• ADEA Masterclass: New role for the RN-CDE, expanding health professional care of people with type 2 diabetes in primary care

Aim:
Aim: To introduce registered nurse, credentialed diabetes educators (RN-CDEs) to a model of professional practice for supporting General Practitioners (GPs) and Practice Nurses (PNs) in treatment intensification, in particular initiation of insulin, in primary care for people with type 2 diabetes (T2D).

Background and rationale: 

The Stepping Up model of care, based on an enhanced role for the PN supported and mentored by the RN-CDE, has been proven effective, with clinically significant reduction in glycaemic levels without deterioration in quality of life. The session will be a mixture of presentations interspersed with practical role playing for the health professional education aspect, assistance with motivational interviewing skills, therapy options to be considered, and discussion about pathology relating to diabetes care.

The RN-CDE is the only category of CDE managing diabetes exclusively. The expertise this allows can be more widely distributed and utilised if we train, mentor and support primary care health professionals assisting with progression of therapy (including injectables), and practical dietary and exercise management. Integrating the availability of frequent clinic visits to the referring GP with a competent PN (as only a few Medicare funded visits are available to the diabetes educator) will be discussed.

We present this model to assist diabetes specialist trained people (endocrinologists and diabetes educators), to increase primary carers diabetes management knowledge, to enhance the care of the ever expanding number of people with type 2 diabetes.

Overview:
Overview presentation of the Stepping Up Model of Care emphasising the large numbers of people with type 2 diabetes, and the current ratio of specialist diabetes trained people to care for them.

Case Study: Introduce a practice nurse from a busy bulk-billing/private billing clinic and the effect of the training on the people with T2D diabetes at her clinic and how it has translated into routine diabetes management. 

Key principle 1: MI
Brief overview of motivational interviewing followed by practical application, with division into pairs, with varied scenarios to be discussed, with the participants in the role of person with diabetes or GP/DE/PN. Gather to brainstorm results. 

Key principle 2: The range of glycaemic therapeutic options facing GPs, PNs and people with T2D
Ensure DEs feel comfortable with the large choices of oral and injectable hypoglycaemic therapy currently available. Safety aspects, various appropriate titration algorithms for titration, and essential knowledge needed by the HPs and PWD.
Hands on manipulation of various injectable devices (insulins, GLP1s), available after the session for interested participants.

Key principle 3: Monitoring
Discuss both useful blood glucose monitoring for change of therapy management, and the pathology routinely done for people with diabetes, and alert levels relating to different oral and injectable medications, including appropriate communication with the treating GP for any safety concerns or discussion of progression of therapy. Include in this section the importance of pathology showing improvement, as one aspect demonstrating the value of the DE working with the clinic GP and nurses. 

Conclusion:
Lessons from the implementation of Stepping Up. Give emphasis to the uptake being greater in lower socio-economic areas where patients are reluctant/cannot afford to pay for a health service.

Learning Objectives:

• To understand the rationale for a reoriented professional practice model in primary care
• To become familiar with the principles of a model of professional practice based on a RN-CDE mentoring role for GPs and PNs in implementing treatment intensification for people with T2D in primary care