Fighting diabetes with interdisciplinary education

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It only takes a few minutes of conversation with any member of Hôpital Montfort’s Diabetes Clinic to grasp the amount of success stories their team has witnessed in the last few years. Members of the team stopped counting the number of patients, most often afflicted with complex cases of type 2 diabetes, who walked out of their offices feeling more confident and autonomous in their pursuit of a healthier lifestyle.

“The motto of our clinic is ‘self-management’: patients leave the hospital with the necessary tools to manage their diabetes, and their overall life,” explains Eva Argibay Poliquin, a registered nurse diabetes educator who works alongside a registered dietitian diabetes educator, two internists, a pharmacologist, a social worker and a psychologist in order to provide education-oriented care to their patients.

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The interprofessional team takes care of approximately 2700 visitors every year, who are either diagnosed with type 1, gestational, or complex type 2 diabetes. The team has adopted an approach that is well-known at Montfort when it comes to the treatment of chronic diseases: teaming up professionals of diverse health fields and collaborating with several community organisms to be able to offer well-rounded, complete patient-oriented care. After getting referred to the clinic by their family doctor or health specialist, patients are directed to one of the internists, who evaluates their case and either refers them to a community service (such as the Community Diabetes Education Program, www.diabeteseducation.ca, who hosts workshops all over the Ottawa region) or to the Diabetes Clinic team.

Interviews are based on the motivational interviewing model, which evaluates the importance patients concede to their condition and the level of confidence they have in their ability to live a healthier life, before looking for concrete solutions to help them reach their own health goals. Once they are admitted to the program, the services they are offered merge towards an overall healthier lifestyle. Members of the care team can, among other things, help patients understand their medication and provide nutritional advice, exercise plans, psychological help and directions to financial resources. This integrated approach helps patients understand and manage their condition, ultimately leading to fewer complications and less overall time spent at the hospital.

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In the last years, many patients expressed their gratitude towards this system: during her appointment, a patient even asked to call the administrator of the ambulatory clinics on her pager to make sure the great comments she had to say about the team would be heard.

With more than ten years of existence, the clinic has not only provided education to thousands of patients, but has also welcomed dozens of students for observation days and internships in the fields of nursing and nutrition. The members of the team also work with other units of the hospital in order to conduct a wide variety of researches: among others, a study on effective management of diabetes and comorbid depression was published last month, as the result of a collaboration between the Diabetes Clinic, the Health Psychology team, and the “Institut de recherche de l’Hôpital Montfort” (IRHM).

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