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CDE Media Champions are ramping up the campaign about the importance of CDEs in diabetes care and education following this year’s National Diabetes Week, which focused on having the biggest conversation about the condition’s impact and on advocating for improvement.
It comes as ADEA and its unified partners encourage all stakeholders to contribute their insights to the organisations’ submission to a parliamentary inquiry into diabetes.
To help encourage discussions and ADEA members’ contributions to the submission, the following CDE Media Champions spoke with ADEA about issues related to the profession and its workforce:
Diana Ly (DL): A lot of the wider public is not very aware of the role of CDEs.
Often, they think they are seeing a dietitian when referred, which somewhat dictates the perceived importance of seeing a CDE compared to seeing a podiatrist, as another example, whom the public may feel they are getting more benefits from as the appointment is physical compared with verbal during a CDE appointment.
There is not enough advocacy about the importance of baseline education provided by CDEs so that patients can be empowered to prevent diabetes-related complications.
Kirstin Turner (KT): CDEs help people with diabetes, their families, and carers to gain the knowledge, skills, motivation, and confidence to manage their condition.
Healthcare professionals value this as part of an allied health team-care approach to optimise patient outcomes.
Low health literacy from a patient perspective is consistently associated with poorer diabetes knowledge, adherence, and uptake of CDE services.
This can be part of a lack of understanding of the value of a CDE in relation to a new diagnosis of diabetes and reactions of disbelief, anger, being overwhelmed, or denial at the point of diagnosis and not wanting to see anyone about it.
The other factor is that diabetes can be asymptomatic for several patients and so they may not perceive seeing a CDE as something they need as they ‘feel normal’ and again do not understand the role and benefits of seeing a CDE at diagnosis.
Belinda Moore (BM): It was quite refreshing to hear how well regarded CDEs were among all panel members [during National Diabetes Week’s first debate].
There was an overwhelming but welcome sense that CDEs are very much the solution in one way or another to enhancing timely and affordable access to care.
Rebecca Greco (RG): I believe that healthcare professionals understand the high importance of referring people living with diabetes to CDEs.
However, the various barriers that exist limit the number of appointments completed.
For example, lengthy time is involved for a GP to develop a referral and GPs and endocrinologists are often unaware of local CDEs available to refer their patients.
We need to work more collaboratively to support our patients living with diabetes regardless of whether we work in the public or private system.
Some GPs are also unaware of the types of referrals available (e.g., the type 2 diabetes group referral can be helpful in addition to the GP management plan for [GPMP] patients to receive better care).
I do not believe that the government understands the crucial role CDEs have in the annual cycle of care.
This is reflected in the government providing minimal support to see a CDE from a Medicare perspective (i.e., minimal rebates provided to patients who see a CDE, lack of appointments available via GPMP—1 or 2 visits per year does not suffice to provide high-quality care to those living with diabetes).
This echoes for private health, which tends not to provide any type of rebate to see a CDE.
DL: I think the main barrier is access: finding a CDE within proximity; being able to make an appointment in a timely matter; and the costs to see CDEs, doctors, endocrinologists, podiatrists, and psychologists. As well as costs for obtaining prescriptions … to say the least.
In addition, not having the public well educated about a CDE’s role makes it difficult for them to accept or want to see one.
Potential solutions, which are solely my opinion, may be to increase advertising—via social media, TV interviews, etc—about what CDEs do and put more CDEs in the public eye on a frequent basis.
Accredited pharmacist (home medicines review), nutritionist, and CDE Diana Ly. Photo: Supplied
In terms of access, the government needs to start with a funding model that is not fee for service as many CDEs work timelessly in their own time interpreting CGM data, filling out forms, writing advocacy letters to departments such as NDSS, NDIS, and DVA to help their patients gain access to certain needs to improve their lives.
Many CDEs often get burnt out helping patients due to long work hours and poor remuneration.
Attracting new CDEs into the workforce is difficult. Further, CDEs don’t have time to train new CDEs, which creates a vicious cycle of reduced access.
KT: The main barrier is the lack of understanding of the value and role a CDE plays in managing diabetes from both an individual patient perspective all the way to the healthcare system.
