265848 Diabetes Awareness to Reach Excellence (DARE) - Making a Difference in the Homeless

Wednesday, October 31, 2012

Lisa Stevens, MD , Medical, The Daily Planet Health Care Center, Richmond, VA
Jean-Venable Goode, PharmD , School of Pharmacy, Virginia Commonwealth University, Richmond, VA
The Daily Planet, a Federally-Qualified Health Care for the Homeless Clinic, has been serving Richmond's homeless population for more than 40 years. The Daily Planet and Virginia Commonwealth University (VCU) also have an established Academic-Community Partnership. Since 2005, they have worked together to enhance medication-related health outcomes among those who experience homelessness in the Richmond community. Project ImPACT: Diabetes Awareness to Reach Excellence (DARE) - Making a Difference in the Homeless was implemented at the Daily Planet in September 2012.

The program is two tiered, one with comprehensive interdisciplinary diabetes outreach and screening and the other, with a diabetes management program. The interdisciplinary team operates within a patient-centered medical home model which includes a physician, pharmacists, nurse, dietitian, health educator, optometrist, and case manager. Outreach events will also provide education and screening for comorbid conditions such as obesity, hypertension, and hyperlipidemia.

The second tier of the program is an interdisciplinary diabetes management program. Patients are offered the opportunity to enroll in the program if they have a hemoglobin A1c > 7.0. We cover cost of medications (if needed), testing supplies, bus passes for visits, and special incentives such as lunch are offered during the visits.

Preliminary and expected outcomes are engaged, educated, healthier patients who are involved in self management of their diabetes. We expect to see long term reduction in emergency room visits, hospitalizations, increased medication adherence, and improved overall quality of life in this very fragile population.

Learning Areas:
Chronic disease management and prevention
Clinical medicine applied in public health

Learning Objectives:
Demonstrate how partnerships between teaching institutions and community health centers can integrate services to provide care to homeless populations. Demonstate home interdisplinary teams such as pharmacist,physicians,nurses, and dieticians can provide patient centered medical care to reduce health disparities in diabetic populations. Demonstrate how patient-centered care 1) Empower patient self-management of medications; 2) Improve access to medications; and 3) Minimize medication gaps during transitions of care.

Keywords: Homeless Health Care, Diabetes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a certified internist, practicing and treating diabetes since 1996. In addition to private/ group practice I have held several faculty positions at several teaching institutions(Associate Professor), of which I am currently a community faculty member affliated with the Virginia Commonwealth University. I am currently the Medical Director of The Daily Planet Health Care for the Homeless,Richmond Virginia. In addition to having my Doctorate in Medicine, I also have my Masters in Public Health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.