Diabetes is the 6th leading cause of death in South gestational diabetes and patients out of 15 mile radius. 305.11), 409 had a type of diabetes (250 …
SMOKING and DIABETES in Newberry County
Nathalie Maitre Lovelace Family Practice August 2000
Smoking and Diabetes: what is the connection?
Smoking is considered a major risk factor for worsened control and increased complications in diabetics heart disease, stroke, peripheral vascular disease, renal disease, neonatal morbidity and mortality Goldman, Cecil Textbook of
Medicine, 21st ed 2000
Smoking and Diabetes: Impact on Newberry County
Diabetes is the 6th leading cause of death in South Carolina and resulted in 57 million in hospital charges in Newberry County in 1997 SC DHEC Report,
1998
Smoking causes more deaths than AIDS, alcohol, automobile accidents, drugs, fires, homicide and suicide combined JAMA, 1993 In Newberry County, 233 of diabetics were reported as current smokers This means smoking is more common in diabetics than is hypertension 202 SC DHEC Report, 1998
AIMS
Improve awareness of smoking issues in diabetics by at least 80 in participants that conclude two sessions Achieve a 50 rate of interest in smoking cessation
MEASURES
Identification of the patient population at LFM targeted by this program Outreach to targeted population Two 30-minute educational
sessions on risks of smoking in diabetic patients and resources for smoking cessation Two questionnaires on material covered in sessions and on desire to quit smoking
PDSA cycle 1: Identify the concerned population
Plan: select patients at LFM for 1 current patients 2 diabetics type I and II 3 smokers 4 Newberry area Do : Found codes for tobacco abuse, tobacco use, all types of diabetes Defined current patients as seen within last year with pulse rate 0 Eliminated gestational diabetes and patients out of 15 mile radius
PDSA cycle 1: Identify the concerned population
LFM patients 8/15/99 to 8/15/00
Diabetic smokers 1 Diabetes Type 1 or 2 only 6 Tobacco use/abuse only 8 Other patients 85
Study: 5562 patients were seen at LFM last year 522 were reported as having a problem with tobacco codes 3051 and 30511, 409 had a type of diabetes 250 codes 147 of diabetic patients in the last year were diagnosed as having a problem with tobacco
PDSA cycle 1: Identify the concerned population
Act: Call the 60 patients who were coded for both diabetes and tobacco abuse and inform them about the smoking cessation program
PDSA cycle 2: Outreach
Plan: call all patients selected in Cycle 1 as
diabetic smokers and ask them to attend evening sessions on smoking cessation and special risks of diabetic patients Do :generate phone list and call all patients If No response try at least three different times during the day Record responses
PDSA cycle 2: Outreach
Study :
Diabetic smokers at LFM: phone responses
Dead or not a patient 17 10 No response 38 23
Agree to come 28 17 Refuse to quit 17 10
PDSA cycle 2: Outreach
Act: Prepare two instructional sessions with presentations as well as questionnaires to educate the patients who said they would attend
PDSA cycle 3: Diabetes and smoking education
Plan: Educate all patients attending on the impact of smoking in diabetics and assess their desire to quit Do :Have patients fill out a pre and post session questionnaire on the impact of smoking on diabetes, hold a 15 minute powerpoint presentation, have a 10 minute question and answer session
PDSA cycle 3: Diabetes and smoking education
Study
Session 1 attendance
Present 29 correct responses
120
Educational goals for session 1
100
P 004
80
60
o-shows 71
40
20
100 patients want to quit 100 patients want help quitting
0
pre-session
post-session
29 improvement
PDSA
cycle 3: Diabetes and smoking education
Act: Encourage patients to attend session 2 to build on their knowledge and to educate them about smoking cessation
PDSA cycle 4: Smoking cessation education
Plan: Educate all patients attending on the impact of smoking cessation and methods to quit smoking Do :Have patients fill out a pre and post session questionnaire on the impact of smoking cessation, hold a 15 minute powerpoint presentation, have a 10 minute question and answer session
PDSA cycle 4: Smoking cessation
Session 2 attendance
70
Educational goals for session 2
71
Present 29
correct responses
o-shows
50
p 0001
30
10 0
233 improvement
pre-session
post-session
PDSA cycle 4: Smoking cessation
Study
of packs smoked per day
18 16 14 12 1 08 06 04 02 0
Intent to quit after session 2
P 0001 Intent to decrease by 545
now
intent in two weeks
PDSA cycle 4: Smoking cessation
Act: Patients have met aims for both improved education and desire to quit The next steps would be to
1 Expand the outreach to the patients with no response 2 Correct the database and code patients who smoke 3 Repeat this program in the corrected database 4 Follow up on the number of
smoking cessation appointments
FINAL COMMENTS
There is a vast difference between a patients intent to quit and there actual course of action A direct approach to contacting patients works better than general advertising in the community The literature suggested that diabetic patients are motivated to smoke and are better educated about the consequences of smoking This was found to be true in Newberry county The aims were achievable in this particular population
Source:musc.edu
