By: Kristin Lund
The California Association of American Diabetes Educators held its second annual meeting October 22 through 24, 2009, in Monterey, California, and Diabetes Health was there. The clinical and educational program, put together by Debra Norman and Kim Higgins, was called “Tidal Wave of Diabetes.” The invited speakers shared innovation, research, and new techniques with the attendees.
Janice C. Zgibor, PhD, from the Graduate School of Public Health at the University of Pittsburgh in Pennsylvania, spoke about “collaborative care.” She emphasized repeatedly that she couldn’t do what she does without the help of all the wonderful CDEs with whom she works. Zgibor said that we are still treating diabetes simply as a chronic disease, when instead we need to look ahead and think about prevention. She warned that not controlling potential cardiovascular problems, for example, more than triples the costs that accrue down the line for these problems. She said that insurers are finally starting to sit up and recognize that diabetes prevention care is getting results-not only in improved health outcomes, but also in reduced costs per patient. The state of Pennsylvania has done such great work on the cutting edge of diabetes research and care that the entire state might be recognized by the national government in the future.
Zgibor uses the Chronic Care Model to improve diabetes education in primary care practices in rural Pennsylvania. She reviewed data on what does work, such as: educators going to the people rather than the reverse; providing handouts in multiple languages; and using standardized messages within the practice. If electronic health records are not available, then caregivers should keep at least keep track of A1c’s. (She noted that even targeting people with an A1c over 9% for follow-up is a large group!). It is also important to pay attention to the geography where the patients are because, for example, some people may not want to cross a bridge or county line to see a healthcare professional.
The very humorous Mary Ann Hodorowicz, RD, LDN, MBA, CDE, CEC, substituted for Greg Millinger on the topic of “Navigating Reimbursement..” Hodorowicz gave a very informative presentation on how to make sure that you are getting reimbursed for everything you should be. She stressed that healthcare professionals, including CDEs, have to be business-savvy and understand how to bill. In order to help people, you have to stay in business, and to stay in business you have to make money. To make money, you have to navigate the complexities of getting insurance companies to reimburse. Hodorowicz gave an example of a hospital that holds a diabetes educational program at the local gym. It is important from a legal and billing standpoint that the hospital pay “fair market value” for the facility rental, because otherwise “anti-kickback” rules are being violated.
Betty Brackenridge MS, RD, CDE, spoke on the topic of “Understanding Behavioral Change to Help Improve Diabetes Outcomes.” Bill Polonsky in San Diego put the program together. Brackenridge spoke about how everyone has something that motivates them and that HCPs just have to work harder to find those motivators. We cannot just say, “Well, I told them to do it, and they just won’t.” It’s important to understand the patient’s state of mind. If patients think there’s no hope and nothing can be done to help them, for example, giving them a list of the 26 “improvements” they must make is going to yield no results. Read a 1993 interview with Dr. Polonsky. You might also be interested in Riva Greenberg’s article on the “Valuable Tool To Control Diabetes” she learned from Dr. Polonsky.
Neal Kaufman MD, MPH, spoke about “Preventing Diabetes in Cyberspace” using programs that his company, DPS Systems, has created. There is no doubt that there is a shortage of CDEs, and it’s difficult to give patients the kind of education and support they need. These programs allow healthcare professionals to maintain contact with patients by reviewing the information entered by the patient from home. For example, the HCP might see that patient “A” is not testing her blood glucose as often as she should and that she hasn’t picked up any test strips from the pharmacy in three months. Then the HCP can telephone patient “A” and find out what’s happening. The software has already proved to allow more patients to receive more contact
Dean Schillinger, MD, presented a talk on “Translating Effectively for Vulnerable Populations.” Dr. Schillinger is a professor of medicine at the University of California, San Francisco, and the director of UCSF’s program for vulnerable populations, as well as chief of the California Diabetes Program. He discussed the connections between basic literacy and “health literacy”-a term that describes how much a patient understands about, in this case, diabetes. He presented intervention studies in primary care settings and discussed the effectiveness of oral communication techniques, written communication, visual aids, and technology such as telemedicine and online healthcare programs.
Nancy J.V. Bohannon, MD, an endocrinologist, gave a fascinating talk titled “Considering the Heart of Diabetes” that made me vow to never eat again-well, not really. But when Dr. Bohannon explained that cells have to put excess fat somewhere and so it ends up around your heart, liver, muscles, and other spots it shouldn’t be, I felt sick to my stomach.
There were many other equally interesting presentations at the conference. If you’re a CDE in California*, I highly recommend that you attend these meetings-they’re very valuable!
By the way, if you are a CDE in Northern California, an AADE chapter is needed in the Redding/Shasta area. Why not be the one to get that started? Contact Kim Higgins via mcade.org for more information.