There needs to be increased appreciation and awareness of what CDEs are capable of and a focus on CDEs having the patient as the centre of care and CDEs working with their clients as part of the healthcare team to improve health-related outcomes.
The perception that CDEs tell clients what to do needs to be removed and replaced with the awareness that CDEs are there to work with their clients in addressing individual concerns and management issues.
Highlighting the flexible and broad skillsets of CDEs and how they can be from different healthcare professional backgrounds would also be effective.
Other major barriers include limited access to care (availability of CDEs and long wait times in the public system); the potential for lower literacy and health literacy levels; and language, cultural, social, and financial barriers.
It is important that all these obstacles be recognised and addressed to create better health outcomes for these patients and the healthcare system in general.
BM: No one anywhere in Australia who is impacted by any type of diabetes is doing it easily.
It’s the same for CDEs … no CDE in any healthcare sector anywhere in Australia is easily delivering diabetes care and education.
I was grateful for the great debate series to cover the themes it did this National Diabetes Week as these themes— especially around the timely and affordable access to diabetes care and education … or lack thereof—are what I am constantly discussing with the clients and colleagues I work with every day of every week.
I mostly find myself discussing with both clients and colleagues about how to navigate access to diabetes services and technology more than supporting people with their daily diabetes management.
I dream of the day when we as CDEs can return to what we are trained to do—that of building daily diabetes management strategies with individuals who live with diabetes so they become confident and independent with their diabetes self-management knowledge and skills.
However, we are far from this because so many people with diabetes can’t even get to see a CDE and so many CDEs can’t reach so many individuals and communities impacted by diabetes largely due to funding and workforce restraints.
One of the most common barriers the system enforces on people living with diabetes is the sense that the onus of attending diabetes-related health appointments is completely on the person with diabetes.
That they must bend over backward to attend all appointments when and where the system or professional dictates.
But really, we are here for them; they are not here for us.
We need to do more to be more flexible and offer care where and how it suits them.
I think the system and professionals sometimes forget that people with diabetes have other things happening in their lives (related to chronic-condition challenges and to everyday non-diabetes commitments) preventing them from being able to be on top of their diabetes management all the time or being available at the click of the fingers.
RG: I believe it is simply a lack of awareness of the crucial role CDEs have in improving the lives of people living with diabetes.
This awareness is not only lacking among various stakeholders but also in the wider community.
Initiatives like Diabetes Week and the great debate series are fantastic ways to start the conversation, but collectively we need to be louder and heard by top government officials.
This can help us to move forward with providing better access to CDEs for those living with diabetes.
DL: In addition to the abolition of fee for service and a new funding model for CDEs as mentioned above, incentives for more senior and experienced CDEs to be remunerated for their time to provide training to newer and less experienced CDEs, especially in pump therapy and CGM, are needed.
Another solution includes allowing CDEs to order relevant pathology for timely screening and prevention of diabetes-related complications.
Also allow CDEs prescribing or dose-adjustment rights within certain criteria so a patient does not need to go back and forth between a GP and a CDE for recommendations then back to a GP for action, which can take weeks or even months.
Safety considerations could be considered with advanced accreditation, for example, for some CDEs to justify taking this action.
KT: There needs to be a specific diabetes-related chronic disease management plan where patients who have diabetes can have access to more subsidised visits in a 12-month period.
Patients need to see multiple allied health professionals when newly diagnosed and this limits access to ongoing management, especially with the strain on the healthcare system at the present time.
The remuneration for CDEs to provide services also needs to increase and account for the fact that all my consultations last 30–60 minutes minimum and if I decide to bulk bill a patient who has financial barriers (majority of my patients), the current rebate is not sufficient for the level of care I am providing.
Also, there are not enough CDEs for the incidence rate of diabetes, which is worse in regional and remote locations where further barriers to care present themselves.
The role of a CDE needs to be valued and remunerated as such and have sufficient referral and Medicare claimable pathways to ensure the retention of CDEs in the future.
BM: People need options—a suggestion that not only came out of my chat [with a person with type 2 diabetes] and out of the first debate during the National Diabetes Week’s great debate series.
It was suggested that people with type 2 diabetes seek care with GPs and CDEs while people with type 1 diabetes seek care through endocrinologists at hospitals (if the rural and remote sectors have access to endocrinologists like metro areas do, which they don’t by the way!).
