By Kathy Kastner with Zal Press
One of the tenets of Patient-centered care is care coordinated around the patient, rather than around the system. For a PWD, it takes a team.
Who’s on the team
Heather, who’s worked in the Diabetes Management Center since its inception in 1991, has become a leading Opinion Leader in team-work and patient-centered care – involving Dieticians, Exercise, Foot Care and special attention to the sores that may not be healing properly – a hazard for a PWD. The key to Heather’s success was buy-in from the Family Doctors. She points out that it’s unfair to expect Family Doctors to know all aspects of Diabetes Care. At the same time, it was essential to assure these good doctors that the intention was not to take patients away, but rather encourage them to embrace the interprofessional teamwork necessary for PWDs to manage. This took a concerted, proactive effort that proved effective.
Cross training maximizes patient centered care
Along with creating interprofessional support for PWDs, Heather’s team is cross-trained with each team member well-versed in every aspect of care: the dietician can examine feet, the nurse can counsel on diet.
Insulin isn’t the enemy – conquering ‘fear factors’
One of the things Heather tackles in the early visits is the fear of going on insulin. She shares her modus operandi: talk about it right up front, as the reality is, insulin is likely in many PWDs future.
With the fear of needles also looming large, it’s another hurdle Heather takes on at the get-go. ”They don’t leave my office until I’ve given them an injection. I demonstrate with a needle that has nothing in it. Most often they close their eyes and scrunch up their face in anticipation. They can’t believe when I tell them open your eyes; I’ve already done it. Takes the fear away.”
The evolution of an Engaged PWD
Aida, diagnosed 7 years ago, feels she now does a better job of managing. That’s an outcome of person-centered care: when patients and caregivers’ needs are met, this can lead to more self confidence in patients’ own ability, thus putting energies toward day to day management.
As an Opinion Leader, Aida also embraces technology in her care-related communications tactics – sending pictures to her healthcare professionals when she needs answers. She’s become a fully engaged PWD.
The Past and the Future of Patient Centered Care
Since her own diagnosis, in 1989, Heather has witnessed a huge change in care for PWDs: back then testers were the size of toasters, and patients going on insulin were hospitalized for a week, using an orange to learn how to inject.
Now, testers are portable, clinics replace hospital ‘stays’ and patients are encouraged to become more empowered and engaged. However, Jim points out one of the barriers that he feels healthcare professionals could be more sensitive to: PWDs often don’t even know what questions to ask nor do they understand the language and terminology. Aida shares how, in her evolution as an engaged PWD, she now takes notes and then does her own internet research.
The Future of Patient Centered Care
These patients, caregivers and Opinion Leaders hold out hope that the future will see what Heather has described as the Gold Standard for Diabetes Management: incorporating team-work, cross-training and seeking partnerships, such as working with the Emergency Department to get patients with Type 2 Diabetes out of ER and into the Diabetes Management Centre.
“You can educate people until the cows come home. What patients need help with is managing – that’s why we’ve moved away from being a Diabetes Education Center to being the Diabetes ‘Management’ Center.” – Heather