Knowing that heart disease and stroke are the leading causes of death and disability among people with type 2 diabetes, Julia Routman, RN, is devoting her year as a Schweitzer Fellow to improving health outcomes in older diabetic adults.
New national guidelines in November 2013 by the American Heart Association and the American College of Cardiology state that starting at age 40, all adults with type 2 diabetes should be placed on statin therapy, Routman said.
The new guidelines focus on an individuals risk of heart attack or stroke. The higher the risk, the greater the potential benefit from a statin.
Whereas the old guidelines targeted diabetics with high cholesterol, Routman said the new guidelines target all diabetics over the age of 40, recommending they take statins even if their cholesterol levels
Northeast Valley participation
Partnering with her husband, David Routman, a student in USCs Keck School of Medicine, Julia, an MSN/FNP candidate at the UCLA School of Nursing, approached her employer, Northeast Valley Health Corporation, San Fernando, Calif., about conducting a year-long outreach program.
We wanted our project to provide a service to both the staff and patients at Northeast Valley, Routman said. After discussing several ideas, we decided to work on outreach to diabetic patients who should be taking statins but are not.
A similar three-month project had been started by a pharmacy student, and the Routmans thought by enrolling new patients and following them over the course of a year, they could take the project to the next level and produce more solid evidence.
It was also an area that the leadership team at Northeast Valley was very interested in addressing since diabetes dramatically increases the risk of various cardiovascular problems, Routman said. For every 23 patients who are diabetics and take statins over five years, a major vascular event will be prevented, Routman said, citing Kaiser Permanente National Clincal Practice Guidelines 2012.
Routman and her husband began their project last May by running reports using Northeast Valleys electronic medical charting system to determine which diabetic patients were on a statin and those who were not. They looked for patients who were over the age of 50, with an LDL over 100, who had never taken statins.
Working with diabetic nurse educators
The Routmans then started working with diabetic nurse educators at Northeast Valley who are familiar with the patients, to conduct phone outreach. Maribel Garcia, LVN, is the primary nurse who began working with these patients, Routman said.
The first step is to determine why the patient isnt on a statin, and if they are a good candidate for statin therapy, Routman said. The nurses then call the patients and talk with them about the benefits of statin therapy, as well as ways they can better manage their diabetes.
If a patient is overweight or smokes, nurses may refer them to one of Northeast Valleys nutrition or smoking cessation classes.
In addition to prescribing statins, there is a strong education component to the program, Routman said. Nurses are talking to the approximately 75 patients weve identified, asking them if they are willing to start a statin, and then following up with them a week later to see if they are being diligent about taking their medication or are experiencing any side effects.
Nurses also answer patient questions and work with them on behavior modification.
We found that as nurses spoke to patients there were a variety of reasons they werent taking statins, Routman said. Many didnt understand how statins could help, or thought that making lifestyle changes could help them to avoid medication.
Routman and her husband plan to finish their year-long project this spring, shortly before they both graduate. They will present their results at the Schweitzer Fellowship Celebration of Service in Los Angeles in April, and say the poster presentation also will be available to other organizations that wish to implement a similar program.