Support for diabetics

Primary-care doctors' offices are overbooked and understaffed. Next year, the problem may worsen as more people gain insurance through the state healthcare exchanges established by the healthcare reform law and begin to seek care.

For millions of people with diabetes, waiting weeks to get an appointment and then hours to see a doctor can make managing the disease more difficult. Conversation over the past few years has focused on the need to expand the role of nurses to help overburdened doctors. This is happening, but it's not enough. Looking ahead to health reform implementation, is there anything that can be done to help people with diabetes get the care they need?

Enter community health workers, also known as promotoras or health promoters. While nearly 26 million people are affected by diabetes in the U.S., not everyone has access to the care and services that allow for successful disease management.

Getting the care that's needed and knowing how to manage the disease when not at the doctor's office are some of the toughest challenges facing the diabetes community.

Research shows that community health workers have been very effective in underserved communities where people with diabetes often face limited access to medical care and shoulder the heaviest burden of the disease. Community health workers can provide diabetes patients the skills they need to manage their chronic disease. They have both the right skill set and the time to answer questions patients may have about managing diabetes or other chronic diseases.

With what we know about community health workers, why are people with diabetes still struggling to get the information and care they need? For many communities, the answer may be the limited availability of community health worker services.

The Alliance to Reduce Disparities in Diabetes, supported by the Merck Foundation, is actively looking for ways to deploy community health workers to overcome the challenges of caring for people who face wide gaps in access to good diabetes care.

In Dallas for example, an Alliance program employs community health workers to address a rapid increase in the number of Latinos with diabetes. The program has a team of community health workers that helps patients learn skills to manage their diabetes and has even broken down the barrier of securing reimbursement for their services. These workers are familiar with the culture of the patients they help, making them a trusted peer for the patients, many of whom have low health literacy and language barriers.

And on the South Side of Chicago, another Alliance program is working with community partners such as the Chicago Park District and Sav-a-Lot food stores to provide patients with access to gyms and healthy food. Peer health educators are administering weekly classes to teach people much-needed skills to better manage diabetes.

In Camden, N.J., program leaders are working with local and regional hospitals to build a health information system for sharing and using health data. The program also partners health outreach workers with nurses and social workers to help patients who frequently visit the emergency room. The goal is to help people get the care they need outside of the ER to help manage their health and reduce healthcare costs.

Diabetes is a complicated condition made even more complicated for those who are the most vulnerable among us and often face a variety of barriers to good care—everything from being uninsured, underinsured or living far from stores with healthy foods.

As healthcare reform implementation continues, it's important to explore ways to deploy community health workers to help ease the burden of diabetes for overstretched primary-care physicians working in underserved communities. This idea just scratches the surface for tackling gaps in quality care, but it's certainly a good place to start.

Noreen Clark is a professor of health behavior and health education and director of the Center for Managing Chronic Disease at the University of Michigan at Ann Arbor.