« The Dual Agenda: May 18, 2016 Issue

Eldercare Voices

A Person-Centered Diabetes Prevention Model

Rosa Palacios

On March 23, the Department of Health and Human Services announced a significant step forward in building a health care system that works better, spends dollars smarter and keeps people healthy. On that date, Secretary Sylvia M. Burwell announced that the independent office of the Actuary in the Centers for Medicare and Medicaid Services (CMS) had certified expansion of the Diabetes Prevention Program, a model funded by the Affordable Care Act that has great potential to reduce net Medicare spending while helping people with diabetes become empowered to improve their health while living with this condition.

As a certified Master Trainer in the Stanford University Diabetes Self-Management Program in both English and Spanish, I was thrilled by this announcement. I have had over a decade of experience working with older adults living with diabetes and have seen the great benefit of helping consumers become active participants in their own health care – working in partnership with medical professionals, rather than simply being recipients of care. I believe that simply providing medical services and prescriptions to consumers without also providing education and information is neither effective nor ethical.

The Stanford Diabetes Self-Management Program is a six-week workshop offered to adults living with the challenges of diabetes. Participants meet weekly for two and one-half hour sessions. Workshops, which are led by two certified lay leaders, use an interactive supportive model that encourages problem-solving, goal-setting and behavior change. Some of the topics include: dealing with difficult emotions; physical activity and exercise; power of the mind; pain and fatigue management; healthy eating; communication skills; medication usage and making informed treatment decisions.

I’d like to share the story of Elena, one consumer I had the opportunity to work with.

Elena heard a suggestion from her nurse practitioner, her physical therapist and her daughter: “There is an educational program that can help you with your diabetes.”  Elena’s nurse was worried because she was not making noticeable  progress in managing her diabetes. The nurse and physical therapist met with Elena and her daughter and discussed her eating habits and provided information. She knew what was good or bad for her diet but she was not following those guidelines very well. She also knew what kind of exercises were good for her but she wasn’t actually doing them. She was worried about her condition but kept looking for the “magic bullet” -- a medication or external factor, outside of what she could do, that could resolve her problems. Elena agreed to attend the Diabetes Self-Management Program and finally began taking steps and getting ready for change. What she learned in the diabetes class, coupled with the support and encouragement she received, helped strengthen her motivation to change and catapulted her into the action stage. She began to make changes and practice her new eating behaviors. The invitations to walk with the group and attend a second class series are helping her maintain the behavioral changes that she began to integrate into her daily life.

The workshop is a mix of activities, group discussions and education which gives participants the tools they need to understand and manage their diabetes. What’s more, simply attending the workshop is helpful to participants. Just coming out and being with the group helps address isolation and loneliness. I believe that getting involved in group activities and meeting new people has a positive, long-term impact on group members. Once people connect in class they can stay in touch and they can create a friend-to-friend support system. This program has been embraced by the participants due to the environment it fosters where they feel happy, welcome and loved, without judgment and without restrictions.

The Medicare Diabetes Self-Management Training (DSMT) benefit represents an opportunity for community-based organizations to partner with health care systems to offer evidence-based diabetes self-management education (DSME) for older adults and people with disabilities. While there is a great need for DSME due to the high prevalence of diabetes, it is not uncommon for health care systems to object to having a community-based organization provide the DSME benefit or incorporate this type of educational program within their own benefits for their patients. Despite the fact that the vital importance of the individual in taking responsibility for her or his own health is strongly recognized by the U.S. Preventive Services Task Force as key to improving health outcomes, engaging the older adult to reach their best quality of life has continued to be a challenge for health care providers. 

There is a paradigm shift starting to take place between professionals and consumers where consumers are empowered to lift up their voices and where professionals listen to them and include them in the decision-making process. After all, consumers know best what they need. Time and again, I have seen older adults taking impressive steps forward in lifestyle changes to improve their health when provided the information and strategies needed.

Rosa Palacios is Consumer Engagement Specialist with the Center for Consumer Engagement in Health Innovation at Community Catalyst. Prior to joining the Center, she served 12 years on the staff of Commonwealth Care Alliance (CCA) as Consumer Involvement Coordinator and Stanford Chronic Disease Self-Management Specialist, where one of her major responsibilities was to implement and bring to scale the Chronic Disease Self-Management Program (CDSMP). She later served as head of CCA’s Department of Health Education and Caregiver Training.

Rosa holds a Master Trainer certificate in the Diabetes Self-Management Program in both English and Spanish issued by Stanford University. She is also a Master Trainer for Healthy Eating for Successful Living in Older Adults. Rosa recently graduated from the Massachusetts Institute for Community Health Leadership Program and was awarded the Emanuel and Lilly Shinagel Scholarship at Harvard University Extension School, Cambridge, MA.

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