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Public Health - PERI MODEL - Schulte & Everhard

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Luke Schulte

on 26 April 2013

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Transcript of Public Health - PERI MODEL - Schulte & Everhard

PERI MODEL Type II Diabetes in Persons Ages 45-64 in Mississippi Problem Etiology Recommendations Implementation Diabetes means your blood glucose, or blood sugar, is too high.

Type 2 diabetes is more common than Type 1 (genetic) diabetes.

In type 2 diabetes ones body does not make or use insulin well.
- Insulin is a hormone that helps glucose absorption into cells
to give them energy.
- Without insulin, too much glucose stays in your blood. Over
time, high blood glucose can lead to serious problems with
your heart, eyes, kidneys, gums and teeth, and nerves. In Mississippi
- Rate: 17,200 per 100,000 persons
- Rate: 12,200 per 100,000 persons Source: (Henry J. Kaiser Family Foundation, 2012) Diabetes in Persons Age 45-64 Prevalence Source: (Mayo Staff, 2013) Incidence In Mississippi
- Rate: 18,410 per 100,000 persons
- Rate: 13,500 per 100,000 persons National Source: (Center for Disease Control and Prevention, Incidence of Diagnosed Diabetes per 1,000 Population Aged 18–79 Years, by Age, United States, 1980–2010, 2012)
Mississippi Source: (Centers for Disease Control and Prevention, 2012) Mortality In Mississippi
- Rate: 29 per 100,000 persons
- Rate: 20 per 100,000 persons Sources: (Foundation, 2012) Source: (Center for Disease Control and Prevention, National Diabetes Fact Sheet, 2011, 2011) Morbidity There is a lack of data of the rates of risk factors pertaining to this age group. However, risk factors include heart disease, stroke, hypertension, blindness, kidney disease, nerve damage, and extremity amputations Hello Previous Recommendations #1: Pharmacist-led diabetes management program in Jackson, Mississippi
- Control glucose levels by managing medications

- Watch patients 24 hours/day
- Diabetes education and diet management
- Revise insulin protocols in hospitals

Did it work?
- After taking blood glucose readings each month, the pharmacists looked for
readings above 200 mg/dL, which decreased over time.

Source: (Warrington, Laurie, & et al., 2012) New Recommendations Recommendation #1: Workforce Insurance Decrease Policy
- Physical activity plays a large role in controlling weight,
which also plays a role in diabetes.
- In order to increase physical activity, employees would
be required to log in 30 minutes of exercise 3 times per
week for a work-based health insurance incentive.
- If they log in this time, their premiums would decrease by
8% and employers will pay for your use of a fitness center.
Discontinuation of the exercise will cause the loss of the

Overall, if premiums decrease, insurance costs decrease for those without insurance as well, which helps the entire population. Recommendation #2: Annual Screening for Prediabetes
Currently, the ADA Screening Guidelines for Prediabetes and Diabetes in Medical Setting indicates that patients should be screened given both of these conditions.

For Persons Age >45,
If BMI is ≥ 25 kg/m^2 AND they meet one of the following risk factors below:
- Physical Inactivity
- Family History of Diabetes
- High Risk Ethnic Group
- Delivered Baby Weight > 9 lbs
- Hypertension
- High Cholesterol
- Previously Impaired Glucose Tolerance
- Polycystic Ovary Syndrome In a prediabetic state:
- Individual is more likely to be at a lower weight
- Approximately 23% of American adults are unaware

A good facet to reduce American diabetes would be to screen annually for prediabetes, regardless of criterion.
-Cost of a blood glucose test is from $0.35 - $1.00 for individuals.
- In a clinical setting cost could be even lower.

