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Topic: Disease Management

Active Management Allows Practice to Improve Diabetes Outcomes
All providers find it challenging to help diabetes patients maintain blood glucose control. But at Southeast Texas Medical Associates (SETMA), providers have designed a coordinated, multifaceted set of initiatives that have prompted a steady 10-year decline in their patients’ mean hemoglobin A1c (HbA1c). In 2001, mean HbA1c was 7.48; by 2011, it had fallen to 6.54.

Naturopathic Care Can Enhance Diabetes Patients’ Outcomes, Self-Management
Primary care physicians’ (PCPs) attitudes toward complementary and alternative medicine (CAM) approaches range from skepticism to cautious interest to enthusiastic support. Most, however, understandably reserve their judgment about particular therapies and approaches until studies confirm a meaningful clinical benefit. The good news for both physicians and diabetes patients is that some CAM approaches have been proven to generate measurable improvements in outcomes. A study published in the April 2012 issue of BMC Complementary and Alternative Medicine suggests that naturopathy, a long-standing CAM approach, can serve as a positive adjunct to usual care for diabetes patients by leading to improvements in blood glucose control, patient self-management behaviors, and self-efficacy.

Group Visits Improve Clinical Outcomes for Diabetes Patients
Group visits for diabetes patients, in which patients receive a brief, one-on-one medical visit in addition to self-management education in a group setting, are being adopted by primary care practices seeking new ways to enhance care quality and efficiency. “The 15 minutes allotted for a typical primary care visit are insufficient to address all of the care needs of a patient with a complex condition such as diabetes,” says Robert E. Burke, DNP, RN, FNP-BC, LAc, an adjunct clinical professor in the College of Health Professions at Pace University’s Lienhard School of Nursing and a family nurse practitioner at Montefiore Medical Center in New York City. “Group visits allow patients with diabetes to receive medical care, medication reconciliation, diabetes education, and peer support during one extended visit.”

Self-Management Website Helps Diabetes Patients Improve Engagement, Self-Care
Lifestyle changes, including those related to diet, exercise, and medication usage, are critical for improving diabetes outcomes. Yet making these changes can be especially challenging for patients who cannot afford or do not have or physical access to ongoing diabetes education. Patients increasingly look to the Internet for diabetes education, but can websites really help? A study called Technologies in Diabetes Education and Self-Care (TIDES) by the Geisinger Health System suggests that the right website, combined with regular prompts from physicians, can make a meaningful difference in patients’ diabetes knowledge, attitudes, and behaviors, as well as their HbA1c levels.

Communication Skill Is Critical in Providing Patient-Centered Diabetes Care
Diabetes patients’ success in self-management has meaningful consequences for clinical outcomes, but too often patients do not successfully adopt the difficult lifestyle changes—including those related to diet, exercise, and medication adherence—that are required to achieve glycemic control. The reasons are multifactorial: diabetes patients may feel overwhelmed by the diagnosis, be frustrated when their efforts do not yield improvements in health indicators, or suffer from “diabetes distress,” a condition in which patients become highly stressed by the implications of the diabetes diagnosis. However, many diabetes experts believe that one way physicians can improve patients’ self-management ability—and, therefore, clinical outcomes—is to improve the quality of their communication with their patients.

Physicians’ Spouses’ Medical Advice Sheds Light on the Benefits of Empathy
I belong to a popular online physician-only networking site (Sermo; www.sermo.com) and was intrigued by the headline about a fellow pediatrician’s spouse. The physician posting this amusing notion went on to write, “This must happen to many of you. A friend asks medical advice and your spouse answers for you.” More than 20 physicians responded, acknowledging that this happens to them as well.

Diabetes Dashboard Improves Physician Efficiency and Accuracy
Many physician practices have adopted electronic medical records (EMRs) to improve care quality and practice efficiency. Unfortunately, they often find these EMRs to be more frustrating than helpful. “As data repositories, EMRs amass a large amount of information, theoretically allowing us to retrieve any data point we need in seconds,” says Richelle J. Koopman, MD, MS, a practicing physician and associate professor of family and community medicine in the University of Missouri’s School of Medicine. “But too often, EMRs are not practical point-of-care tools. Many EMRs are poorly organized, and the data points we need to evaluate when treating a particular condition are buried in the record. Physicians often expend considerable effort to retrieve all the facts they need from the EMR.”

Mobile Phone Applications Facilitate Ongoing Diabetes Management
Mobile device technology has prompted the development of new tools to help diabetes patients monitor their condition. A number of smart phone applications allow patients to record their glucose levels and other data, while wireless glucometers can automatically send glucose results to a centralized database.

Program Helps Patients With Chronic Illness Reduce Medications, Increases Practice Revenue
The increasing incidence of chronic conditions such as diabetes and hypertension in recent years has placed a heavy burden on the health care system. According to the National Diabetes Fact Sheet, released in January of this year by the Alexandria, Va.-based American Diabetes Association, an estimated 25.8 million Americans currently suffer from diabetes, including an estimated 18.8 million cases that have not yet been diagnosed. The cost of diagnosed diabetes to the U.S. health care system in 2007 was $174 billion, the Fact Sheet indicates.

Telephonic Counseling, Walking Improve Health, Outlook of Diabetes Patients With Depression
Depression is common in patients with a wide array of chronic medical conditions, including diabetes. Unfortunately, depression often goes untreated in patients with diabetes, due to the many competing demands physicians face when treating these complex patients.