All the measurements taken by the groups to gauge success
showed improvement.
Helping people set their own goals. Giving them a call when
they're due for a lab test or physical exam. Coaching them on how to manage
their health.
These seem like simple enough steps, but they can
make a significant difference in the health of people with diabetes.
A dozen clinical teams from around New Mexico
came together under the leadership of the New Mexico Medical Review Association
to try these approaches in helping patients manage their diabetes.
"This really is just the beginning," said Leslie
Shainline, director of the collaborative. "The teams will now spread the patient
registry and system of change to other doctors, clinics and (apply them to)
other chronic diseases."
The results, which encompass 1,435 patients,
showed that:
* The percentage of patients meeting a goal that
exemplifies good blood-sugar management only increased from 30.8 percent to 32.3
percent. However, the percentage of those meeting the next highest measurement
increased from 40.9 percent to 66.5 percent, while those falling below the third
rung rose from 40.9 percent to 78.7 percent.
* Those meeting a "lofty goal" of LDL
(low-density lipoprotein -- the "bad" cholesterol) levels below 100 milligrams
per deciliter only rose from 23 percent to 29.8 percent. But those who kept
their LDL levels below 130 rose from 31.2 percent to 64.5 percent. Higher LDL
levels contribute to heart disease, a major complication of diabetes.
* The percentage of patients who got a documented
annual eye exam rose from 34.2 percent to 63.3 percent. Diabetes can lead to
blindness.
* Only 12.8 percent of patients had set goals for
managing their diabetes, compared to 53.6 percent a year later.
Dr. Robert Ferraro, an Albuquerque
endocrinologist in private practice, said he and his patients sign a contract in
which they spell out their goals and what steps they will take to manage their
disease. "It's a negotiation. You can't dictate to a patient," he said.
An aging population will bring a Social Security
crisis and a Medicare crisis, he said. "The rates of diabetes in this population
will double in the next 10 years," he said. "Lifestyle improvements can moderate
this disease."
Ferraro has a patient registry to track whether
people were getting needed tests to watch for blood-sugar control and
complications. He also set up group visits, in which patients could get
check-ups, access to different experts and educational sessions.
"It was a cohesive team approach," said Mary Lynn
Johnston, diabetes educator at UNM. In the past, patients sometimes would be
told one thing by one health care provider and another thing by another --
spurring them to ignore all the advice, she said. Now they are getting a
consistent message and are more likely to respond, she said.
Source: Diabetes In Control Dot Com.
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