OT-Led Interdisciplinary Diabetes Self-Management Prgm

Effective interventions to support patients' diabetes management are urgently needed to curtail the growing financial and human cost of diabetes. However, sustainable solutions to this health challenge have been elusive due to the intrinsic and extrinsic barriers patients face when attempting to incorporate necessary health behaviors into their daily routines (e.g., dietary changes, physical activity, medication management, blood glucose monitoring, and stress management). The focus of occupational therapy (OT) is to work with patients within the context of their daily lives. OTs identify current patient roles (work, family, community), habits, and routines, then work with the patient to identify and address barriers to diabetes self-management within these aspects of their daily lives. Within OT, an intervention approach informed by Lifestyle Redesign (LR) has been shown to be effective at improving diabetes-related health outcomes among people with diabetes. This study proposes to introduce an OT- led diabetes intervention program into an outpatient OT clinic. The intervention is an interdisciplinary team approach as the intervention is informed and monitored by the interdisciplinary team members, who are part of the planning process, and who will participate in regular review of the intervention and the patient needs. With OT leading the team to address barriers to lifestyle modification, the primary care medical team will continue to oversee the overall health care of the patient. The OT will communicate regularly with the primary care team.

OTs with training in diabetes education will deliver the intervention to patients in the study within the course of their typical work day at the OT clinic. Treatment activities and materials will be delivered in English or Spanish, per patient preference as one of the OT interventionists is fluent in Spanish. Patients receiving OT services for development of diabetes self-management skills will be seen for approximately 8 forty five-minute to one-hour sessions over 6 months. OT notes will be maintained within the Electronic Health Record (EHR) as is standard practice at this clinic; the therapist will communicate with other interdisciplinary care team members using EHR messaging, phone calls, and in-person communication as needed. There will be at minimum a monthly consult meeting with a doctor of psychology (Psy D), registered dietitian (RD), social worker (SW), and pharmacist (PharmD), and the primary care medical team will be provided with monthly progress notes.

The intervention will be offered in a one-on-one direct therapy format. The intervention will focus on lifestyle modification strategies that will improve the patient's diabetes self-management skills. The intervention is organized into five modules that address:

• living with diabetes,
• strategies to communicate with healthcare providers to ensure patient needs are met,
• analyzing and modifying patient habits and routines to determine what changes they must make to manage their diabetes,
• identify and use social supports to help manage diabetes
• strategies to reduce stress and depression, improve emotional well-being, and minimize risk of diabetes burn-out (patient frustration with living with the disease)

Each patient receives an individually tailored combination of modules, and treatment activities within each module as established through collaborative goal setting between the patient and OT during the initial evaluation.

The investigators will analyze outcomes using descriptive analytics and paired t-tests to test our hypotheses. The investigators will collect EHR data on HbA1c and compare pre/post measures of the clinically relevant self-report surveys on diabetes self care, and barriers to self-care and management (Diabetes Empowerment Scale, Medication Adherence Assessment Scale, and the Canadian Occupational Performance Measure), physical, mental, and social health (Patient-Reported Outcomes Measurement Information System® PROMIS-29). Changes in HbA1c levels will be tracked by obtaining recent levels from the patient's primary care team. With patients referred to the OT intervention who have not had an HbA1c within ≤4 weeks of the initial referral date, the OT will consult with the primary care physician and determine if an HbA1c level can be obtained as a part of their normal care. The investigators will collect EHR data on follow-up HbA1c testing scores that are available within 12 weeks of the 8th OT visit and self-report surveys the day of 8th OT visit. If a patient has completed the full intervention, the study staff will follow-up biweekly for no more than 3 months after their initial visit, and attempt to collect self-report data up to 6 months after the final visit to determine the sustainability of outcomes.