2010 Third National DNP Conference, San Diego

Breakout session T4 Details, Thursday, September 30, 2010, 1:45PM
Monte Carlo Room

Phyllis Wolff-McDonagh, DNP, CPNP, ANP, CDE
Diabetes and Endocrinology Center of Suffolk, Patchogue, NY
Using Insulin Pump Therapy in Poorly Controlled Type 2 Diabetes

Goal of Presentation:
The primary purpose of this pilot study was to determine whether using continuous subcutaneous insulin infusion (CSII) therapy in insulin-requiring subjects with poorly controlled type 2 diabetes was more effective than conventional treatment with multiple daily doses of insulin (MDI). A secondary aim was to build the body of evidence regarding the use of insulin pumps in this population to influence Medicare policy, which denies CSII to subjects with type 2 diabetes and some insulin production.

Objectives:
1. Learn the current trends in the management of type 2 diabetes.
2. Learn the advantages of insulin pump therapy in insulin resistant patients
3. Learn the potential cost benefit of insulin pump therapy over conventional therapy.

Speaker’s Background:
Phyllis Wolff-McDonagh, DNP, CPNP, ANP, CDE has been a nurse practitioner for over 26 years. She has been managing an out-patient population, children then adults, with diabetes throughout that time. For the past 12 years, she has managed adults with type 1 and type 2 diabetes and has developed a large multidiscipline pregnancy and diabetes program in a private endocrinology practice setting. Her recently completed research on insulin pump therapy in poorly controlled type 2 diabetes, a topic that has not been well studied, makes her the best qualified individual to present this topic at the conference. Type 2 diabetes has reached epidemic proportions in our country and DNPs in all areas of practice must be knowledgeable regarding current treatment options and the evidence that supports them.

Iris Sanchez, DNP, APRN-BC, FNP-BC, CDE, BC-ADMNP
Weslaco Medical Clinic, San Juan, TX
Implementation of Diabetes Self-Management Education using Shared Medical Appointments in Primary Care for Adults

Goal of Presentation:
The purpose of the project was to implement Diabetes Self-Management Education (DSME) program in a primary care setting using the Chronic Care Model (CCM) and Theory of Innovation through shared medical appointments (SMA) to provide evidence-based interventions to improve patient outcomes. The question of interest was whether DSME provided in a primary care setting through SMA had the potential to positively impact patient self-efficacy to manage all aspects of diabetes, improve patient outcomes, improve patient and provider satisfaction, and decrease the rate of or slow the progression of complications as compared to standard management practices.

Objectives:
1. Discuss implementation of the Chronic Care Model and the Plan-Do-Check-Act cycle to implement Shared Medical Appointments
2. Provide Diabetes Self-Management Education in a primary care setting to allow patients to self-manage diabetes
3. Improve process and measure outcomes, increase provider and patient satisfaction, and sustain a financially viable program

Speaker’s Background:
Dr. Iris Sanchez, FNP-BC, CDE, DNP lives and practices in San Juan, Texas, which is a border town along the US-Mexico border in South Texas. Her years of experience with a population disproportionately affected by diabetes mellitus (DM) has prompted her to explore innovative models of practice and care, which can be implemented in a primary care setting to improve quality indicators of comprehensive diabetes care, improve process and outcome measures, and decrease long-term complications often associated with DM. Dr. Sanchez currently practices at two internal medicine practices caring for adults and older adults. The majority of the patients cared for in the clinics are Mexican-American and are at high risk for or have been diagnosed with DM.
Dr. Sanchez implemented a diabetes self-management education (DSME) program in a primary care setting using shared medical appointments (SMA). She is dedicated to the prevention and management of DM not only in vulnerable populations but also in all individuals with DM or at increased risk for DM. Dr. Sanchez has been a Certified Diabetes Educator and is board certified in Advanced Diabetes Management. In the primary care setting, she is responsible for the diagnosing, management, and treatment of patients with diabetes and the associated complications. She is in charge of scheduling and facilitating the SMA. Additionally, she is in the process of submitting data to acquire Diabetes Recognition from the NCQA. She is actively involved with the American Association of Diabetes Educators and has published on best practices for diabetes management. Her expertise in diabetes management and knowledge regarding reimbursement allowed her to successfully implement SMAs to provide education to patients to improve outcomes while still maintaining a financially viable program.