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1/14/2020
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1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Connecting the Dots: Working with
Pharmacists to Promote and Increase
Access to Diabetes Prevention and
Management Services
Jill Joseph, RN, BSN Nurse Consultant
Diabetes Prevention and Control Program
Population and Community Health Bureau
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Presentation Objectives:
1) Summarize the work of the Diabetes Prevention and Control Program around diabetes prevention and management.
2) List diabetes prevention and management programs offered by the Diabetes Prevention and Control Program
3) Recommend appropriate evidence-based prevention and management programs to patients with pre-diabetes, diabetes and related chronic health conditions.
4) Identify resources for referrals to community-based diabetes prevention and management programs.
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1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
New Mexico Department of Health
Diabetes Prevention and Control Program
• Vision: New Mexicans have the resources and skills to
prevent or effectively manage type 2 diabetes.
• Mission: Reduce the burden of diabetes and its complications in New Mexico through proven prevention and self-management education services, community-based and health care system partnerships, and training of health care professionals.
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Diabetes
• The condition in which the body does not properly process food for use as energy.
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1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Types of Diabetes
• Type 1 Diabetes- body does not produce insulin
• Type 2 Diabetes- body produces insulin but the person is insulin resistant (does not use insulin properly) or does not make enough insulin
• Gestational Diabetes-in pregnant women who have never had diabetes before but who have high blood sugar levels during pregnancy
• Type 1.5- Latent Autoimmune Diabetes in Adults
• MODY- Maturity Onset Diabetes of the Young
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1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
A Snapshot: Diabetes In New Mexico Adults (2018)
Prediabetes
Diabetes
567
Thousand250
Thousand
8 in 10 were aware of it 3 in 10 were aware of it
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Diabetes in New Mexico is costly in both human and economic terms
$2 billion
a year Estimated costs for
people with diagnosed
diabetes.
RIP
6th leading
cause of
death
686 deaths listed as
diabetes being primary
cause in 2018.
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1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Reduce the Burden of Diabetes
Increasing access to, and participation in, proven diabetes prevention and self-management services:
• National Diabetes Prevention Program (National DPP)
• Diabetes Self-Management Education and Support Program (DSMES)
• Chronic Disease Self-Management Programs
• Kitchen Creations
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
What is Prediabetes
Prediabetes is when your blood sugar is higher than normal but not as high as it would be with diabetes.
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1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
What can I do if I have prediabetes?
Prediabetes is a warning sign that you could develop type 2 diabetes.
The best ways to prevent or delay type 2 diabetes are to:
• Lose weight
• Be active (regular physical activity)
• Cut down on high fat foods
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
What is the National Diabetes Prevention Program?
• Partnership of public and private organizations working to prevent or delay type 2 diabetes.
• Evidence-based framework for diabetes prevention efforts.
• CDC-approved curriculum.
• Lifestyle intervention developed by the CDC for people with prediabetes or at risk for diabetes, based on the original Diabetes Prevention Program research study.
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1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
National DPP Delivery Basics
• Small group (10-20 participants).
• One year program led by a trained Lifestyle Coach• 16 weekly, one-hour sessions• 6-8 monthly, one-hour sessions
• Community-based programs in locations such as libraries, churches, hospitals, senior centers.
• New health system-based programs in hospitals, primary care clinics, public health offices
• Focus on healthy eating, increasing physical activity, losing weight, action planning, and problem solving.
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
What is Self-Management?
Self-management is defined as the tasks that individuals must undertake to live with one or more chronic conditions.
These tasks include having the confidence to deal with the medical management, role management, and emotional management of their conditions.
Institute of Medicine 2004
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1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Self-Management Programs
• Chronic Disease Self-Management Programs (CDSMP)
• Diabetes Self-Management Education and Support Programs (DSMES)
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Is Self-Management important? CDSMP National Study Analyses
Better Health
• Better quality of life
• Less depression
• More active lives
• Fewer sick days
Better Care
• Improved communication with doctors
• Improved medication compliance
• Improved health literacy
Lower Health Cost
$714 per person
saving in emergency
room visits and
hospital utilization.
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1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
What is CDSMP?
• Peer led small groups.
• Standardized training for leaders.
• Highly structured teaching protocols.
• Standardized participant materials.
• Several topics per session.
• Well researched and studied (evaluated in
randomized trials to establish the evidence-base).
• Designed to be culturally neutral.
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
CDSMP Includes…
• Chronic Disease Self-Management Program
• Diabetes Self-Management Program
• Chronic Pain Self-Management Program
• Cancer: Thriving and Surviving Program
• HIV: Positive Self-Management Program
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1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
CDSMP Delivery Basics
• Small group workshops (10-20 participants).
• One session per week for six weeks.
• 2 - ½ hours per session.
• Led by a pair of peer leaders, a least one of whom has a chronic health condition.
• Convenient community locations such as libraries, churches, hospitals, senior centers.
• Focus on self-efficacy, action planning, problem solving, and communication.
