Integration of Motivational Interviewing Techniques May Improve Outcomes
There is abundant evidence the current medical system is not meeting the needs of people with Type 2 diabetes, nor adequately educating patients on the strategies they may use to delay or eliminate the onset of the disease.
One reason may be that people are being cared for in an acute care system not well suited to address the complex and on-going needs of someone suffering with a chronic disease. Primary care systems have the expertise and experience to optimize care in many situations, but chronic illnesses with several accompanying comorbid conditions strains the system to overload.
These challenges underscore the importance of high quality case management, which has shown to be effective in improving outcomes and reducing the risk of complications of Type 2 diabetes.
Financial Burden Rising for System, Families
The Centers for Disease Control and Prevention estimates that 23.1 million people in the United States have been diagnosed with Type 2 diabetes, and an additional 7.2 million people have the disease but are unaware of it.
The CDC found the overall cost of treating diabetes in 2017 was $327 billion, which included $90 billion in reduced productivity and $237 billion in direct medical costs. This represents a 26% increase over the last five years.
A recent study that explored the cost per person of living with Type 2 diabetes found that men diagnosed with disease at age 45 would spend $106,000 on medical costs in their lifetime, and women diagnosed at the same age would spend $110,000.
Lack of treatment or poor treatment increases the risk of associated comorbid medical conditions, which also increases the incidence of rising financial burden and early death. The World Health Organization estimates diabetes was the seventh leading cause of death worldwide in 2016 and it held the same rank in the U.S. in 2015.
Case Management Proven to Enhance Patient Outcomes
One study looking at the effectiveness of case management in helping people control their diabetes and avoid costly exacerbations found that patients participating in care management programs did better in improving glycemic control, monitoring skin lesions, and screening for diabetic retinopathy that may lead to blindness.
In another study, the Cleveland VA Hospital initiated a system-level change to address the rising number of veterans affected by diabetes. This change, which included the use of case managers recruited from within the clinic system, achieved meaningful improvement in glycemic control of patients being treated at the hospital.
The purpose of case management in chronic disease is not only to ensure insurance coverage of hospitalizations, but also to work closely with patients to reduce the overall financial and family burden through education on lifestyle and medication changes.
A 2011 study demonstrated patients suffering with diabetes, hypertension and high blood cholesterol demonstrated greater control of all three parameters when they were assigned to case managers.
Motivational Interviews May Improve Self-Care
Care managers who use motivational interviewing techniques can be successful in helping patients and clients improve management of Type 2 diabetes.
Motivational interviewing is a strategy designed to strengthen an individual’s motivation to make behavior changes. It has been applied to several situations including managing diabetes.
Although the strategy is simple, it takes practice and it is not always easy to learn. The process engages the patient’s decision-making skills by getting their input before giving any advice and allowing the patient to develop the argument for change that impacts their health. Using interview questions, the case manager can elicit an individual’s internal motivation required for lasting change.
Motivational interviewing techniques engage the patient in a collaborative effort to support their autonomy while caring for them in a non-judgmental, patient-centered manner. It requires a mindful act of active listening in order to express empathy and avoid arguments. The information gathered may be used to further efforts that result in improved patient outcomes.
SOURCES
National Diabetes Statistics Report, 2017 (2017) Centers for Disease Control and Prevention.
Zhuo, X., Zhang, P., Hoerger, T.J. (September 2013) Lifetime Direct Medical Costs of Treating Type 2 Diabetes and Diabetic Complications. American Journal of Preventive Medicine. 45(3):253
Wagner, E.H. (October 15, 1998) More Than a Case Manager. Annals of Internal Medicine. 129(8):654
Diabetes Statistics (September 2017) National Institute of Diabetes and Digestive and Kidney Diseases,
Diabetes (October 30, 2018) World Health Organization
Management of Common Comorbidities of Diabetes. American Association of Clinical Endocrinologists
Alli, C., Daguio, M., Kosciuk, M., et al. (November 2008). Does Case Management Improve Diabetes Outcomes? Journal of Family Practice. 57(11):747
Watts, S.A., Lawrence, R.H., Kern, E. (2011) Diabetes Nurse Case Management Training Program: Enhancing Care Consistent With the Chronic Care and Patient-Centered Medical Home Models. Clinical Diabetes. 29(1)
Ishani, A., Greer, N., Taylor, B.C., Kubes, L. et.al. (August 2011) Effect of Nurse Case Management Compared With Usual Care on Controlling Cardiovascular Risk Factors in Patients With Diabetes. Diabetes Care. 24(8):1689
Iglay, K., Hannachi, H., Howie, P.J., Xu, J., et.al. (April 4, 2016) Prevalence And Co-prevalence Of Comorbidities Among Patients With Type 2 Diabetes Mellitus. Current Medical Research and Opinion. 32(7)
Motivational Interviewing. National Institute of Diabetes and Digestive and Kidney Diseases