This Blog is presented to you by Linda Siminerio, RN, Phd, CDE
As the diabetes epidemic continues to escalate, diabetes educators need to be strategic in how they reach people the vast number of people in need of their service while resources become scarce. Program Reinforcement Impacts Self-Management (PRISM) is a comparative effectiveness study designed to determine the effectiveness of diabetes self-management education (DSME) delivered in primary care and a comparison of self-management support (SMS) approaches delivered by educators, trained peers or practice staff. Findings revealed that when certified diabetes educators (CDEs) provided DSME to patients within the primary care practice, patients had significant improvements in HbA1c, lipids, empowerment levels and reductions in distress. Improvements were maintained with SMS throughout the delivery of SMS interventions regardless of SMS agent. These results reaffirm the critical role of diabetes educators. Not only did the educator-driven DSME intervention in primary care have a significant impact on clinical and behavioral outcomes, participants who received SMS from the CDE had trends toward better maintenance of HbA1C levels, significantly better empowerment scores and reported highest satisfaction. In addition, findings indicated that educators have unique skills in promoting patient empowerment and positive behaviors. Given the disproportionate ratio of CDEs to the growing number of people with diabetes, educators may need to re-evaluate resources and their roles. For example, the masses of diabetes patients may be better served if educators concentrate their efforts on the delivery of DSME and expand their roles to include supervisory and training responsibilities of peer and practice staff.
Diabetes is a self-management disease and in order to obtain positive outcomes and sustain them for the long term, we will need to consider DSME and DSMS approaches. Organizations like the National Committee of Quality Assurance (NCQA) already recognize self-management and include it as a key requirement in the NCQA Patient Centered Medical Home (PCMH) recognition process. Therefore primary care practices operationalizing the PCMH will need to identify methods to provide self-management services. Our results suggest that DSME delivered in the PCMH is effective and multiple SMS modalities are reasonable.
The newly revised National Standards for DSME highlight the importance of diabetes SMS. As patient-centered and quality care approaches are being examined, delivery of diabetes self-management education and support becomes paramount. Future efforts should target government and organizational policies and procedures which will make DSME and DSMS a mandatory service and universally accessible in community settings, like primary care. This is feasible and has the potential to be generalizable and cost-effective.
Online article can be found at:
http://tde.sagepub.com/content/early/2013/06/17/0145721713492570