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Interview: Rachel J. Johnson, RNP, PLNC, LSC; ADH Diabetes Section Chief III

Interviewee: Rachel J. Johnson, RNP, PLNC, LSC Diabetes Section Chief III Registered Nurse Practitioner, Arkansas Department of Health

State: Arkansas (AR)

In efforts to communicate how federal and state governments continue helping those living with diabetes, I’ve had the pleasure of speaking with several department of health executives nationwide. This afternoon I caught up with Arkansas’ diabetes Section Chief, Rachel Johnson. Upon learning about dMeetings, Johnson was immediately convinced, knowing it would be a positive solution for the state of Arkansas. She was eager to share her experience on the current state of diabetes in Arkansas, where it’s headed, and how online diabetes patient education has helped change its trajectory.

Ravyn Towns: In addition to online diabetes self-management education and support, tell me about some of the best methods and specific programs you use in order to help people living with diabetes.

Rachel Johnson: We proudly have 48 accredited AADE programs and 26 recognized ADA programs for a total of 74 DSMES sites across the state by using our “door to door approach” in providing technical assistance to onsite programs. Our section was seeking methods to improve access to and participation in ADA and AADE recognized diabetes self-management education and support program. To meet the needs of our Center for Disease Control’s (CDC) 1305 grant, dMeetings became a perfect solution. Upon discovering the web series, I was in LOVE. I immediately embraced the concept and I wanted to position it well to ensure our diabetes population would receive all of its benefits. Arkansas is one of the first health departments to utilize dMeetings online patient education.

RT: Why were you confident in dMeetings being a solid solution for your state?

RJ: I knew that dMeetings concepts and programming would allow us to access our hard to reach populations with accredited diabetes self-management education. As the Diabetes Section Chief, I spent many hours dialoging, brainstorming, and researching with other states to understand how Arkansas could best utilize this program.

RT: Where did you begin offering dMeetings?

RJ: So, we began offering dMeetings to state employee worksites, community organizations, and even promoting it at local health fairs.

RT: After witnessing its initial success of leveraging outcomes, where was it next offered?

RJ: Well, the goal was, and remains, to impact larger populations and extend outreach. So, we began networking and started extending the program to small and large healthcare systems throughout the state including through their hospitals and hospital-owned clinics as well.

RT: Where has this approach been successful?

RJ: Overall, this approach has been very successful in rural areas where we have hospital-owned clinics along with privately-owned medical practices.

RT: If any, what patient demographics do you specifically target (rural, ethnic, economic status, age, etc.)?

RJ: Our diabetes population is mostly rural, because we are largely a rural state. Inevitably, a vast majority of our diabetes population faces economic hardships with Arkansas overall having a low socio-economic status.

RT: Who are current recipients of your support, what help are you offering and what benefits are you able to extend?

RJ: We are approximately 86% rural. I have been personally approached by diabetes patients who are employees of companies with strenuous schedules working nights regularly, seven days straight, or even 10-hr shifts. With dMeetings innovative online education, we are able to support a wide range of patients in eliminating barriers that are inevitable for rural areas.

RT: What are the barriers your diabetes population faces?

RJ: These barriers include limited access to healthcare, limited broadband, limited and lack of public or personal transportation along with the prevalence of unhealthy food choices. Patients I’ve personally spoken with have expressed their desire to participate in programs to help better manage their diabetes; however, logistics have made it extremely difficult. Work schedules also affect sleep schedules.

RT: Explain how reaching different providers has increased outcomes?

RJ: Reaching different providers helps eliminate barriers. Many of these rural areas that lack of access to healthcare, you will find a local community pharmacist that is their primary and only access. If you think about it, how many times do you see your pharmacist a year? Probably more often than you go to the doctor. If we are going to serve the total population then we have to all work together as a multi-disciplinary health care team. After all, with diabetes being a huge epidemic there is no shortage of people with diabetes that need help.

RT: Tell me about the provision and impact of one-on-one attention in the state.

RJ: It was an immediate priority to redirect our thinking and then it clicked: go where the people are and see, firsthand, their everyday routines. It has certainly made a positive difference to be up close and personal with our diabetes population. It’s helped us understand their needs better to actually meet their needs.

