Project Title
Date of Award
Summer 2023
Document Type
Final DNP Paper
Degree Name
Doctor of Nursing Practice (DNP) in Family Nurse Practitioner
Department
Nursing
Faculty Chair
Dr. Laura Barrow
Preceptor
Dr. Ashley Lackey
Abstract
Background: Formal education for type 2 diabetes mellitus (T2DM) patients is essential, especially in rural areas where diabetes is approximately 17% higher than in urban areas (Bolin & Ferdinand, 2018). In 2019, diabetes was listed as the direct cause of 1.5 million deaths, and 48% of all deaths due to diabetes occurred before 70 years (American Diabetes Association, 2021). According to the American Diabetes Association (2021), approximately 550,149 people in Alabama, or 14.1% of adults, have been diagnosed with diabetes. An additional 119,000 people in Alabama have diabetes but are unaware, significantly increasing their risk of complications (American Diabetes Association, 2021).
Purpose: The DNP project aimed to identify whether implementing Chronic Care Management (CCM) for T2DM patients in rural areas would help reduce the participants' hemoglobin A1C. Diabetes is an increased concern for rural communities compared to urban communities because of risk factors prevalent in rural communities and access to various services. These risk factors include obesity, physical inactivity, poor diet, older age, and lack of access to healthcare. Statistics show that in rural areas there are fewer healthcare providers, higher rates of uninsured, and fewer transportation options (Rural Health Information Hub, 2020).
Methods: Chronic Care Management developed by the Centers for Medicare and Medicaid Services was utilized. As part of the patient's standard treatment, hemoglobin AlC levels are drawn every three months on diabetic patients. The intervention was monthly phone calls for three months with qualifying patients. To qualify, patients must have Medicare and/or Medicaid and at least 2 chronic conditions. Topics of discussion included blood glucose readings from home and medication reconciliation. The goal was that the participants' AlC levels show a 1% or greater improvement when redrawn at three months, decreasing the likelihood of experiencing or worsening type 2 diabetes complications.
Results: To test the hypothesis that CCM had no effect on A1C, against the idea that CCM improved A1C, a paired t-test was performed to account for the matched-pairs of data. At the 0.05 level of significance, the results indicate that a mean difference exists between the A1C values before and after participation in CCM (t =4.52, df = 29, p <0.001). This implies that CCM is effective in significantly reducing A1C values for patients with Type 2 diabetes.
Conclusion: Management of chronic conditions in family practice is essential. The DNP project proved that extensive monitoring and management of type 2 diabetes results in improved patient outcomes. The project also displayed that the majority of T2DM patients also carry a diagnosis of hypertension, or other chronic conditions. Sustained, tedious monitoring of patients with chronic conditions can aid in preventing major complications. Ongoing implication of CCM displays the foundations of nursing such as promoting health and wellness, preventing illness, and restoring health (Cruz, n.d.).
Recommended Citation
Kelley, Joni, "Use of Evidence-Based Telehealth to Reduce Complications in Adults with Type 2 Diabetes in a Rural Health Facility" (2023). Doctor of Nursing Practice Projects. 89.
https://digitalcommons.jsu.edu/etds_nursing/89