The importance of diabetes control and the means to achieve it are well understood. However, it is often elusive especially for patients with poor access to multidisciplinary diabetes care because of finances or language. To improve care for these patients, we have developed the Diabetes Management Programs (DMP). The DMP makes it possible for existing personnel in a Free Medical Clinic to counsel patients on self-care behavior issues usually managed only by multidisciplinary teams who specialize in diabetes care. The proposed project will refine and provide preliminary testing for the DMP and methods for implementing it in a Free Medical Clinic. The DMP consists of two computer programs. One supports a nurse with the management of patient self-care behaviors. This program administers to the patient a questionnaire in English or Spanish about self-care behaviors and barriers to these behaviors, summarizes key results from the questionnaire, presents brief recommendations to address the barriers, and identifies and prints relevant education sheets. The nurse helps motivate the patient to make the recommended behavior changes. The second program summarizes clinical information from the medical record so that the physician can use it more easily. Over a six-month period we will recruit 12 patients in a Free Medical clinic. Half of these patients will be Latinos who prefer to speak Spanish. A nurse or nurse's aide will use output from the DMP to help the patients improve their self-care behaviors. The nurse will also enter the medical record information into the second DMP program to create a clinical summary for the physician. Patients will receive the intervention for six months. Physicians, nurses, and patients will assess the feasibility and effectiveness of the DMP and contextual factors (facilitators and barriers) that modify the effectiveness. We will also measure changes in clinical parameters (HbA1c level, weight, and lipid levels) after implementing the program. If the DMP appears to be feasible to implement and likely to help with the care of both Spanish and English speaking patients, the next step will be to modify the program as necessary and test it on a larger scale. Project Narrative: A patient's self-care behaviors greatly influence diabetes control. However, there are inadequate resources for assisting vulnerable patient populations with these behaviors. To address this problem, we developed an intervention to help manage self-care behaviors of both English and Spanish speaking patients when diabetes specialists are not accessible. The proposed study will provided information about the potential value of this computer program and what additional adaptations are needed for a Free Medical Clinic.
