February 27, 2013

National Standards for DSME and DSMS - Part 6

Part 6 of 6 Parts

The standards are very well thought out in general and I can support them. There are several areas that need emphasis. The first is, “In the course of its work on the Standards, the Task Force identified areas in which there is currently an insufficient amount of research. In particular, there are three areas in which the Task Force recommends additional research:
1. What is the influence of organizational structure on the effectiveness of the provision of DSME and DSMS?
2. What is the impact of using a structured curriculum in DSME?
3. What training should be required for those community, lay, or peer workers without training in health or diabetes who are to participate in the provision of DSME and to provide DSMS?”

I mentioned this in Part 1, and I will cover more of this now. If you have not read the standards yet, please consider doing so. These were published back in September of 2012, but not on the ADA site until January 2013. This is the better read as it can take you to each standard, it has links to research papers, and the AADE website is a download of a PDF file and no active links to research papers. As of this writing, the American Association of Diabetes Educators (AADE) has not seen it necessary to correct prior publications or update those on the books for 2013. The AADE has written about their goals for 2013 to 2015, but did not mention anything about the national standards. This may be read by downloading a PDF file at this link, named the 2013-2015 AADE Strategic Plan.

This plan is mainly a generalization of self improvement for those already in the educator field and some general ideas for expansion. This means keeping their control of the educator field and not bringing in lay people to assist them in any way. With the continued shortage of CDEs, how is this any help to the expanding number of people diagnosed every day with diabetes.

I doubt there is any structured curriculum for DSME and what may exist is still thought of as DSME and DSMT. There is nothing presently for DSMS. In attempting to follow discussions and locate DSMS information, you will need to read DSMT (diabetes self-management training).

If you are looking for information on community, lay, or peer workers without training in health or diabetes who are to participate in the provision of DSME and to provide DSMS, you will not find anything. This is only on the books in the American Diabetes Association link above and as of yet, the AADE has rejected publishing any material about it.

What ever strengths or weaknesses exist in the current standards will need to wait until the next Task Force is activated in probably the fall of 2016. If the new regulations put forth by the Affordable Care Act create unforeseen problems for the ADA and AADE then we might see it happening sooner. The past Task Force was activated in the fall of 2011 and most of the material made public in September of 2012. Final publication did not happen until January of 2013 for most material.

Members of the Task Force included experts from the areas of public health, underserved populations including rural primary care and other rural health services, individual practices, large urban specialty practices, and urban hospitals.” It is good to see that the underserved populations were included; however, I think that the elderly were not part of this underserved group. The following two paragraphs are important enough to quote as they do mark a point of change and an extremely large area that the AADE may not be able to meet.

The Task Force made the decision to change the name of the Standards from the National Standards for Diabetes Self-Management Education to the National Standards for Diabetes Self-Management Education and Support. This name change is intended to codify the significance of ongoing support for people with diabetes and those at risk for developing the disease, particularly to encourage behavior change, the maintenance of healthy diabetes-related behaviors, and to address psychosocial concerns. Given that self-management does not stop when a patient leaves the educator’s office, self-management support must be an ongoing process.”

Although the term “diabetes” is used predominantly, the Standards should also be understood to apply to the education and support of people with prediabetes. Currently, there are significant barriers to the provision of education and support to those with prediabetes. And yet, the strategies for supporting successful behavior change and the healthy behaviors recommended for people with prediabetes are largely identical to those for individuals with diabetes. As barriers to care are overcome, providers of DSME and diabetes self-management support (DSMS), given their training and experience, are particularly well equipped to assist individuals with prediabetes in developing and maintaining behaviors that can prevent or delay the onset of diabetes.”

The last paragraph before the definitions covers something many CDEs may not want, but is important. It is the risk for comorbidities (that is – heart disease, lipid abnormalities, nerve damage, hypertension, and depression) and other medical problems that may affect or interfere with self-care. What I find most intriguing is this statement - “The Standards encourage providers of DSME and DSMS to address the entire panorama of each participant’s clinical profile.” These may be some of the areas many CDEs are least comfortable and will not be able to use mandates to bypass.

This is where these standards become important for the patient to learn and be somewhat knowledgeable about to hold CDEs to providing high-quality education and support.

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

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