La Clinica de La Raza
Project Director: Joan Thompson, RD, CDE
Project Coordinator: Carlos Flores
Preventive Medicine Department
1515 Fruitvale Avenue
Oakland, CA 94601
jthompson@laclinica.org
www.laclinica.org
The Advancing Diabetes Self management (ADSM) program at
La Clinica de La Raza targets Spanish-speaking
adults with type
2 diabetes who reside in Oakland, CA, and are patients at La Clinica’s Fruitvale and San Antonio clinics. Eighty-five
percent of
the patient population have family incomes at or below 150
percent of the federal poverty level, and the majority are either uninsured or enrolled in MediCal.
These patients often have
difficulties gaining and maintaining control over their diabetes
through the traditional health care system, so innovative
approaches are required.
The goal of the ADSM project is to improve health outcomes for
patients with diabetes by helping them successfully manage their
condition. The project uses a multifaceted approach to improve
diabetes self management based on the Transtheoretical Model of Change (TTM), a theoretical model of behavior change. It
incorporates two elements missing from the standard medical
model of care: involvement of the patient’s community through
peer support and patient-centered
counseling. Providers at
La Clinica are trained in TTM principles and use them in their
clinical practices.
Patients are referred to the project by their primary care provider.
They then attend an orientation meeting facilitated by a
promotora, who provides support throughout the patient’s
involvement in the project. In addition, patients are invited to classes and groups designed to teach self management skills.
Patients who are also diagnosed with depression may attend
special support groups that are facilitated by a mental health professional and tailored for people who have both depression
and diabetes.
Despite a variety of challenges, the Fruitvale and San Antonio
neighborhoods are vibrant, lively communities where residents
are actively involved in improving their surroundings and their
lives. Through its use of TTM and empathetic promotoras,
La Clinica’s ADSM program builds on this spirit and empowers
its patients to effectively manage their diabetes – one patient at a
time.
Summary
Key
Interventions
- Diabetes education classes
- Groups for people with different needs:
- "Circle of Friends” support group
- Meditation/ stress reduction group
- Cognitive behavioral therapy group for people with
depression and diabetes
- Walking club
- Family home visits
- One-on-one interaction with promotoras
- Patient-centered
staging and counseling based on the
Transtheoretical Model of Change
- Quarterly promotora-provider
case conferences
Key Accomplishments
- Implemented a theoretically framed program and
intervention activities
- Developed materials for providers that aid in assessing
patients’ readiness to change
- Trained and successfully integrated promotoras into the
primary care team
- Trained promotoras to work with patients on self
management plans
Lessons Learned
- Providers can gain greater understanding of patients' needs
and barriers to treatment adherence though working as a
team with promotoras
- Promotoras can successfully stage patients using the TTM
and use their patient's stage to intervene appropriately
- Working with promotoras in a patient-centered
program
improves patient outcomes when compared with care as
usual
- Promotoras can be trained to recognize and triage depression
and to participate in mental health interventions
Grantee Presentations
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