Telephonic diabetes education and support program – Success for Rural Living

More than 25 million people in the U.S. have diabetes-a serious condition that, if not controlled, can lead to serious health complications and even death. Diabetes is one of the four leading causes of death in Maine. A 2004 study conducted by the State of Maine indicated that most people with diabetes had never participated in formal diabetes education. To improve the accessibility and affordability of effective diabetes management and address barriers such as transportation and an aversion to group encounters, which have particular relevance for people living in rural and medically under-served areas, MCD Public Health created the Telephonic Diabetes Education and Support Program.

 Enrolled participants receive a full year of monthly diabetes education and support from a certified diabetes educator, all through the convenience of a telephone call. They also receive incentives for participation, such as a waiver of pharmacy co-payments for diabetes medications and supplies.

 This voluntary diabetes self-management program is carried out in collaboration with employers who offer it to employees, early retirees, and adult dependents. Certified diabetes educators receive specialized continuing education in effective patient engagement via telephone, motivational interviewing techniques, and patient chronic disease self-management best practices. Feedback is collected and analyzed to assure the program is meeting the needs of participants and providers.

 Six years of implementation results confirm exciting results:

• Improvement in clinical measures such as blood sugar and cholesterol levels
• Increased knowledge and self-efficacy
• Increased medication adherence
• Increased utilization of preventive care services

The program design includes important elements that differentiate it from typical insurer offered disease management programs. The payment structures and delivery mechanisms have important policy implications for payers, employers, and providers. Telephonic delivery addresses barriers such as poor internet connectivity in some rural areas and improves on traditional gender enrollment ratios, while also accommodating shift work and privacy concerns. Delivery of best practice diabetes education content through local providers enhances follow up care and referrals to other services while supporting the local economy. Lessons learned by TDES can inform emerging Patient Centered Medical Homes and Accountable Care Organizations. Delivery methodology and participant outcomes suggest a pathway for achieving shared savings as well as improved patient wellness by adopting the patient-centered strategies shown to be effective in this program.