“I feel one thousand times better…. like a brand new person.”
That’s how Crystal McKinney, a 34-year-old diabetic patient, describes her health today after almost a year working with the team at the Edmonton Southside Primary Care Network. The team of health professionals provides increased support and improved access to chronic disease care to help patients better manage diseases such as diabetes, heart disease and other illnesses.
“I have more energy. I know how to look after my blood sugars better. I am happier. Before I was very, very moody but now I’m not anymore,” she says. McKinney has lived with diabetes for about five years, having first been diagnosed and treated when she lived in New Brunswick. Her overall health and wellness has improved dramatically since she moved to Alberta and became a patient at a family medicine clinic participating in the Network.
However, McKinney also admits it wasn’t always easy. She remembers when the team decided that the pills she was on to control her diabetes weren’t effective and they wanted to switch her to insulin injections. “I was scared to death but Kate poked herself in the belly to show me how it was done and that it didn’t hurt so I thought if you can do it I can too,” she says.
McKinney was recently one of 743 patients who participated in a study that measured the impact of a team approach to diabetes care and management. The study, which linked patients with targeted nursing care, found that the extra support resulted in improved patient outcomes and more rigorous testing of key health indicators known to improve diabetes management.
“We found statistically significant decreases in three key clinical indicators – A1C, LDL and the cholesterol/HDL ratio – all of which are important in the overall health and management of diabetic patients,” says Sheri Fielding, the Nurse Practitioner who led the study for the Network. “These decreases have resulted in better outcomes, including reducing the risk of long-term health complications, and better management of the disease overall.”
The study began in the spring 2007, continuing until the spring of 2009. Of the 734 diabetic patients involved over 50 per cent were women and the average age was between 50 and 69 years. Most patients have also had diabetes for more than five years.
In Alberta today estimates suggest that approximately one in 20 Albertans are living with diabetes and the number is climbing. The latest statistics show that over 164,000 Albertans suffered from diabetes and it’s estimated that 40 per cent will develop serious health complications such as heart disease, kidney disease or blindness, resulting in increased demand on the health system overall.
The Primary Care Network study provides valuable information to look at how having access to a variety of health professionals can positively improve patient outcomes and impact other areas of the health system. “By ensuring that diabetic patients had timely access to diabetes testing and the right support we were able to demonstrate positive improvements in overall health,” says Kate Miner, one of the nurses who supported patients in the study.
For example, one indicator looked at in the Network’s study was the A1C levels of patients. A1C levels provide an overall snapshot of diabetes control and involve the testing of average blood sugar levels in a two to three month period. Testing should be done every 12 to 24 weeks. In its study, the Edmonton Southside Primary Care Network found the A1C results of patients overall dropped five per cent from 2007 to 2009. It also found that the average time between testing was 20.1 weeks, well within the guidelines outlined above.
In addition, the study also showed that the levels for the other two key indicators also dropped. The Low Density Lipoprotein (LDL) – commonly known as the bad cholesterol that can result in the narrowing and hardening of arteries and increase risk of heart disease – dropped eight per cent. The third indicator was the cholesterol:HDL ratio – a ratio found by comparing the total cholesterol (LDL) in blood to the good cholesterol (HDL) – also dropped 5.6 per cent. The time for both tests was also within acceptable clinical standards.
Diabetic patients participating in the study still saw their family doctor however they were also linked with a nurse who helped manage their care. In addition they also had access to a team of other health professionals – such as dietitians and social workers – as required to better manage their care. Patients reported high satisfaction with the team approach, as well as increased awareness of diabetes and what they could do to improve care and management of their disease. “By working as a team and providing targeted nursing support we were able to achieve some significant reductions and improve diabetic patients overall health,” says Dr. Bob Carter, a family physician in the Edmonton Southside Primary Care Network. “The team approach works because it allows us to be more rigorous in our testing, follow-up and education as we can draw on the strengths of each individual team member to ensure that patients receive the right care from the right health professional at the right time.”McKinney echoes those thoughts and says the team has given her the right tools – such as teaching her how to manage her diet or building regular exercise into her day – so that she knows what she needs to do to take better care of herself. “I really do feel like a new person,” she says.