By Amanda Austin, BSN, RN
As the Director of Chronic Care Management (CCM) at a federally-qualified health center, I know firsthand the importance of helping people keep their hearts healthy. Just like 4 out of 10 American adults, the people we see in rural Arkansas through CCM have two or more chronic diseases. In CCM, our team supports the whole gamut—dementia, chronic obstructive pulmonary disease, depression, and even HIV and cancer. But, whenever we see someone with hypertension, hyperlipidemia, or cardiovascular disease, it’s almost certain that there’s some connection to prediabetes and diabetes.
“Oh, my parents both had diabetes,” they’ll say. “My older brother’s doctor told him he’s on the border,” another mentions to me. “Heart disease just runs in my family,” another shares, counting on their fingers as they think about their grandfather who had a stroke, their uncle who had triple bypass surgery, and brothers, sisters, and cousins with other cardiovascular diseases. And it turns out almost all of them had diabetes, too.
At my health center, prediabetes and diabetes are the elephants in the room. As doctors focus on bringing down someone’s dangerously high blood pressure, they may neglect to talk about weight, their slowly increasing blood sugar, or healthy self-care behaviors that can reduce risk. Their providers may not have time to break down how high blood sugar and heart disease are connected. And they may not be able to get to know every patient, understand what’s important to them, and get to their “why” for participating in DSMES or a CDC-recognized diabetes prevention program. It’s up to our Chronic Care Management team to break through that wall through our person-centered approach to care.
Once we start listening, and build that mutual trust, a lot of the people we see go from “I don’t need anybody calling me” or “I don’t need to join some group,” to valuing the accountability, connection, and ongoing care they receive from our team and their peers. They start to tell us what’s important to them, what they’re motivated to “fix,” and what challenges they face to get active, eat healthy, manage stress, and monitor their blood sugar, cholesterol, and blood pressure. On paper, all the heart health goals look easy. But it’s hard to focus on 150 minutes of physical activity if you live in a rural area that’s not safe or walkable. If someone don’t know where their next meal is coming from or how to afford their prescription, a heart healthy diet and medication for high blood pressure seem out of reach. We help them connect with resources, find peer support, and take small steps to manage their health.
This all takes time. If somebody says, “My! You’re full of questions today!” I’m probably focusing more on my mental checklist than on building a strong relationship. With education, it’s a delicate balance. If we make it too simple, one person may think we’re talking down to them, but, if we talk fast with lots of healthcare jargon, they may not understand us, or even hear us, especially if they have hearing loss, too. COVID makes this all harder, as we don’t always have the chance to meet face-to-face.
What makes it all worth it are the success stories. An older adult who plants her garden every year to eat healthy, but who needed our help affording her prescriptions and valued the connection with our team during the social isolation of COVID. A man who joined our diabetes prevention program, reluctantly at first, but saw the benefits, lowering his A1c from 6.0 to under 5.0 and reducing his blood pressure by eating healthy, going to the gym, and losing a modest amount of weight. The woman in our Chronic Care Management program who saw reductions in her daily medications for her diabetes and high cholesterol as she made lifestyle changes that support diabetes self-management and heart health. By seeing people as people, and connecting them with the care they need, we achieve our health center’s mission of “Health for All,” and we help people reclaim their health and well-being.
ADCES Perspectives on Diabetes Care
The Association of Diabetes Care & Education Specialists Perspectives on Diabetes Care covers diabetes, prediabetes and other cardiometabolic conditions. Not all views expressed reflect the official position of the Association of Diabetes Care & Education Specialists.
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