Ending Type 2 Diabetes One Exercise, Nutrition, and Gardening Class at a Time

Posts Tagged ‘OGTT’

OGTT Sketch

In OGTT Screening on February 10, 2012 at 11:18 AM

Some drink the Glucola solemnly, obediently. It’s unclear whether they know the full extent to which we are testing their health status this morning. Others seem somewhat nervous, and still others chat away cheerfully until their name is called for the needle and flat orange sugar drink event.

The kids are restless, sucking on the backs of chairs as they watch the phlebotomy, or any sign of movement in the room.

The best is the tough guy with the mohawk. His name is called and he stays sitting, in a sheepish stand-off with the clinician’s assistant. And then, as he eventually pulls his tee shirt up over his tattooed forearm, he describes how much he hates needles.

Amazing how for style or nostalgia, an inked needle is welcome! And for an oral glucose tolerance test, it is so thoroughly resisted.

And yet resistant or not, bored or cheerful, nervous or curious, the 21 adults and their families present today will leave here with knowledge of diabetes, their risk, and some implementable-tools for improving the quality of their health. Cheers to them!

Tatoo!

OGTT!

Not Giving Up, Even After 4 No-Shows

In Intensive Lifestyle Intervention - General on February 22, 2011 at 2:46 PM

I couldn’t figure out why all the intake equipment was set up in the conference room. It was a typical day in the Diabetes Prevention Program; soup being served that raises funds for the garden, administrators talking to Yale about the joint child-obesity program, patients calling throughout. Intakes usually take place before the start of a new Intensive Lifestyle Intervention, when the program needs to be filled with those whose results from OGTT screenings placed them in the category called prediabetic. We were six weeks into our twelve-week program, however. Hardly the time to begin filling the next program.

Mari flies in the office door, her scrubs swishing against a busting notebook. She mumbles to herself, ‘She’s not here!’

I couldn’t help but ask.

‘It’s the intake I had scheduled. This patient isn’t here…again.’

‘Again?’

‘She’s been scheduled four times.’

Mari picked up the phone with resolve. She plays with the patient, in a stern voice informing her of the missed appointment, and then laughing with compassion as the patient realizes her folly on the other end of the line. When they get off the phone, I ask how they decided to resolve the patient’s continued absence.

‘I’m going over to her house to do the intake.’ Mari exclaims proudly, like a woman who’s taken fate by the horns.

I couldn’t help wondering why – with 15,000 patients at FHCHC, how has this particular patient instigated a home visit? And what is Mari’s motivation for persisting?

‘It’s hard.’ She explained. ‘Weather, wrong numbers, messages left without call-backs. It’s difficult to generate participation. So when someone is interested and simply can’t get here, I’ll take an extra step.’

Why OGTT Screenings Should Not Take Place Between the 1st and 5th Days of any Month

In OGTT Screening on December 9, 2010 at 5:32 PM

This past Saturday, 36 patients were scheduled to attend our OGTT screening. As per the usual protocol, our DPP staff called people at risk for diabetes weeks in advance. The head DPP provider also called to confirm their attendance a few days before the screening. Despite repeated efforts to ensure a full house, only 17 patients were in their chairs that December 4th morning.

As is the DPP’s custom, the lead provider took a few minutes at the close of the screening to consider what worked and didn’t work. She directed her attention to the attendance. While most of the DPP staff were perplexed, the clinic’s social worker was incredulous.

“Today is December 4th! What did you expect?”

Silence. No one understood what the social worker was getting at.

She sighed and made another attempt to explain, “It’s when everyone gets their checks.”

In Connecticut, state aid, including SNAP and other entitlements, is distributed on the first day of every month. Federal aid, SSI, arrives on the third. By then, the social worker continued to expound, people’s pantries, bank accounts, and access to credit, have dried up. It is on the first Saturday of the month, after their checks have arrived and the work week has slowed down, that many Fair Haven residents go grocery shopping, and run around town paying their light, electricity, phone bills.

“Not to mention, November was a 5-week month. Extra long, and extra hard.”

Needless to say, we won’t be scheduling OGTT screenings on the first Saturday of the month moving forward.

 

FHCHC DPP OGTT Screening Follow-Up

In OGTT Screening on December 8, 2010 at 3:50 PM

The following checklist takes the reader through a step-by-step process of completing the group OGTT screening.

 

FHCHC DPP OGTT Billing Spreadsheet

In OGTT Screening on December 8, 2010 at 1:06 PM

The FHCHC Diabete Prevention Program maintains spreadsheets for all data to ensure research accuracy. This spreadsheet chronicles the relevant patient, billing, and insulin numbers for all OGTT screening attendees.

For a look at the whole billing flow, click here.

Are You There? 2 Solutions for a Common OGTT Recruitment Breakdown

In OGTT Screening on November 9, 2010 at 4:23 PM

It’s been two weeks and Eva is making her third attempt to reach Sandra. Referred by her provider to get screened, Eva sits looking dejected in front of the referral note (click here for the OGTT recruitment write-up script).

Out of 20 referrals, Eva typically reaches five. The remaining 15 are unreachable – either not home or sporting a disconnected phone number. Eva leaves a message with those who have answering machines or someone capable of taking a message. Two or three will return her message. Now, what happens with the remaining 12 or 13 patients who were never spoken with after their provider wrote them an OGTT referral? Herein lies the rub.

A note is written on their referral form, and it is returned to the chart, filed away until the patients’ next scheduled PCP appointment. When is that appointment? Someday (indeed, elusive someday) in the future.

The problem with this scenario is not colossal: if the PCP has an urgent concern for the patient’s blood glucose level, they schedule an individual OGTT screening lab for that week as opposed to writing a group OGTT screening referral. An emergency, therefore, is not the problem. The main drawbacks of this system are as follows:

1) If the provider requests additional blood tests, like TSH, on that referral form, those requests are lost.

2) The elusive someday is truly elusive; for one reason or another the patient might not return to the clinic for years, by which time their prediabetes could easily have metamorphosed into type 2 diabetes.

A simple solution to this systems breakdown is to file the referral form into the referring providers’ folders after our Diabetes Prevention Program staff has finished with them, instead of into patients’ charts. Providers would then have the opportunity to see and, most importantly, react to the outcome of their referral request – whether that be to send a letter out themselves to those who were unreachable or note that the patient is scheduled for their screening.

Possible solution #2 is to attach a scheduling form to each referral form. In the moment that the provider chooses to refer the patient to a screening, a date and time would thereby be assigned. Both the scheduling and referral forms would get routed to the DPP office, and the DPP staff would take it from there, ensuring that the patient was set up to attend the screening.

OGTT Recruitment Write-up Script

In OGTT Screening on November 9, 2010 at 3:33 PM

This script is designed to serve as an OGTT recruitment guideline. It has been tested – DPP staff make up to 100 recruitment calls per week. The key here is that the simpler the message, the more return-calls the DPP tends to receive.

OGTT Recruitment Call Script for Individual Adults in English:

OGTT Recruitment Call Script for Individual Adults in Spanish:

OGTT Recruitment Call Script for Families or Individual Children in English:

OGTT Recruitment Call Script for Families or Individual Children in Spanish:

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