I was involved in a quality group around diabetes management through  
the Centre for Effective Practice at UofT a while ago.  We definitely  
discussed the need to address SDOH as part of a multidisciplinary  
FHT-based approach to diabetes.  You could try to contact them for the  
report and tools they developed.

Gary

Quoting Ilene Hyman <[log in to unmask]>:

> Dennis Raphael and colleague wrote an excellent article on the social
> determinants of diabetes.
>
>
>
> Raphael D, Anstice S, Raine K, McGannon KR, Rizvi SK, Yu V (2003). The
> social determinants of the incidence and management of type 2 diabetes
> mellitus: are we prepared to rethink our questions and redirect our research
> activities? International Journal of Health Care Quality Assurance, 16, 3.
>
>
>
>
>
>
>
> -----Original Message-----
> From: Social Determinants of Health [mailto:[log in to unmask]] On Behalf Of
> Campbell, Carolynn
> Sent: Wednesday, October 07, 2009 9:26 AM
> To: [log in to unmask]
> Subject: [SDOH] Help to find a succinct article or two linking diabetes to
> social gradient
>
>
>
> Hello All
>
>
>
> Background:
>
> Yesterday at a staff Lunch and Learn, one of our physicians presented on a
> chronic disease management initiative of our LHIN. You may know that doing
> better preventive and management of chronic disease was one of the
> rationales for the development of Family Health Teams model.
>
> We have an excellent Diabetes team made up of a nurse and a dietitian.  They
> have complied a list of all our diabetics with three initial goals :
>
> 1)      Monitoring the HgA1Cs (For those of you who are none medical, this
> as a way to check on blood glucose control.  From a single  blood sample
> they can determine the highest blood glucose as person has had in the last
> few months)
>
> 2)      Monitoring that all diabetics have had their feet examined
>
> 3)      Monitoring that all diabetics have had a retinal exam
>
>
>
> They are also tracking  every pre-diabetic is seen at least once to twice a
> year by their doctor and every diabetic,  2 to 4 times a year.
>
>
>
> Diabetics are at elevated risk for kidney damage, and for heart and stroke,
> so intervening here can prevent more chronic illness.  The team will be
> presenting the results to the LHIN.  We also run a group based on the
> Stanford model Living with Chronic Illness, and a Healthy You group that
> looks at individual's diet and exercise.
>
>
>
>
>
> So you can imagine my reaction.  First of all I genuinely believe it is wise
> for us to create these programs as one can't abandon those for whom the
> horse is metaphorically out the barn door.  They can positively modify
> better health and quality of life, so I gave enthusiastic credit to those
> working so hard on this, BUT once again the focus is on individual fault
> finding.
>
>
>
> There was initial silence when I raised the question about what kind of
> policy follow up we were going to advocate at the LHIN and the MOHLTC once
> we have our data. We know we should be starting with pre-natal care and
> financial adequacy.  I made the social gradient and stress link with
> diabetes and other chronic illnesses.  This is family medicine and I am
> encouraged to report that my docs get this.  They work with individuals and
> family systems over generations, unlike specialists who may see someone's
> body part for a single treatment.  I also teach a unit to family practice
> residents that I have shared with some of you.
>
>
>
> The doctor presenting paused and then said, "I should take you with me to my
> next meeting with the LHIN."  I will try to make that happen and I want to
> be prepared.
>
>
>
> Short Question:
>
> Can anyone point me to some readings that are directly pertinent to social
> gradient and diabetes?  They should likely be brief and pithy.  I know I
> have seen some come by me since joining the listserv.  Jill Eisen may have
> commented on this in Sick Person or Sick Society on CBC radio.  I am so busy
> trying to deal with all the stress and poverty related clinical work that
> comes my way daily, I know I am not going to get to the library for a
> search.
>
>
>
> Many thanks, Carolynn
>
>
>
>
>
> Carolynn Campbell MSW RSW
>
>
>
> The Ottawa Hospital Academic Family Health Team,
>
> 210 Melrose Avenue,
>
> Ottawa, ON, Canada
>
> K1Y 4K7
>
>
>
> Tel: 613-798-5555 ext 17670     Fax: 613-761-4200
>
>
>
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