“National Health Service Corps Providers Working to Prevent Diabetes in Their Communities”
Diabetes Mellitus is a chronic, debilitating disease which affects every organ system, and is the 7th leading cause of death in the United States. Diabetes affects nearly 26 million people, and another 79 million people are at increased risk for developing this condition. The National Health Service Corps (NHSC) helps to build healthy communities by supporting health care providers working in areas of the United States with limited access to care. The NHSC participants detailed in this spotlight have chosen to focus on the prevention and treatment of diabetes in their communities.
Since its creation in 1972, the National Health Service Corps has provided support for more than 40,000 primary care medical, dental, and mental and behavioral health professionals. Today, there are more than 10,000 NHSC members who provide culturally competent care to more than 10.5 million people. This care is provided at one of the more than 17,000 NHSC-approved health care sites in urban, rural, and frontier areas.
The NHSC awards scholarships and loan repayment to primary care providers in NHSC-eligible disciplines. NHSC providers, in turn, commit to serving for at least two years at an NHSC-approved site located in a Health Professional Shortage Area (HPSA). Many choose to continue serving at their sites beyond the initial NHSC service commitment. In addition to providing quality primary care, many of the NHSC members are leaders in their communities, working to address health issues prevalent among the population they serve.
The Centers for Disease Control and Prevention estimates that diabetes affects nearly 26 million people in the United States, and that another 79 million people are at an increased risk for developing this condition. Diabetes Mellitus is a chronic, debilitating disease affecting every organ system and is the 7th leading cause of death in the United States. Type 1 diabetes is an autoimmune disease which usually strikes children and young adults.
Diabetes is a lifelong disease for which there is not yet a cure, and which can lead to serious complications such as blindness, kidney disease, and nerve damage. It is critical for diabetics to regulate their blood glucose in order to lower the risk of long-term diabetes complications.
The U.S. Department of Health and Human Services has provided more than $500 million under the Recovery Act for programs across the Department to increase research into the causes and treatments of diabetes, invest in health information technology that can lead to better and more efficient care, support prevention and wellness strategies, and increase access to health care.
Kyla Simpson, an athlete and gardener, is committed to slowing the rate of childhood obesity by educating pediatric patients and their families about healthy eating and exercise. She is a family practice physician assistant who received an NHSC loan repayment award in 2009. Ms. Simpson works at the Petaluma Health Center (PHC), a Federally Qualified Health Center in Sonoma County, CA. Her passion for youth wellness was ignited during her graduate studies, where she started an after school nutrition and exercise education program for elementary school students. She brought this experience to her current job where she initiated and now directs the Petaluma Loves Active Youth (P.L.A.Y.) program, a wellness program for overweight and obese pediatric patients. She runs the program based on the principle of Hippocrates, the Father of Western Medicine: “Let your food be your medicine and your medicine be your food”!
Realizing that children were among those most affected by diabetes and obesity, PLAY coordinators sought to establish creative ways to teach children about healthy eating and exercise to ward off these health problems. In fact, one in three of the Clinic’s pediatric patients had a Body Mass Index (BMI) in either the overweight (19.37%) or obese (22%) range. Patients who are at risk of developing diabetes are identified by their medical provider during a regular visit, and are then referred to participate in the PLAY program. These patient’s charts are flagged in the Clinic’s electronic health record system as being referred to the PLAY program, and can be tracked for follow-up purposes. PLAY began as a series of optional, weekly sessions where participants were taught about healthy eating practices and physical activity. The program also took the innovative approach of devoting portions of each session to group physical activities (e.g. hip hop dancing, zumba, plyometrics).
Recent funding support from the Kaiser Foundation has allowed the Center to evolve PLAY into a 12 week long longitudinal program. Now, families that choose to participate are divided into different groups and are required to attend each of the weekly sessions and Petaluma has collaborated with a community partner to administer the new program. Petaluma Bounty - a local organic farm whose mission is to provide food to the underserved - provides each family with a box of organic vegetables every week, in addition to nutrition education and cooking demonstrations. Families in the PLAY program now receive 6 weeks of educational sessions at the Clinic, followed by 6 weeks of program activities at the Farm. Boxes of organic food are provided for the entire duration of the 12 week program.
Petaluma is planning an evaluation of the program, which will include collecting BMI and vital signs data. A series of focus groups will also be performed to determine how attitudes towards healthy eating have changed. A PLAY survey document is shown below.
Rita Meadows is a nurse practitioner at Georgetown Medical Associates in Sussex County, Delaware and has been a NHSC program participant since 2010. She came to her NHSC practice site with a passion for diabetes management because her daughter is a Type 1 diabetic. With support from her collaborating physician, she conducts group and individual weight management sessions for pre-diabetic and obese patients. In a community that has limited access to primary care, Mrs. Meadows and her collaborating physician are trying creative ways to see more patients and improve quality of life in their community. Their busy practice has about 11,000 visits per year.
One of the most rewarding aspects of Mrs. Meadows’ work is that she gets to treat the whole family, from child to grandparent in some instances. She conducts both group and individual weight management sessions for both pre-diabetic and diabetic patients. She's found these group sessions influential in preventing the onset of diabetes and improving patient outcomes. Patients really value these sessions since most insurance companies will not cover nutritionist services for those at risk of diabetes but without a formal diagnosis.
Mrs. Meadows’ insight into insurance coverage options and medication assistance programs are valuable in ensuring that patients have the tools they need to be successful. "Being creative and knowledgeable of the resources available for diabetic patients is essential when more than 60% of your patient population is comprised of Medicare, Medicaid and uninsured patients," she explains. There may be resources available for the treatment of diabetes that many providers might not be familiar with. Rita One of Mrs. Meadow’s patients just received a new, updated insulin pump which was covered under her insurance. This pump allows more precise insulin delivery which have led to major improvements in glucose levels, has affecting both overall energy and well-being.
Mrs. Meadow’s success is demonstrated through multiple patient stories, including a 9-year old girl who went from being obese (with a BMI of 44) with high cholesterol and pre-diabetic in 2009 to a very healthy 11-year old today (BMI of 22). This outcome was a result of Mrs. Meadows' work with the girl and her family to provide nutritional counseling and to help develop an interest in physical activities through a camp experience. At the end of the program, the patient vowed to become a nutritionist when she grew up. One year later, she worked with her 18 year old brother (who was obese) and helped him to achieve a normal BMI.
Outside of her clinical work, she is an avid volunteer and advocate for diabetes research and advocacy organizations. She's a frequent medical staff volunteer with diabetic youth camps and is a Board Member for the Juvenile Diabetes Research Foundation (JDRF), acting as a JDRF Government Advocacy Leader for the State of Delaware. In this role, she connects the diabetic families in Delaware with members of Congress and meets with Senators and Representatives on their behalf.
Please visit www.nhsc.hrsa.gov or call 1-800-221-9393. for more information on the NHSC.
Please email Ms. Kyla Simpson at email@example.com for more information on the PLAY program.
Please email Mrs. Rita Meadows at firstname.lastname@example.org for more information on her work.