Objectives Upon completion of this module, learners will be able to: - - PDF document

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9/18/2017 An Evidence Based Intervention Fall Pharmacy ForumNortheast Kentucky AHEC September 23, 2017 Kim Coy DeCoste RN, MSN, CDE, MLDE Kentucky Department for Public Health Kentucky Diabetes Prevention and Control Program (KDPCP)

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An Evidence‐Based Intervention

Fall Pharmacy Forum—Northeast Kentucky AHEC September 23, 2017

Kim Coy DeCoste RN, MSN, CDE, MLDE Kentucky Department for Public Health Kentucky Diabetes Prevention and Control Program (KDPCP)

Objectives

Upon completion of this module, learners will be able to:

1. Describe quality diabetes self‐management

education (DSME).

2. List at least 3 expected outcomes of DSME.
3. Utilize the Kentucky Diabetes Resource

Directory for referral sources for DSME and support.

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Diabetes in Kentucky

458,000

with diagnosed diabetes

1.1 million

with Prediabetes*

240,000 Kentucky Adults (8.4%) report a diagnosis of prediabetes (KY BRFSS, 2015) *National Health Interview Survey estimates

applied to KY

Diagnosed Diabetes in Adults KY Counties 2013

106 of Kentucky’s 120 counties had rates of diagnosed diabetes at 11.2% or above ─ ranking these counties among the top in the nation! (2013 CDC Diabetes Atlas) http://www.cdc.gov/diabetes/atlas/countydata/atlas.html

Diabetes Prevalence by Area Development District

2014 KY Behavioral Risk Factor Surveillance Survey

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Clinical and Self‐Care Measures

Kentucky Department for Public Health and CDC, BRFSS Survey, 2011, 2012, 2013, 2015

DSMES is an integral part of standard diabetes care.

“… Ongoing patient self‐management education and support are critical to preventing acute complications and reducing the risk of long‐term complications …”

ADA. Standards of Medical Care. Diabetes Care (2017)

What is DSMES?

“Diabetes self‐management education and

support is the ongoing process of facilitating the knowledge, skills, and ability necessary for prediabetes and diabetes self‐care as well as activities that assist a person in implementing and sustaining the behaviors needed to manage his or her condition on an ongoing basis, beyond or outside of formal self‐ management training”

Beck et. al, Diabetes Care and The Diabetes Educator, July 2017

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National Standards for DSMES

2017 –The Standards define timely, evidence‐based quality DSMES services that meet or exceed the Medicare DSMT regulations. Evidence supports person‐ centered services. The current Standards are designed to reflect the value

f ongoing support and multiple services

National Standards for DSMES

1) Internal Structure 2) Stakeholder Input 3) Evaluation of Population Served 4) Quality Coordinator Overseeing DSMES Services 5) DSMES Team

DSMES Team

 At least one team member facilitating DSMES will be a RN, RD, or Pharmacist with training and experience pertinent to DSMES or another health professional holding a certification as a diabetes educator (CDE) or Board Certified Advanced Diabetes Manager (BC‐ADM).  Licensed Diabetes Educator

 In 2011, KY became the first state to pass legislation

relating to licensure of diabetes educators.  Diabetes Paraprofessional

 Must directly report to the qualified DSMES team

member.

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National Standards for DSMES

6) Curriculum 7) Individualization 8) Ongoing Support 9) Participant Progress 10) Quality Improvement

Evidence‐Based Curriculum

Core Content Areas

 Diabetes pathophysiology and treatment options  Healthy eating  Being active  Monitoring and using patient‐ generated health data  Taking medication  Problem solving  Healthy coping –with psychosocial issues and

concerns

 Reducing risks –preventing, detecting and treating

acute and chronic complications

National Standards for DSMES

6) Curriculum 7) Individualization 8) Ongoing Support 9) Participant Progress 10) Quality Improvement

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DSMES Improves Outcomes

Immediate Intermediate Post‐intermediate Long‐Term

Outcomes Continuum

Clinical

Indicators

Improved

Health Status

Behavior

Change

Learning

DSMES Improved Outcomes

 More likely to receive guideline driven care  More likely to take medications as prescribed  More likely to use primary care and preventive services or follow‐ up on treatment recommendations  More healthful eating patterns and regular activity  Increased self‐efficacy and empowerment

 Healthy coping  Improved quality of life

 Improved A1C ‐ 1% reduction translates to:

 21% reduction in diabetes‐related death  14% reduction in MI  37% reduction in microvascular complications

 Reduced hospital admissions and readmissions  Reduced healthcare costs

Four critical times for DSMES

At diagnosis. Annually for assessment of education, nutrition and emotional needs. When new complicating factors influence self‐ management. When transitions in care occur.

