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As the role of diabetes educators expands, one expert offers solutions for improved care
INDIANAPOLIS — As health care changes, so does the role of diabetes educators. At the American Association of Diabetes Educators annual meeting, Ann Constance, MA, RD, CDE, encouraged certified diabetes educators and registered dieticians to seek innovative ways to use their skills and advanced expertise in diabetes management to influence various health centers, communities and policies.
“When you think about our health care costs, many of us think about the health system. But really, 40% of our health care costs are linked to how we live or where we live. We know that diabetes and prediabetes have strong lifestyle components, and we know people with diabetes are on their own most of the time. This has been a huge role in public health. It really is going to take all of us to make a difference,” Constance said during a presentation.
Patient-centered medical homes
During her workshop-style presentation, Constance discussed patient-centered medical homes, community-based self-management support, technology programs, and how environmental and policy changes are crucial in the scheme of prevention and management of diabetes.
Ann Constance
One example of a successful patient-centered medical home is the Genesee Health Plan in Flint, Mich., where 25,000 uninsured patients are served using a team-based care approach. Since its implementation, there has been a 50% decrease in ED visits and 15% fewer in-patient hospitalizations, Constance said.
A second example is The Johns Hopkins Hospital, where the staff uses teams of nurses and primary care providers in the clinic setting, and the nurses focus on the highest risk Medicare patients.
“The nurses are working directly with the patients and families to help them identify the symptoms that would potentially bring a person into the ED and how it can be addressed in the home setting,” Constance said.
There has been great success, with 24% less in-patient hospital stays and 15% fewer ED visits, she said. The staff also did cost analyses and estimated that the patient-centered medical home resulted in annual net Medicare savings of $75,000 per guided care nurse deployed in a practice.
In Denmark, the patient-centered medical home was implemented a number of years ago, “and they’ve got some of the highest patient and provider satisfaction rates throughout Westernized countries,” Constance said.
She reported that they also have the lowest per capita health care expenditure in developed countries.
“We spend a lot on health care, but our outcomes don’t match the amount of money that we spend. There are definitely things, not only that diabetes educators can potentially do differently, but also that our health care system can do differently,” Constance said.
Beyond health systems
Technology is one arena that is becoming more exciting in the field, and diabetes educators should take advantage of the potential benefits of managing chronic disease through telehealth and evolving means of communication, Constance said.
Moreover, Constance said the Affordable Care Act (ACA) will provide patients with the opportunity to gain insurance coverage and begin preventive measures.
“The original bill had dollars for small employers for wellness programs. I know a lot of hospitals are doing health risk assessments and coupling them with programs. I’m hopeful that this opportunity will be coming soon for employers, and diabetes educators can certainly play a role there,” she said.
By contacting senators and legislators, Constance said, diabetes educators should expand their role in health care. Yet, many diabetes educators struggle with this idea because they are focused on helping their primary patients, Constance said.
“This excites me because policies can affect thousands, even millions of people. If you’re in a diabetes class, you affect a smaller group or one patient at a time. With this, you impact millions,” she said. – by Samantha Costa
For more information:
Constance A. #S01. Presented at: The American Association of Diabetes Educators 2012 Annual Meeting & Exhibition. August 1-4, 2012; Indianapolis.
Disclosure: Ms. Constance reports no relevant financial disclosures.
Perspective
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We’re expecting that patients will come to us and right now, there is a huge arena where we, the diabetes educator, with our expertise can really expose diabetes education, our profession, and provide for our patients and our health care providers with much of our expertise.
I think the patient centered medical home is a crucial place where we, the diabetes educator, need to be an important player. Ann touched on many of the topics where we need to be. First, we need to be training the staff; we need to be the ones training the medical assistants. For instance training the MA in how to do a visual foot exams, what to look out for, what to talk to the patient about, what to alert the physician about, is just one example.
Also, we need to be the ones that are training the nurses in the clinics – how to start a conversation with the patient, how to do the basic education. For instance having a patient that is newly diagnosed is a great opportunity for the primary care nurse to start talking about diabetes and just cover the basic information. But, the nurse also needs to know how to refer to the diabetes educator in the clinic so they can provide the diabetes education program. The primary care nurse is also a great way how to provide ongoing diabetes education support. We should be the one that provide that training as well.
In the communities, we absolutely need to be there. For instance we need to support the weight loss programs as well as other programs. We need to talk with employers; we need to say, “Look this is the amount of hours that you are wasting when your employees with diabetes are actually missing work. I am here, I am the expert; ask me. Let’s work together to help you reduce that.”
There are many, many places where the diabetes educator really needs to be.