February 21, 2013

National Standards for DSME and DSMS – Part 2

Part 2 of 6 Parts

In this blog, I will start with the standard number one and cover several of them. However, the definitions should be stated first and I will quote them.
DSME (Diabetes Self-Management Education).
The ongoing process of facilitating the knowledge, skill, and ability necessary for prediabetes and diabetes self-care. This process incorporates the needs, goals, and life experiences of the person with diabetes or prediabetes and is guided by evidence-based standards. The overall objectives of DSME are to support informed decision making, self-care behaviors, problem solving, and active collaboration with the health care team and to improve clinical outcomes, health status, and quality of life.”

It is important to note that prediabetes is mentioned here and no distinction is made to prefer one type of diabetes over another. Yet, this distinction is prevalent in the activities of certified diabetes educators (CDEs) in practice today. This is the reason for calling attention to this.

DSMS (Diabetes Self-Management Support).
Activities that assist the person with prediabetes or diabetes 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. The type of support provided can be behavioral, educational, psychosocial, or clinical.”

These are the two key definitions that apply to this and several following blogs. Keep them in mind when reading the materials.

The first standard states, The provider(s) of DSME will document an organizational structure, mission statement, and goals. For those providers working within a larger organization, that organization will recognize and support quality DSME as an integral component of diabetes care.”

This is a powerful standard in any profession, but from practical knowledge, this is the first standard violated by most providers (CDEs). There are a few that do have this in place and do make use of it for the intended purpose. I am aware of one diabetes clinic in a Midwest city that has something like this on file and all new personnel are required to read this and agree with it before an interview even takes place. In addition, some of the literature handed out by the clinic includes parts of this document. CDEs that fall short of this or violate it are dismissed rather quickly. This is not my clinic, but one in a city about three hours distant depending on the traffic.

Another clinic also has a similar documentation, but this one was written by the doctors that own the diabetes clinic and it works very well. As to how it conforms to the above standard, I can only guess, but a relative of mine does say that she receives excellent education in all areas except nutrition. Since she is a retired nutritionist, she has learned not to include dietitians on her team.

The second standard states, The provider(s) of DSME will seek ongoing input from external stakeholders and experts in order to promote program quality.”

This is a standard that depends on the office, clinic, or hospital. Some doctors prefer their input only, while others want their CDEs out in the community and participating in community meetings and after work activities. One primary care physician does have his CDEs involved with the school system and checking that pupils with diabetes are receiving proper care. When it was discovered that the school system had made a budget cut to eliminate the nurses, he went before the school board and warned them that they had better reinstate the cut or have the ADA investigating as well as the state board of education. It was reinstated at the next meeting and the two nurses rehired.

Some diabetes clinics do work to have input from the community and have proper channels for other input. I am not aware of any formal advisory boards, but they may exist and I don't know about them.

The third standard states, The provider(s) of DSME will determine who to serve, how best to deliver diabetes education to that population, and what resources can provide ongoing support for that population.”

Ouch! It is no wonder there is widespread discrimination in the service provided. In many areas, this has to be the reason people with type 2 diabetes don't have CDEs available to them and receive no education about diabetes. Yes, even the standards authors recognize this and state, “Currently, the majority of people with diabetes and prediabetes do not receive any structured diabetes education.”

It is interesting the follow up statement the standards people make. Without the qualified people to be available, this just points out the fact that lay people need training to fill in gaps where CDEs are not available.

This information is from the National Standards for DSME and DSMS.

No comments: