Bridget LevichPatients whose physicians give them the unwelcome news that they have a chronic, possibly progressive, disease may experience a sense of isolation, helplessness or desperation.

They're sometimes told that they may be dependent on medication, and that they may anticipate recurring bouts of symptoms. Often, they are encouraged to notice food choices, begin exercise programs and consider changing other behaviors that can affect their health. Such patients need education and, of equal importance, talking with other people who are undergoing similar experiences.

That's the basis for establishment of "Diabetes: In Charge and In Control", a six-year-old patient education program conducted through the Department of Family and Community Medicine. The self-management program, consisting of four two-hour classes taught at the medical center or at a UC Davis Medical Group office, has earned prestigious recognition by the American Diabetes Association. The program trains patients how to manage their condition through monitoring and self-care skills.

Students in the class benefit from each other's experiences, and from those of instructor Bridget Levich as well. Levich, one of four instructors, knows the territory well, as a result of living with diabetes for nearly 30 years.

Levich, a registered nurse, is a clinical nurse specialist and director of Chronic Disease Management in the health system. She works with Chronic Disease Management staff to coach patients with chronic illnesses, including congestive heart failure, asthma, and hypertension.

"All of those chronic conditions are very much influenced by behavior," said Levich. "My first passion, though, is working with diabetes patients."

Diabetes didn't sidetrack nursing career

Her involvement with the disease began when she was a nursing student in her early 20s. She became seriously ill and after undergoing tests learned that she had type I diabetes. Her pancreas had stopped producing insulin, a hormone required for basic cellular functions throughout the body. After she began taking insulin injections, she was able to return to school and obtained her associate degree in nursing. She worked for 11 years at Queen of the Valley Hospital in Napa.

"Then I realized that acute care, in which I had been working, really wasn't utilizing my strongest skills," she said. Levich returned to school and obtained her public health certificate. When she and her husband relocated to Yolo County, she worked briefly for Woodland Healthcare until a former colleague, Winifred Varnau of the Center for Nursing Education, recruited her to join the UC Davis Health System's Home Care Services unit in 1995.

As she trained self-management techniques to diabetes patients, she enrolled at California State University, Sacramento, where she obtained her master's degree in nursing. Levich shifted in 2001 to the Department of Family and Community Medicine, which received a grant from the Robert Wood Johnson Foundation.

"The grant was to initiate a program to help change the paradigm of health care from urgent acute care to chronic care. Out of that two-year project we became passionate about the concept of self management and teaching proactive techniques to patients who have chronic illnesses," Levich explained. That momentum led to establishment of a Chronic Disease Management team at the health system.  The team is part of UC Davis Medical Group and includes Gail Shamberg R.N., Glee Van Loon R.D., C.D.E., Jessica Wilson, Community Program Representative and Larry Taylor who is a report writer for Ambulatory Care. 

Certified by board — and life experience

Levich, who for 21 years has been credentialed as a Certified Diabetes Educator (CDE) by the National Certification Board for Diabetes Educators, coordinates the four UC Davis health-care professionals who teach "In Charge and In Control" sessions.

Her CDE certification helps lend credibility to the "In Charge and In Control" program. For the patients she counsels, however, she derives much of her credibility from her own lengthy experience of living with diabetes.

"I've been through some of the challenges that people with diabetes can encounter," Levich said.

She documented her approach to medical self-management in a chapter she wrote on that subject for a recently published book titled "Chronic Disease Management." UC Davis physician Jim Nuovo was the principal editor of the book, to which UC Davis physicians Thomas BalsbaughWilliam Lewis and Samuel Louie also contributed. 

The Chronic Disease Management team recently launched a website that provides information on chronic illness classes in the health system as well as information about multiple self management strategies for these conditions.  The website is www.ucdmc.ucdavis.edu/chronicdisease/

In addition to teaching classes, Levich counsels patients individually on nutrition, use of insulin, blood testing, exercise and other aspects of self-management. She uses a teaching aid called the "decision wheel," which she and her team members designed. In her individual and class sessions, she engages principles developed by Improving Chronic Illness Care, a program of the Seattle-based MacColl Institute for Healthcare Innovation. 

"The model I use has not yet been completely embraced in the medical community. I don't see that as a problem, though; it's a means by which to challenge the acute-care model," Levich said. "I'm pleased that we have an American Diabetes Association-recognized program at UC Davis, because we should, and I'm proud that I led that cause."