Pioneers in Ambulatory Diabetes Education and Advocacy: We started in Pennsylvania!
Part 1
A bit of Diabetes Educator history… three of us decided to share some memories with the current group of PA/DE diabetes educators
Contributors: Barbara Bradley, MS, RN, CDE; Marianne McAndrew, MSN, RN, CDE; Jean Kovaleski, MS, RN, BSN, CDE, formerly of Wyoming, Luzerne, and Lackawanna Counties, respectively.
The early days of diabetes education in NE Pennsylvania…
In the early days, all diabetes education was provided on an inpatient basis. Patients were admitted to the hospital with a diagnosis of Type 1 or Type 2 diabetes. Educators would see the patients prior to discharge to provide “education” while the patient was in the hospital. However most of us realized that patients did not learn best during this time frame, as they were still acutely ill and the attention span was limited, most likely due to sleep deprivation while hospitalized. The focus changed when DRGs evolved in 1982 and the focus was at decreasing hospital costs. The outpatient diabetes education concept was born. Those of us in the early days were instrumental in the piloting the National Standards of Care for Diabetes Self-Management Programs and attempting to secure healthcare insurance coverage for these programs. Peg Adams, MSN, RN, PA Department of Health diabetes nurse facilitator was the organizer of such a movement in Pennsylvania. Peg was recruited to West Virginia to establish an outpatient education program.
This was before reimbursement for diabetes education. As a result of this pilot study, Ms. Bradley’s program at Tyler Memorial Hospital received PA health Department recognition for meeting National Standards and Blue Cross/BlueShield of PA provided a portion of coverage for the cost of members attending the program. Ms. McAndrew established a program at Mercy, Wilkes-Barre; Ms. Kovaleski, a program at Carbondale General.
In 1988, Jean Kovaleski chaired the ADA-Mid Atlantic Capitol Hill Climb, Washington, DC, to promote expanded reimbursement-coverage for Diabetes Treatment and Training. She attended as a national advocate.
There were town meetings held in various municipalities, with individuals sharing their story. In those days, we could get pharma companies to provide unrestricted educational grants to assist with travel and events. All Senior citizens, diabetes educators and individuals with diabetes met with their legislators to share their story of having diabetes.
In late 1997, educators across the state of PA started to work together to march on the capital in Harrisburg. Educators across the state marched on Harrisburg in 1998 to get Act 98 of 1998 passed to ensure coverage for diabetes education and supplies in Pennsylvania. What a successful march it was. Act 98 of 1998 passed the PA legislature like a “slick oiled machine”.
It was the advocacy efforts of us all that moved this forward in Pennsylvania. Never underestimate the power of the people.
Barbara moved to Florida at end of October 1988. Peg went to WV soon after, and in 1990 recruited Barbara to WV. She then attended a diabetes management program offered by the medical school at Eastern Carolina University. Both ladies initiated the re-establishment of the children’s diabetes camp in WV. Peg and Barbara were each, in different years, president of the board of directors for Camp Kno-Koma and each was camp director for separate years. Barbara was involved with state-wide training of DSME staff around the state and within Charleston Area Medical Center. Peg took her turn as president of WVADE. Barbara started an insulin pump program, and a renal transplant diabetes follow up program in collaboration with the transplant surgeons; collaborated with physicians for protocols for transition from open heart cardiac surgery to step down units; obtained medical staff approval for flexible orders for sliding scale insulin use and the prevention of iatrogenic hypoglycemia. She also presented a poster session at the Boston AADE annual meeting to share information about the renal transplant/diabetes program.
In February, 1996, Peg Adams and Barbara Bradley testified at a joint session of the West Virginia state legislature providing testimony for obtaining coverage for DSME in WV. Fortunately, it passed despite strong lobbying against it by the insurance companies. In 1996, Peg Adams was nominated and awarded as National Diabetes Educator of the year for AADE, recognizing accomplishments for diabetes advocacy and an early telemedicine project for foot care with Charleston Area Medical Center and West Virginia University Medical School. Also, in 1996, our WVADE chapter was awarded small chapter of the year by AADE and recognized at a national conference.
In 1997, Barbara joined Insulin-pumpers.org, an online community for insulin pump users and was invited to join their advisory board. Barbara was asked to assist an insulin pump user living in northern Mexico. Early long distance pump training and management was born. (I never gave it a thought about needing a license for nursing in Mexico since my counseling was written in WV, where I had a license.)
Barbara was president-elect for WVADE in 1999, but returned to Delaware when the hospital decided to downsize all programs not making a profit. She later worked as a clinical manager at Animas Corporation where she authored and co-authored continuing education self- learning materials for intensive insulin management and began writing insulin pump self- management articles for Diabetes Interview/Diabetes Health magazine, and presented a poster session about insulin pumps in the school systems. In Delaware, Barbara has been active with the Diabetes Coalition, served as a speaker and volunteer with the ADA, taught with ABC Diabetes programs, and with the Diabetes Prevention and Control Program in DE.
Marianne
Marianne held various leadership positions in NE and SE chapters of diabetes educators and as well as local American Diabetes Association and Nursing leadership positions. Marianne was nominated by her peers in 1999 as AADE National Diabetes Educator of the Year and received this award at the 1999 AADE meeting in Orlando Florida.
The award honors a diabetes educator who has made a special contribution to the field through dedication, innovation and sensitivity in patient care. In 1999, Marianne left NE Pennsylvania to join the Southeastern PA chapter of AADE.
One of Marianne's noted achievements is successfully advocating for insurance coverage for diabetes education and supplies in Pennsylvania. She previously served as supervisor of Outpatient Diabetes Services at Mercy Health Partners, Northeast region, Pennsylvania; and managed a diabetes self-management program at Chester County Hospital in West Chester, PA. She worked for Medtronic Diabetes as a clinical manager, creating a national program Now You Can, aimed at intensive management in diabetes care.
Marianne presently works as a clinical nurse/pump specialist with CCS Medical and as a diabetes disease management consultant in the Philadelphia area. Her patients have described her as a "true advocate" for persons with diabetes. She has diabetes education blog articles posted through her CCS Medical, Inc. employer. She has published articles in The Diabetes Educator, Nursing Administration and various patient publications.
In a role to improve advocacy, Marianne remains active in various diabetes educator and nursing organizations. She earned her Master’s in Nursing in 2009 and is completing her Doctorate in Nursing Practice at West Chester University this summer.
Next week, Part 2, Jean's story