But this really won’t work—people rightly don’t like being told what to do nor how to do it; they have every right to be the leaders in how they access diabetes care and education.
For their care to be therapeutic, they need to seek care from those they connect with, not based on their demographics or diabetes type.
How, when, and where care is delivered must be person-centred at every level.
Registered nurse-midwife and CDE Belinda Moore. Photo: Supplied
Just because Australia is being confronted by a diabetes epidemic does not mean we forget about maintaining humanistic person-centred care in diabetes education service delivery.
I feel like we need a central triage system set up and run by CDEs in each state and territory for GPs, allied health professionals, and other CDEs to refer people with diabetes or for people with diabetes to call, so they can be appropriately referred to relevant CDEs in a system that will work for the person’s individual diabetes and lifestyle needs.
With voices from Diabetes Australia, ADEA, and ADS having unified to design and release renewed diabetes strategic plans that will largely shape the parliamentary inquiry into diabetes, I do remain cautiously optimistic about timely and affordable access to diabetes care and education improving.
My optimism will grow in confidence as our CDE voices become unanimously louder in this once-in-a-lifetime opportunity of an inquiry into the future of diabetes care and education in Australia.
RG: Simplifying the credentialing process to become a CDE to begin working will allow those who have just graduated to enter the workforce quicker.
Allowing CDEs to perform more roles like providing pathology forms for HbA1c and oral glucose tolerance tests and diagnosing diabetes will not only reduce double handling in the healthcare system but also allows for quicker and more effective tailored action.
Addressing the job shortage and employing more CDEs in the hospital environment and aged care sector will also make the role more attractive, which will see more CDEs enter the workforce and allow for better diabetes care in these settings.
There also needs to be more preventative campaigns aimed at the younger population to allow for reduced rates of diabetes or better and more timely care provided to help achieve remission of their diabetes.
If you are interested in helping form ADEA’s submission to the parliamentary inquiry into diabetes, you may submit your contribution via our online form, which closes on 17 August.
CDEs may also encourage their clients to complete Diabetes Australia’s national consultation survey, which will help Diabetes Australia’s submission.
CDE Media Champions are ramping up the campaign about the importance of CDEs in diabetes care and education following this year’s National Diabetes Week, which focused on having the biggest conversation about the condition’s impact and on advocating for improvement.
It comes as ADEA and its unified partners encourage all stakeholders to contribute their insights to the organisations’ submission to a parliamentary inquiry into diabetes.
To help encourage discussions and ADEA members’ contributions to the submission, the following CDE Media Champions spoke with ADEA about issues related to the profession and its workforce:
Diana Ly (DL): A lot of the wider public is not very aware of the role of CDEs.
Often, they think they are seeing a dietitian when referred, which somewhat dictates the perceived importance of seeing a CDE compared to seeing a podiatrist, as another example, whom the public may feel they are getting more benefits from as the appointment is physical compared with verbal during a CDE appointment.
There is not enough advocacy about the importance of baseline education provided by CDEs so that patients can be empowered to prevent diabetes-related complications.
Kirstin Turner (KT): CDEs help people with diabetes, their families, and carers to gain the knowledge, skills, motivation, and confidence to manage their condition.
Healthcare professionals value this as part of an allied health team-care approach to optimise patient outcomes.
Low health literacy from a patient perspective is consistently associated with poorer diabetes knowledge, adherence, and uptake of CDE services.
This can be part of a lack of understanding of the value of a CDE in relation to a new diagnosis of diabetes and reactions of disbelief, anger, being overwhelmed, or denial at the point of diagnosis and not wanting to see anyone about it.
The other factor is that diabetes can be asymptomatic for several patients and so they may not perceive seeing a CDE as something they need as they ‘feel normal’ and again do not understand the role and benefits of seeing a CDE at diagnosis.
Belinda Moore (BM): It was quite refreshing to hear how well regarded CDEs were among all panel members [during National Diabetes Week’s first debate].
There was an overwhelming but welcome sense that CDEs are very much the solution in one way or another to enhancing timely and affordable access to care.
Rebecca Greco (RG): I believe that healthcare professionals understand the high importance of referring people living with diabetes to CDEs.
However, the various barriers that exist limit the number of appointments completed.
