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Looking for novel ways to help improve patient outcomes, the Johnson & Johnson Diabetes Institute is using innovative adult education techniques to train diabetes educators around the world. While the cultural and epidemiological differences in each region can be challenging, David L. Horwitz, M.D., Ph.D., FACP, Chief Medical Officer of the Johnson & Johnson Diabetes Institute, feels confident this program can make a positive impact to help improve patient outcomes.
The Johnson & Johnson Diabetes Institute (JJDI) provides health professionals with no-cost education and training programs in key regions of the world - China, Japan, the U.S. and Europe. At the Diabetes Institute, educators are trained on the safe and effective use of its products including glucose monitoring and insulin pump products.
The Johnson and Johnson Diabetes Institute developed specific programs in each region to meet educator's needs. In China, Institute staff worked with the Chinese Diabetes Association and Ministry of Health to develop the nation's first certification program for diabetes educators. The week-long training program provides rigorous didactic training with extensive education in the basic science of diabetes and its management. The Health Ministry then places the participants in hospitals for practical experience before they are certified as Diabetes Educators.
The Institute's program in Europe addresses the behavioral aspects of diabetes, and according to Dr. Horwitz, there is no one else in Europe offering any type of program like it. In Japan, the Johnson & Johnson Diabetes Institute has programs for both physicians and allied health professionals.
The Diabetes Institute is moving the U.S. focus toward more hands-on training designed to help educators change patient behaviors that undermine diabetes management. This is because many of those coming for the training are already experienced diabetes educators and have different expectations of the program. Dr. Horwitz explains, "Practitioners come to us asking -‘What am I going to learn here that I don't know'? My job is to keep the content fresh and up to date. We design our U.S. program to be highly participative, using the best adult education practices. We have to respect and engage the knowledge of our audience."
One exercise that has proven to be especially effective takes a "day in the life" approach, where the educators try to experience what it is like to self-manage diabetes. "This morning before lunch, we gave everyone a chance to use a blood glucose meter and really get to know how to use it," said Dr. Horwitz. "At lunch, they counted their carbs, with some help. Then, at the end of the day, we started them on an insulin pump (without insulin, of course). They had to wear the pump and then to go to dinner in a restaurant, without carb cards and figure it out. This can be interesting because the dieticians sometimes don't agree among themselves about the right way to calculate the carbohydrate content, especially without measuring tools or an ingredients list. That's part of the learning experience. If they ever wondered why their patients can't get it right, this shows them that it isn't easy," adds Horwitz.
By learning what is important to the patients, educators can focus their limited time on effective behavior change and motivation. "At the Diabetes Institute, we focus more on the patient experience and how that affects compliance," said Dr. Horwitz. "When educators complete the program, they will be able to start a real dialogue with the patient about how to use the glucose monitors and the pump. They will have a real understanding of the patient's experience. Our goal is to help diabetes educators increase the number of their patients attaining and maintaining their target scores."
The program is not a traditional Continuing Education program and does not offer CME credits. "We are not competing with the ADA," said Dr. Horwitz. "The Institute provides a product training program. It is centered on the achieving the most effective use of our products, our glucose monitors and software. And because we don't offer CMEs and focus on product training, we can subsidize the educators travel here, which is helpful to hospitals without large training budgets."
The program has a loyal base of alumni who continue to meet online. "We have an online community where people can talk about what they learned in class, share experiences and even discuss problems. I use my blog on the site to talk about things that interest me in the literature and try to start a conversation," said Dr. Horwitz. The alumni have become the Diabetes Institute's best recruiters. "Virtually all recruiting is now by word of mouth, and because we can only take 30 people at a time, the waiting list is well over a thousand. We try to select people from underserved areas, those who will benefit the most. They are people who have a large number of individuals with diabetes."
One question that often arises around the topic of diabetes education is what happens after the training? How do you know if you have been successful? "When we developed the program, we set targets and developed metrics," explained Dr. Horwitz. "Participants are asked to rate their confidence in various areas: when to prescribe insulin; how to use a pump; how to rate the results of blood glucose monitoring. After the training, they are asked these questions again and we look at changes in confidence. We see dramatic changes after 2 days of training, often around 20 percent. We also ask what percent of patients say they stay at their target scores, before training and then 3, 6, and 12 months later."
When asked why J&J became involved in the area of diabetes education, Dr. Horwitz responded, "People traditionally didn't think of J&J as a diabetes company, although we are among the global leaders in our glucose monitoring and pump products. We decided we wanted to make a difference "in the trenches", using the best practices of adult education to train diabetes educators how to change behaviors and motivate their patients."
"We asked ourselves how do we help educators teach the new skills once they leave the training program? We know that lectures are not effective in changing behaviors, so we had to develop other methods. We had to change behaviors within the faculty, too. We use the way we teach the diabetes educators as an example of how to teach patients. The people that come to the Diabetes Institute are doing adult education with their patients. So by setting an example of participatory learning, they learn how to give the patient a chance to talk, too."
After many years in clinical research, Dr. Horwitz is enjoying his return to education. "My training was on the clinical team at University of Chicago. I've was on the faculty at the University of Chicago and later the University of Illinois for 20 years altogether, teaching students, providing patient care and doing research in diabetes. I was one the first people to get involved in insulin pumps and had one of the largest insulin pump practices in Chicago. Eventually I came to Johnson and Johnson, initially for clinical research, medical affairs and regulatory affairs worked in those areas until a little over a year ago. I came to the Johnson and Johnson Diabetes Institute because it was a good opportunity to get back into the educational realm. I have made it my mission to make sure the course content stays fresh and up to date, relevant to the needs of the people we are training and the patients they serve. My primary goal is to expand our reach. We can't bring the whole world to our four Institutes, so we have to try to expand outward with multiple programs and "take it on the road."
Dr. David L. Horwitz, M.D., Ph.D., FACP, is presently the Chief Medical Officer of the Johnson & Johnson Diabetes Institute. Previously, he was vice president for Worldwide Clinical Affairs & Evidence Based Medicine at LifeScan, Inc., a Johnson & Johnson company. During his time at LifeScan, Dr. Horwitz has at various times been responsible for Clinical Research, Medical Affairs, Regulatory Affairs, and Advocacy & Professional Affairs. Dr. Horwitz obtained his bachelor's degree at Harvard University, majoring in Chemistry and Physics, and has an M.D. and Ph.D. (in physiology) from the University of Chicago and an MBA from the Lake Forest Graduate School of Management. He is a Board-Certified internist and endocrinologist, and was on the faculty of the University of Chicago and the University of Illinois, where he was Clinical Professor of Medicine and adjunct professor in the Department of Nutrition and Medical Dietetics. He has published over 100 articles in scientific and clinical journals, primarily in the areas of diabetes and metabolism. He served as President of the Illinois Affiliate of the American Diabetes Association, and has also been active nationally in the ADA, acting as chair of the Committee on Planning and Organization, and vice-chair of the Committee on Research. He is currently the industry representative on the FDA advisory panel on clinical chemistry and toxicology.
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