Using A Patient-Centered Approach In Effective Diabetes Management

“We got the sense that people really do care about their diabetes; they just don’t have the tools they need.” – Patricia Witherspoon, M.D.

The way Leo took the lead and determined the goal he wanted to achieve during his appointment represents a significant shift from the traditional doctor/patient relationship. While he is a fictional patient, his scenario is one that is slowly starting to take hold within the field of medicine. This patient-centered approach to health care has been found to be particularly successful among groups of well-educated Caucasians who have been introduced to it in certain parts of the United States. Until recently, low-income individuals like Leo have not been exposed to patient-centered care, nor has its effectiveness been studied in poor and minority populations. Yet for the past year Dr. Patricia Witherspoon, associate professor in the Department of Family and Preventive Medicine, has been doing just that.

“The patient with diabetes is not living in a vacuum, and factors like finances and emotional state play a part. With the patient-centered approach we acknowledge the psychosocial aspects of their disease,” Dr. Witherspoon said. The study underway by Dr. Witherspoon and her research team has centered on three components: 1) focus groups with patients in the targeted population, 2) a Family Practice Center provider survey on patient-centered care, and 3) development of a diabetes patient registry.

Focus Groups

Eight focus groups were held with patients who receive care for their diabetes from the Family Practice Center. While the participants were generally satisfied with the care provided by faculty members and residents, the common thread that emerged from the groups was that the patients felt a real need for ongoing education to help them manage their chronic illness. “We got the sense that people really do care about their diabetes; they just don’t have the tools they need,” said Dr. Witherspoon.

Dr. Witherspoon explained that one way to meet educational needs would be through cluster visits, a concept that has been introduced in some cities. For patients with diabetes, this would mean that a number of them would be scheduled for physician appointments on the same day. Before they saw their doctor individually, all patients would attend an educational class on a particular topic provided by a health care professional. Ample opportunities would be available for questions and discussion. “This way when patients see the doctor they can be very knowledgeable and know what they want to ask. It would be a more efficient visit,” Dr. Witherspoon said.

The focus group participants were also interested in the idea of a hotline. Instead of having to make an appointment to address a simple question, they could leave a message on a dedicated diabetes hotline and receive a return call from the physician’s office the same day. Dr. Witherspoon sees the proposition as a win-win situation. “These patients have a high incidence of coming in to see us. A hotline would give them more control and decrease the burden on the health care system,” she said.

Provider Survey

The second component of Dr. Witherspoon’s study was a survey given to faculty, residents, and nurse practitioners at the Family Practice Center. The self-administered survey, DAS-3, examined diabetes-related attitudes. The results found that residents scored lower than faculty in all five components of the survey (seriousness of diabetes, the value of tight glucose control, psychosocial impact of diabetes mellitus, patient autonomy, and the need for special training). In two of the five areas - the need for special training and patient autonomy - the scores were statistically significant. "Traditionally it is the provider who knows the disease process and must tell the patient what to do. Being so much closer to the traditional medical school curriculum, the residents were not as open minded about patient-centered care," Dr. Witherspoon said. Additionally, residents who were further along in their training tended to have a greater appreciation for taking a new tack to diabetes management. The survey also highlighted the fact that not all providers were ready to adopt the patient-centered approach, indicating that the process will take time to gain a higher level of acceptance.

Registry Developed

Dr. Witherspoon recognized that another way to provide better care to people with diabetes would be for them to be easily identifiable within the system at the Family Practice Center. Since last November she and her team have been involved in the arduous process of identifying some 1,500 patients who receive care there for their diabetes. Every one of their files is labeled with the same prefix, which immediately makes all providers at the Family Practice Center aware of the diabetes diagnosis. This registry provides a vehicle for tracking patient data and allows for better continuity of care. It also proves particularly helpful when patients come in for treatment unrelated to their diabetes or see a particular faculty member or resident for the first time.

While the registry is still undergoing some fine-tuning, Dr. Witherspoon is encouraged about how it can help the level of care provided to people with diabetes in the Midlands. She's also excited about the potential impact of a patient-centered approach to diabetes management. "If we can help patients take care of their diabetes the best they can, then we can improve the lives of 1,500 people," Dr. Witherspoon said. "We can really make a big impact and limit their risk for complications like blindness, renal failure and heart disease. Diabetes is so prevalent in South Carolina. If we can diagnose early and address the complications, it would be a great thing for this state," she said.

Reprinted from Connections newsletter, September 2003

Connections is produced twice a year by University Specialty Clinics ®. Connections articles are copyrighted and may be download and/or reprinted for personal use only. Prior written consent is required in order to reprint or electronically reproduce any articles, graphics, and photographs appearing on the website. For more information, contact Diane J. Epperly, Connections editor, at wordchef@atlanticbb.net .