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Diabetes Self-Management Education and Support (DSMES)
• Definition: The ongoing process of facilitating the knowledge, skills, and ability necessary for diabetes self‐care, as well as the activities that assist the person with 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.
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1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
History of DSMES
• 10 National Standards for Diabetes Self Management Education established in 1984
• Centers for Medicare and Medicaid Services (CMS) began to reimburse for DSME in 1997
• National Accreditation Organizations:
• American Diabetes Association in 1986
• American Association of Diabetes Educators in 2009
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
DSMES hallmarks
• Individual Assessment- by health care personnel
• Person centered goals- developed collaboratively
• Combination of individual education and counselling with group workshops
• Group workshops- can be led by paraprofessionals
• Program must provide documentation, quality assurance, supervision and oversight.
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1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
When people with diabetes need DSMES- 4 crucial times
• At diagnosis
• Annual assessment of needs
• If complications occur
• Transition in care
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
What is Kitchen Creations?
• Cooking class for adults with type 2 diabetes and their caregivers.
• Curriculum was adapted, in partnership between the DPCP and New Mexico State University Cooperative Extension Service. It’s based on a successful West Virginia curriculum, Dining with Diabetes.
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1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Kitchen Creations Delivery Basics
• Small group cooking classes (10-20 participants) of adults.
• 4 weekly sessions, 3-hours each.
• County Extension office kitchens.
• Focus on meal planning, balancing carbohydrates, vegetables, beans and grains, and heart-healthy cooking.
• Includes instruction about diabetes, heart disease
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Pharmacy roles with diabetes prevention and management
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1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Pharmacy and DSMES, NDPP
• Establish a DSMES or National DPP program in your pharmacy or organization
• Partner with other pharmacies to become a DSMES or National DPP provider under 1 organization
• Partner with a local health care facility for referrals
• Partner with health care plan(s) to offer National DPP or DSMES to their clients
• Refer clients with diabetes to local DSMES sites already in existence
• Offer/support workshops at your pharmacy or in your community
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Medicare Reimbursement
• Medicare- reimburses for National DPP, DSMES
• DSMES:
• Original Medicare will reimburse for up to 10 hours during the 12 months after submission of the first claim for DSMES.
• After this first year Medicare will reimburse for follow-up training for up to 2 hours annually.
• A Registered Dietician should be involved with the supervision and billing process to assure Medicare reimbursement
• Medicare term for DSMES: DSMT
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1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Medicare Reimbursement
MEDICARE DIABETES PREVENTION PROGRAM (Medicare DPP)
• Medicare DPP began in January 2018 with Medicare reimbursement starting in April 2018
• Eligible beneficiaries have coverage of Medicare DPP services with no cost-sharing
• Medicare DPP suppliers are paid performance-based payments through the CMS claims system
• Medicare payments to suppliers can be up to $689 per beneficiary over 2 years, depending on beneficiaries’ attendance and weight loss.
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
How do I refer patients? Where?
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1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Paths to Health New Mexico
www.pathstohealthnm.org
(505) 850-0176or
(575) 703-2343
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
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1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
References• https://www.cdc.gov/diabetes/basics/prediabetes.html
• https://www.cdc.gov/diabetes/prevention/pdf/pharmacists-guide.pdf
• https://www.cdc.gov/media/presskits/aahd/diabetes.pdf
• https://www.diabeteseducator.org/docs/default-source/practice/algorithm-of-care.pdf?sfvrsn=2
• https://www.healthline.com/health/type-1-5-diabetes
• https://www.ncbi.nlm.nih.gov/pubmed/25581748
• https://www.ncoa.org/wp-content/uploads/National-Study-Brief-FINAL.pdf
• https://nmhealth.org/about/phd/pchb/dpcp/
• https://www.resourcesforintegratedcare.com/sms
1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
References
• https://www.cdc.gov/diabetes/pdfs/programs/stateandlocal/emerging_practices-work_with_pharmacists.pdf
• Lorig KR, Ritter P, Stewart AL, Sobel DS, Brown BW, Bandura A, González VM, Laurent DD, Holman HR. Chronic Disease Self-Management Program: 2-Year Health Status and Health Care Utilization Outcomes. Medical Care, 39(11),1217-1223, 2001
• Whitelaw, N., Lorig, K., Smith, M. L., & Ory, M. G. (March 19, 2013). National Study of Chronic Disease Self-Management Programs (CDSMP)
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1190 S. St. Francis Drive • Santa Fe, NM 87505 • Phone: 505-827-2613 • Fax: 505-827-2530 • nmhealth.org
Thank You
For more information contact:Jill Joseph, RN, BSN Nurse ConsultantDiabetes Prevention and Control ProgramPopulation and Community Health BureauPhone: (505) 476-7618Email: [email protected]
Dorine ConleyDiabetes Prevention CoordinatorDiabetes Prevention and Control ProgramPopulation and Community Health BureauPhone: (505) 841-5861Email: [email protected]
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