For example, lengthy time is involved for a GP to develop a referral and GPs and endocrinologists are often unaware of local CDEs available to refer their patients.
We need to work more collaboratively to support our patients living with diabetes regardless of whether we work in the public or private system.
Some GPs are also unaware of the types of referrals available (e.g., the type 2 diabetes group referral can be helpful in addition to the GP management plan for [GPMP] patients to receive better care).
I do not believe that the government understands the crucial role CDEs have in the annual cycle of care.
This is reflected in the government providing minimal support to see a CDE from a Medicare perspective (i.e., minimal rebates provided to patients who see a CDE, lack of appointments available via GPMP—1 or 2 visits per year does not suffice to provide high-quality care to those living with diabetes).
This echoes for private health, which tends not to provide any type of rebate to see a CDE.
DL: I think the main barrier is access: finding a CDE within proximity; being able to make an appointment in a timely matter; and the costs to see CDEs, doctors, endocrinologists, podiatrists, and psychologists. As well as costs for obtaining prescriptions … to say the least.
In addition, not having the public well educated about a CDE’s role makes it difficult for them to accept or want to see one.
Potential solutions, which are solely my opinion, may be to increase advertising—via social media, TV interviews, etc—about what CDEs do and put more CDEs in the public eye on a frequent basis.
Accredited pharmacist (home medicines review), nutritionist, and CDE Diana Ly. Photo: Supplied
In terms of access, the government needs to start with a funding model that is not fee for service as many CDEs work timelessly in their own time interpreting CGM data, filling out forms, writing advocacy letters to departments such as NDSS, NDIS, and DVA to help their patients gain access to certain needs to improve their lives.
Many CDEs often get burnt out helping patients due to long work hours and poor remuneration.
Attracting new CDEs into the workforce is difficult. Further, CDEs don’t have time to train new CDEs, which creates a vicious cycle of reduced access.
KT: The main barrier is the lack of understanding of the value and role a CDE plays in managing diabetes from both an individual patient perspective all the way to the healthcare system.
There needs to be increased appreciation and awareness of what CDEs are capable of and a focus on CDEs having the patient as the centre of care and CDEs working with their clients as part of the healthcare team to improve health-related outcomes.
The perception that CDEs tell clients what to do needs to be removed and replaced with the awareness that CDEs are there to work with their clients in addressing individual concerns and management issues.
Highlighting the flexible and broad skillsets of CDEs and how they can be from different healthcare professional backgrounds would also be effective.
Other major barriers include limited access to care (availability of CDEs and long wait times in the public system); the potential for lower literacy and health literacy levels; and language, cultural, social, and financial barriers.
It is important that all these obstacles be recognised and addressed to create better health outcomes for these patients and the healthcare system in general.
BM: No one anywhere in Australia who is impacted by any type of diabetes is doing it easily.
It’s the same for CDEs … no CDE in any healthcare sector anywhere in Australia is easily delivering diabetes care and education.
I was grateful for the great debate series to cover the themes it did this National Diabetes Week as these themes— especially around the timely and affordable access to diabetes care and education … or lack thereof—are what I am constantly discussing with the clients and colleagues I work with every day of every week.
I mostly find myself discussing with both clients and colleagues about how to navigate access to diabetes services and technology more than supporting people with their daily diabetes management.
I dream of the day when we as CDEs can return to what we are trained to do—that of building daily diabetes management strategies with individuals who live with diabetes so they become confident and independent with their diabetes self-management knowledge and skills.
However, we are far from this because so many people with diabetes can’t even get to see a CDE and so many CDEs can’t reach so many individuals and communities impacted by diabetes largely due to funding and workforce restraints.
One of the most common barriers the system enforces on people living with diabetes is the sense that the onus of attending diabetes-related health appointments is completely on the person with diabetes.
That they must bend over backward to attend all appointments when and where the system or professional dictates.
But really, we are here for them; they are not here for us.
We need to do more to be more flexible and offer care where and how it suits them.
I think the system and professionals sometimes forget that people with diabetes have other things happening in their lives (related to chronic-condition challenges and to everyday non-diabetes commitments) preventing them from being able to be on top of their diabetes management all the time or being available at the click of the fingers.
