Addressing Uncontrolled Diabetes in Primary Care: A Lifestyle Redesign Approach
Beth Pyatak PhD, OTR/L, CDCES, FAOTA
Co-Investigator: Stacey Schepens Niemiec PhD, OTR/L, DipACLM
July 2017 to December 2018 | Total funding $74,375
Keck School of Medicine of USC / Southern California Clinical Translational Science Institute (SC CTSI) (UL1TR001855) $74,375
This study is examining the feasibility of implementing an occupational therapy intervention addressing diabetes management in a primary care clinic within the Los Angeles County Department of Health Services (LAC-DHS), as well as the impact of this intervention approach on clinical outcomes, efficiency and patient-centeredness of care. This implementation science study is evaluating two emerging trends in healthcare delivery: (1) the integration of nontraditional providers into primary care medical home (PCMH) settings to facilitate the delivery of high-quality, comprehensive primary care while reducing the burden on physicians; and (2) the potential value of using occupational therapists to address chronic disease management in this setting.
Approximately 140 participants with diabetes aged 18-75 years whose most recent HbA1c level is >9.0% are randomized to either the LR intervention condition or a matched no-contact comparison group. The intervention includes approximately 8 one-hour OT sessions over 4 months. To assess implementation and service evaluation, we are conducting interviews and surveys with DHS staff and participants, as well as evaluating treatment notes, observing OT sessions, and review the referral process. To evaluate the intervention’s impact on health and quality of life outcomes, we are collecting electronic medical record (EMR) data on HbA1c and depressive symptoms, and administering brief, clinically relevant self-report surveys on diabetes self-care, general health, and quality of life.
Working collaboratively with DHS investigators from primary care and occupational therapy, this study will lay the foundation for implementing an effective, scalable, and cost-effective service throughout LAC-DHS primary care settings that has the potential to improve the quality, efficiency, and patient-centeredness of care system-wide.