Last summer I attended the American Association of Diabetes Educators (AADE) Annual Meeting in St. Louis, MO. I went there, as usual, to learn as much about the diabetes community and industry as I possibly can. I also went there armed with a writing assignment for Diabetes Health magazine. I thought I'd compose an article on "Educating the Educators," all about how CDEs get trained to help us. So I started interviewing everyone who had anything to do with diabetes education, from every angle -- from AADE presidents to CDE trainees to family physicians to the head of the certification board to (of course) affected patients. What I discovered was a field facing a crisis.
See the resulting exposÃ© finally posted over at Diabetes Health magazine as of late last week.
It's no secret that the American healthcare system is a mess. It's actually been referred to as "a hairball" that may take a decade or two to untangle. The problems with diabetes education are, to a large extent, rooted in this hairball. But with only about 15,000 CDEs in the US, despite nearly 21 million Americans affected -- and the number growing daily -- we don't have a decade or two to wait. Who will help all these patients manage their disease?
In order to serve them all, every existing educator would have to see at least 1,400 people four times a year: this works out to more than 22 people every single weekday. NOT. As in not going to happen. Not going to help the patients even if it did happen.
We're not going to be able to magically cure the healthcare system, either. But as it turns out, there's a lot the various stakeholders in diabetes education could do right now to improve patient access, the education experience, and ultimately, health outcomes, if we collectively set our minds to it.
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To boil down six months' worth of research into a few paragraphs, here are the call-to-action items for each stakeholder group, including those for us patient end-user types. If you want to know the rationale behind these recommendations, please go read the article. You may find it very educational :)
Laying It On The Line - What Each Group Can Do to Help Diabetes Education Thrive
The Governing Organizations - AADE and NCBDE: Remove the barriers to becoming a certified educator by loosening up pre-certification requirements, creating an entry-level certification, and instituting an internship or mentorship program for budding educators. Establish a "student teaching" requirement to help CDE newbies learn best practices firsthand.
Primary Care Physicians: Make it standard practice to refer all your diabetes patients to an educator. Or consider contracting a CDE part-time to work on-site with your patients. Create some sort of feedback mechanism, like a quick survey form, to evaluate patients' experience and outcomes after seeing the educator. Be sure to ask your patients whether the education has increased their motivation to engage in self-care.
The Diabetes Educator Community: Learn about the
business side of being an educator. Consider lobbying to be part of your
job -- lobbying for doctor referrals, for financial support within your clinic, and
for supportive healthcare legislation. With patients, focus not only on what
they learn, but on how they learn best. Make courses interactive and fun,
perhaps by organizing a diabetes educational cruise, a support group communal meal, or a bike
Hospital and Clinic Administrators: If at all possible, make it a priority to obtain the Joint Commission of Accreditations of Hospitals (JCAHO) accreditation for inpatient diabetes care, which proves that your standards are up to snuff (details can be found at www.jointcommission.org). Encourage your financial staff to lobby insurance providers for reimbursement of all diabetes services, including unlimited education that lasts until each patient understands how to achieve and is motivated to practice healthy diabetes self-care. Then provide the option of regular refresher courses.
Health Insurance Providers (aka Payers): Institute
standard reimbursement for monthly visits to a diabetes educator at least twelve
times per year (which will help prevent the high cost of treating complications
down the line). To make access easier for patients, make it a "self-referred
benefit," eliminating the need for patients to beg their physicians for a
referral. Promote your company's diabetes successes by publishing statistics
related to your diabetes care programs; for example, report your rates of
diabetes complications, strokes, kidney disease, and average A1c's. Patients
want to know how diabetics fare long-term with your health plan, and they should
be able to find out which insurers have the best outcomes with regard to type 1
and type 2 longevity.
Patients: Ask to be referred to a diabetes educator. Insist on it, in fact. Then be sure to report back to your doctor on your experience -- including the good stuff, not just complaints. In order to keep diabetes education programs from being cut, lobby the Congressional Diabetes Caucus chairperson at www.house.gov/degette/diabetes/index.html.
Dear highly motivated DiabetesMine.com Readers,
You may not feel that you personally need the services of a diabetes educator. But keep in mind that for every "on it" patient like you, there are 20 more people out there who could desperately use some help managing their diabetes. That's why this matters. In this case, education really can save lives.