self-Care Behavior Concerns
NEXTWhat are the
behavior problems related to clinical
markers?
Level 3: Barriers by Self-Care Behavior
THENWhat barriers
for self-care can the patient identify?
Barriers to Monitoring• Pain• Inconvenience• Interference with lifestyle• Testing skills• Fear of the numbers
(high and low)• Cost/expense
Barriers to Taking Medications• Needle phobia• Fear of hypoglycemia• Costs• Forgetting to take• Complexity of the regimen• Medication side effects• Understanding the regimen• Perceived treatment benefits• Not taking medications
in the presence of others• Medication knowledge
Barriers to Physical Activity
• Unwilling• Lack of appropriate/
safe place
• Weather• Poor conditioning• Cost of facilities• Lack of support• Competing time priorities• Fear of hypoglycemia• Pain• Unpleasant physical
responses – sweating, feeling ill, shortness of breath
Barriers to Coping• Lack of skills• Lack of support• Social pressures• Unmanaged stress• Time management
skill deficit• Emotional distress• Cognitive barriers
Barriers to Healthy Eating
• Eating out• Time pressure• Portion sizes• Nutrition/meal
planning deficit
• Feeling deprived• Competing priorities• Cost of healthy foods• Cultural preferences/
knowledge deficit on incorporation into meal plan
• Food craving• Eating at social events
or school• Snacking when bored
or alone
Barriers to Risk Reduction
• Lack of knowledge• Lack of adequate
medication taking• Cost of medications• Medication side effects• Fear of hypoglycemia• Unhealthy eating
• Lack of confidence in self-efficacy
• Lack of motivation
• Limited understanding of vulnerability
Use in conjunction with My Action Plan to Solve a Problem.
FINALLYContinue with planning and
implementation.
• ER visits
• Preventable hospitalizations
• Emergence or progression of diabetes complications
• Inadequate control: BP, lipids, glycemia
• Trouble coping
• Difficulty reducing risks
• Unable to problem solve