Success is built sequentially. It’s one thing at a time. – Gary W. Keller
Building on our last blog about how to have a productive type 2 diabetes (T2D) diagnosis conversation using a solution-focused approach, NOW let’s focus on how to incorporate these techniques into follow up visits. These follow-up visits are ideally “diabetes only” visits. In a brief primary care visit that is addressing multiple issues, it can be too challenging to focus on specific diabetes priorities. The American Diabetes Association recommends scheduling “diabetes only” appointments to focus on and address diabetes-related concerns. This diabetes only visit is an opportunity to be a think partner with your client to answer questions, address concerns, and map out a plan together.
Using a solution-focused approach at a “diabetes only” visit?
Since asking eliciting questions is a primary tenet of a solution-focused encounter, we encourage starting all visits by listening and learning from your client. Even though the client is new to diabetes, they are the expert in that they know what works in their life in other aspects, and they know what they are capable of doing now. (Read more about experts here)
The goal is to focus on things that are working well, and when something works, do more of it! Help your clients to recognize their strengths by identifying exceptions. We’ve written about exceptions here). “Diabetes only” visits can be structured in a systematic way.
10-step model for a “diabetes only” visit
- Start with a question. “I’m looking forward to hearing how things have been going since our last visit. Can you tell me one thing that went well for you this past week (or since we last met)?”
- Explore the reply further. “How do you think you can do more of (that)?”
- Personalize. “I want to make sure this visit is successful for you, what do you need to know or learn by the end of the visit?”
- Empower. Empower people with diabetes with tailored education and support to ensure their questions, needs and desires are met.
- Set a SMART goal. A SMART goal helps move the individual towards the direction they want to move based on your conversation. It helps quantify progress with measurable steps and keeps things reasonable and achievable.
- Ask a scaling question. “On a scale of 0-10 where zero is never and 10 is all the time, how confident are you that you can achieve your goal?
- Use their answer to finish the visit and provide one action for them to focus on.
- If 0-4: Encourage them to revise their smart goal, it might be too difficult to achieve.
- If 5-7: Identify one strength they already have and build upon it. “What is one thing you do where you feel confident in your actions? How can you do more of that?”
- If 8-10: Encourage them to challenge themselves and consider a goal that might move them closer to their overall health behavior outcomes.
- Review the four critical conversations. As we discussed in the last blog, we encourage you to build upon these conversations at each visit. (adapted from ADA Overcoming Therapeutic Inertia)
Conversation 1: The nature of T2D is to change over time, as your insulin production changes.
“Although diabetes is progressive, and can change over time, your actions can make a difference in slowing the progression over time.”
Conversation 2: Your treatment plan will change over time as your diabetes changes.
“We will work with you to find a treatment plan that achieves health goals while also considering your preferences and values.”
Conversation 3: You can’t do this alone.
“Seek help from family, friends and community support resources.”
Conversation 4: Share your difficulties with managing your diabetes.
“Your healthcare team is on your side and we will support you in whatever ways you need to manage your diabetes”
- Refer for diabetes self-management education and support.
- Thank them for coming in and for working hard.
- Plan follow-up. Plan the next diabetes only visit.
Join us next time as we continue our series on incorporating a solution-focused approach when managing T2D in the primary care setting. We’ll continue to help you build your solution-focused tool-kit. Our goal is to start slow and share small, achievable bite-size practice changes you can implement over time.
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Deb is employed by Dexcom, but her words and opinions in this blog are her own.
Tami is employed by the University of Kentucky HealthCare Barnstable Brown Diabetes Center, but her words and opinions in this blog are her own.