As diabetic patients and their physicians continue to work together to combat this metabolic disorder, researchers and medical organizations are uncovering new ways to fight this illness. With 26 million Americans currently battling the disease and 79 million already diagnosed with pre-diabetes, this disease poses a serious threat to our society and our overall healthcare system.
With these startling statistics in mind, the Northern States Ambulatory Research Network (NORTHSTAR), a practice-based research network composed of primary care providers in North Dakota and led by Charles Christianson, MD, joined together with The Physicians Foundation, a nonprofit national organization dedicated to improving the quality of healthcare for all Americans and advancing the work of practicing physicians.
The two groups conducted a study that examined which practice interventions used by physicians and other healthcare providers in North Dakota clinics produced better compliance with recommendations for diabetes care. This research resulted from a $370,000 Physicians Foundation grant awarded to establish NORTHSTAR, which is part of the University of North Dakota.
Tracking patient compliance is critically important for effective patient treatment because it enables physicians to see if patients are attending office visits and receiving lipid-level tests, annual eye examinations, and other recommended care.
In the study, researchers surveyed 425 primary care physicians in order to understand which diabetes interventions were available and utilized within North Dakota clinics. They compared the respondents’ results to an aggregated summary of provider data given to them by Blue Cross Blue Shield of North Dakota.
The insurers’ information included the number of diabetic patients assigned to each physician and their adherence to five clinical guidelines: annual office visits, hemoglobin A1c tests, eye exams, lipid tests, and microalbumin tests, as well as a general “all five categories met” measure.
The study, titled “Diabetes Care Interventions: A Best Practices Study,” revealed three best practices for both physicians and patients to utilize in ongoing diabetic treatments:
Use of a diabetes patient registry. The numbers of patients who require treatment for diabetes far exceed the supply of doctors, which, consequently, puts considerable strain on health providers to maintain accurate records and information. Additionally, factors such as unforeseen medical changes and individuals switching providers can impact treatment consistency, continuity, and effectiveness. Therefore, it is paramount to use tools such as a diabetic patient registry to document patient information accurately and effectively.
By employing a diabetic patient registry, physicians and health providers can track a number of interventions and understand a patient’s overall medical history better. The registry also can alert doctors about patient compliance issues or problems that affect treatment timing. Examples include scheduling blood tests to measure hemoglobin A1c (HbA1c)/lipid/microalbumin levels and making certain patients are complying with treatment regimens.
Patient performance reporting and feedback tools. Treatment measures for diabetic patients are diverse and wide-ranging. Patient conditions constantly change and require clinicians to adjust treatments to reflect these developments. Instituting a comprehensive reporting and feedback system helps to mitigate errors and fosters a higher level of quality of patient care.
Additionally, such a system enables physicians to prioritize interventions that are most effective in patient care because they have access to up-to-date treatment information. As a result, clinicians can actively monitor and adjust patient treatments to maximize the possibility of healthy outcomes. Both of these interventions can be made with paper records, but are more easily implemented with electronic health records.
Use of a dietitian. Individuals with diabetes are confronted with issues that impact both their diet and exercise. Beyond conventional medical treatments, diabetic patients can greatly benefit from working with a dietitian to advise them on a balanced approach that combines healthy eating and appropriate exercise programs.
Importantly, dietitian encourage patients to take a more active role in monitoring their diabetes. This leads to regular compliance with office visits and having their HbA1c and lipid levels tested as needed. This active approach not only allows patients to address diabetes physically, but also provides a sense of individual empowerment.
Collectively, these three practices greatly enhance the treatment of diabetes. Physicians are better positioned — through reporting/feedback tools and an accurate diabetic registry — to support patients in a pragmatic and effective manner. Patients also benefit from the physical health advantages of a dietitian and the psychological empowerment of knowing they can actively combat diabetes.
Although this study was conducted in North Dakota, the findings can be applied to practices across the U.S. Diabetes continues to be a deadly and financially costly disease. However, the advancement of effective treatments and continued research provides us with tremendous hope and optimism for the future.
Alan L. Plummer is the vice president of The Physicians Foundation and a professor of medicine at Emory University.
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