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Dr. Jayant Dey, medical director of the Diabetes Treatment Center at North Mississippi Medical Center in Tupelo.

In the state which bears a dubious distinction as America's diabetes capital, healthcare professionals are finding the need to go beyond traditional physician-patient models of care and are getting creative about ways to extend comprehensive diabetes treatment to the rural communities that need it most.

"I tell my patients that treating diabetes is not like treating pneumonia, where you get medications and in five or 10 days you're better," said Dr. Jayant Dey, medical director of the Diabetes Treatment Center at North Mississippi Medical Center in Tupelo. "Diabetes is a lifelong disease, and we need to do much more than take pills and shots. If we empower our patients with the knowledge they need for going about their day-to-day activities, they will be able to deal with this much better than having them completely dependent on us."

At NMMC's center, recognized by the American Diabetes Association as a Diabetes Center of Excellence, that philosophy has meant building a team of certified diabetes educators, registered dieticians and other healthcare professionals. With complimentary skills, they provide one-on-one counseling and instruction on both an inpatient and outpatient basis. The center also offers an intensive two-day comprehensive diabetes self-management program at NMMC hospitals in Eupora, Tupelo, West Point and Hamilton, Ala.

Meanwhile, educators also travel to satellite diabetes treatment clinics in West Point, Pontotoc and Hamilton, Dey said.

"We have plans to have more satellite clinics in other physician offices as other service areas," he said. "One of our other initiatives is telemedicine, so we could have patient groups in areas where it's very hard to justify placing a full-time educator."

The rural challenge is the same — and even more urgent — across the state in the Delta, where diabetes and other diseases associated with obesity have earned the region one of the lowest life-expectancy ratings in the nation.

It's there that the University of Mississippi Medical Center (UMC) has forged a multifaceted partnership to create team-based chronic care clinics — a support to physicians frustrated with the limits of traditional care models. Since the program launched in 1999, five clinics have been established: two in Jackson, two in Clarksdale and one in Greenville, with more to come.

"This is really about the university projecting its teaching expertise into small Mississippi towns — directly and physically — which is something UMC has never done before," said Dr. Marshall Bouldin, an associate professor of medicine who initiated the clinic program.

The system Bouldin worked to create involves training local physicians already in place in rural communities, but also using them sparingly in order to reproduce the system in areas where physicians are scarce. It relies heavily on other professionals like nurse practitioners, registered nurses, diabetic educators, pharmacists and dieticians.

As the program has matured, the most recent strides have included the ability to demonstrate the clinic model's success in the long term, Bouldin said.

"We've shown that the improvements we make in the short term in blood sugar and blood pressure are actually sustainable over a five-year period," he said.

"That's news, because a lot of times those kinds of things can't be sustained. People are very interested in this, but the real lesson is that if we can achieve the kind of turnarounds we've seen when we also have the worst of conditions, anybody in the United States can do this. It's the system of care that's the problem."

Working closely in partnership with the Delta Health Alliance, local communities, regional universities and a host of other partners has been challenging, Bouldin said, but also key to the program's success.

"Our own 'down-homeness' is actually our greatest advantage here," he said. "We're small, we know each other and we get along reasonably well. So we've been able to put these collaborations together so much faster than they could in other parts of the country."

As the program expands, the clinics stay connected to UMC experts, who share access to a Web-based data system of patient information and also consult and teach remotely through telehealth connections.

Technologies like noninvasive glucose monitoring and insulin pumps have given certified diabetes educator Phyllis White, RN, a reason to be upbeat about her work and how it's changed over the years.

"This is a wonderful time to be involved in diabetes education, because there is just so much available for people," she said. "We can now say, 'If what you're doing is not working, don't despair. There are other things available.'"

Working in diabetes education at Hattiesburg's Forrest General Hospital (FGH) since 1988, White helped develop the FGH Twin Lakes Diabetes Camp and was named Diabetes Camp Educator of the Year for 2006 by the American Association of Diabetes Educators.

The annual camp hosts more than 100 young campers and counselors for a week each summer, reinforcing in a supportive environment the message that diabetes management is a constant part of daily life.

As the role of diabetes educators has evolved over the years, White has seen other health professionals grow more willing to seek an educator's opinions.

"The educator's role is not only to help individuals with diabetes, but also peers, physicians and other professionals," she said.

Required courses and workshops help educators stay up-to-date with the information they have to share — but getting insurance companies to validate their role in patient care through reimbursement has so far been a challenge. Medicare did begin covering some diabetes education services last year, Dey said.

As another aspect of diabetes patient care, facilities like Rankin Medical Center's Wound Healing Center are using modern treatment methods such as hyperbaric oxygen therapy, as well as applying techniques like transcutaneous oxygen measurement, dressing changes and wound debridement.

Among patients seen by staff at the center are those suffer from diabetic ulcers and other lower-extremity injuries that are slow to heal and could lead to amputation. In developing individualized plans of care, the staff must evaluate each would and its healing on a daily or weekly basis.

While patients can be referred to the center by a physician or self-referred, the center also acts as a referral hub to direct patients to home health, nutrition and diabetic-education professionals.

The circular pattern defines a team approach that is helping Mississippi combat its challenging odds and shake off the "diabetes capital" distinction.


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November 206

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