Evidence-based educational in home program to improve self-management adherence and A1C levels for patients with diabetes
Garrett Blaker DNP, APRN, FNP-C, I obtained my BSN in 2016 at Jacksonville University and DNP in 2020 at Jacksonville University. I am a board certified Family Nurse Practitioner, currently employed at Greater Philadelphia Health Action, Philadelphia, Pennsylvania, USA.
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Background: Diabetes diagnosis rates continue to grow, affecting many patients, communities, and health care organizations. One of the greatest challenges faced by patients with diabetes is maintaining diabetes self-management activities including self-blood glucose monitoring, physical activity, a healthy diet, and daily foot checks in order to control their diabetes and reduce their A1c. Diabetic Medical Concepts (DMC) previously provided intermittent and inconsistent in-home diabetes self-management education. An in-home diabetes self-management education program, adherence system and A1c testing component was implemented among DMC’s patients as part of a quality improvement project.
Aim: The aim of the quality improvement project was to provide in-home diabetes selfmanagement education and A1c testing to determine if these education sessions had an impact on patient’s diabetes self-management adherence and A1c levels.
Methods: The education was provided in the patient’s home by DMC home health care nurses once a month for 3 months. The education session included discussion of the American Association of Diabetes Educators (AADE7) handouts and following the in-home education checklist provided to each nurse. Patient adherence to the diabetes self-management education was measured by the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire. A1c
testing was performed in the home by point-of-care testing provided by the nurses.
Results: The results revealed improvement in overall adherence to SDSCA activities (SBGM, physical activity, a healthy diet, and daily foot checks). The difference between the pre- and postcompliance mean scores of 23.24 points (median 23.50) was statistically significant (p <0.0001),
significance level of 5%. The pre-intervention SDSCA mean was 34.3 (SD = 7.74) and the postintervention SDSCA mean was 57.54 (SD = 8.39). The mean difference between the A1c preand post-implementation was 0.03 points (median 0) and this was not statistically significant (p = 0.11), significance level of 5%. This result indicated that in-home diabetes self-management education had no significant improvement on the participant’s A1c levels. The pre-intervention A1c mean was 8.14 (SD = 0.92) and the post-intervention A1c mean was 8.11 (SD = 8.11).
Conclusion: Incorporating in-home diabetes self-management education increases patient adherence to diabetes self-management and may potentially reduce A1c levels with further duration.
|Type||DNP Capstone Project|
|Review Type||Faculty Approved: Degree-based Submission|
|Evidence Level||Quality Improvement|
|Research Approach||Quantitative Research|
Glucose Testing Adherence;
Self-Monitoring of Blood Glucose;
Patient Diabetes Education;
Diabetes Physical Activity;
A1C Diabetic Diet;
A1c Diabetic Diet
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