Thus, screening the entire population in Mississippi due to the higher prevalence of diabetes would be at minimal cost to the population, and would greatly outweigh the costs/risks. #2: Mississippi Diabetes Prevention and Control Program
Prevention of the disease and its complications, promote wellness, increase community level efforts to address the problem, and decrease Mississippi diabetes prevalence rates

- Mini grants given to organizations willing to work with the program to prevent and control the disease
- Keep healthcare providers up-to-date on preventing/managing type 2 diabetes
- Frequent documentation to the burden of disease
- Increase the number of professionals in health care settings with the ability to identify the at-risk diabetic foot and appropriately intervene to prevent complications

Did it work?
- Study is ongoing, however the programs developed in the study have provided services to 372,000 Mississippians with diabetes. The data suggests those involved in the programs services are experiencing significant benefits from the study.

Source: (Health, 2012) Contributory Causes Weight/Obesity
- Adipose (fatty tissue) is known for insulin resistance. Populations of obese people have higher rates of Insulin resistance.

Sedentary Lifestyle
- Physical activity helps to control weight and uses up glucose as energy. This process makes the cells more sensitive to insulin. Family History
- Susceptibility increases if your parent/sibling has type 2 diabetes. This is due to lifestyle risk factors which can have effects on type 2 diabetes
- Risk of type 2 diabetes increases over the age of 45
- Higher than normal blood glucose levels are a precursor for type 2 diabetes
- Almost 30% of U.S. adult population had prediabetes in 2005-6
- Only 7.3% were aware they had prediabetes Contributory Causes - Cont. - Previous insurance incentives are in place and have increased
physical activity. However, these policies do not include the
workforce requirement.

- Employers want healthy workers so they don't have to pay for
them to visit the doctor or find replacement if they are absent

- Insurance premiums and health care is expensive, this would be
good motivation to stay healthy

- Insurance companies are always looking to cut costs. If more
customers are healthy, the less insurance companies have to pay.

- Helps with the uninsured Workforce Policy - Will it work? Pilot Trial (6 months)
- State and School Employees receive benefits for
health insurance through Blue Cross Blue Shield
- Discuss with this company and the Department of
Finance and Administration about the benefits of a
physical activity policy
- Have these companies advertise and begin the policy

Community Stakeholders
- Health and wellness centers
- Insurance companies
- Employers Workforce Policy Works Cited 1.) Bantle, J. P., Wylie-Rosett, J., Albright, A. L., Apovian, C. M., Clark, N. G., Franz, M. J., . . . Wheeler, M. L. (2007). Nutrition Recommendations and Interventions for Diabetes. American Diabetes Association. Retrieved from http://care.diabetesjournals.org/content/30/suppl_1/S48.full

2.) Centers for Disease Control and Prevention. (2011). Diabetes Public Health Resource. US Department of Health & Human Services. Retrieved from http://www.cdc.gov/diabetes/

3.) Centers for Disease Control and Prevention. (2011). National Diabetes Fact Sheet, 2011. Retrieved from Department of Health and Human Services: http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf

4.) Centers for Disease Control and Prevention. (2012, February 14). Incidence of Diagnosed Diabetes per 1,000 Population Aged 18–79 Years, by Age, United States, 1980–2010. Retrieved from Department of Health and Human Services: http://www.cdc.gov/diabetes/statistics/incidence/fig3.htm

5.) Centers for Disease Control and Prevention. (2012, January 7). Incidence of Diagnosed Diabetes per 1,000 Population Aged 18–79 Years, by Age, Mississippi, 2010. Retrieved from Department of Health and Human Services: http://apps.nccd.cdc.gov/DDTSTRS/Data/Modeled%20Incidence.xls

6.) Foundation, H. J. (2012). Mississippi: Diabetes. Retrieved from State Health Facts.org: http://www.statehealthfacts.org/profileind.jsp?cat=2&sub=22&rgn=26

7.) Geiss, L., James, C., Gregg, E., Albright, A., Williamson, D., & Cowie, C. (2010). Diabetes risk reduction behaviors among U.S. adults with prediabetes. American Journal of Preventative Medicine, 403-9. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/20307809

