February 22, 2013

National Standards for DSME and DSMS – Part 3

The fourth standard states, A coordinator will be designated to oversee the DSME program. The coordinator will have oversight responsibility for the planning, implementation, and evaluation of education services.”

This works well in larger cities where two or more certified diabetes educators (CDEs) work for the same office, however, I do have to wonder about CDEs working alone in some of the smaller offices, clinics, and hospitals. As the DSME continues to evolve, the coordinator should play a pivotal role in ensuring accountability and continuity in the education program. Will coordinators need to travel from large offices to smaller offices and rural areas as an area coordinator? This is something to be considered. The standard does state, in some cases, particularly in small practices, the coordinator may also provide DSME and/or DSMS.

The fifth standard states, One or more instructors will provide DSME and, when applicable, DSMS. At least one of the instructors responsible for designing and planning DSME and DSMS will be a registered nurse, registered dietitian, or pharmacist with training and experience pertinent to DSME, or another professional with certification in diabetes care and education, such as a CDE or BC-ADM. Other health workers can contribute to DSME and provide DSMS with appropriate training in diabetes and with supervision and support.”

Maybe historically, nurses and dietitians were the main providers of diabetes education, but in recent years, this has been expanded to mainly pharmacists. It is therefore natural to see this in the hierarchy of people in the literature and whom they assign the functions of the different standards to for completion. At least the obligatory continuing education is included as a way of segregation to keep lay people on the sidelines.

The next area seems an attempt to make everyone welcome, but remember it is only the CDEs that can supervise and monitor the education and support. This means fewer CDEs doing actual DSME and DSMS. A number of studies have shown that a multidisciplinary team approach to diabetes care, education, and support works well for the patient. Yet in too many cases, the patient is often not the center of the efforts and central to the team approach.

The disciplines that may be involved include, but are not limited to, physicians, psychologists and other mental health specialists, physical activity specialists (including physical therapists, occupational therapists, and exercise physiologists), optometrists, and podiatrists. More recently, health educators (e.g., Certified Health Education Specialists and Certified Medical Assistants), case managers, lay health and community workers, and peer counselors or educators have been shown to contribute effectively as part of the DSME team and in providing DSMS.”

Yes, they do include lay health and community workers plus peer counselors or educators when it is to their advantage. But, notice that a system must be in place that ensures supervision of these lay people. I agree that for questions the lay people do not have answers for need to have professionals available to answer when the questions are beyond their training. This is wise even for the CDEs to have doctors or other professionals available to back them up, but this seems to be an insult to their credentials.

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

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