Managing Diabetes Takes More Than Medication. This Health Center is taking a Patient-Centered Approach. – Direct Relief

Like most providers, Julie Valdes used toprescribe medicationbased on a patients diagnosis. But for those with uncontrolled diabetes, the approach wasnt working.Despitegivingthem the best medications available, they kept returning with high blood sugar levels.

It kind of forced me to say, You know what, medications arent number one. The person as a person is number one,said Valdes, who works as a clinical pharmacist at Zufall Health Center in Dover, New Jersey.

Now, whenshemeets with a patient, shebeginswith a series of questions, seemingly unrelated to diabetes: Where do you work? Where do you live? Do you have appliances in your home?These questions helpValdes get a better understanding of what kind ofmedication regimenwill be best for the patient, given their circumstances. If they dont have a fridge at home,for example,temperature-sensitive insulinis not going to be an effectivetreatment, despite being the gold standard in diabetes care.You cant always just go by the book. You have to go by where [the patient is] at, what theyre willing to do, what is in their capacity to do.

Valdes spends up to an hour with patients far longer than the typical 15-minute provider visit identifyingbarriers to gettingpatientsdiabetes under control.

Most of the time, its money.I would say poverty or socioeconomics is probably the number one risk factor for diabetes, she said.

Some patients simply cant afford their diabetes medication.Other times, socioeconomic troubles make it difficult for patients to live a healthy lifestyle, particularly when it comes to diet.If you make minimum wage or less, think about the quality of food you can buy, said Valdes. Many of her patients are financially strapped,oftenforcedto choose between payingutilities andbuying groceries. Aloaf of wonder bread, like cheap white bread, is a dollar.To get whole grainbread is $4.Soif you only have $10, are you going to buy the white bread or the wheat bread?

The healthcenterprovides patients with bags of food, grocery store gift cards, and information on how toaccessthe local food pantry.This combined with education on nutrition, which Valdesprovidesas a certified diabetes educator, has helped patients achieve dramatic results one patient reducedtheir A1C score, a measure of blood sugar over athree-monthperiod by three hundred percent.

Still, other patientsjust dont have the time to take their medication. Valdeshaspatients who work12-hour shifts and cant get a break to inject their insulin. For these patients, she prescribes a once-daily oral medicationthats easier for them to take on the job.The drug theyre actually willing to swallow and take, thats the drug thats going to work, even if that means taking a drug thats technically less effective. We can have another medication that is doubletheefficacybut if theyre never going to take that, [then] having the drug thats only half as good that theyre going to take a hundred percent of the time, thats the medication for them.

Valdes also workswith patientsto overcomepreconceived notionsabout diabetes medication.In my population, insulin is the number one feared thing, saidValdes.They said,Oh, my grandma started insulinand then a month later she lost her leg or,I Googledinsulinor I GoogledMetformin and it says it breaks your liver.Thoughthese side effects have not beenproven,all drugs have effects, says Valdes and alot of times the risk of uncontrolled diabetes is way worse.

But some patients need more than just a tailored medication regimen.For many, psychological struggles are the main barrier to achieving good health.

If you dont have good mental health and youre not in the right space, youll never be able to implement all the dietary things, taking your medication ontime.It requires like a lot of organization and a lot ofself-care,said Valdes.

Thats where the healthcenterssocial workerscome in.A lot of our patients have been through things that are traumatic that can increase their risk for chronic conditions, said Sarah Aleman, a licensed clinical social worker and the director ofbehavioralhealth at Zufall Health Center.Someof her patientshave experienceddomestic violence,childhood abuse, or witnessed gang violence.

Research shows thesetypes ofexperienceshinder a persons ability to manage stress, making it moredifficult to turn off the fight or flight response.Whenstress hormonesareconstantly surging through the body,chronic diseasebecomes more likely. The hormones that are going through your body when youre stressed can increase your sugar levels,andover timecan putsomeone at higher risk for diabetes, explained Aleman.

In addition,several studies have documented the link betweentraumaandfeelings ofhelplessness.When someoneis exposed to harm they have no way of escaping,they have a harder time removingthemselvesfromunhealthy situationslater onin life. As researcherand psychiatristDr.Bessel van der Kolkputs it,peoplebecome unable to take action to stave off the inevitable.For those with a chronic disease, thiscan manifest as putting off treatment or forgoing care altogether.When people have experienced trauma, the self-image and self-esteem, the depression, can make it much harder for them to reach out for help,explained Aleman.

Maria Menzel, a licensed clinical social worker at Zufall Health Center, notes another impact of trauma: self-sabotage. She has seen patientsrefuse to take their medication orevenstop takingitafter seeing improvements.Historically, this has led providers to blame or scold patients, but as Valdes found, this kind of approach has yielded poor results.Now, providers likethose atZufall Health Center, are practicingtrauma-informedcare.

Trauma-informed care means assuming people have been through something and shifting from whats wrong with this person to whats happened to them, said Aleman. When we can think[about]whats happened to them, we can get them connected to resources in anonjudgmentalway.

For Valdes, this kind of approachrepresents a shift inhealth care.I think as a field, medicine is learning that its not alwaysthe data and its now always the clinical trials and labs, she said. Its about the person.

Direct Relief, together with BD, has provided Zufall Health Center with a $150,000 grant to expand home monitoring diabetes care for at-risk patients by providing them with equipment and supplies, including blood glucose kits and blood pressure cuffs. The funding, part of the Helping Build Healthy Communities initiative, is also being used to deploy a dedicated care team that will tailor clinical interventions to meet the individual needs of patients and provide them with education and online assistance in multiple languages.

Read the original here:
Managing Diabetes Takes More Than Medication. This Health Center is taking a Patient-Centered Approach. - Direct Relief