Building Competency in Diabetes Education THE ESSENTIALS

FOUNDATIONS OF DIABETES SELF-MANAGEMENT EDUCATION AND SUPPORT| 2-7

CHRONIC DISEASE MANAGEMENT

The diagnosis of diabetes has a ‘ripple effect’. Although education and support for patient centered care is the primary focus for this manual, it is recognized that there are many other components which influence the ability to successfully manage diabetes. Over the past several decades, it has become evident that we cannot use the same methods to treat chronic disease as we have been using to treat acute disease. Within the wider scope of practice, we need to consider the way we are delivering our health services, how we are supporting and communicating with our health-care providers, and how electronic information systems can add value to our practice (14,15). Beyond this, there are community factors and government health policies which have the ability to help or hinder successful management. We now realize that chronic disease management requires “multi-pronged strategies” in order to be effective (9,15-17). It is a slow process to adapt our provincial health systems to chronic disease management. The clinical aspect in the delivery of chronic care needs should be revamped for sustainability and coordination, and other elements that have a greater influence on prevention and population health must be reviewed. Several models have been proposed, each with a different focus yet the same goal: to improve chronic care management using an integrated systems approach (18,19). The most robust of these models and the one that has more evidence-based outcomes is the CCM (9,20-22). This model clearly identifies the relationship between the various elements involved in chronic disease management (15). Of particular note is the key message that ‘diabetes care should be delivered using as many elements as possible of the Chronic Care Model’ (15,23). The “Organization of Diabetes Care” chapter in the 2018 Guidelines clearly outlines how the: CCM model as a multifaceted, interdependent framework to improve health-care delivery from prevention to advanced management can be used in diabetes care (14,15). An original model proposed by Wagner et al. illustrates how chronic disease is best managed by productive interactions between informed, activated patients and prepared, proactive health teams (24). Barr et al. expanded this original model, enhancing the elements of community participation and incorporating the social determinants of health (15). This expanded CCM model highlights the need for partnerships between health systems and communities which provide a core element to the successful management of chronic disease (9,15,21,25). The essential elements of the CCM model are illustrated in Figure 1.