Filling the Primary Care Gaps with the Emerging Role of Online Diabetes EducationFriday, September 28, 2012
Gary Scheiner, CDE, is helping people with diabetes with his online learning initiative, Type 1 University. This set of programs provides a convenient method of learning utilizing highly specialized information to people who greatly need it.
By: John Parkinson, Clinical Content Coordinator, DiabetesCare.net
With the adaption of technology within every facet of our lives, brings the increasing comfort level in people seeking guidance about health issues within this spectrum. As such, one of the newer healthcare trends in diabetes education that is emerging is online learning.
Having the ability to watch webinars, chat through Skype, or even ask personal health questions via e-mail provides people with diabetes another viable option to learn, troubleshoot, and get into control.
While Gary Scheiner, CDE, (pictured, left) has a physical office for his practice, Integrated Diabetes Services, located in Wynnewood, Pa., he is also a strong proponent of online education. He refers to it as “remote education,” and he points to its convenience and accessibility factors as to why they are so vital today.
Scheiner is himself a longtime type 1 diabetes veteran, and he has carved out a niche in insulin-dependent diabetes education. He is the author of the book, Think Like a Pancreas, and he has developed his Type 1 University online education initiative. Type 1 University is a set of online programs, and they allow people the ability to learn about specific areas of self management. Type 1 University is a viable option to receive continued education in a contemporary setup. Anyone can purchase these programs and people can sit down in the privacy of their homes, at a time that is convenient for them, to view these webinars.
Scheiner says he is bridging the gap between the huge educational needs of diabetes patients and what the present day paradigm of primary care can deliver. Scheiner sees the evolution of our dependence on technology and how we communicate today as an opportunity to give people more of what they want.
DiabetesCare.net spoke with Scheiner recently about the challenges of delivering diabetes education in primary care; why online education is so valuable today; and how his Type 1 University initiative is helping people with diabetes who are insulin-dependent get into better control.
DiabetesCare.net: Why did you decide to start your own practice, Integrated Diabetes Services?
Scheiner: I saw a tremendous teaching need that wasn’t being met. There is a gap between what healthcare providers can deliver and what patients need, especially with those who are on intensive-insulin programs, whether they are type 1s or type 2s. Most healthcare providers can’t deliver that now as they are hamstrung by managed care expectations today, especially in terms of how much time they can spend with people, how they can access patients, and often, the expertise itself.
You would be surprised that at some of the best diabetes clinics in the country there is an inability to work effectively with individual patients; these clinics don’t have the resources to handle it. I don’t blame them; it is a matter of time constraints. These clinics are having to put out fires for patients who are in serious trouble.
I’m filling the gap between the huge patient need and what they are able to get.
DiabetesCare.net: Talk a little about your practice, and explain what services you offer?
Scheiner: The primary service we offer is one-on-one learning for those who are on insulin intensive therapy regimens. It is a combination of two things we deliver: one is teaching people how to self-manage effectively—giving them skills to take care of themselves better. That is probably 50 to 60 percent of our topic areas, and everything from properly dealing with hypoglycemia to teaching them about continuous monitors and everything in-between. The second part is the actual blood sugar management part. We help people self-adjust their doses so that they can achieve the best control possible.
DiabetesCare.net: What types of patients are you seeing mostly?
Scheiner: The new type 1s are a rarity. We might see one or two a month. The vast majority of our clients have had diabetes for some time and have thrown their hands up in the air and are completely frustrated. Their control is not where they want it to be and they are not able to get the help they need with their providers.
“Pump therapy is a specialty of ours. Approximately, 90 percent of our clients are using insulin pumps, and of the ones who are not on insulin pumps, many are moving in that direction. Of course we also care for patients who are on multiple daily injections too. We are able to work within the confines of whatever the needs of our patients are.
We work with children and their families as well as adults. We do have a fair number of clients who do have type 2 diabetes and are using insulin.”
DiabetesCare.net: One of the things you have developed as part of your practice is the online initiative Type 1 University. Can you please provide an overview of it?
Scheiner with a couple of his patients showing off their diabetes supplies.
Scheiner: We call it a school of higher learning for insulin users. Just like you would go to college it is a series of courses. You pick the courses that are part of your major, and within that specialty there are certain topics.
Viewers watch it on screen and there is a presenter who uses slides to explain the information. Each class is close to an hour and it focuses on one topic. For example, one of them focuses on pregnancy and type 1 diabetes and some of the keys to success. There is another about sports and blood sugar control. That one focuses on how to best manage glucose levels when people exercise. People can opt to watch just one video, a few, or all of them. We only charge $20 per class, which today is similar to the co-pay at a doctor’s office visit.
DiabetesCare.net: If a person pays for a specific webinar, are they able to go back and refer to a program or is it a one-time viewing?
Scheiner: It is one-time viewing, but they have enough time allotted where they can pause, rewind, take notes. And if anybody who watches a class wants a copy of the slides, they just have to e-mail us and we are happy to send those along.
DiabetesCare.net: How does this online program help versus a typical one-on-one visit with a patient and educator?
Scheiner: Interestingly enough, most of our one-on-one visits today are done remotely. I would say two-thirds of our clients, never come into our office. They are in other parts of the country and all over the world. So if someone who lives in Seattle needs help with their diabetes management, they can work with us. We can e-mail, text, and Skype back and forth with patients.
