ROADBLOCKS ON THE PATH TO TB & DM ... OBJECTIVES •At the end of this session, participants will be able to: 1. Understand an example of TB-DM implementation and anticipate the challenges

ROADBLOCKS ON THE PATH TO TB & DM IMPLEMENTATION IN NEW MEXICO

LEARNING OBJECTIVES

• At the end of this session, participants will be able to:

1. Understand an example of TB-DM implementation and anticipate the challenges to integrated care

2. Understand the importance of education and culture in TB-DM integration to improve treatment of patients

FIVE FUN FACTS: NEW MEXICO

1. Santa Fe is the highest capital in US

7,000 feet above sea level

2. Each October ABQ hosts world’s largest international balloon fiesta

3. Lakes/rivers make up only .002% of state surface area….lowest ratio in US

4. One of “Four Corner States” (Colorado, Utah & Arizona)

5. The Navajo Nation: covers 14 million acres

TB & DM IN NEW MEXICO

WHERE IT ALL BEGAN…….

• National Webinar – December 10, 2009

• Dr. Brostrom: “Integrating Diabetes and TB Programs”

• National TB Conference – presentations

• EL Paso – Binational Border Infectious Disease (2011)

• poster by Hawaii, Curry Center and USAPI group

NM DIABETES PROGRAM

• Spring 2010:

• Short PP done for DM program

• “Double Trouble: Diabetes & Tuberculosis”

• Enthusiastically received

• Collaborated with diabetes educator & diabetes nurse

• over course of year (Feb 2011)

• “FAX” Blast created – 11.1.11

• Share information with providers about TB & DM

DECEMBER 2011 – FAX BLAST…..

DECEMBER 2011 – FAX BLAST…..

COLLABORATION WITH HAWAII (JANUARY 2013)

• Met by conference call with Hawaii program

• Dick, Bonnie & Angela

• Hawaii proposal (Included NM)

• add small #TB &DM patients

• New Mexico collect HgbA1C data • TB Disease protocol since 2013

• Inexpensive to add: $7/test

• Utilize Hawaii TB/DM Flip chart for brief educational intervention…..

HAWAII’S FLIPCHART

• Beautiful Design

• Excellent content

• Decided to use in NM

• Ordered flipcharts - for each NM health office

• Conf call with Nurses

• Introduce Flip chart

• Explain what we wanted to do

• Sought feedback from nurses

• How different NM is from Hawaii

• Nurses were ready to take it and run with it

THIS IS WHEN THE “CONTROVERSIES” BEGAN….

• Complaints: (ok – I know I am supposed to call these challenges)

• Culturally not appropriate for NM audience

• I could agree there

• Had not included health offices in the planning

• Well….(I had) but not “right” people

• Medical Director of Diabetes program needed to approve

• Had Dr. Burgos call and elicit collaboration

• NOT successful…..

• Chronic Disease Bureau….why had I not talked to them?

STEP BACK AND (RE)GROUP…..

• Design flipchart specific to NM

• Address NM culture – Hispanic & American Indian

• Made the flipchart a bit more generic

• work for wide audiences

• Logistically how to design a flipchart

• Starting from scratch…….

• Graphic Designer in Las Cruces

• Andre Walker

• Had a nursing student to do a bit of the background work

NEW MEXICO FLIPCHART - ENGLISH

NEW MEXICO FLIPCHART - SPANISH

NM APPROVAL PROCESS SYSTEMS CHANGE IN LOCAL HEALTH OFFICES

• NM Centralized Health Department

• All employees work for state in local health offices

• Submitted plan to incorporate Diabetes education into TB Program activities

• Regional Meeting: put on agenda

• March 18, 2013

• Present by Bureau Chief (I did not attend)

• GREAT deal of negative comments on implementation of diabetes education into TB program

ADDRESSING CONCERNS….. • Clients need to be linked to primary care

• TB Program 100% agrees

• Primary Care should manage diabetes for patient • TBP 100% agrees

• Diabetes medications will not be changed by TB physician • Nurses will not discuss BMI, calorie counts, fingersticks etc….this will still be

managed by PCP and their diabetes educator

• “Extra” time to provide education • DM education already taking place

• Flipchart will standardize & decrease amount of time to present materials

• Is it worth the time for small # of patients • NM Mortality study 2007 – 2009

• 28% of patients that died due to TB had diabetes

• Creating Co-dependence in our TB patients • Developing rapport • Helps to complete TB treatment • LOTS of teachable moments during TB treatment

• Providing patient information to make informed choices on lifestyle changes

WHERE ARE WE….TODAY?

• Flipchart Pilot to begin Soon!

• Met with Midtown (ABQ) TBP

• VERY enthusiastic!!

• Developing Pre/Post Questionnaire

• Knowledge, Attitude, Practices

• TB/DM Documentation Form

• How much time spent

• Where education took place

• Who provided the education

DIABETES CHART REVIEW 2010 - 2014

• Nurse Consultant & ID Fellow

• Conducting chart reviews

• Impact that diabetes has on active TB patients

• Ready(?) for June National TB Conference