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

9/18/2017 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. 2 3 1

9/18/2017 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 4 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 5 Diabetes Prevalence by Area Development District 2014 KY Behavioral Risk Factor Surveillance Survey 6 2

9/18/2017 Clinical and Self ‐ Care Measures Kentucky Department for Public Health and CDC, BRFSS Survey, 2011, 2012, 2013, 2015 7 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 9 3

9/18/2017 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 of ongoing support and multiple services 10 National Standards for DSMES 1) Internal Structure 2) Stakeholder Input 3) Evaluation of Population Served 4) Quality Coordinator Overseeing DSMES Services 5) DSMES Team 11 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. 12 4

9/18/2017 National Standards for DSMES 6) Curriculum 7) Individualization 8) Ongoing Support 9) Participant Progress 10) Quality Improvement 13 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 14 National Standards for DSMES 6) Curriculum 7) Individualization 8) Ongoing Support 9) Participant Progress 10) Quality Improvement 15 5

9/18/2017 DSMES Improves Outcomes Immediate Intermediate Post ‐ intermediate Long ‐ Term Behavior Clinical Improved Learning Change Indicators Health Status Outcomes Continuum 16 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 17 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 18 6

9/18/2017 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 19 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/ 20 Kentucky Diabetes Resource Directory 21 7

9/18/2017 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 22 Jump Right In 23 Public Web Address https:/ / prd.chfs.ky.gov/ KYDiabetesResources/ GOOGLE: Kentucky Diabetes Resource Directory 24 8

9/18/2017 Home Page Click Search… Tw o W ays 25 Search Page W hat it looks like… 26 Search Categories 27 9

9/18/2017 Category Description click on either icon 28 Description of Resources 29 Description of Resources 30 10

9/18/2017 Search Page Search for one or all the resources at the sam e tim e 31 Search Page Search by county, adjacent counties or entire state 32 EXAMPLE: Search Nationally Recognized or Accredited DSME Classes ( all counties) lists by resource, county in alpha order, etc. Lists by resource 33 11

9/18/2017 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! 34 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 ? 35 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? 36 12

9/18/2017 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) 37 Other Features Allow s inform ation to be printed as “printable results” to be used as a hand-out and PDF 38 Printable Results (by county, adjacent counties, or state) 39 13

9/18/2017 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.) 40 Other Features Links for general diabetes inform ation ( ADA, CDC, JDRF, KDN, KDPCP, NDEP, NI DDK, etc.) 41 KENTUCKY DIABETES RESOURCE DIRECTORY Purple cards – share with others! 42 14