Implementation of a Diabetes Treatment Algorithm in Primary Care for Use in the Adult Hispanic Population

8.00
Hdl Handle:
http://hdl.handle.net/10755/622565
Category:
Full-text
Format:
Text-based Document
Type:
DNP Capstone Project
Level of Evidence:
Other
Research Approach:
Translational Research/Evidence-based Practice
Title:
Implementation of a Diabetes Treatment Algorithm in Primary Care for Use in the Adult Hispanic Population
Author(s):
Dillenbeck, Heidi Marshall
Additional Author Information:
Heidi M. Dillenbeck, FNP-C
Advisors:
Stetina, Pamela
Degree:
DNP
Degree Year:
2017
Grantor:
Northern Arizona University
Abstract:

Diabetes Mellitus Type 2 (DM2) is a growing problem in the United States. Hispanic Americans have a higher prevalence of diabetes than Non-Hispanic Whites and suffer from more severe complications of the disease. Although advances in diabetes treatment over the last decade has improved, management of diabetes in primary care is inconsistent despite well-publicized guidelines from the American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE). With the growth of the Hispanic population expected to reach 25 % of the U.S. population by 2050, practice changes must be made to improve diabetes management. The literature supports the use of standardized clinical practice algorithms to provide structure and consistency in clinical decision making and diabetes treatment plans.       The purpose of this doctor of nursing practice project was to implement a diabetes treatment algorithm in a primary care community health center for use during patient visits by the primary care provider (PCP) with Hispanic diabetic patients. The participating PCPs were educated on the use of the algorithm and encouraged to utilize the tool at each visit with qualified patients. The tool contains several categories including documentation of an annual foot exam, bi-annual glycated hemoglobin (A1C), A1C number, annual lipid panel, microalbumin, and glomerular filtration rate (GFR), documentation of statin, aspirin, and angiotensin-converting-enzyme inhibitor (ACEI) or an angiotensin II receptor blocker (ARB) use if indicated, titration of medications, documented weight at each visit, and weight management. Chart audits were performed to determine utilization of the tool by pulling data from these categories. During the 30-day study period, 87 patient charts were audited all of which used the algorithm to some degree. Data was analyzed using descriptive statistics and frequency distributions. Of the 87 charts audited, 86 (98.9 %) contained a documented A1C in the treatment algorithm with a mean A1C of 7.6 percent. Documentation of GFR and aspirin therapy were seen in about half of audited charts. Adherence to recommended annual foot exams, documented microalbumin, and addition or titration of DM medications fell well below 50 %. Weight management through an RD referral was the worst measurement in guideline adherence with only 11 out of 87 patients referred to a dietician. Following the completion of this project, it is evident that adherence to the recommended standards of care is suboptimal in this practice setting. The goal of this practice change project was to improve documentation and guideline adherence through a systems change by implementing a DM treatment algorithm to be utilized by the PCP when treating Hispanic adults with DM2. This process must be sustained and improved upon to close the gap between the national evidence-based recommendations and current clinical practice.

Keywords:
Diabetes Mellitus; Hispanic Americans; Primary Care; Treatment Algorithm
CINAHL Headings:
Diabetes Mellitus, Type 2; Diabetes Mellitus, Type 2--Prevention and Control; Hispanics; Primary Health Care; Patient Care Plans; Patient Compliance; Algorithms--Utilization; Algorithms; Guideline Adherence
Note:
This work has been approved through a faculty review process prior to its posting in the Virginia Henderson Global Nursing e-Repository.
Repository Posting Date:
2017-09-01T19:53:02Z
Date of Publication:
2017-09-01

Full metadata record

DC FieldValue Language
dc.contributor.advisorStetina, Pamelaen
dc.contributor.authorDillenbeck, Heidi Marshallen
dc.date.accessioned2017-09-01T19:53:02Z-
dc.date.available2017-09-01T19:53:02Z-
dc.date.issued2017-09-01-
dc.identifier.urihttp://hdl.handle.net/10755/622565-
dc.description.abstract<p>Diabetes Mellitus Type 2 (DM2) is a growing problem in the United States. Hispanic Americans have a higher prevalence of diabetes than Non-Hispanic Whites and suffer from more severe complications of the disease. Although advances in diabetes treatment over the last decade has improved, management of diabetes in primary care is inconsistent despite well-publicized guidelines from the American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE). With the growth of the Hispanic population expected to reach 25 % of the U.S. population by 2050, practice changes must be made to improve diabetes management. The literature supports the use of standardized clinical practice algorithms to provide structure and consistency in clinical decision making and diabetes treatment plans.       The purpose of this doctor of nursing practice project was to implement a diabetes treatment algorithm in a primary care community health center for use during patient visits by the primary care provider (PCP) with Hispanic diabetic patients. The participating PCPs were educated on the use of the algorithm and encouraged to utilize the tool at each visit with qualified patients. The tool contains several categories including documentation of an annual foot exam, bi-annual glycated hemoglobin (A1C), A1C number, annual lipid panel, microalbumin, and glomerular filtration rate (GFR), documentation of statin, aspirin, and angiotensin-converting-enzyme inhibitor (ACEI) or an angiotensin II receptor blocker (ARB) use if indicated, titration of medications, documented weight at each visit, and weight management. Chart audits were performed to determine utilization of the tool by pulling data from these categories. During the 30-day study period, 87 patient charts were audited all of which used the algorithm to some degree. Data was analyzed using descriptive statistics and frequency distributions. Of the 87 charts audited, 86 (98.9 %) contained a documented A1C in the treatment algorithm with a mean A1C of 7.6 percent. Documentation of GFR and aspirin therapy were seen in about half of audited charts. Adherence to recommended annual foot exams, documented microalbumin, and addition or titration of DM medications fell well below 50 %. Weight management through an RD referral was the worst measurement in guideline adherence with only 11 out of 87 patients referred to a dietician. Following the completion of this project, it is evident that adherence to the recommended standards of care is suboptimal in this practice setting. The goal of this practice change project was to improve documentation and guideline adherence through a systems change by implementing a DM treatment algorithm to be utilized by the PCP when treating Hispanic adults with DM2. This process must be sustained and improved upon to close the gap between the national evidence-based recommendations and current clinical practice.</p>en
dc.formatText-based Documenten
dc.language.isoen_USen
dc.subjectDiabetes Mellitusen
dc.subjectHispanic Americansen
dc.subjectPrimary Careen
dc.subjectTreatment Algorithmen
dc.titleImplementation of a Diabetes Treatment Algorithm in Primary Care for Use in the Adult Hispanic Populationen_US
dc.typeDNP Capstone Projecten
thesis.degree.grantorNorthern Arizona Universityen
thesis.degree.levelDNPen
dc.description.noteThis work has been approved through a faculty review process prior to its posting in the Virginia Henderson Global Nursing e-Repository.-
dc.primary-author.detailsHeidi M. Dillenbeck, FNP-Cen
thesis.degree.year2017en
dc.type.categoryFull-texten
dc.evidence.levelOtheren
dc.research.approachTranslational Research/Evidence-based Practiceen
dc.subject.cinahlDiabetes Mellitus, Type 2en
dc.subject.cinahlDiabetes Mellitus, Type 2--Prevention and Controlen
dc.subject.cinahlHispanicsen
dc.subject.cinahlPrimary Health Careen
dc.subject.cinahlPatient Care Plansen
dc.subject.cinahlPatient Complianceen
dc.subject.cinahlAlgorithms--Utilizationen
dc.subject.cinahlAlgorithmsen
dc.subject.cinahlGuideline Adherenceen
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.