RT: Tell me about the partners you currently work with in order to help them and yourself in your missions.

RJ: We first began using dMeetings with our own State Employee Benefits Division through Arkansas Department of Health’s Worksite Wellness Program called AHELP and CHELP. Also, we’ve extended the use of the program to the Pharmacy Division of Harps Food Stores, Inc., which is a large pharmacy grocery store chain in Arkansas. Harps has 26 stores across the state. Baptist Health Physician Partners (BHPP), is another partner, and has a clinically integrated network (CIN) of over 1500 providers and 275 clinics in 25 counties throughout Arkansas. BHPP collaborates with the Baptist Health system and its 7 hospitals throughout the state. BHPP educates, informs and pushes out the online DSMES course to all areas within their CIN.

RT: What are your funding resources? (federal, state, county, grants, etc.?) Please explain.

RJ: Our current funding is 100% provided by the Center for Disease Control and Prevention for diabetes prevention and control from the CDC’s 1815 Cooperative Agreement, which is a grant. Our state does not provide any funding for such resources.

RT: Does your funding allow you to get creative as to who you can choose as a partner, what their mission is and in what ways you work with them?

RJ: The 1815 grant outlines specific strategies and goals that helps us to create activities and allows us to select partners who we believe will best help us achieve our goals.

RT: Are there additional goals for AR’s use of the CDC 1815 grant?

RJ: Yes, actually. To take it a step further with our CDC 1815 grant we want to continue reaching the population at the local, community level in areas where there is little to no access to an accredited or recognized diabetes self-management programs. Through our State Department Local Health Units Team Based Care Nurses, we’re able to offer diabetes and hypertension care management as well. Not only does it help the population that we serve, it helps our nurses gain hours working in diabetes education as training, thus documenting the 2,000 hours in diabetes education to prepare them to sit for their Certified Diabetes Educators exam.

RT: How does this help your internal infrastructure?

RJ: This helps us build our internal processes to possibly one day become a DSMES state health department provider.

RT: What are the next steps for the Arkansas Department of Health in empowering and supporting its diabetes patients and providers?

RJ: One next step is to extend dMeetings to our local community pharmacies through our Community Pharmacy Extended Services Network. Currently in Arkansas, we’ve made great strides in impacting our Medication Therapy Management through “MTM the Future Today”. This program was designed with rural and urban community pharmacies in mind using the pharmacist and pharmacy tech approach.

It is foreseeable that online education will continue reaching patients in areas that are underserved or unable to attend education classes for various reasons. Baptist Health Physician Partners is very passionate about diabetes prevention, wellness and treatment. Their goal is to help structure and standardize diabetes education and expand their telehealth offerings. This will definitely help in the south of Arkansas where we lack programs.

The CDC continues supporting the United States and the District of Columbia in their efforts to address serious national health problems with diabetes remaining a top priority. As Johnson noted about Arkansas, some states are 100% funded by the CDC’s Improving the Health of Americans Through Prevention and Management of Diabetes and Heart Disease and Stroke grant. This funding continues supporting Arkansas’ efforts to prevent and delay the development of type 2 diabetes in people at high risk and improve the health of the diagnosed population. In September 2018, Arkansas was awarded $906,189 for diabetes related tasks, initiatives, and programs. This award, distributed under a 5-year cooperative agreement, supports all state health departments efforts toward type 2 diabetes prevention and diabetes management. In regard to type 2 diabetes prevention, it will increase access to, coverage for, and enrollment and retention of people with prediabetes in the National Diabetes Prevention Program’s (National DPP) lifestyle change program.

It will also allow state health departments to work with health care organizations to identify people with prediabetes and refer them to CDC-recognized organizations offering the National DPP lifestyle change program. In regard to diabetes management, it will increase access to, coverage for, and participation of people with diabetes in diabetes self-management education and support Diabetes Self-Management Education (DSMES) and Support programs recognized by the American Diabetes Association (ADA) or accredited by the American Association of Diabetes Educators (AADE). Lastly, it will support the increase in the use of pharmacists in providing DSMES and in helping people with diabetes manage their medications. As Ravyn Towns continues chronic disease research across the nation, these findings will be published in a series of case studies, articles, and interviews.

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