Why Are Referrals to DSME So Few and Far Between?
Knowledge is power.
SO WHY AREN'T HEALTHCARE PROVIDERS EMPOWERING THEIR PATIENTS BY REFERRING THEM TO DIABETES SELF-MANAGEMENT EDUCATION (DSME)?
The 76th American Diabetes Association Scientific Sessions recently took place in New Orleans, Louisiana. Amongst the varied presentations was "If DSME Was a Pill, Would You Prescribe It?", given by Dr. Margaret Powers, ADA President of Health Care and Education. The question posed by Dr. Powers is one that the medical community needs to be asking themselves--why is access to diabetes education, a proven and effective necessity, so low?
In reporting on the presentation, Diatribe.com chose highlights from Dr. Powers speech; three heavy-hitting points that make real sense (commentary is my own):
1. "If diabetes education were a medication, it would score highly across the official ADA/EASD diabetes management criteria."
This seems like a no-brainer, right? When people have access to pertinent and accurate information, they can make informed decisions about their care. When newly diagnosed adults or families are sent home from the hospital without a referral to DSME, they have to fend for themselves in the face of a complete upheaval in their life. Often, those individuals aren't even aware that diabetes education is in existence and available to them in their community. It is reimbursable by Medicare and most private insurances, so cost isn't necessarily the barrier that is keeping people from getting this essential education and support. The format of education could be a class, one-on-one counseling, or a combination thereof.
If one doesn't want to attend after receiving a referral, that's a different issue that can be addressed by their doctor. But why aren't we giving people the option and encouragement to get life-saving/life-maintaining information about their diabetes, type 1 or type 2?
2. "Diabetes education can increase healthcare savings."
Yes. YES, of course diabetes education can increase healthcare savings. This seems like a no-brainer and it is also backed up by research. Useful and necessary information about avoiding and treating hypoglycemia and hyperglycemia can help prevent hospitalizations due to extreme low blood sugar or diabetic ketoacidosis (DKA). These hospitalizations rack up thousands upon thousands of dollars in healthcare costs.
Stress, heartbreak, and the road to long-term complications stem from a lack of diabetes education and access to affordable supplies and medication. We can do better than that.
This begs the question that the diabetes community is constantly wondering: why won't insurance companies pay for preventative measures that assist in diabetes management, but will cover complication care after the damage has been done?
Spend a little money now by giving people what they need (education and access to medication and supplies), and save money and human lives later when the numbers of individuals needing dialysis or amputation drop because of proactive patient care.
3. "Diabetes education provides psychological benefits that medications do not."
Anyone who has ever dealt with a health challenge knows how important it is to feel like you have a team that stands with you in all that you are facing. Diabetes education gets patients in a room with someone who has experience and knowledge to share. In a classroom setting, diabetes education gets a patient in a room with other patients who are experiencing the same fears, questions, and accomplishments in their lives with diabetes. Diabetes distress and burnout are real conditions that affect management and quality of life.
The knowledge that you are not alone cannot be prescribed in a generic tier 1 drug, but it can be proven by exposure to diabetes education with compassionate and knowledgeable educators and the support of your community beside you.
Note: In advocating for referrals to DSME, we must also take into consideration that even when people:
a. are referred to DSME
b. have DSME covered by their insurance, thereby removing affordability as a barrier
c. attend classes and/or one-on-one education sessions
...they are not always getting the most accurate, useful, or up-to-date information. Something needs to be done about that, but that's a crusade for another day.
IT HAPPENED TO ME
By the time I had been released from the hospital after my ER admission and ICU stay, I had battled DKA and left the hospital with a type 1 diabetes diagnosis, I was given information about a community diabetes education class. My mother made the call to sign me up, since I was still incapacitated and unable to handle the task myself. Upon hearing that I had been just diagnosed with type 1, the kind woman on the other end of the phone had the presence of mind to explain that the course was designed to benefit adults with prediabetes or a type 2 diagnosis, and would not be helpful to me. She apologized that she had no alternative program for us to turn to for education on an adult type 1 diagnosis.
Incidentally, I've received the feedback from clients newly diagnosed with type 2 diabetes who have taken the class that this particular curriculum is not the comprehensive source of information and resources that their healthcare provider told them it would be, so perhaps there is room for improvement all around, regardless of type.
I then asked my endocrinologist to refer me to a Certified Diabetes Educator (CDE). The referral I received from my doctor ended in a consultation with a woman who turned out to be a nutritionist who works with type 2 patients, and had zero experience with type 1 diabetes. After exhaustive independent research, I found a diabetes clinic where I could schedule one-on-one appointments. My last appointment with a veteran nurse practitioner at that clinic ended with her apologizing that she didn't know how to answer my questions, or assist in adjusting my medication. She explained that she was most comfortable with working with people living with type 2 diabetes. I cannot express to you how frustrating that experience was for me in my fresh diagnosis.
My experience seeking out diabetes self-management education was not ideal. I do not wish that same or similar experience on anyone. I work to actively do my part to prevent those feelings of loneliness and desperation for knowledge and support from landing on the shoulders of other patients. My experience was, in fact, one of the most influential factors in my decision to move into the health field as a trained coach and diabetes educator. I offer a patient-centered alternative to impersonal classes that may or may not address the day-to-day challenges that diabetes presents. Coaching and diabetes education can also be a complementary treatment to your traditional diabetes care. Even after years of living with diabetes, the desire to "tune-up" management or seek support and accountability is common. A coach that specializes in living with diabetes and chronic illness can provide support for those things in a way that a diabetes clinic may not be set up to offer at this point in time.
THE BOTTOM LINE:
No matter how you cut it, accurate, relevant, and up-to-date diabetes education is a win for patients with type 1 and type 2, as well as insurance companies. We should be informing patients of its existence, and then encouraging them to participate for its positive influence on health outcomes and healthcare savings, not to mention another important reason that is often lost in the shuffle: removing the burden of isolation caused by chronic illness.