Diabetes Case Manager Interview Guide. Engaging the Individual Patient With Diabetes. Case Manager Interview Guide

Transcription

1 Diabetes Case Maager Iterview Guide Egagig the Idividual Patiet With Diabetes 1 Case Maager Iterview Guide

2 Itroductio Diabetes is a complex coditio that requires a multidiscipliary approach amog healthcare providers, coordiatio of care alog the diabetes care cotiuum, ad patiet commitmet to a care pla. 1 As a case maager, you are ot oly i a positio to support your patiets with diabetes to help them achieve or maitai glycemic cotrol ad to help reduce the risk of developig diabetes-related complicatios, but you also play a key role i facilitatig the care coordiatio amog your patiets ad the other members of their healthcare team. By egagig your patiets o a idividual level, you may be able to foster a shared decisio-makig approach, where you mutually exchage importat iformatio regardig diabetes care. 2 Placig patiets at the ceter of care ad ivolvig them i healthcare decisios may ehace adherece to therapy. 2 The followig iterview guide provides you potetial iterview questios ad tips framed i the America Associatio of Diabetes Educators (AADE) self-care behaviors to help you egage your patiets ad uderstad their behaviors so you ca actively maage their care. AADE7 Self-Care Behaviors 3 Healthy eatig Beig active Moitorig blood glucose Takig medicatio Problem solvig Healthy copig Reducig risks 2 Case Maager Iterview Guide

3 Healthy Eatig Esurig that your patiets are makig healthy food choices is vital to successful diabetes maagemet. 3 It is importat to educate your patiets about these key poits that someoe with diabetes should uderstad: carbohydrate coutig, fat cotrol, readig labels, plaig ad preparig meals, ad learig about the effect of food o blood glucose. 3 A utritious diet ad weight loss may help patiets achieve their goals for blood glucose,a1c, cholesterol, triglycerides, ad blood pressure. 1,3 However, sice every patiet is differet, it s importat to assess each idividual to develop the best maagemet approach possible. 1 You may also wat to cosider whether a referral to a pla-sposored dietitia is appropriate. 1 Healthy eatig tips for your patiets 4 : Trade a high-fat food for a low-fat choice each week. Make your meal appear bigger by servig it o a smaller plate. If you eat at a restaurat, make sure you get half of your meal to go. Drik a glass of water 10 miutes before each meal to help curb your appetite. Wait 20 miutes after fiishig a meal to determie if you re still hugry, sice it takes that log for your brai to kow you re full. Do ot eat i frot of the TV, sice people ted to eat more while watchig. Here are some helpful questios to ask your patiets about their curret utritio routies: How may times do you eat each day? What do you typically eat for breakfast, luch, ad dier? What kid of effect do you thik your diet has o your diabetes? Ca you explai your meal pla? What do you like/do t like about your meal pla? How well is your meal pla workig for you? Ca you tell me which foods ad beverages you should avoid? How ca I help esure that your meal pla reflects your cultural backgroud? How ca I help you reach your goals? 3 Case Maager Iterview Guide

4 Beig Active Exercise is a very importat activity for your diabetes patiets. 1,3 It helps improve glycemic cotrol, body mass idex, ad weight maagemet ad also reduces stress ad helps cotrol lipids ad blood pressure. 1,3 Make sure patiets speak with their doctors or healthcare providers before begiig ay exercise program. 1 For those uable to egage i traditioal exercises, simple activities such as vacuumig, parkig farther from a store, takig the stairs over the elevator, ad washig widows ca be beeficial. 4 Be sure to ask your patiets to log their activities to show progress. Suggest workig out with a fried to make it more ejoyable ad improve compliace. 4 Also, istruct your patiets to stay hydrated, moitor blood glucose, ad check their feet followig ay exercise. 4 Here are questios to ask your patiets about their exercise/ activity routies: O a scale of 1 to 10, how fit would you describe yourself? What types of exercise do you do every day? Ca you describe your exercise program for me? How well do you thik your exercise program is workig? Are there thigs that get you off track? Do you have ay specific problems with your exercise program or ay issues of cocer? How well do you feel the activities i your program match your iterests? What are your exercise goals ad have you bee able to attai them? If you are havig trouble meetig your goals, how ca I help? How else ca I help? 4 Case Maager Iterview Guide

5 Moitorig Blood Glucose Makig sure your patiets self-moitor plasma or blood glucose (SMBG) is a vital part of maagig diabetes. 3 Moitorig blood glucose will help your patiets evaluate how well they re maagig their diabetes. 3 This process will eable your patiets to assess whether their diet ad exercise plas ad their medicatio are helpig them reach their goals. 3 The ADA suggests the followig glucose levels for may adults with diabetes 1 : Before eatig (fastig plasma glucose): mg/dl 1-2 hours after eatig (postpradial plasma glucose)*: <180 mg/dl *Postpradial glucose may be targeted if A1C goals are ot met despite reachig prepradial glucose goals. These goals should be idividualized. Be sure to discuss with your patiets doctors ad healthcare providers what umber is right for them. 1 Cosider askig the followig questios to assess your patiets ability to moitor their blood glucose: What kid of equipmet ad supplies do you have to self-check your blood sugar? How ofte has your doctor/healthcare provider istructed you to check your blood sugar? What helps you remember to check it ad what gets you off track? Do you keep a blood sugar log book? Do you brig your log book to your doctor visits? How well do you thik you are cotrollig your blood sugar? How else ca I help? 5 Case Maager Iterview Guide

