1. Farrell, Kathleen DNSc, CS, CCNS

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To establish a protocol to help volunteer healthcare providers render consistent, optimum care to clients receiving healthcare from a rural, subsidized community clinic for the working poor.



The rural clinic provides care to the working poor of the community. Lack of access to healthcare is often cited as a reason for poor control of chronic illnesses such as diabetes. A variety of community healthcare professionals volunteer and provide the needed services at this clinic, yet this process often posed the problem of inconsistency in treatment regimens and lack of adequate follow-up. Practice guidelines have a proven track record, but must be implemented to work.



Retrospective data were retrieved from the diabetes patients' medical record for a 1-year period to conduct a quality-improvement study. Glycosated hemoglobin levels (HgbA1c), low-density lipoprotein (LDL), and blood pressure readings were monitored and analyzed to determine the clinical outcomes of care. This small, quality-improvement study demonstrated the need to establish consistency in the care being delivered to the clients.



CNS established protocol based on American Diabetes Association (ADA) guidelines and recommendations from the ATP II guidelines and JNC VII recommendations. In addition, a decision algorithm was established for all providers to use. Consistency was established by having the CNS oversee the care of all the diabetes patients.



(1) Mean HgbA1c levels went from 9.9% to 7.2%. (2) >90% clients are partnering with providers and setting realistic goals. (3) Several individual case studies indicate good control now established. (4) A variety of healthcare professionals can provide quality, consistent healthcare despite a setting with many obstacles.



(1) Guidelines must be implemented to work. (2) Consistent care and follow-up lead to improved outcomes. (3) Clients must partner with the provider in managing chronic illness.