Powers, et. al, 2015

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DSMES makes the biggest impact when:

Both group and individual education are involved Provided by a team rather than an individual More than 10 hours is attended The DSMES is individualized to the participant Is focused on behavior and engages the participant rather than didactic

Call to Action

 Make DSMES referral part of your practice.  Observe a quality DSMES program.  Become a licensed diabetes educator.  Become an accredited or recognized DSMES provider.  Provide ongoing diabetes self‐management support within your practice setting.  Utilize the Kentucky Diabetes Resource Directory

 https://prd.chfs.ky.gov/KYDiabetesResources/

Kentucky Diabetes Resource Directory

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Kentucky Diabetes Resource Directory

 Created in 2010 based on a recommendation from a statewide planning initiative  Diabetes assessments (county by county) are completed yearly by local health departments to help maintain current information in resource directory  The directory is built where the health care provider can enter new information or update resources & contact information  The completeness and accuracy of the directory depends on feedback from service providers

Jump Right In

Public Web Address

https:/ / prd.chfs.ky.gov/ KYDiabetesResources/

GOOGLE: Kentucky Diabetes Resource Directory

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Home Page

Click Search… Tw o W ays

Search Page

W hat it looks like…

Search Categories

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Category Description click on either icon

Description of Resources

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Search Page

Search for one or all the resources at the sam e tim e

Search Page

Search by county, adjacent counties or entire state

EXAMPLE:

Search Nationally Recognized

r Accredited DSME Classes ( all counties) lists by

resource, county in alpha order, etc.

Lists by resource

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Now for the Games…

On your iphone (if you don’t have internet on your phone – work as a team with a partner) The first person to shout out the answer to the question gets a prize!

Go to:

Kentucky Diabetes Resource Directory 1 . Search for Diabetes Prevention

Program s / DPP Organizations 2 . Search ALL in state 3 . W hat entity is listed as 5 th?

Another Exam ple

1 . Search for “Nationally "Recognized" or "Accredited" Diabetes Self‐Management Education and Support Class” 2 . Search Carter County only 3 . * How Many “Resources” are listed? * W ho is the first entity listed?

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Other Features

Providers may update or add their own information (reviewed / approved before it goes onto site – Takes few days to see updates or new entries)

Other Features

Allow s inform ation to be printed as “printable results” to be used as a hand-out and PDF

Printable Results (by county, adjacent counties, or state)

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Other Features‐Kentucky Diabetes Links

Links to other national sites w hich house listings for Kentucky diabetes providers

( like AADE’s find a diabetes educator; ADA’s find a recognized program ; NCQA, etc.)

Other Features

Links for general diabetes inform ation

( ADA, CDC, JDRF, KDN, KDPCP, NDEP, NI DDK, etc.)

KENTUCKY DIABETES RESOURCE DIRECTORY

Purple cards – share with others!

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Other Resources are Available

http:/ / dca.ky.gov/ DCA% 2 0 Resource% 2 0 Docum ent% 2 0 Library/ SharpsDisposalFactSheet1 2 1 4 1 6 .pdf

References & Resources

 Garfield, Downer, Rosenberg, Greenwald, Reconsidering Cost‐Sharing for Diabetes Self‐Management Education: Recommendation for Policy Reform, Center for Health Law & Policy Innovation, Harvard Law School (2015).  Powers et. al, Diabetes Self‐management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics, Diabetes Care 2015; 38:1‐11/DOI: 10: 10.2337/dc15‐0730  Duncan et.al., Assessing the Value of the Diabetes Educator, 37, The Diabetes Educator, no. 5, 638‐657. Sept./Oct. 2011.  Li R, S. , et. al; Centers for Disease Control and Prevention (CDC). MMWR Morb Mortal Wkly Rep. 2014 Nov 21;63(46):1045‐9  Norris et. al, Self‐Management Education for Adults With Type 2 Diabetes .A meta‐analysis of the effect on glycemic control; Diabetes Care 2002 Jul; 25(7): 1159‐1171. https://doi.org/10.2337/diacare.25.7.1159  Beck, et. al; National Standards of Diabetes Self‐Management Education and Support; The Diabetes Educator; July 2017.  ADA Standards of Medical Care in Diabetetes‐2017 Jan; 40 (Supplement 1).  Kentucky Board of Licensed Diabetes Educators: http://bde.ky.gov/Pages/default.aspx  American Association of Diabetes Educators—https://www.diabeteseducator.org  Kentucky Diabetes Network‐‐ http://www.kydiabetes.net/  American Diabetes Association—http://www.diabetes.org/  Kentucky Diabetes Prevention and Control Program‐‐ http://chfs.ky.gov/dph/info/dpqi/cd/diabetes.htm