6 Takig Medicatio For patiets who have prove usuccessful i makig lifestyle chages, such as utritio ad exercise, medicatio becomes the oly treatmet. 1 If prescribed, medicatio adherece is importat for successful outcomes i diabetes. 3 For each medicatio, patiets should be made aware of the dosage, timig ad frequecy of admiistratio, potetial side effects, mechaism of actio, ad storage istructios. 3 A discussio reaffirmig the importace of stayig compliat should be scheduled with your patiets durig each ecouter. Cosider askig the followig questios to assess medicatio adherece: How did your doctor (or healthcare provider) tell you to take your medicatio? Ca you tell me what your medicatios are for ad how they help you? How do you thik the medicatio is helpig you cotrol your blood sugar? How ofte do you miss takig your medicatios? What happes that causes you to miss takig your medicatios? Ca you explai ay difficulty you have takig your medicatios? If you have had ay problems gettig your medicatios, what were they? What questios do you have about medicatios? How else ca I help you? 6 Case Maager Iterview Guide

7 Problem Solvig Diabetes is a jourey for patiets ad ca chage daily. Emergecies ca happe, ad it is importat to problem solve ad make adjustmets. Oe example is whe a patiet suffers a hypoglycemic evet. The sigs ad symptoms you, the patiet, ad caregivers should be aware of iclude 4 : Dizziess or shakiess Nervousess Rapid heartbeat Trouble cocetratig Headache Irritability, moodiess, or ager Sweatig Tiglig i the face or lips Extreme huger If patiets experiece these symptoms, they should be istructed to take immediate steps if their blood sugar is too low (plasma glucose <70 mg/dl). Recommeded istructios iclude 1 : Eat grams of glucose (sugar) or simple carbohydrates (for example, 2 tablespoos of raisis or 1 tablespoo of hoey) ad check your blood sugar agai after 15 miutes. If your blood sugar is still low, repeat this step. Oce your blood sugar returs to ormal, eat a small sack if your ext plaed meal or sack is more tha a hour or two away. If a hypoglycemic evet occurs multiple times, the patiet should cosult a physicia for evaluatio. 1 Beyod a hypoglycemic evet, problem solvig is a importat skill for you ad your patiets to work o together, sice it spas all of the elemets ivolved i diabetes maagemet. 3 Cosider the followig questios to foster a problem-solvig dialogue with your patiets: Have you experieced ay problems with ay aspects of your diabetes care? If so, what have you experieced? What is workig well ad what is ot workig? Is there aythig you would like to chage about your diabetes care? If so, ca you explai what you would like to chage? How well are you doig o your utritio ad exercise plas? Do you keep a food or exercise joural? Ca you explai how your doctor or healthcare provider istructed you to take your medicatio? How importat do you thik it is to keep track of your ext exam/test? (ie, A1C, lipid screeig, foot exam, detal exam, etc)? How else ca I help you? 7 Case Maager Iterview Guide

8 Healthy Copig Diabetes is a difficult disease that requires patiets to make may challegig chages, which may go agaist may of their log-established lifestyle routies. 3 Such chages ca seem overwhelmig to may patiets ad require better copig skills. Fid out if there are ay barriers that may make it difficult for them to do this. The customize your care to help them overcome those barriers. 3 By focusig o diabetes as a maageable coditio ad remidig your patiets that their diabetes does ot defie them as a idividual, you may be able to help guide them to thik positively ad help them cope. Family ad frieds may be a great support system to help your patiets. 1 Cosider askig the followig questios to help determie how your patiets are copig: How are you copig with diabetes? Do you believe that, with the right support from your care team, you ca help yourself succeed? How are you doig copig with lifestyle chages, such as eatig healthier ad exercisig? What challeges have you faced i makig those chages? How does havig diabetes make you feel? Do you thik you re doig a good job maagig your diabetes? Why do or do t you feel that way? How helpful is the support from your care team? How else ca I help you? 68 Case Maager Iterview Guide

9 Reducig Risks Risk reductio behaviors may help reduce diabetes complicatios. 3 Itervetios such as smokig cessatio ad regular eye, foot, ad detal examiatios are importat compoets to diabetes maagemet. 3 Help patiets lear about diabetes stadards of care, their idividual therapeutic goals, ad prevetive care services to help decrease potetial risks. 3 Reiterate the importace of diabetes maagemet actios patiets ca do ow their ow such as 3 : blood pressure moitorig blood glucose self-moitorig persoal care record keepig Ecourage your patiets to take the lead role i their care. Patiets ca help maage their diabetes ad the associated risks by kowig their diabetes care goals ad umbers, trackig ad moitorig them appropriately, adherig to their care pla, ad workig closely with you ad their full care team. 1 Cosider usig the followig questios to help assess how well patiets are workig towards maagig their diabetes ad reducig the potetial complicatios: Ca you tell me the potetial log-term complicatios of diabetes? How ofte do have your A1C, blood pressure, ad cholesterol checked? What were the latest results? What tests ad examiatios should you have doe each year? (eg, foot, eye, detal exams, etc) Which tests ad examiatios have you doe this year? Do you eed help schedulig these tests/exams? Have you had your glucose moitor checked to see if it s workig correctly? How ofte do you check your blood sugar? What difficulties are you havig with ay aspect of your care pla? How else ca I help you? AADE7 is a trademark of the America Associatio of Diabetes Educators. Refereces: 1. America Diabetes Associatio. Stadards of medical care i diabetes Diabetes Care. 2014;37(S1):S14-S Izucchi SE, Bergestal RM, Buse JB, et al. Maagemet of hyperglycemia i type 2 diabetes: a patiet-cetered approach. Diabetes Care. 2012;35(6): America Associatio of Diabetes Educators. Guidelies for the Practice of Diabetes Educatio. Chicago, IL: America Associatio of Diabetes Educators; Rogers S. Case Maagemet Adherece Guidelies Diabetes. Little Rock, AR: Case Maagemet Society of America; Case Maager Iterview Guide