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Diabetes care must include social influences, context
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HOUSTON — Diabetes care providers should attend to the social determinants of health to get the most benefit for individuals and the health care system overall, according to a speaker at the American Association of Diabetes Educators annual meeting.
“We have a ton of evidence that upstream factors impact our health, and we have no interventions to address these challenges,” Michael A. Harris, PhD, professor and chief of pediatric psychology at Oregon Health & Science University and director of behavioral health in the Harold Schnitzer Diabetes Health Center in Portland, Oregon, told Endocrine Today. “The upstream challenges are mostly social in nature, and as a result, we need to address them by identifying them in the context in which people live — neighborhoods, communities, schools, work, etc. We have a ton of data that supports the impact of these social factors on health, but virtually no interventions that target these challenges of daily living of our most vulnerable patients.”
Harris, who is director of the Novel Interventions in Children’s Healthcare (NICH) program, and colleagues construct individualized care plans for their patients, who are predominantly from underserved and disadvantaged groups, by addressing their social challenges.
“I’m interested in the lived experience of individuals with diabetes more than anything,” Harris said. “I’m interested in the social ecology, the context in which people are embedded, as those are the things that have the greatest influence on our ability to manage our health successfully. NICH is about the intersection between those most medically vulnerable and those most socially vulnerable.”
During his presentation, Harris said children within the NICH program have required fewer hospital visits than before enrollment and have also experienced improvements in markers such as HbA1c, but most importantly cost the system less money.
Harris outlined some lessons he has taken from his work that can be adapted for other health care providers.
First, do not make assumptions about patients. Part of that involves turning away from strictly focusing on results to address how behaviors can be adjusted, which ultimately improves health.
Second, share metrics and other insights with patients.
“Most patients are only as good as their last HbA1c,” Harris said. “When you start talking about HbA1c in the context of their life, they start seeing it less about, ‘I’m doing really good’ or ‘I’m doing really poorly.’ They’re starting to understand how life impacts diabetes and how diabetes impacts life and how there’s this reciprocal relationship.”
Treat all aspects of diabetes, including the biological and emotional factors at play, and use treatment plans that are specific to the disease and patient alike. This may require health care providers to enter new territory.
“We all get in our lane, and that’s kind of how we provide care, which is ridiculous because many of us have a skill set that is broader than that swim lane,” Harris said. “Dare to go out of your swim lane, and dare to address what you think is the most salient thing. Use your broad skill set to manage these patients more effectively.”
In addition to being less stringent with roles, Harris said health care providers of all types should avoid making assumptions and harping on the negative to achieve improvements in how patients deal with their diabetes.
“Usually, consequences don’t drive behavior that well. In the short term, consequences can change behavior, punishment can change behavior, but it’s very short-lived,” Harris said. “The thing that will sustain behavior change is reinforcement.”
Lastly, Harris told Endocrine Today that health care providers should “encourage individuals with diabetes to increase their touchpoints with diabetes such that it doesn’t involve a clinic visit or some medical issue, such as running a 5K that supports diabetes research, or attending educational conferences about diabetes, or engaging in social media with others who have diabetes.”– by Phil Neuffer
Reference:
Harris MA, et al. GS03. Presented at: American Association of Diabetes Educators; Aug. 9-12, 2019; Houston.
Disclosures: Harris reports no relevant financial disclosures.