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New models of care pave way for improved diabetes education
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PHILADELPHIA — By the end of the decade, diabetes will affect 15% of US adults, yet a dearth of diabetes educators may hinder the effective management of these patients. Better access to care through certified diabetes educators and health centers, however, can improve patient outcomes, presenters said at the American Diabetes Association’s 72nd Scientific Sessions.
For patients
Jessica Greene, PhD, MPH, an associate professor in the department of planning, public policy and management at the University of Oregon, discussed the Patient Activation Measure (PAM) — a program designed to educate patients on healthy food choices, physical activity, the appropriate use of health care and chronic self-management, including HbA1c control and fewer hospital visits.
For PAM, Greene and colleagues developed a list of 13 statements of confidence, knowledge and skills about managing one’s health. These statemens are answered by patients on scale that ranges from zero to 100. Patients are then categorized into different levels according to their scores.
In level one, “patients are generally passive recipients of care,” whereas in level four, “patients engage in health promoting behavior, but sometimes struggle to maintain those changes or behaviors in times of stress,” Greene said. During levels two and three, PAM focuses on building knowledge and confidence as well as guiding action.
After linking patients’ activation level to their electronic health records (EHRs), Greene and colleagues found that patients with lower PAM scores had poorer health outcomes. They were also less likely to have cervical cancer screenings, visit the ED, and have triglycerides and HbA1c levels in the normal range.
“Higher PAM numbers mean more likelihood of having HbA1c in control,” Greene said.
For providers
To address these gaps in diabetes care, Nadine M. Tomaino, RN, MEd, CDE, a practice-based care manager and diabetes educator at the University of Pittsburgh Medical Center in Pittsburgh, Pa., said more qualified nurses, educators and specialists are needed. She noted that incorporating them into the patient-centered medical home offers opportunities for patients.
“We see a lot of chronic, complex patients; people that use unplanned care, such as the ED, as their primary care provider. We really want to change that practice and have patients think differently,” Tomaino said.
Tomaino said she has many more tools now compared with several years ago, including direct access to physicians, EHRs and, at her institution, the UPMC Health Plan database. She also has access to patient claims data and medicine refill information; alerts for overdue testing and physician visits; and alerts for hospital and ED admissions and discharges.
“We compared 2008 to 2009, with the patient-centered medical home vs. the non-patient-centered medical home, in the UPMC Health Plan. HbA1c improved to less than 8% [in 18.1% of patients in the patient-centered medical home] compared to 5.7% in the non-medical home,” Tomaino said.
“The key to integrating successful self-management education in the patient-centered medical home is a motivated medical health system champion, active engaged providers and an empowered health team,” Tomaino said.
For peers
Tricia S. Tang, PhD, an associate professor in the department of medicine, division of endocrinology at the University of British Columbia in Vancouver, pointed out that conventional efforts toward improving long-term diabetes self-management often fail for a number of reasons. She noted that, typically, diabetes education programs are time-limited, curriculum-led (vs. patient-led) and not responsive to patients’ individual needs.
Tricia S. Tang
Diabetes self-care should be thought of as a continuum that starts with diabetes self-management education and evolves into ongoing diabetes self-management support, she said.
Tang, who has conducted research focused on developing effective peer support, introduced a new model of long-term self-management support that involves both professional educators and peer leaders. She highlighted a variety of contexts in which educators and peers can work together, including training, evaluation, remediation, consultation, tracking, supervision and support.
Tang also presented an example of an educator-peer model: the 15-month Peer-Led, Empowerment-based Approach to Self-management Efforts in Diabetes (PLEASED) program. The PLEASED program provides patients with short-term weekly education sessions delivered by a diabetes educator and peer leaders followed by ongoing self-management support sessions facilitated by only the peer leaders. The goals of the PLEASED program are to help transition patients from the clinic setting to the community setting, stay motivated and maintain lifestyle changes in the long term, she said. – by Samantha Costa
For more information:
- Greene J. Health care delivery is changing symposium — Where do diabetes educators fit? Can patients be activated to improve self-management behaviors?
- Tang TS. Health Care Delivery is changing Symposium – Where do diabetes educators fit? How educators work with peers.
- Tomaino ND. Health care delivery is changing symposium – Where do diabetes educators fit? Should diabetes educators be case managers in primary care?
- All presented at: the American Diabetes Association’s 72nd Scientific Sessions; June 8-12, 2012; Philadelphia.
Disclosures:
- The researchers report no relevant financial disclosures.