American Medical Association, YMCA of Delaware team up on diabetes prevention

     Delaware Governor Jack Markell speaks at a diabetes event hosted at the YMCA earlier this month.(photo courtesy Governor Markell's office)

    Delaware Governor Jack Markell speaks at a diabetes event hosted at the YMCA earlier this month.(photo courtesy Governor Markell's office)

    Delaware is getting national attention for its efforts to help people stave off diabetes.

    In coming months, a team from the American Medical Association will work with the YMCA of Delaware to make it even easier for doctors to refer their patients to the Y’s diabetes-prevention program. The Center for Medicare and Medicaid Innovation is funding the partnership.

    In general, health experts know what it takes to help patients live a few years longer without confronting a diabetes diagnosis. There are a number of healthy-living courses that work, and registered dietitian Tricia Jefferson said the Y’s program is among them.

    It’s been harder, she said, to pinpoint what motivates people to actually sign up for those education sessions.

    Experts call the problem the “clinic to community” gap. Doctors often know which of their patients are candidates for intensive diabetes prevention, but many patients never make it to the classes that might help.

    The Y’s prevention program is a yearlong course. Participants attend 16 weekly meetings, then attend a monthly meeting for the rest of the year. The program is $429 for patients paying on their own. Medicare patients enroll free of charge.

    Easy access — and finding a welcoming location — are important. The Y has hosted classes at more than a dozen sites including senior centers, doctor’s offices and churches, she said.

    “Anywhere that there’s a room, door, table and chairs, we can do it,” said Jefferson, director of Healthy Living and Strategic Partnerships at the Y.

    Making referrals easier

    The Y’s program has been around for about four years. Now, the organizers and the AMA are partnering to make it easier for doctors to refer their patients to the program.

    Direct referrals are already part of the program, Now, however, most of those recommendations are done on paper, and doctors are notified by mail when a patient finishes the program.

    Rebecca Jaffe, a family doctor in Wilmington, said her team has referred “a few” patients to the Y but didn’t get much feedback.

    “I think, maybe once, we got piece of paper that they successfully completed the course, but that was about it,” Jaffe said.

    She said more frequent progress reports would be helpful.

    “If I knew that [the patients] just had something on food in their last program, then I can sort of quiz, and make sure, and emphasize that they understood what was given to them in the program,” Jaffe said

    In the next six months, the AMA and the Y will work to narrow the “clinic to community” gap.

    Doctors make suggestions, offer patients advice and usually know which people are candidates for intensive diabetes prevention. But many patients never enroll in the health and education classes that can slow the progression to diabetes, Jefferson said.

    The AMA-YMCA partnership is a chance to work with four Delaware physicians and uncover ways to make direct-referral system work better.

    One idea is to make the program referrals and progress reports part of each patient’s electronic medical record.

    Stressing the urgency of prevention

    Another idea is to teach doctors to better emphasize the urgent need for prevention.

    Physicians sometimes waffle, Jefferson said, when it comes to communicating that a patient is “on the cusp” of diabetes.

    “They may be saying, ‘You know, your blood sugar is a little bit elevated. Work on it, and come back in a few months and we’ll check it again,’ not really letting them know that they have pre-diabetes,” Jefferson said.

    When a doctor diagnoses “pre-diabetes,” most consider it a wake-up call that it’s time to make diet and lifestyle changes. Still, there’s debate about the term and varying opinions about that label’s helpfulness in motivating behavior change.

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