George Mason University

By Michele McDonald

A simple phone call from a Mason nurse practitioner once a week is helping patients keep their diabetes in check.

A nine-patient pilot study begun this spring called TeleHealth Insulin Program (TIP) uses phone lines to connect patients to caregivers. The project is an offshoot of the Mason PATH faculty practice at the Jeanie Schmidt Free Clinic (JSFC) in Herndon. The nurses are from Mason’s School of Nursing.

The process is simple. Patients prepare for the weekly call by recording blood sugar levels taken at various times of day. Too much sugar in the blood is a symptom of diabetes. Insulin, a hormone produced in the pancreas, can be used to help control blood sugar.

Mason School of Nursing faculty members and students have been assisting at the Jeanie Schmidt Free Clinic for several years. Photo by Laura Sikes.

“The call is very helpful because [the nurse practitioner] is asking me the whole record,” says one patient from Reston. “If she needs to adjust my insulin or tell me to skip certain medications, then I can do that after the telephone conversation. My sugar level is now controlled.”

Whether patients would want to participate was the initial concern, says Joanne Iannitto, who graduated from Mason this spring with a doctor of nursing practice degree and joined Mason’s nursing faculty. Not to worry. “Every single one of them is waiting for our call. The reality is, any time you call a patient, you make them feel important, and it encourages them to do better.”

Mason’s School of Nursing works closely with the free clinic, where patients must have an annual income of 200 percent or less of the federal poverty level (about $22,000 for one person) and have diabetes, hypertension, or both. The School of Nursing launched the Mason Partners for Access to Health Care (PATH) program two years ago with a $1.6 million grant from the U.S. Health Services and Resources Administration. About 73 Mason nursing students have had clinical experiences at the clinic this past year.

Kathy Dickman, PATH program director and assistant professor in the School of Nursing, meets with the clinic’s team of staff members and volunteers. Photo by Laura Sikes.

The TeleHealth program saves time for the clinic’s diabetes patients and encourages them to meet their blood sugar goal.

Mason PATH helps provide medical care to those who need it the most, says Kathy Dickman, Mason assistant professor in nursing and project director of the grant. Without the clinic, many would stay sick. Mason PATH’s TeleHealth program is modeled after a similar one at the Charlottesville (Virginia) Free Clinic, she says.

“Getting patients into the clinic once or twice a month is time-consuming for patients and for providers, especially when resources are so limited,” Dickman says. “And if they see their provider only once a month, they will not meet their blood sugar goal for many months.”

Some patients are day laborers and have to take jobs when they come, even if it prevents a trip to the clinic, Iannitto says. With TeleHealth, patients can continue to progress toward their goal while working to support their family. This is much better than a wait-and-see attitude that can result in complications such as heart attack and stroke, Iannitto says.

Nurses follow a worksheet during the phone call so the same questions and issues are asked every time, Dickman says. Nationally approved algorithms are used in calculating the correct dosage of insulin. There’s also continuity. “I call the same patients each week and build relationships with them,” she says.

The pilot program began after Iannitto, then a doctoral student, looked to find out whether the clinic’s patients were hitting their goals for lower blood pressure or blood sugar. Only 41 percent of the diabetes patients were in control of their blood sugar, compared to 50 percent of the nation’s uninsured diabetics who are in control, she says.

After hearing about the Charlottesville Free Clinic’s success with diabetic patients, Iannitto and Dickman initiated TIP.

“TeleHealth is not new,” Iannitto says. “It’s just underutilized.”

The clinic also helps train student nurses. “The idea is this will be a learning experience for our students, in addition to providing a good service for our patients,” Dickman says.

As for the diabetes patient from Reston, that phone call made a difference. He has some advice for fellow sufferers, many of whom are from other countries and may not want to reach out for help.

“I think [the patients] are kind of shy, and they don’t want to disclose that they are not careful about their health,” says the patient, who discovered five years ago he had diabetes. “They don’t need to hide anything about themselves from the doctor.”

He tells other diabetes patients, “One day you are going to control this disease if you follow what your doctor (or nurse practitioner) tells you to do.”

He now walks two to three miles a day and has ditched junk foods. “I feel exactly the same way I used to six, seven years ago—strong.”

This article originally appeared on the university’s News site.

To read more stories about Mason, check out the university’s News site.