Advancing Diabetes Self Management
Gateway Community Health Center, Inc.

Project Director: Lucy Garcia, BSN
Project Coordinator: Lourdes Rangel

1515 Pappas Street
Laredo, TX 78041

lulur.gateway@tachc.org
www.gatewaychc.com

Gateway Community Health Center (GCHC) is a federally
qualified health center located on the U.S. Mexico border in Laredo, TX, that serves residents of Webb County. More than 95 percent of the county’s residents are Hispanic, and more than one-third fall below the federal poverty level. Among patients served by GCHC, nearly two-thirds are uninsured and 23 percent qualify for Medicaid. Approximately 16 percent of the adult patients at GCHC have diabetes.

Patients served by GGHC who have type 2 diabetes are the target population for the Advancing Diabetes Self Management project. The project goal was to build an infrastructure and methodology to assist patients with diabetes in controlling their
blood sugar levels over an extended period of time by implementing and integrating diabetes self management programs and services in a culturally sensitive manner.

As a result of ongoing quality improvement efforts, GCHC found several components to be integral to their diabetes self management system of care: provider use of self management principles; an infrastructure that supports patient input yet provides some choices regarding care; a system of referral, follow up, feedback, and documentation that produces integrated and consistently high quality self management clinical practice; a system that recognizes and manages chronic illness related depression; and a community-based, culturally-sensitive approach.

A critical component of GCHC’s comprehensive approach involves the integration of promotoras (community health workers) into the care of patients with diabetes. Promotora-led interventions include a 10-week diabetes self management course tailored for the target audience, a subsequent 10-week support group that meets on a biweekly basis, and weekly phone follow up and support. Knowledge and skills related to blood glucose monitoring, medication management, physical activity, healthy eating and healthy coping are taught by promotoras in the self management course. Goal setting and problem solving are practiced at each class and during the support groups that follow. Weekly telephone calls from the promotoras reinforce problem solving strategies and help keep participants motivated.

The program infrastructure supports and reinforces these interventions. There are appropriate job descriptions, extensive competency and skills training, performance monitoring and supervision for promotoras. Policies and procedures ensure coordination of patient care, and monthly promotoras provider conferences include discussion of patient self management issues. Assessment of patient behavior, collaborative goal setting, goal follow up, goal revision, and problem solving to overcome barriers occur during all patient interactions (physician, promotora, and certified diabetes educator visits). Finally, the Patient Electronic Care System is used to collect and manage self management processes and outcomes.

By incorporating patient feedback and striving for quality, the Advancing Diabetes Self management program is helping GCHC achieve its mission: “To improve the health status of the people in Webb County and surrounding areas by providing high quality medical and dental care, health promotion and disease prevention services in a professional, personal, and cost effective manner.”

Summary

Key Interventions

• 10-week promotora-led diabetes self management course that includes depression screening, referral and follow up promotora-led support groups
• Standard protocols for promotora follow up and support, including weekly phone calls to participants for problem-solving and support

Key Accomplishments

• Integrated promotora-led self management interventions into clinic protocols and usual systems of care for people with chronic conditions
• Developed a culturally-competent diabetes self management education curriculum that also addresses cardiovascular disease and depression
• Became certified by the State of Texas Health Department as a Certified Center for Health Promoters; developed curricula and increased spread of training workshops for promotora

Lessons Learned

• A comprehensive system of care and a team approach are essential for successful program outcomes
• Integrating a self management program into a primary care system results in high quality diabetes care
• Integrating promotoras into a healthcare delivery system results in more comprehensive services and better outcomes

Grantee Presentations

• The Road to Effective Patient Self Management: The Role of Lay Health Workers in Managing Diabetes (8/2007)
• Comprehensive System of Care for Patients with Diabetes (10/2006)
• The Role of the Promotora in a Comprehensive System of Care (8/2006)
• Enhancement of Promotora-Led Self-Management Class Improves Sustained Metabolic Control (8/2005)
• Improving Diabetes Self Management Education in Community Health Centers by Incorporating Promotores in the Health Care Team (5/2005)
• Benefit-to-Cost Analysis and Program Effectiveness Evaluation of the Gateway Diabetes Self Management Project (3/2005)
• Gateway Community Health Center Program Overview (8/2003)