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New Diabetes Model:
Treatment in a Group Setting
"We're learning that people who are living
with a chronic condition really require an approach
to medical care that is different than the acute
care model.”
Managing diabetes can be confounding and all-consuming.
Diabetics must test their blood sugar several times
a day and adjust their medications accordingly.
They have to watch what they eat, check their blood
pressure, monitor the circulation in their feet.
More than half of all diabetics eventually must
inject themselves with insulin twice a day.
Now doctors and nurses at a Eugene medical clinic
are trying a new model for diabetes management:
treating diabetics in a group setting. Since January,
the Volunteers in Medicine Clinic has provided monthly
group visits at its office.
The setting provides diabetics with much needed
support and gets them into regular, continuing care
for their chronic disease.
About 70 people are enrolled in eight different
groups at Volunteers in Medicine and a ninth group
will begin soon, said Cheryl Ana Moore, a diabetes
nurse educator who coordinates the program.
Three of the groups are for Spanish-speaking patients;
Mexican-Americans are twice as likely to develop
diabetes as white people, according to the federal
Centers for Disease Control and Prevention.
The Volunteers in Medicine Clinic, which provides
free health care to low-income, uninsured Lane County
residents, is one of a handful of clinics in Oregon
to try the group approach.
Studies have shown that diabetics who participate
in group visits reported improvement in their blood
sugar levels, improved quality of life and diabetes
knowledge compared with patients who received conventional
diabetes care. More study is needed to determine
why, according to an article in the latest issue
of the journal Diabetes Spectrum.
In Oregon, the group visit model is used at the
Clackamas Public Health Clinic in Sandy and at the
Samaritan Internal Medicine Clinic in Corvallis,
said Linda Dreyer, who manages the Oregon Diabetes
Prevention and Control Program for the state Department
of Human Services.
"We're learning that people who are living
with a chronic condition really require an approach
to medical care that is different than the acute
care model that most of us are exposed to with our
medical care provider," she said.
Under the acute care model, people see their doctor
only when they get sick. They get a prescription,
go home and don't think about seeing a doctor until
next time they get sick, she said.
"Chronic conditions aren't going away,"
she said. So doctors and nurses need to figure out
a better way to treat such conditions, she said.
The group meetings are combination of a regular
visit to a doctor and a support group. A doctor
and nurse are there to provide education, check
blood pressures and adjust medications, but much
of the good seems to come from the support and information
the diabetics provide to each other.
At a group visit last Thursday morning at the Volunteers
in Medicine Clinic, Dr. Hugh Johnston, the clinic's
medical co-director, explained how different diabetes
drugs work, why some are effective and some aren't.
Then he talked with the patients individually.
The setting allows doctors and nurses to cover the
bases more efficiently.
"Essentially you get better management,"
Moore said. "You're giving the same information
to six or seven or eight people instead of one,
so you don't start dribbling off details after the
fourth or fifth patient."
Each patient also brings a binder to document their
self-treatment.
"The object of the notebook is that they learn
they are managing the disease and I am not,"
Johnston said.
Group members also talked together informally, sometimes
offering advice. For example: Mark Royce gave Sheila
Werth a tip to liven up her diet without compromising
its healthfulness: Tabasco. Diabetics often must
eat bland diets to keep their blood sugars in check.
Werth said she's tired of trying to eat a healthy
diet. "I'm in rebellion," she said. "I
want to eat Cheetos."
But the group, she said, has been a big help. "I
never learned anything about diabetes before I came
here," she said. "It's like any support
group. You've all got the same problem. You learn
what other people are going through." For more
information: Contact Volunteers in Medicine at 685-1800.
New Diabetes Model:
================================
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