Diabetes is a more costly disease than is commonly understood. Not only does it permanently damage major organs, but it also activates the chronic diseases of hypertension and hyperlipidemia. People with diabetes need to know how to control weight, blood pressure and cholesterol, as well as glucose levels.
The article, “Diabetes Self-Care Improves Slowly, US Report Finds” comments on the improvements diabetic Americans have made during the first decade of the 21st century as it relates to glucose (8%), blood pressure (12%), and cholesterol (21%). A most important finding is that 14% of diabetic Americans tightened control of all their risk factors. This leaves a large portion of the diabetic population not meeting their target goals. With almost 26 million people in this country having diabetes and healthcare expenses being 2.3 times greater when diabetes is present; there is enormous room for improvement.1
Dr. Graham McMahon, a diabetes specialist at Brigham and Women’s Hospital in Boston offers his comments to the news report from the U.S. CDC and NIH. Disappointed by the study results, he believes that changes need to be made in how diabetes is managed and reimbursed in order to see large scale improvements. He speaks of exploring and dismantling the obstacles patients’ experience.
The American Association of Diabetes Educators 2007 end of year report lists a number of the barriers people experience when trying to get their medical education.2 People find training to be unaffordable, inaccessible, and inconvenient. Physicians, who refer patients to these programs, find them equally dissatisfying. They cannot find enough referral sources and they mistrust the quality of the programs. From the classroom perspective; the subject matter is complex and time-consuming to learn, while it is also costly to teach. These barriers are only the beginning for people with diabetes. In the real world, people have insecurities to surmount, doubts about self-empowerment to conquer, a constant barrage of deceptive advertising to overcome, and a string of ever changing life circumstances to navigate.
It is our responsibility as healthcare providers and third party payers to dismantle the clinician-centered model used in Diabetes Self-Management Training (DSMT) and transform the process into one that is patient-centered. Chandler Macleod, a recruiting firm that surveyed 1,200 companies, found that employees prefer to learn online.3 In support of this; Training Magazine reported a 50-70% savings when corporations replace instructor-led training with self-paced electronic study.4 Web-enabled training tailors learning to the individual far more than is possible in the classroom setting by offering more “learning by doing”. SRI International, while working for the U.S. Department of Education, concluded that the effectiveness of e-training exceeds that of classroom training.5 Best yet, online DSMT meets the disease management standards outlined by the American Diabetes Association and the National Business Coalition on Health while also being compatible with value-based purchasing strategies. Web-enabled training brings us closer to patient-centered care. Learning is self-paced, interactive, and customized.
Part of dismantling the clinician-centered model requires that we show people respect and stop micro-managing their training. Most current online DSMT programs, due to reimbursement requirements, contain deadlines and a laundry list of requirements. These often demotivate people and yield counter-productive results. People know what lifestyle behaviors they are willing to change and when they have questions. Web-enabled training does not require strong and oppressive clinician management in order to be effective. During a time when chronic disease is escalating at an exponential rate and health care costs are spinning out of control, web-enabled disease management training without oppressive clinician regulation allows people to make educated decisions for their lives and offers a high quality, cost-effective solution that is easily scalable for large populations.
1. National Diabetes Fact Sheet. (2011). Retrieved from http://www.cdc.gov/diabetes/pubs/estimates11.htm.
2. Peyrot M. (2010, September 1). AADE DSMET Access Grant Project, 2007 End of Year Report. Retrieved from http://www.diabeteseducator.org/export/sites/aade/_resources/pdf/AADE_DSMET_Access_Grant_Project–07_EOY_Report_M._Peyrotx_PhD.pdf
3. E-learning good way to keep employees keen. (2005, May 2). Retrieved April 3, 2012 from http://www.nzherald.co.nz/employment/news/article.cfm?c_id=11&objectid=10123231
4. About Us. Web Advantage referencing Training Magazine. (2000). Retrieved April 3, 2012 from http://webadvantageinc.com/about/about.htm
5. Evaluation of Evidence-Based Practices in Online Learning, a Meta-Analysis and Review of Online Learning Studies. (2010, September). U.S. Department of Education. p. 41, para. 3. Retrieved from http://www2.ed.gov/rschstat/eval/tech/evidence-based-practices/finalreport.pdf
About the Author:
Frustrated by barriers to patient learning, Laurie Van Wyckhouse, MS, RD, LD/N developed NutriTutor® web-enabled & telehealth disease management programs to help empower people toward better health and reduce costs for payers and businesses. NutriTutor® programs combine the cost-effectiveness of technology with solid training principles; acting as the first line of treatment for chronic disease