PATIENT EDUCATION

Components of the Diabetes TeamComponents of the Diabetes Team The Ideal ScenarioThe Ideal Scenario

DietitianDietitian EndocrinologistEndocrinologistNurse EducatorNurse Educator Exercise TherapistExercise Therapist

Case ManagerCase Manager

PCPPCP

Patient Education

Change of the Attitude and Behavior towards common health problems for better control or reduce its complication

Goal of Health Education

1. Knowledge2. Improvement , development and corrects skills3. Change attitudes and believes

LIFE STYLE MODIFICATION

STAGES OF PATIENT HEATH EDUCATION

1. Explanation of details2. Convinced by the knowledge given 3. Change believe4. Application attitude5. Transformation of recipient to donor health educator

WHO PERFORM THE HEATH EDUCATION

1.Physicians2.Nurses3.Dieteticien4.Social support5.Volunteers6.Patients themselves

Characteristics of Health educator

•Good Knowledge & experience•Good listener•Good observer•Simplicity•Repetition & Concentration•Speech tone and expression•Verbal & visual communication•Avoid scientific terms•Respect •Accepting errors

Factors in The recipient

1. Interest 2. Concentration3. The capability to change the attitude

Factors Affecting the Process of Learning

1.Time2.Place3.Intellectual ability4.Motive

The Subject must be :

short

ClearComplete

Plan For health education program

What are the goal

Who will do it

Content of knowledge & skills

When & to who

Duration &cost

THE WAY USED

• Person to person• Small groups• Large group lecture• Media: Newspaper Radio T V Pamphlets

Person to person education

Influence and effective

Friendship environment

Convenient to newly discovered

Disadvantage : Time consuming

Success depend on Welcoming & friendship environmentExpression and voice pitch changesSelection of subjectSimplicity, clarity, local accentGood occasion to ask questions

Person to person

Small group health education

No from 8 to 12

Done on short interval Once weekly on 6 sessionsNot more than 60-90 minutes

Selection of the groupType of diseaseAge & sexSpecial situation pregnancyIntellectual levelPrevious attendance

Encourage DiscussionSelf experience

Some beneficial notes in group education

Stop and ask questionsSummarize before transition from point to pointNo blame for wrong answerUse verbal and visual expressionTell small story to increase attentionSkills explained on vivid examples and tools

Education of large group

Communication with audience weakerLow degree of retention

PrerequisitesClear goalGood LecturerGood comfortable placeGood preparationSelection of the groupDuration 20 to 25 minutesAllow enough time for discussionUse audio visual aidsSimple language Summarize the lecture

Patient Education through the Media TV, Videocassette……

Easy to large no in short time and attractiveCan be repeated

DisadvantagesIncrease knowledge but not the attitudeMisunderstandingNot free from marketing influence

Evaluation of educational program

Degree of disease controlBld sugar, Wt,Glycated Hb, Lipids, Bld pressure

Prevalence of acute and chronic complication

Evaluation of the degree of retentionPre and post program questionnaireSkills direct observation

Continuous health education and repetition

Interventions to Improve Quality of Care

Luigi Meneghini, MD, MBADiabetes Research Institute (DRI)

University of Miami School of MedicineII PAHO-DOTA Workshop on Quality of Diabetes Care

DRI, 14–16 May 2003

Mastering Your Diabetes Metabolic & Psychosocial Outcomes

Diabetes Empowerment Scale (DES)Diabetes Empowerment Scale (DES)The DES is a valid and reliable survey of patient The DES is a valid and reliable survey of patient empowerment which yields an overall empowerment empowerment which yields an overall empowerment score based on all 28 items and three subscale scores score based on all 28 items and three subscale scores (range for all scales: 1.0-5.0). Improvement was evident (range for all scales: 1.0-5.0). Improvement was evident on all DES scales for participants in the MYD pilot on all DES scales for participants in the MYD pilot study, despite high baseline values.study, despite high baseline values.

Diabetes Empowerment ScaleDiabetes Empowerment Scale PretestPretest PosttestPosttest 3mF/U3mF/UOverall empowermentOverall empowerment 4.1 4.24.1 4.2 4.3* 4.3*Managing psychosocial aspects Managing psychosocial aspects 3.9 4.23.9 4.2 4.2 4.2Dissatisfaction/readiness to changeDissatisfaction/readiness to change 4.3 4.54.3 4.5 4.6* 4.6*Setting/ achieving diabetes goalsSetting/ achieving diabetes goals 4.0 4.04.0 4.0 4.1 4.1(*P<0.05 v. baseline)(*P<0.05 v. baseline)

Quality of Life & Self-EfficacyQuality of Life & Self-EfficacyMeasures of both Quality of Life (QOL) and Self-Measures of both Quality of Life (QOL) and Self-Efficacy showed statistically significant improvement Efficacy showed statistically significant improvement following the intervention. At the three month follow-up following the intervention. At the three month follow-up the most significant improvement in QOL sub-scales the most significant improvement in QOL sub-scales was for Satisfaction (p=0.0113).was for Satisfaction (p=0.0113).

8.848.84

8.018.01

7.657.65

8.108.10

7.507.50

6.806.80

7.007.00

7.207.20

7.407.40

7.607.60

7.807.80

8.008.00

8.208.20

8.408.40

8.608.60

8.808.80

Mea

n H

bA

1c %

Mea

n H

bA

1c %

Mo 1-3Mo 1-3Pre-Pre-MYDMYD

* p<0.05 v. pre-MYD* p<0.05 v. pre-MYD

Mo 4-6Mo 4-6 Mo 7-9Mo 7-9 Mo 10-12Mo 10-12

**

**

**

Impact of Comprehensive Impact of Comprehensive Diabetes Management ProgramDiabetes Management Program

Source: Rubin RJ, et al. J Clin Endocrinol Metab 1998; 83: 2635.

$406

$362

$182

$135

$84$76$44$45

$66$76

$29$30

$0

$50

$100

$150

$200

$250

$300

$350

$400

$450

Ave

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Total Inpatient Outpatient MD Drugs Other

Baseline (54,186 member months) Follow-up (55,879 member months)

* Total costs decreased by $44 per member/month (10.9%) which would translate into savings of $528,000 in the first year for a plan with 1000 members with diabetes. Break-even at 1,265 members with diabetes as per DTCA.