Almost all the pumps and meters now are downloadable to web-based programs, so the data can be shared easily with our educators. As long as we have access to our computer systems, we can work with people anywhere.
DiabetesCare.net: Is there a way to gauge what is working in the Type 1 University classes? Do you ask for any feedback at the end of a course or do you review the classes to make sure the information remains topical?
Scheiner: With Type 1 University we send out surveys after people have viewed their videos. People can also provide suggestions for other educational topics. There is always interest in expanding what we do. When someone finds some useful information in one of our courses, and they need to apply it to something unique in their lives, they can contact us by phone or e-mail.
DiabetesCare.net: So for people who take courses in Type 1 University they are able to have follow-up with an educator?
Scheiner: Yes, they can, but it is not included as part of the fee for the video. And when someone needs our help and wants to work with us, we do a very comprehensive intake assessment to learn all the details about how they are managing and what their challenges are. We gauge things properly.
For example, athletes will want to work with us to get their blood sugars under control while they are participating in sports. Often, what we find when we are assessing them is that their blood sugar is not at a good level most of the day. This affects their performance while playing, and so we have to go back to the drawing board and rework their program to make sure they have better management overall.
DiabetesCare.net: Are you currently expanding your online programs and what is the work that is involved in creating such a program?
Scheiner: If there is a program that makes sense to produce and we have a market for it, we will definitely do it. We use a program called WebEx, which produces webinar programs. When you produce a program on WebEx, you can record it with a little camera attached to the computer. Once you learn the mechanics to set up the programs, it’s not too difficult to do. The content, however, has got to be right on target.
I’m lucky to have a team of diabetes educators that work with me, and everyone on my clinical staff has type 1 diabetes. So everyone is experienced both professionally and personally.
We are able to put some good specific content on the videos. I don’t like being vague when it comes to diabetes. Some providers are concerned about lawsuits or have other reasons for not providing enough specifics. My feeling is if you are charging someone, you better give them something valuable. I’m not afraid to give specific recommendations, with the caveat, ‘this is not going to work for everybody. You have to experiment; you have to take notes; and you have to make adjustments.’
Exercise is a perfect example—what works for one person is not going to work for another. And even what works for one person won’t work for that person every single time.
DiabetesCare.net: What is the process when you do create a program?
Scheiner: We usually put together an outline and from there we create a slide set. We then present the slide set and record it. It takes a few times to get the presentation right on camera.
You have to consider the quality of the presentation to make sure the sound and the video are also good. As a collective team, we look at these things. Everyone has their area of expertise, and all of our clinicians are excellent. For example, we have one person who really is a specialist in weight management and balancing insulin, weight, and control. Another person here is very good in dealing with the psychological issues associated with diabetes. It’s important to get feedback from people with different disciplines.
DiabetesCare.net: Is having online teaching a necessity today for diabetes education? And if so why?
Scheiner: I think it is for accessibility issues. Given how many people have diabetes and how spread out they are across the country and the world, and there are not enough providers to serve their needs.
There is also a convenience factor. People with diabetes already have a lot on their plates, and requiring them to come to a clinic at certain times is difficult. Anything that can be made easier for these people is worthwhile.
While there are certain things you need to do in face-to-face meeting, diabetes education can be delivered very effectively on a remote basis. The vast majority of what we do in diabetes care does not have to be done in person, especially with the availability of Skype and video.
We invite people to communicate with us in-between appointments. That is the big difference between what we do from other practices. Often, when you go to your doctor, you save everything you have up until then, and you often have 15 to 30 minutes to dump everything on your clinician and try to come up with some treatment solutions.
We save the appointment times for some of the higher level teaching, and for the times in-between appointments, we invite people to send us their log sheets, data, and their questions. This is where we can do a lot of fine-tuning.
I have had diabetes for 27 years, and I have learned the beauty is in the daily details. It is not in a lab test done periodically.
DiabetesCare.net: Do you see technology being a complementary aid to in-person diabetes education?
Scheiner: It might even be more of a replacement to in-person programs. You don’t have to travel or have scheduled appointments. It can save time and money, and it is extremely efficient. I think remote diabetes education might be superior to in-person education.
DiabetesCare.net: In the current paradigm you had laid out, the clinician and patient have short amount of time to figure everything out. Is online education the ability to learn in a more relaxed, natural pace and comprehend what is being taught more effectively as well?
Scheiner: Without a doubt. The whole paradigm in how medicine is practiced is around acute illness and not chronic care. Diabetes cannot be managed by seeing a doctor for 15-30 minutes every 3 or 6 months. It has to be an ongoing thing. It requires coaching, teaching, and adjustments. We are changing the paradigm in how patients are being managed. Instead of it being a compulsory appointment, it is ongoing care. We give our clients the ability to work with us in a one-on-one basis or on a retainer. They have unlimited access.
Almost 95 percent of them choose the retainer method, because they realize having access to an expert who can guide you along in an ongoing relationship, makes such a difference.
Scheiner has written a new book, Until There Is a Cure: The Latest and Greatest in Diabetes Self Care, which can be found on his publisher`s site here. DiabetesCare.net will be interviewing Scheiner in the coming weeks, so look for his interview here soon.
To find out more about Type 1 University, interested parties can go here. While on the site, interested readers, can watch one of the Type 1 University videos, Blood Sugar and Pizza.