RG: I believe it is simply a lack of awareness of the crucial role CDEs have in improving the lives of people living with diabetes.
This awareness is not only lacking among various stakeholders but also in the wider community.
Initiatives like Diabetes Week and the great debate series are fantastic ways to start the conversation, but collectively we need to be louder and heard by top government officials.
This can help us to move forward with providing better access to CDEs for those living with diabetes.
DL: In addition to the abolition of fee for service and a new funding model for CDEs as mentioned above, incentives for more senior and experienced CDEs to be remunerated for their time to provide training to newer and less experienced CDEs, especially in pump therapy and CGM, are needed.
Another solution includes allowing CDEs to order relevant pathology for timely screening and prevention of diabetes-related complications.
Also allow CDEs prescribing or dose-adjustment rights within certain criteria so a patient does not need to go back and forth between a GP and a CDE for recommendations then back to a GP for action, which can take weeks or even months.
Safety considerations could be considered with advanced accreditation, for example, for some CDEs to justify taking this action.
KT: There needs to be a specific diabetes-related chronic disease management plan where patients who have diabetes can have access to more subsidised visits in a 12-month period.
Patients need to see multiple allied health professionals when newly diagnosed and this limits access to ongoing management, especially with the strain on the healthcare system at the present time.
The remuneration for CDEs to provide services also needs to increase and account for the fact that all my consultations last 30–60 minutes minimum and if I decide to bulk bill a patient who has financial barriers (majority of my patients), the current rebate is not sufficient for the level of care I am providing.
Also, there are not enough CDEs for the incidence rate of diabetes, which is worse in regional and remote locations where further barriers to care present themselves.
The role of a CDE needs to be valued and remunerated as such and have sufficient referral and Medicare claimable pathways to ensure the retention of CDEs in the future.
BM: People need options—a suggestion that not only came out of my chat [with a person with type 2 diabetes] and out of the first debate during the National Diabetes Week’s great debate series.
It was suggested that people with type 2 diabetes seek care with GPs and CDEs while people with type 1 diabetes seek care through endocrinologists at hospitals (if the rural and remote sectors have access to endocrinologists like metro areas do, which they don’t by the way!).
But this really won’t work—people rightly don’t like being told what to do nor how to do it; they have every right to be the leaders in how they access diabetes care and education.
For their care to be therapeutic, they need to seek care from those they connect with, not based on their demographics or diabetes type.
How, when, and where care is delivered must be person-centred at every level.
Registered nurse-midwife and CDE Belinda Moore. Photo: Supplied
Just because Australia is being confronted by a diabetes epidemic does not mean we forget about maintaining humanistic person-centred care in diabetes education service delivery.
I feel like we need a central triage system set up and run by CDEs in each state and territory for GPs, allied health professionals, and other CDEs to refer people with diabetes or for people with diabetes to call, so they can be appropriately referred to relevant CDEs in a system that will work for the person’s individual diabetes and lifestyle needs.
With voices from Diabetes Australia, ADEA, and ADS having unified to design and release renewed diabetes strategic plans that will largely shape the parliamentary inquiry into diabetes, I do remain cautiously optimistic about timely and affordable access to diabetes care and education improving.
My optimism will grow in confidence as our CDE voices become unanimously louder in this once-in-a-lifetime opportunity of an inquiry into the future of diabetes care and education in Australia.
RG: Simplifying the credentialing process to become a CDE to begin working will allow those who have just graduated to enter the workforce quicker.
Allowing CDEs to perform more roles like providing pathology forms for HbA1c and oral glucose tolerance tests and diagnosing diabetes will not only reduce double handling in the healthcare system but also allows for quicker and more effective tailored action.
Addressing the job shortage and employing more CDEs in the hospital environment and aged care sector will also make the role more attractive, which will see more CDEs enter the workforce and allow for better diabetes care in these settings.
There also needs to be more preventative campaigns aimed at the younger population to allow for reduced rates of diabetes or better and more timely care provided to help achieve remission of their diabetes.
If you are interested in helping form ADEA’s submission to the parliamentary inquiry into diabetes, you may submit your contribution via our online form, which closes on 17 August.
CDEs may also encourage their clients to complete Diabetes Australia’s national consultation survey, which will help Diabetes Australia’s submission.
