Audio Transcript
[0:10] Host: Hello, and thank you for joining us for this edition of the Valuable Insights podcast – a series dedicated to sharing value-based care success stories and best practices. I’m your host Sholeh Killingsworth and in this episode on diabetes education, we will be talking to Dr. Audrey Jones from Advantage Health Clinic in Alamo, Texas, and Olga Oviedo, a CareAllies registered nurse and certified diabetes educator, about the diabetes education they offer to patients who need extra support. Thank you both for taking the time to share your story today.
[0:44] Oviedo: Oh, thank you so much. I'm happy to be here.
[0:48] Dr. Jones: Thank you glad to be here.
[0:51] Host: Dr. Jones, diabetes education requires an “all hands on deck” approach. It can involve the expertise of other health care professionals to help patients with diabetes achieve their goals. Can you start by telling us why additional diabetes education is important to you?
[1:05] Dr. Jones: It's important to me because a lot of times, if you can help a patient control their diabetes, they have a much better quality of life, and health care costs are kept under much better control.
[1:21] Dr. Jones: when we could really work at keeping people healthy, it, it's worth doing, I mean, financially it's worth doing, and for health care is worth doing and for quality of life, it's worth doing.
[1:37] Host: So, how do you identify patients with diabetes that need this additional support?
[1:43] Dr. Jones: Mainly by what their lab work is looking like. And I'm the type of physician that if you have lab done in my office, you're required to come back for an appointment and sit down with me and go through that lab work line by line. I explain what everything means. And particularly with diabetics, I'm looking at renal function. I look at lipids, and I look at their A1C, and I make sure all my patients understand what those mean and why.
[2:13] Dr. Jones: So it's important to be to help them keep that under control. I can't go home with them and keep it under control for them. And those patients who are not doing well, I explain to them what that means and how we can help them get more information about diabetes and spend some time learning about what they need to do to take better care of themselves.
[2:36] Dr. Jones: It's a situation that they have to take ownership of and take care of themselves. So they need to be inspired to do that.
[2:44] Host: Olga, can you tell me a little about the diabetes education you provide patients, including Dr. Jones' patients?
[2:53] Oviedo: Yes, absolutely. As a diabetes educator, I do teach six weekly diabetes education classes. These classes cover different topics on diabetes self-management, and these are things like understanding diabetes and how it affects their body and their organs. We talk about complications of diabetes, and also how to monitor blood glucose, what kind of exercises are appropriate for them, and the benefits of exercise as well as how to manage diabetes through nutrition. We also talk about medication medications, and how they work in the body to control blood sugars. And, you know, we also include information on stress and how to manage it, because that is also very important. We also help the patient to identify things that they want to talk to their physician about.
[3:50] Oviedo: But I think one of the most important elements of the class is when we talk about goal setting. We have them set simple goals every week. And these goals are very simple because we want them to succeed. And when they succeed, hopefully, they will be able to make permanent or long-lasting behavior changes.
[4:07] Host: Do you feel this additional face-to-face time helps patients make those long-lasting behavior changes?
[4:16] Oviedo: These classes are very interactive and participatory. And, you know, they really enjoy them. The patients like the teaching approaches that are used because they're able to visualize. There's a lot of demonstration on the different skills that they need to know to manage your diabetes as well as there is just a lot or plenty of hands-on activities to encourage them to learn. And so when they're able to practice, they can master that skill, such as checking their blood sugars, or even exercise, we have them do some exercise during the class that's very light. And they're able also to. They're able to perform some activities such as they're able to put together how much fat, how much sugar, and how much salt is in a particular meal. And once they do that, they're just fascinated. And it's an eye-opener, I think, for them.
[5:03] Host: And I imagine this kind of “eye-opening” experience helps you in your own diabetes management discussions with patients, is that correct, Dr. Jones?
[5:13] Dr. Jones: Oh, wow. It's, it's amazing when they come back and go, Well, I didn't know that all the tortillas were causing my blood sugar to go high. So they do come back with a lot more understanding about what they should be eating and how they, how they should be injecting their insulin and, and all of those things. So it's, it's been invaluable for my patients.
[5:35] Host: That’s great! My impression is that the classes are very empowering for patients to better self-manage their diabetes. Would you agree, Olga?
[5:44] Oviedo: Well, absolutely, the patients that have come to the class are very appreciative, very grateful that we are there to help them to learn about their diabetes. They're very appreciative. They write positive notes on the evaluations that they give us at the end of each class, such as: “thank you so much for encouraging me and supporting me and making me feel like I can do this.” So definitely, they're very appreciative, very thankful. And it's very rewarding for me.
[6:18] Host: It sounds like it’s very well received once they are in the program, but Dr. Jones, have you experienced any barriers in getting patients to start the program?
