Noncompliance is biggest problem in diabetes CM

Patients find it hard to change their lifestyles

The most frustrating part of Ginette Levesque’s job as a diabetes case manager is convincing her clients to make the changes necessary to get their disease under control.

"Most of the members with diabetes are overweight. That’s where the hard part of the job comes in. Nobody wants to change their lifestyle and diet. I tell them that I’ll be their cheerleader," says a case manager for ConnectiCare’s DiabetiCare program in Farmington, CT.

The case managers try to get the members stabilized so they can turn their attention to members at higher risk.

"One of the real challenges is to contact and interact with as many members as you can," says Jay Salvio, BSN, MBA, director of ConnectiCare’s Health Management department. "There are so many members who need assistance, and there are always new people coming along. In a perfect world, it would be nice to have the resources to keep every member in the program as long as they need it. But we have to try to graduate them and get them on their way."

Here’s a typical scenario. The case manager asks a patient to check his blood sugar level twice a day. She calls him back and finds out he’s checked it once in a week.

"These are the kinds of patients who have already frustrated their doctor. He’s telling them what to do, and they’re not doing it," says Gina Dulak, RN, DiabetiCare case manager.

After a few telephone calls, the case managers usually can tell who is going to be a compliant patient and who is not.

"I try to give them as much education and consultation as possible. The best I can do is to tell them the consequences of noncompliance and document it. We get to a point when we know nothing is going to change with this patient," Levesque says.

But even the compliant patients are likely to be back in the program a year a so after they graduate.

"The case managers do a good job of educating members and getting them stabilized, but once they graduate from the program, there is a good likelihood that without the calls, the patients will stray from the path," Salvio says.

The HMO is able to identify graduates of the program who become at high risk again by the laboratory data, Delaronde points out.

"If a graduate from the program has lab results that are out of range, they get another call. The program is not static," he adds.