8.) Health, M. S. (2012). Diabetes in Mississippi. Retrieved from http://msdh.ms.gov/msdhsite/_static/43,0,296.htm

9.) Henry J. Kaiser Family Foundation. (2012, February 3). Mississippi: Percentage of Adults with Diagnosed Diabetes by Age Group, 2010. Retrieved from State Health Facts.org: http://www.statehealthfacts.org/profileind.jsp?ind=73&cat=2&rgn=26&cmprgn=1

10.) International Diabetes Federation. (2006). The Diabetes Atlas: Fifth Edition. Retrieved March 7, 2013

11.) Kishore, P. M. (2013). Diabetes mellitus (DM). The Merck Manuals: The Merck Manual for Healthcare Professionals.

12.) Mayo Staff. (2013, January 25). Type 2 diabetes. Retrieved from Mayo Clinic: http://www.mayoclinic.com/health/type-2-diabetes/DS00585

13.) nursingforward. (2013, April 7). Diabetes Mellitus Type 2. YouTube Video. nursingforward.com. Retrieved from

14.) Saydah, S., & Lochner, K. (2010, May-June). Socioeconomic Status and Diabetes Mortality Risk. Public Health Reports, 377-88. Retrieved from http://www.publichealthreports.org/Documents/Aug31-2010.pdf

15.) Warrington, Laurie, & et al. (2012). Implementation of a pharmacist-led, multidisciplinary diabetes management team. American Journal of Health-System Pharmacy, 1240-45. Retrieved from http://www.ajhp.org.ezp1.lib.umn.edu/content/69/14/1240

16.) Weyer, Christian, & al, e. (2001). Hypoadiponectinemia in Obesity and Type 2 Diabetes: Close Association with Insulin Resistance and Hyperinsulinemia. The Journal of Clinical Endocrinology & Metabolism, 1930-35. Retrieved from http://jcem.endojournals.org.ezp2.lib.umn.edu/content/86/5/1930.short Rinse and Repeat!

The world is constantly in need of improvement. Annual Screening for Prediabetes Policy Formation:
1.) Speak to Mississippi Governor Phil Bryant, or a rep to talk about a state implemented health policy of annual prediabetes screening.

2.) Lobby the state government to approve the health care budget to include prediabetes screening, so it available to all of Mississippi’s citizens at their annual checkup.

3.) Effectively advertise to the targeted population.
- Targeting the counties with the highest prevalence of diabetes.

Community Stakeholders
Numerous non-profit organizations support diabetes assistance
- Cure 4 Diabetes
- Diabetes Center
- Diabetes Research Foundation
- Diabetes Research and Wellness Foundation
- Etc. Schulte & Everhard Workforce Policy - Cont. Data
- Insurance policies record how many people have
used this incentive based on the workforce
- Health and wellness centers record new members
and increase of activity
- We would distribute and collect a survey on
motivation and benefits of physical activity (weight
loss, more energy, less fear of disease, etc.)

After Trial:
- Look for an increase in insurance policies through the
state or school system
- Look for an increase in the use of wellness centers
- Implement throughout state if successful Sources:
(Center for Disease Control & Prevention, 2011)
(Geiss, et al., 2010) Analyzing Effectiveness

The best method for analyzing effectiveness would be a cohort study:
- A 5 year long cohort study would follow patients ages 45-64
- During their annual checkup blood glucose levels would be analyzed
- Doctors would educate individuals whom are found to be prediabetic, and warn them of future complications w/o lifestyle changes
- If effective average blood glucose levels of all subjects should decrease toward the healthy direction.
- Data could be effectively analyzed by a the CDC
- They have already established methods for getting medical information from health care systems, w/o breaching doctor-patient confidentiality. Annual Screening for Prediabetes - Cont. Source: (nursingforward, 2013) Background Image Source: CorpoETreino. 2009.
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