The Multidisciplinary DSMES Team

Multidisciplinary teams

Multidisciplinary teams may include:

• Primary care physicians.
• Specialty providers (such as endocrinologists).
• Mental health specialists.
• Exercise physiologists.
• Pharmacists.

Non-traditional providers like community health workers (CHWs) and community health representatives can also provide education and behavioral support.

Team approach

Multidisciplinary health professionals can serve as a link to the health care system, coordinate care, and provide ongoing support for behavior change. Collaborating to provide DSMES also enhances partnerships between health care providers and educators.

Additional benefits of a multidisciplinary diabetes team include:

• Access to multiple experts for patients.
• Better glycemic control.
• Increased patient follow-up.
• Lower risk for diabetes complications.
• Improved quality of life and patient satisfaction.
• Reduced hospitalizations.
• Decreased health care costs.

Pharmacists

Pharmacists are among the most accessible health care professionals. People with diabetes see a pharmacist 7 times more often than they see a primary care physician. The National Standards for Diabetes Self-Management Education and Support specifically addresses the pharmacist's role in providing DSMES.

Pharmacists can lead DSMES in a wide variety of settings such as:

• Community pharmacies.
• Clinics or provider practices.
• Hospitals.
• Managed care organizations or long-term care facilities.
• Government entities such as:
  • U.S. Department of Veterans Affairs medical centers.
  • Federally Qualified Health Centers.

Pharmacists interested in obtaining DSMES accreditation can view this webinar as an example of innovation in DSMES services.

For another example of pharmacies providing DSMES services, see the Tennessee Department of Health's DSMES pharmacy initiative.

CHWs

CHWs and community health representatives are trusted community members. They help people with diabetes and their families learn to manage the condition and find community resources.

These frontline public health workers serve as liaisons between health or social service agencies and communities. These relationships enable them to facilitate access to services, improve service quality, and make services more culturally relevant. People in these roles are generally not clinicians, but instead are trained to build capacity in their communities.

CHWs and community health representatives can participate in DSMES by:

• Helping to improve DSMES management and efficiency.
• Addressing barriers to care.
• Teaching a variety of DSMES topics.
• Providing follow-up education on self-management behaviors.
• Performing nonclinical tasks.

Resources

1. National Standards for Diabetes Self-Management Education and Support
2. Community Health Workers as Diabetes Paraprofessionals in DSMES and Prediabetes
3. Benefits of Including Community Health Workers on the Diabetes Care Team
4. Comparative Effectiveness of Peer Leaders and CHWs in DSMS: Results of a Randomized Controlled Trial

State health departments

CDC funds state and local health departments to support services and activities to prevent or delay type 2 diabetes, and to improve health outcomes for people with diabetes. These state and local health departments are critical to the success of DSMES services. According to CDC's Emerging Practices in Diabetes series, "Because state health departments are on the front lines of coordinated chronic disease public health prevention efforts, they are exploring and testing innovative approaches that will provide critical insight and lessons learned."

State health departments can work to promote existing DSMES services, or they can establish community partnerships to start new DSMES services. CDC encourages state health departments to increase access to, participation in, and coverage for DSMES.

Health department activities

• Convening key stakeholders to identify DSMES barriers and create a plan to address them.
• Using strategic communication to reach people with diabetes and their providers to promote DSMES. This includes targeted marketing and social media approaches to reach providers and health care systems.
• Building or adopting systems (such as electronic health records) to track referrals, providing technical assistance, and delivering training on DSMES referrals and reimbursement.
• Linking organizations and government agencies and health care systems with DSMES services.
• Providing support to health systems (including Federally Qualified Health Centers, community health centers, local health departments, and other safety-net organizations) to support new or existing DSMES services recognized by the American Diabetes Association (ADA) or accredited by the Association of Diabetes Care and Education Specialists (ADCES).
  • Obtaining a statewide umbrella license from ADA or ADCES to expand recognized or accredited DSMES services.
• Sharing information on group visit models to maximize reimbursement.
• Working with state employee health plans and state Medicaid agencies to extend coverage where needed.
• Working with established DSMES services to consider additional services (such as medical nutrition therapy, medication therapy management, and the National Diabetes Prevention Program's lifestyle change program).
• Integrating DSMES services and referrals into coordinated care such as the patient-centered medical home.

They can also partner with managed care organizations to integrate DSMES into performance improvement plans and programs. By implementing systems and increasing partnerships to facilitate bi-directional referral between community resources and health care systems, state health departments can help drive access to and use of DSMES services.

DSMES program examples

Alaska DSMES Umbrella License
Alaska Department of Health and Social Services

Kentucky Cabinet for Health and Family Services
Kentucky Diabetes Self-Management Education and Support Programs

Michigan Department of Health and Human Services
Diabetes Prevention and Control Program

North Carolina Division of Public Health
DiabetesSmart: Diabetes Education Recognition Program

Community partners

Community organizations may be interested in providing infrastructure to support DSMES. They can provide support by:

• Promoting DSMES to their members.
• Offering space for DSMES classes.
• Providing CHWs or peer counselors to teach classes.
• Becoming a DSMES provider.

Community-based DSMES can be held in many facilities such as community centers, libraries, private facilities, or faith-based centers. By offering convenient locations, community support, and cultural relevance to participants, community-based DSMES services can help reach more people with diabetes.

Area Agencies on Aging

Area Agencies on Aging (AAAs) may offer DSMES services in community settings for older adults with diabetes. Many AAAs are accredited or recognized DSMES providers, and if not they can help to expand other DSMES services. Older adults with diabetes who are already receiving other AAA services can benefit from DSMES, especially those who live in underserved communities.

Like other community health agencies that cannot bill Medicare directly, AAA can partner with Medicare Part B providers for Medicare reimbursement.