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Improving care for rural diabetics

The MU school of medicine hopes to include community members in developing an outreach program.
Saturday, May 12, 2007 | 12:20 a.m. CDT; updated 8:26 a.m. CDT, Monday, July 21, 2008
Michelle Howell helps Alma Richardson get out of the van and into a wheelchair March 30 outside a dialysis clinic in Boonville.

Michelle Howell says each of the vans in her medical transport business pile up about 350 miles a day from driving people in rural mid-Missouri to and from their medical appointments. Her company, Advantage Medical Transport, based in Fayette, employs 12 drivers in more than 13 counties. On average, she says, each trip is 45 miles one way.

One-third of the passengers are diabetic, which speaks to the difficulties patients in rural areas face in getting to medical care.

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Joseph LeMaster, a professor of family and community medicine at MU, said diabetes rates are 17 percent higher in rural areas than in cities in Missouri. As of 2003, almost seven in 100 people suffered from diabetes, according to the state Department of Health and Senior Services.

The higher rates accentuate the difficulties for diabetics in rural areas not only in getting transportation, but in accessing information, and exercise centers, LeMaster said.

LeMaster and other researchers at MU’s school of medicine landed a $1.29 million grant from the Missouri Foundation for Health to fund a three-year project to improve diabetes care in rural Howard and Callaway counties.

LeMaster said the grant will be used to reorganize the way diabetes care is delivered. He said the focus will be on bringing together businesses, churches, volunteer groups and other community resources to improve networking among rural diabetics.

Along with building a network, some of the grant money will be used to set up a database at health clinics to track the needs of individuals. The grant will also cover the salaries of licensed practical nurses at six clinics in both counties, and will cover training for community members interested in becoming mentors for diabetics. The mentors would help diabetics find resources they need to care for themselves.

The efforts in Callaway and Howard counties could serve as a model for future rural diabetes programs.

“The single most important goal is to help community groups and businesses organize themselves to use their resources the best way they can,” LeMaster said.

Advantage Medical Transport is one of those businesses. It’s become Lynda McSpadden’s lifeline, getting her to and from a dialysis clinic in Boonville, where she also lives. McSpadden was diagnosed with Type 2 diabetes when she was 16, and has lived with it for several decades. She relies on dialysis three days a week to clean her blood. It’s a regimen to which other diabetics who have suffered liver damage from complications of the disease must adhere.

The rural diabetes program started in January, and one focus in the first months was informing people such as Howell and McSpadden about the project. Money for TV and newspaper advertisments was set aside to get out the word on informational meetings in both counties, said the study’s program director, Tamara Day, of MU’s school of medicine.

She said the meetings give community members opportunities to learn about the project and tell researchers about their needs. “We will have cooking classes (to improve their diet) set up, if that is what they need,” Day said.

“The majority of the funds will be used to directly pay for education and enrolling people into the program,” she said.

The educational activities will include showing community leaders how to teach diabetics to manage their own care, which is known as self-management, Day said.

A diabetic who practices good self-management is able to self-administer medication, exercises, controls diet and glucose levels, and gets to regular checkups, LeMaster said. The licensed practical nurses hired for the program will provide on-site support for people in the community who want to learn to teach diabetics better self-care.

“More often than not,” failing self-management, LeMaster said, “is an issue of access — cost and transportation.”

LeMaster said that families in rural areas with only one car often use it for work, which can leave a diabetic without the ability to go to regular health exams.

After a Wednesday treatment in Boonville, Howell drove McSpadden home from the dialysis clinic. The drive gave McSpadden the opportunity to ask Howell, who is a registered nurse, health-related questions.

Once home, McSpadden slowly stepped out of the white van, thanked Howell, and declined an offer to be helped to the door.

“She’s a very independent woman,” Howell said.

Howell met LeMaster at a Howard County Human Service Council meeting in March, where he described the plans to address diabetes.

“LeMaster is doing exactly the right thing,” Howell said. “He asked, ‘How can I best help the diabetics in your community?’”

Sharon Lynch of the Callaway County Health Department offered a solution for helping diabetics with their diet: she said a dietician comes to the health department twice a week and could serve as a resource for diabetics. “We are at the throwing-around-the-ideas stage right now,” she said.

A local ministerial alliance in Fayette that works with local food banks could also be part of the solution. Paula Richie, of Fayette, who’s involved in the alliance, said that with some guidance, the organization could offer food bags specifically for diabetics. Richie said the alliance could also administer money for health-related transportation needs.

LeMaster said Howell’s transportation service and the ministerial alliance share a common goal and may be able to help each other help diabetics. He said Howell’s service provides transportation to paying customers, and the ministerial alliance might be able to cover some of the expenses for people who can’t pay.

The overall goal, LeMaster said, is to improve “the network of agencies.”

“In both of the counties we are bringing together people who are interested in diabetes and diabetes care.”


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