Professional Documents
Culture Documents
County, Michigan
Community Change Project
Group 1
Charles Dietrich
Nurs 340
Amber Kulppi
Holly Owen
Lori Rosendale
Introduction
Lake County, Michigan has an increased
rate of diabetes due to many factors.
The following is a proposal as to how to
decrease this risk.
Problem Statement
Population
Environment
12.7% Unemployment
White pop. 87.3%; Black 9.2%; Hispanic 2.4% Access to health care providers 18.8%
Obesity Lake Co-43.1%; MI 35.6%
High School Diploma 80.8%
Bachelors Degree 8.2%
Obesity
Access to fresh fruits and
veggies
Safe areas for children to
play; adults to exercise.
Nutrition/Exercise
education starting early in
the school system
Analysis
District #10
Lake County
Diabetes
Statistics
Lake County
Michigan
Population
11,498
9,883,360
Poverty
26.9%
17.5%
$30,390
$48,471
12.7
8.7
No healthcare
provider
18.8%
13.2%
No healthcare
due to cost
15.1%
12.9%
20%
15.1%
Median Income
Jobless Rate
Uninsured
Statistics
Lake County
Michigan
Receiving
free/reduced lunch
94%
48.2%
Diabetes related
mortality rates
92.5
76.9
Lack of Activity
26%
23.4%
Overweight
36.1%
30.1%
Obese
43.1%
35.6%
24.1%
16.3%
80.8%
88.7%
18.8%
13.2%
15.1%
12.9%
92.5
76.9
Diagnosed Diabetes
18.5%
9.3%
Obesity
41.3%
35.6%
77.7%
78.2%
District Health Department #10 (2014). Health profile chart book 2013: Lake County.
Retrieved from: http://dhd10.org/images/Lake_Chartbook_2013__Feb_18_2014.pdf.
Planning and
Intervention
Yates Dial-A-Ride
SMART Goal
SMART Goal
Specific:
Choose a goal
The use of transportation by the
diabetic community in Lake County.
Relevant:
Does the publics knowledge directly contribute to
the mission/goals of the department and Lake
County. Yes, if the public has a millage vote to
fund public transportation.
Time-Based:
There should be a clear time frame, deadline, or
other time-based expectations when the action,
activity or behavior will take place. Efficiencies in
public transportation should be evaluated after
each month. Any capital investment changes in
the public transit will be evaluated after the fiscal
year.
Implementation
Implementation
Advertising for low income and free clinics
in Lake County and nearby areas.
Flyers posted in local establishments as well
as senior living centers and recreation
centers.
Listing the name, location and phone
numbers of nearby low income/free clinics.
Listings provided to area medical centers
and doctors offices for referral of patients
who cannot afford services.
Implementation
Evidenced Based
Practice
EBP continued
Testing of fasting lipid panel increased
considerably from 53% of eligible patients
pre-intervention to 72% post-intervention.
Similarly, testing of fasting blood glucose
screening rose from 59% of eligible patients
pre-intervention to 82% post-intervention.
EBP Continued
EBP conclusion
The information gathered by the study
concludes that clinics that are made
available to low income and uninsured
individuals do in fact increase the amount of
diabetes testing.
By making the low cost clinics in the Lake
County area well known, and a low cost
transportation system well known, there
should then be an increase in diabetes
screening and education.
Diabetes Education
Medications and Nutrition
Education: Medications
Metformin
A pill that is considered the first line of defense drug
used in conjunction with a change in eating and
physical activity. Because of gastrointestinal adverse
reactions it is recommended to start the drug at a
low dose of 500 mg daily, increasing by 500 mg
every 1 to 2 weeks, up to an ideal and maximum
dose of 2000 mg daily in divided doses. Greater than
2000mg has no benefit.
Benefits:
1.Potential weight loss
2.Less frequent finger sticks compared to insulin
3.Improves insulin sensitivity.
4.Taking oral pill without injections. This is painless
and may increase adherence.
5.Less instruction time
6.Only the IR form has been approved for children.
Other medications
Oral:continued
Education: Medication
Insulin
1.
2.
3.
Education: Nutrition
Calories come from carbohydrates, proteins and fats.
1g fat = 9 calories
1g protein = 4 calories
1g carbohydrate = 4 calories
Diabetic Superfoods
1. Beans
2. Dark Green Leafy Veggies
3. Citrus Fruit
4. Sweet Potatoes
5. Berries
6. Tomatoes
7. Fish High in Omega 3s
8. Whole Grains
9. Nuts
10.Yogurt and Fat Free Milk
Foods to Avoid!
1. Processed and refined sugars
2. Candy
3. Cake
4. Sweetened sodas
5. High fat foods
Evaluation
Short Term
1. There will be an immediate increase in the
number of uninsured individuals receiving
diabetes screening and education.
2. Yates Dial-A-Ride will help the 25% of individuals
without personal transportation.
3. Education of these services through flyers and
public broadcast will be immediate.
Evaluation Continued
Long Term
1. Region 10, Lake County Health
Department will show a decline in
diagnosed diabetes.
2. Region 10 will show a decline in health
care costs related to diabetes.
3. Region 10 will display an increased
adherence to diabetes screening and
education in the uninsured population.
Conclusion
Increased awareness through flyers in
public places, and knowledge of public
transportation will increase the amount of
uninsured individuals that use these
services.
In the long-term there will be an increased
amount of individuals that will adhere to
diabetes screening and education.
There will be an eventual decline in the
diabetes rates in Lake County.
References
algorithm for the initiation and adjustment of therapy. Diabetes Care, 32: 193203.
from
http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/understanding-
carbohydrates/glycemic-
index-and-diabetes.html
American Diabetes Association, (2014). What can I eat? Retrieved from http://www.diabetes.org/food-andfitness/food/what-can-i-eat/
Butela, N.M., Murk, W., Horwitz, L.I, Graber, L.K, Bridger, L. (2012). What is the quality of preventive care
provided in a student-run free clinic? Journal of Healthcare for the Poor and Underserved, 23(1), 414424.
Copeland, K. C., Silverstein, J., Moore, K. R., Prazar, G. E., Raymer, T., Shiffman, R. N., & ... Flinn, S. K. (2013).
Management of Newly Diagnosed Type 2 Diabetes Mellitus (T2DM) in Children and Adolescents.
Pediatrics, 131(2), 364-382. doi:10.1542/peds.2012-3494
References Continued
District Health Department #10 (2013). DHD #10 community statistics. Retrieved
from:
http://dhd10.org/images/Lake_Chartbook_2013_Feb_18_2014.pdf
Free Medical Search. (2014). Lake county clinics. Retrieved from: http://www.freemedicalsearch.org/cit/mi-luther
Harkness, G.A., DeMarco, R.F. (2012). Community and public health nursing: Evidence for practice (5th ed.).
Philadelphia, PA: Lippincott Williams & Wilkins.
Michigan Department of Transportation. (2014). Yates township transportation system. Retrieved from:
http://www.michigan.gov/mdot/0,1607,7-151-9625_21607-164380--,00.html.
Onboard Informatics. (2012). City data: Lake County, Michigan. Retrieved from: http://www.citydata.com/county/Lake_County-MI.html.
University of Wisconsin Population Health Institute. (2014). Building a culture of health county by county. In County
Health
http://www.countyhealthrankings.org/sites/default/files/state/downloads/CHR2014_MI_v2.pdf