[6:27] Dr. Jones: Actually, I have. And some of the barriers are kind of interesting in this part of Texas. I do have a lot of winter Texans that come in, and they are very busy with their activities. Just the idea of getting them to come to to come to an education class takes a lot of convincing.
[6:50] Dr. Jones: And so we just kind of go back over what it takes and the time investment that's going to take. Sometimes that interferes with their golf game, but I'm usually pretty, pretty good at convincing them to spend a little time in in doing some education.
[7:04] Host: So Olga, once they are convinced, do patients tend to stick with the program?
[7:09]Oviedo: Most of the patients that come to the first class actually complete all the classes.
[7:15] Host: And once they complete the classes, what kind of results have you seen?
[7:20]Oviedo: Recently, we looked back and analyzed some patients who had attended diabetes self-management education classes. We found that before they attended the classes, almost half of them had a hemoglobin A1C of greater than 9%. But after attending the diabetes education classes. A few months later, that number decreased to about a third of them having their hemoglobin A1C over 9%. So we also were able to see that this improvement continued over time over an eight-month period, their hemoglobin A1C continued to improve. So we definitely are very happy to see that that that what they're learning in the classroom they're putting into practice at home, and it shows with the improved hemoglobin A1C and blood sugars.
[8:17] Host: That’s a pretty big impact in a short time. Do you have any stories that stick out in your mind where a big impact was made on a patient’s life?
[8:25]Oviedo: So we had an example of a patient that she was on an increased dose of insulin, and she would come to the class, and so she was always just telling me she just didn't feel very well, she just had an overall feeling of just being tired all the time and her blood sugars were relatively high, maybe the three hundred and her feet are achy. As we were teaching a medication class, she explained to me how she was injected her insulin. So we discovered that she was not injecting properly. In fact, she wasn't injecting at all. So when we identified that, we worked collaboratively with her physician and the office staff to make any necessary changes that needed to be made. Ultimately, the patient did learn how to inject herself properly. There was a dramatic improvement in her blood sugars and in her overall health and her overall state of well-being. She would tell me, I feel so much better I have so much more energy, and my blood sugars are much better. And she continues to do well to this day.
[9:49] Host: I’m always amazed by the stories where one change can make a huge difference in a patient’s life. Dr. Jones, what do you think others should be mindful of when seeking to make a bigger impact on their diabetic patients?
[10:00] Dr. Jones: I think that being very mindful of what lab results look like. And when we need to pull the trigger on making things happen more quickly. I happen to believe that a patient whose diabetes is out of control should not take months to get back in control, it should only take a matter of days or weeks. If they’re out of control, I want them texting me their blood sugars every morning, because I can adjust their medications more easily that way.
[10:29] Dr. Jones: I also have a thing about every patient who comes in who's diabetic has to take off their shoes and socks, no matter how many times they come in. I want to look at their feet. And I spend some time talking to them about their feeling on their feet and how it's different. So I tend to have a pretty much hands-on approach with the group of patients I have who are diabetic.
[10:54] Host: Can you tell me a little more about texting? I’m not sure many physicians have adopted this as a formal method of communication with patients yet.
[11:03] Dr. Jones: I know some physicians didn't like patients to have their personal cell phone numbers. So instead of having a landline, I have a smartphone as my front desk number. That's a change that we made that was that was really positive because patients who are tech-savvy can text things to us. Most of them, I just have them text me because I can make immediate changes right there. I'm just asking him to text me a number, then we'll call them to make their changes. It’s working out well.
[11:34] Host: That’s so great to hear. Especially with the results you mentioned earlier, Olga.
[11:38] Oviedo: I'm very thankful for doctors like Dr. Jones that take diabetes education for their patients very seriously and believe in it and encourage their patients to attend these diabetes classes. So Dr. Jones wholeheartedly supports their patients and encourages them to attend. I cannot emphasize the importance of it enough because it works. And I think that knowledge is power for the patient. That's why we empower them during the class. Because they can go home and do it. They can go home and make the changes that they need to make. We can make the proper provisions, and adaptations for you to be able to be happy and enjoy life and be healthy as well.
[12:41] Host: Definitely inspiring. Lastly, Dr. Jones, can you talk about clinical outcomes metrics and the role CareAllies plays with your team to achieve goals?
[12:49] Dr. Jones: When the metrics come in, and we're looking at things and we’re working on, you know, calling patients to go get their mammogram. “Hey, you missed your lab work, you've got to get in here.” You know, I guess CareAllies has been a really big help in that, they help train staff about that as well. So, it's made a big difference for us. Sometimes you're lucky and you stumble on people that you get along really well with them, and they have the same interest you do in taking good care of patients. So I'm lucky.
[13:19] Host: Absolutely. That wraps up our time for today, so thank you for listening to this edition of the Valuable Insights podcast, and thank you Dr. Jones and Olga, for joining us today.
