Abstracts / Can J Diabetes 36 (2012) S24eS76 S29

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Exploring the Experiences of Adults Living with Type 1 DiabetesAccessing CareYVONNE MULLAN*, BOZENA FUSEK, JANET C. MACLEOD,ZUBIN PUNTHAKEE, DIANA SHERIFALIHamilton, ON

Currently 45% of patients receiving care at Hamilton HealthSciences’ (HHS) Diabetes Care and Research Program (DRCP) havetype 1 diabetes mellitus (T1DM). Individuals with T1DM haveunique concerns that may not be addressed with currentprogramming and services. We recruited 20 individuals with T1DMfrom our patient population to participate in focus groups. Partic-ipants were divided into three cohorts based on age. The objectivesof this project were: 1) to explore experiences of individuals withT1DM accessing DCRP services; 2) to generate themes regardingT1DM care to inform areas of improvement; and 3) to identifypotential generational challenges related to T1DM. Focus groupswere tape-recorded and transcribed. Data was analyzed andthemes were generated using qualitative research methods(thematic analysis). Common themes identified across all agecohorts included: 1) the need to improve communication processesand follow-up care using social media and technologies; 2) moresupport with managing the impact of exercise on blood glucose;and 3) recognizing the emotional, physical and financial burden ofliving with T1DM. Age-specific themes included: 1) 18-29 years eliving two lives and the dilemma of structure versus freedom; 2)30-54 years e managing own and health care provider expecta-tions; and 3) 55+ years e desire for knowledge, concerns aboutsafety, fear of hypoglycemia. Initial process improvement changesinclude: 1) the development of a T1DM group education programwith an emphasis on self-management principles and 2) intro-duction of rapid-access clinic appointments. These findingscontinue to inform changes in program content and delivery.

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My Diabetes PlayboxDONNA KOLLERToronto, ON

In order to address the educational of young children with dia-betes, a new psychoeducational tool has been created. My DiabetesPlaybox is an interactive and portable kit that includes a book andother related materials aimed at increasing a young child's compe-tency around disease management. General knowledge of diabetes,issues related to self-care and feelings are explored using a devel-opmentally appropriate approach. This resource is an outcome ofa research study funded by the CDA that found young childrenwithdiabetes in need of additional education regarding their disease.

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Central IntakedA Streamlined Process for Diabetes EducationReferralsDEBBIE E. HOLLAHAN*, SARAH E. CHRISTILAW, ELENA M. ORESCHINACambridge, ON

Through stake-holder engagement, patient focus groups andinventories of services for the region, a need and priority forimproved system navigation was identified, resulting in theestablishment of a central intake (CI) process for diabetes educationreferrals.

Objectives included: developing a CI fax number with onecommonphysician referral form and a self-referral form; developinga model of care with clear definition of the roles of each diabetesprogram; identifying triage criteria to improve access to the appro-priate care; developing standardwait-times for education; providingtimely access to information regarding the status of referrals forprimary care providers and patients; monitoring wait-times ofprograms; building and maintaining capacity of diabetes education

programs; standardizing data collection in order to improve quality,monitor outcomes and implement appropriate changes.

The CI process has been a successful project to date, withachievement in all the identified objectives.

Standardized data collection has led to improved quality of infor-mation allowing for the monitoring of outcomes, building and main-taining capacity, improving access to appropriate care and makinginformed process changes to help streamline the referral process.

TheCIwill beofmoreusewhen it becomes theonlyentrypoint forreferrals. The self-referral form is just starting to have an impact, andis anticipated to improve access as it becomes more widely known.

As of May 2012, the CI process has processed 1656 referrals from135 health care providers to 16 diabetes education programs acrossthe Waterloo-Wellington Local Health Integration Network regionand beyond.

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Making Connections: Supporting Self-management Throughthe Integration of Diabetes and NephrologyCHRISTINA VAILLANCOURT, HEATHER REID, EMILY HARRISON*

Whitby, ON

Diabetes is the leading cause of chronic kidney disease (CKD).The Ontario Renal Network (ORN) reports that 50% of incidentpatients have diabetes. Throughout the province there areprograms that focus on either diabetes or CKD. The Clinical PracticeGuidelines for the management of diabetes and best practices forCKD both recommend a multi-disciplinary approach. However,these best practices are also contradictory in key areas of medicalmanagement such as nutrition. Current service models requireclients to attend multiple appointments with multiple teammembers in which they often receive contradictory managementrecommendations. The end result is confused and frustrated clientswhose confidence to self-manage is low at best. Ontario's expandedChronic Disease Prevention and Management (CDPM) modelsuggests that the healthcare system needs to be redesigned forsmooth transition, easy navigation and patient empowerment thatleads to informed activated patients and prepared proactive prac-tice teams. At Lakeridge Health, using the principles of CDPM, thediabetes and nephrology programs have been integrated. Thisintegration includes: diabetes and nephrology programs consoli-dated under one Directorship and management portfolio, CertifiedDiabetes Educators in nephrology, a unified CKD and diabetes clinicwith endocrinology presence, cross appointed frontline staff, andthe creation of common education materials. Next steps includeexpanding endocrinology services for patients who are receivingrenal replacement therapy and additional cross appointed posi-tions. This integration has facilitated interprofessional collabora-tion resulting in a patient centered environment which easesdisease burden by providing clear disease management for theindividual living with these complex chronic illnesses.

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Post-gestational Diabetes: Patient Perspectives on theOrganization of Health ServicesTRINA L. FITTER, JENNIFER J. JOHNSON, PAULA M. BRAUER,AMY E. WAUGHFergus, ON, Hamilton, ON, Guelph, ON

Objectives: To gather information on the thoughts and ideas ofwomen with a previous gestational diabetes mellitus (GDM) diag-nosis on the organization and structure of type 2 diabetesprevention services.Methods: Women with a previous diagnosis of GDM were iden-tified from medical records and invited to participate in a focusgroup by mail, 10/30 women accepted. A single 60 minute focusgroup was facilitated with a professional moderator. Five