Leveraging teamwork to more effectively treat prediabetes and type 2 diabetes

When Dr. Marie Brown cares for patients with prediabetes or type 2 diabetes, they often fit a specific profile. The patient is middle-aged, obese, has at least six of her comorbidities, and a long list of medications.

“It’s a very complex history and visit because we’re not addressing one problem,” Dr. Brown, an internist and AMA director of practice redesign, said on an episode of “AMA STEPS Forward.” Told.^® Podcast,” featuring AMA Senior Physician Advisor and Internal Medicine physician Jill Ginn, M.D.

Diabetes and prediabetes are often impossible to manage alone in a 20-minute visit. And it takes a village to manage the care of these patients, Dr. Brown said.

During the episode, Drs. Brown and Jin discussed team-based approaches and opportunities to save time while improving patient health, as highlighted below. AMA STEPS Forward Toolkit.

There are 96 million adults in the United States with prediabetes and 37 million people with diabetes. However, many people do not even know that they have these symptoms. Physicians have a responsibility to make sure patients are aware of their condition before it gets out of control and complications develop, Dr. Brown said.

Lack of time is one of the major challenges in managing diabetes care. Physicians must juggle patient expectations, pressure to be punctual, and computer documentation, coding, and ordering.

Dr. Brown said the team-based approach addresses the many comorbidities that plague this chronic disease, including high blood pressure, chronic pain, arthritis and depression, and patients lead sedentary lifestyles. They noted that the cycle of weight gain, depression, and other problems continues. .

The goal is for the clinical team to work together to address all of these issues in the same visit and coordinate care, Dr. Jin said.

Part of this strategy includes “pre-visit planning,” where the team follows protocols, identifies patients who need or qualify for screening, and enters orders, Dr. Brown said in a follow-up interview.

The U.S. Preventive Services Task Force recommends screening for prediabetes and type 2 diabetes in all obese or overweight adults ages 35 to 70. The American Diabetes Association also has extensive screening criteria for asymptomatic adults.

If routine HbA1c testing reveals that a patient is prediabetic, the team should refer the patient to the National Diabetes Prevention Program and schedule a follow-up visit with a physician. Patients should also receive education about prediabetes through the portal to ensure they are fully informed and empowered at their next visit as the team prepares next steps.

“We want to activate that person and immediately provide a referral to a diabetes prevention program,” Dr. Brown said.

Medical assistants, nurses, physician assistants, and nurse practitioners perform periodic screenings, so-called “production tasks,” so that physicians have time to do “solution shop” tasks, such as addressing new patient symptoms and conditions. ” must be in charge. Discuss weight loss, Dr. Brown pointed out.

She emphasized that taking these steps in an organized manner will avoid fragmentation of care and better meet patient needs. As a result, the team gains back an additional 1-2 hours of her time each day.

“Then you have time to save that time and dig a little deeper into the aspects of the solution that you’ve been trained to do,” Dr. Brown said.

Dr. Brown recommended several resources to encourage healthcare teams to invest in this approach. For example, “Deimplementation Checklist”” (PDF) Learn how to reduce your burden, including minimizing alerts and inbox notifications.

on the other hand,”get rid of stupid things”Toolkit Identify opportunities to save an hour or two by simply deleting unnecessary messages in your EHR inbox. These measures free up team time to “think about team-based approaches to managing patients with chronic diseases, including prediabetes and diabetes,” Dr. Brown said.

of AMA’s Diabetes Prevention Guide We help physicians and healthcare organizations develop and implement evidence-based diabetes prevention strategies. This comprehensive, customized approach helps clinical practices and healthcare organizations identify prediabetic patients and manage their risk of developing type 2 diabetes. This includes referring at-risk patients to the National Diabetes Prevention Program’s lifestyle change programs based on individual needs.