For Kim Hanchette, MEd, CDE, keeping up with the diabetes Joneses has never been a problem. With the conclusion of the Diabetes Control and Complications Trial in 1993, Hanchette says most doctors in her hometown of Raleigh, North Carolina, had come to embrace the concept of self-management. As a CDE at an outpatient clinic there, Hanchette had her work cut out for her, with patients flowing in at a steady stream for classes on nutrition, glucose levels, exercise and medication.
Not all was well, however, in the state of North Carolina.
“You get 20 minutes out of Raleigh-Durham/Chapel Hill, which is a pretty big urban area, and it gets really rural really fast,” Hanchette says. “The whole mindset of health management is about 10 to 15 years behind.”
Hanchette lists a whole host of problems that residents of the surrounding communities face in finding diabetes self-management training, but she says it all boils down to two key problems: access and quality.
Still, solutions seemed scant until Hanchette attended the 2000 American Association of Diabetes Educators conference in San Diego, California. It was there, while she sat in one of the conference’s workshops, that the first flashes of inspiration came. If people in the counties of Raleigh-Durham and Chapell Hill were having problems coming into town to get their education, Hanchette thought, she would bring it to them.
Back at the helm of her newly-formed company, the aptly-named Diabetes Management Solutions, Hanchette began to set her project in motion. Literally. With the help of two major sponsors, Novo Nordisk Pharmaceuticals and the local Golden Corral restaurant franchise, Hanchette began work on what she calls the “Diabetes Bus.”
The idea is relatively simple—convert a 30-foot recreational vehicle into a mobile classroom, park it in front of doctors’ offices in rural counties and give out information to patients who might need it.
Hanchette has devised a curriculum of three basic classes: “Starting,” also known as “Starting Over,” which deals with the basics of diabetes self-management; “You and Food,” which explains the elements of nutrition; and “It’s Time to Move,” which focuses on exercise.
Each class is roughly two hours long, with an emphasis on hands-on instruction. Classes on nutrition are conducted in the RV’s kitchen, with demonstrations on how to reduce the fat and carb contents of popular area dishes. The exercise class requires that all attendees test their blood sugars before and after a walk to demonstrate the difference that even a little bit of fitness can make. Attendees who take all three can conclude by taking a class called “Problem Solving,” which teaches them to overcome obstacles in their self-management regimen.
Hanchette says her program’s goal is to educate, rather than just administer information, and she has selected her curriculum, as well as her staff members, accordingly.
“What I bring to diabetes management is really good motivation skills, behavioral change skills and creative approaches to self-management,” Hanchette says. “I firmly believe that if you have a good teacher, you can teach them the diabetes part. But if you have a nurse or clinician who isn’t comfortable in the teaching role, it’s going to be harder to give them the teaching skills.”
Of course, covering all of North Carolina by RV is an enormous task, and Hanchette’s project is still in its infancy. So she looked at the numbers for the region to find the appropriate starting points, which led her to two nearby counties, Franklin and Johnson.
“Statistics showed they had a very high rate of diabetes and poor outcomes,” Hanchette says.
She began approaching doctors’ offices in the area, informing them of the project. For the most part, they were more than happy to enlist, agreeing to let her use their parking lots at the beginning of the project, and referring patients to her. The response has been enthusiastic enough to pack the bus’s schedule beyond capacity, and Hanchette hopes that results will only bolster the number of participating physicians.
“We want to prove our worth with a small group of people,” she says, “so we can go on and get bigger.”
Although Hanchette sees a big future for the Diabetes Bus, her company remains, at the moment, a 501(c)(3) non-profit, relying entirely on grants and donations. She urges interested parties to contact her through her Web site, diabetessolutions.org, or by phone at (919) 781-6664.
The bus’s departure date was March 19. Although its trial run is supposed to last for one year, Hanchette says she has no plans to slow down after that-in fact, she expects it to grow at the rate of two counties a year.
“We look at this as a pile-up project,” Hanchette says. “But I don’t know of anyone else doing it and it makes so much sense to me. I would love see this become like the Bookmobile.”