Teachable Moments in Diabetes Care: Approaching Patients at the Point of Diagnosis

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by David Hite PhD

As clinicians we face the unenviable task of delivering distressful diagnoses to patients. When the diagnosis involves a chronic condition such as diabetes, it’s important to take the time to go beyond simple explanations of the disease process, and offer the patient an understandable, workable roadmap for successful management of their disease.

Physicians are in a uniquely powerful position to influence patient perceptions. At this teachable moment, the patient stands at a crossroad where acceptance and adherence to a treatment plan may well determine their clinical outcome.

Unfortunately for the clinician and the patient, adherence to long-term therapy for chronic illnesses averages only 50%. This severely compromises the effectiveness of treatment plans, and increases the risk of complications. Healthcare costs from chronic conditions account for about 75% of the cost of healthcare. 133 million Americans, nearly one in two, live with a chronic health problem, accounting for 7 out of 10 deaths.

A physician’s tools are often limited to medication management. When dealing with chronic conditions, this modality alone may be insufficient. It’s important to impress upon the patient that many of the complications associated with chronic conditions are not inevitable, and that what the patient does to improve their health condition outside the clinic may be as important as anything that goes on inside the clinic. Studies show that lifestyle changes are as effective as medication at lowering A1c. Successful management of a chronic condition requires a partnership.

Many patients will find it hard to overcome attitudes and beliefs they hold about disease, doctors, drug companies, and the healthcare system in general. Some view doctors simply as pill pushers. One strategy I find effective in overcoming this patient perception is to explain that there may be alternatives to medication that involve lifestyle change. This can be a point for negotiation, say a six-month trial at lifestyle change before employing a medication regimen. If you are fortunate enough to have a diabetes educator on staff, have them meet with the patient to talk through these feelings.

In my role as a Clinical Health Educator in the Chronic Conditions Management Department, I have the opportunity to meet patients at the time of diagnosis and listen to their fears and concerns. I also use this opportunity to introduce them to a common sense model of diabetes self-care called the 5M’s. This model focuses the patient on five elements that affect blood sugar control: Monitoring, Meals, Motion, Motivation, and Medication. I’ll offer details of this self-care model in next month’s blog.

Empowering the patient to make lifestyle changes will be effective only to the extent that the patient understands and can execute the treatment plan. The patient may not understand the factors that make complications more common, or doubt their ability to make and sustain healthy lifestyle changes. They may have tried and failed at previous attempts. Express your belief that they can be successful making positive change. On-going support and encouragement are also vital components of this plan.

Connecting with the patient and getting buy-in for a treatment plan at the point of diagnosis is critical for success. Trust is the key to this patient buy-in, and buy-in is the first step to achieving compliance. The patient needs to understand their role, and be willing to play their part. While you have the patient’s full attention, recognize that your response to them will lay the groundwork for a successful patient outcome. This is clearly a teachable moment. Don’t let the opportunity pass.

Sources

Improved outcomes in hypertension after physician tutorials
http://www.ncbi.nlm.nih.gov/pubmed/937876

Identifying teachable moments for health behavior counseling in primary care
http://www.ncbi.nlm.nih.gov/pubmed/21183305

Adherence to long-term therapies
http://www.who.int/chp/knowledge/publications/adherence_full_report.pdf

Chronic Diseases and Health Promotion
http://www.cdc.gov/chronicdisease/resources/publications/AAG/chronic.htm

Diabetes Control and Complications Trial
http://diabetes.niddk.nih.gov/dm/pubs/control/

United Kingdom Prospective Diabetes Study
http://care.diabetesjournals.org/content/26/suppl_1/s28.full

Diabetes Education Seems to Help Improve Blood Sugar Control
http://consumer.healthday.com/Article.asp?AID=657733

How do I get them to do what they're “supposed” to do?
http://www.medscape.com/viewarticle/493600_4

Improving health outcomes with better patient understanding and education
http://dx.doi.org/10.2147/RMHP.S7500

About The Author
David Hite PhD, is a lifelong educator, spending 20 years teaching biology, chemistry, and health education at the high school and community college levels, two years teaching science at Cairo American College in Egypt, and two years at Shanghai American School in China. Dr. Hite developed the patient-friendly "Take Control - Diabetes Basics," a diabetes educational DVD used by clinicians to encourage their patients to implement and maintain effective self-care strategies, and has spent the past 11 years working daily with diabetes patients as a Clinical Health Educator in the Chronic Conditions Management Department for a large non-profit healthcare provider in Sacramento, California. Dr. Hite is a member of the American Association of Diabetes Educators, and the American Diabetes Association.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of DiabetesProductSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

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