SAN ANTONIO — When diabetes patients team up as mentors and mentees – with one coaching the other on how to best control the disease – a curious thing happens: Not only do those being coached do better, but the patients doing the coaching do better as well.
Mutual accountability is the reason, said Dr. Robin Eickhoff, a family physician helping pilot the technique at WellMed, a San Antonio–based company specializing in medical care for people aged 65 years and over.
Mentors think, “If I am going to try to teach you to be a better diabetic, I should sing the same tune” as a role model, Dr. Eickhoff said during an interview. Mentors and mentees “tend to hold each other accountable. There's a certain accountability you have when you are working with somebody and setting goals,” she said.
In a project funded by an American Academy of Family Physicians grant, WellMed has paired 41 mentors with 113 mentees at 15 of its clinics since late 2009.
Dr. Eickhoff explained that the idea sprang from the work of Dr. America Bracho, who has successfully used peer mentors at Latino Health Access in Orange County, Calif.
Patients at WellMed were paired up after they completed an 8-week introduction to diabetes course that instructed them about medications, blood glucose monitoring, and healthy meal planning, among other things. By the end of November 2010, 246 patients had completed the course.
Although WellMed has only preliminary data on its peer-mentoring efforts, the results appear to show benefit for mentee and mentor alike.
For instance, before the diabetes course, patients tested their blood sugar 4.4 times per week. After the class and 6 months of mentor-mentee partnerships, mentees reported checking an average of 6.5 times per week, while mentors checked 5.2 times. Compared with how they were doing before the course, mentors and mentees reported improved hemoglobin A1c levels, exercising more, and eating less fat and more fruits and vegetables.
WellMed educators look for potential mentors during the diabetes introductory course, taking note of good listeners with a willingness to learn, Dr. Eickhoff said. Those selected get additional guidance on how to talk to other patients, and are then matched with mentees from similar backgrounds whose lab values indicate they need extra diabetes help.
Most patients accept the invitation to be mentors, Dr. Eickhoff said at the meeting, cosponsored by the Society of Teachers of Family Medicine and the AAFP.
The initial mentor-mentee meetings were at WellMed's monthly diabetes group meetings, so they could be supervised. WellMed staff wanted to ensure that mentors gave sound advice and that the relationships worked. Rarely, there were problems, as when a mentor mentioned that she'd stopped taking her diabetes medications and was doing fine on dietary supplements.
After the kinks are worked out, the relationships blossom. “We have seen so much positive feedback from both the mentors and the mentees,” Dr. Eickhoff said. “The enthusiasm from patients has been huge.”
Mentors and mentees interact at least 4 hours per month, part of it at the group meetings, and the rest by phone, over lunch, or however else they chose to interact, Dr. Eickhoff said. They might brainstorm problems together, give each other emotional support, share recipes, and compare lab values, among other things.
For example, one woman's family did not want to give up its high-fat, high-carbohydrate diet, including mashed potatoes. Her mentor suggested mashed cauliflower; the family didn't' even notice the switch, Dr. Eickhoff said.
Another woman, unable to go grocery shopping, felt she had no control over what her daughter brought back to the house. Her mentor suggested giving the daughter a weekly shopping list. It helped.
“They tell each other things that they don't tell us as providers, but will share with someone in a similar situation,” Dr. Eickhoff said. Plus, physicians “don't necessarily have time to delve into [patients'] day-to-day lives, yet so much of their diet and their lifestyle are affected by their social [situations].
“Mentors have the ability to talk about those things, because they've been through it,” she said.