Sup­port for di­a­bet­ics

Health work­ers aid over­stretched docs by help­ing pa­tients man­age dis­ease

Modern Healthcare - - OPINIONS / COMMENTARY - Noreen Clark

Pri­mary-care doc­tors’ of­fices are over­booked and un­der­staffed. Next year, the prob­lem may worsen as more peo­ple gain in­sur­ance through the state health­care ex­changes es­tab­lished by the health­care re­form law and be­gin to seek care.

For mil­lions of peo­ple with di­a­betes, wait­ing weeks to get an ap­point­ment and then hours to see a doc­tor can make man­ag­ing the dis­ease more dif­fi­cult. Con­ver­sa­tion over the past few years has fo­cused on the need to ex­pand the role of nurses to help over­bur­dened doc­tors. This is hap­pen­ing, but it’s not enough. Look­ing ahead to health re­form im­ple­men­ta­tion, is there any­thing that can be done to help peo­ple with di­a­betes get the care they need?

En­ter com­mu­nity health work­ers, also known as pro­mo­toras or health pro­mot­ers. While nearly 26 mil­lion peo­ple are af­fected by di­a­betes in the U.S., not ev­ery­one has ac­cess to the care and ser­vices that al­low for suc­cess­ful dis­ease man­age­ment.

Get­ting the care that’s needed and know­ing how to man­age the dis­ease when not at the doc­tor’s of­fice are some of the tough­est chal­lenges fac­ing the di­a­betes com­mu­nity.

Re­search shows that com­mu­nity health work­ers have been very ef­fec­tive in un­der­served com­mu­ni­ties where peo­ple with di­a­betes of­ten face limited ac­cess to med­i­cal care and shoul­der the heav­i­est bur­den of the dis­ease. Com­mu­nity health work­ers can pro­vide di­a­betes pa­tients the skills they need to man­age their chronic dis­ease. They have both the right skill set and the time to an­swer ques­tions pa­tients may have about man­ag­ing di­a­betes or other chronic dis­eases.

With what we know about com­mu­nity health work­ers, why are peo­ple with di­a­betes still strug­gling to get the in­for­ma­tion and care they need? For many com­mu­ni­ties, the an­swer may be the limited avail­abil­ity of com­mu­nity health worker ser­vices.

The Al­liance to Re­duce Dis­par­i­ties in Di­a­betes, sup­ported by the Merck Foun­da­tion, is ac­tively look­ing for ways to de­ploy com­mu­nity health work­ers to over­come the chal­lenges of car­ing for peo­ple who face wide gaps in ac­cess to good di­a­betes care.

In Dal­las for ex­am­ple, an Al­liance pro­gram em­ploys com­mu­nity health work­ers to ad­dress a rapid in­crease in the num­ber of Lati­nos with di­a­betes. The pro­gram has a team of com­mu­nity health work­ers that helps pa­tients learn skills to man­age their di­a­betes and has even bro­ken down the bar­rier of se­cur­ing re­im­burse­ment for their ser­vices. Th­ese work­ers are fa­mil­iar with the cul­ture of the pa­tients they help, mak­ing them a trusted peer for the pa­tients, many of whom have low health lit­er­acy and lan­guage bar­ri­ers.

And on the South Side of Chicago, an­other Al­liance pro­gram is work­ing with com­mu­nity part­ners such as the Chicago Park Dis­trict and Sav-a-Lot food stores to pro­vide pa­tients with ac­cess to gyms and healthy food. Peer health ed­u­ca­tors are ad­min­is­ter­ing weekly classes to teach peo­ple much-needed skills to bet­ter man­age di­a­betes.

In Cam­den, N.J., pro­gram lead­ers are work­ing with lo­cal and re­gional hos­pi­tals to build a health in­for­ma­tion sys­tem for shar­ing and us­ing health data. The pro­gram also part­ners health out­reach work­ers with nurses and so­cial work­ers to help pa­tients who fre­quently visit the emer­gency room. The goal is to help peo­ple get the care they need out­side of the ER to help man­age their health and re­duce health­care costs.

Di­a­betes is a com­pli­cated con­di­tion made even more com­pli­cated for those who are the most vul­ner­a­ble among us and of­ten face a va­ri­ety of bar­ri­ers to good care—ev­ery­thing from be­ing unin­sured, un­der­in­sured or liv­ing far from stores with healthy foods.

As health­care re­form im­ple­men­ta­tion con­tin­ues, it’s im­por­tant to ex­plore ways to de­ploy com­mu­nity health work­ers to help ease the bur­den of di­a­betes for over­stretched pri­mary-care physi­cians work­ing in un­der­served com­mu­ni­ties. This idea just scratches the sur­face for tack­ling gaps in qual­ity care, but it’s cer­tainly a good place to start.

For mil­lions of

peo­ple with di­a­betes, wait­ing weeks to get an ap­point­ment and

then hours to see a doc­tor can make man­ag­ing

the dis­ease more dif­fi­cult.

Noreen Clark is a pro­fes­sor of health be­hav­ior and health ed­u­ca­tion and di­rec­tor

of the Cen­ter for Man­ag­ing Chronic Dis­ease at the Univer­sity of Michi­gan at

Ann Ar­bor.

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