The 130th Annual Meeting of APHA

Abstract #41144

Sheila S. Tann, RN, ND, College of Nursing, Arizona State University, P.O. Box 872602, Tempe, AZ 85287-2602, 480 965-7558, sheila.tann@asu.edu

A health assessment was conducted with the objective of identifying issues that may be compromising glycemic control in members of an American Indian tribe in the Southwest. Methods: The target population consisted of Tribal members with type 2 diabetes who utilize the Tribal health facility. Both quantitative and qualitative data were collected. Three annual chart audits (1998-2000) were conducted on a sample of patient records using the Indian Health Service diabetes audit tool. The audit includes descriptors of glycemic control, self-management, complications, and standards of care. Data was trended and analyzed using descriptive statistics. The Mantel-Haenszel chi-square and ANOVA were used to compare categorical variables. Qualitative data was collected through survey and group process and analyzed using content analysis. Results: Audit results revealed poor blood sugar control (77% >7.0% HbA1c) and a low rate of meeting accepted standards of care. Additionally, it was shown that the time since being out of medication (r=0.40, p=0.008) and the time since the clients’ last diabetes-focused visit (r=0.35, p=0.01) was each positively associated with HbA1c. Qualitative data revealed that transportation, appointment availability and cultural congruency were the major barriers to meeting standards of care. Conclusions: The successful management of diabetes is determined by a variety of behaviors on the part of both the client and health care provider / health care system. The complexity of self-management may be reduced through the implementation of a care coordination program aimed at assisting clients in making health-supportive decisions.

Learning Objectives: At the conclusion of this session, the participant (learner) will be able to

• Describe the process of developing an innovative community-based approach to a clinical problem (diabetes).
• Apply presented concepts of community assessment to program planning and implementation
• Replicate the presented pilot model of community-based team services for testing in other populations or clinical situations

Keywords: American Indians, Case Management

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.