Original Article
Outcomes in an Interdisciplinary Diabetes Clinic in Rural Primary Care
Abstract
Objective: The purpose of this study was to evaluate the effectiveness of an interdisciplinary diabetes team model of care in assisting patients to achieve improved glucose control in a primary care rural setting.Methods: A family medicine clinic at a rural university medical center developed an interdisciplinary diabetes team clinic composed of a certified diabetes educator/dietitian, a case manager, a pharmacist, nursing staff, a family medicine resident, a psychologist, and a board-certified family medicine attending physician. Patients were referred if their hemoglobin A1c (HbA1c) was ≥9% (75 mmol/mol); patients were seen for an initial consultation and for additional visits as needed.
Results: A total of 94 patients attended an initial visit and at least 1 follow-up within 6 months. Mean age was 57 ± 13 years, and 54% were female. Median time from the initial intensive diabetes clinic visit to a follow-up visit was 2.8 months. There was a significant reduction in median HbA1c percentage from 10.25% (88.5 mmol/mol) ± 1.4% (range 73–104 mmol/mol) at the initial intensive diabetes clinic visit to 8.7% (72 mmol/mol) ± 1.8% (range 52–92 mmol/mol) at a 1- to 6-month follow-up (z = −7.161, P < 0.001) and a significant difference between baseline HbA1c (10.25% [88.5 mmol/mol] ± 1.4% [range 73–104 mmol/mol]) and latest HBA1c (1–18 months later) 8.4% (68 mmol/mol) ± 2.2% (range 44–92 mmol/mol; z = −7.022, P < 0.001). Overall, 86% of patients had a lower HbA1c at follow-up, and 33% had an HbA1c <8% (64 mmol/mol). There were no differences in patients’ blood pressure, immunization rates, or lipid values between baseline and follow-up visits (P > 0.05).
Conclusions: An interdisciplinary team approach to glycemic control can achieve significant reductions in HbA1c in the rural primary care setting.
This content is limited to qualifying members.
Existing members, please login first
If you have an existing account please login now to access this article or view purchase options.
Purchase only this article ($25)
Create a free account, then purchase this article to download or access it online for 24 hours.
Purchase an SMJ online subscription ($75)
Create a free account, then purchase a subscription to get complete access to all articles for a full year.
Purchase a membership plan (fees vary)
Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.
References
1. Tapp H, Philips SE, Waxman D, et al. Multidisciplinary team approach to improve chronic care management for diabetic patients in an urban safety net ambulatory care clinic. J Am Board Fam Med 2012;25:245-246.
2. American Diabetes Association. Foundations of care and comprehensive medical evaluation. Diabetes Care 2018;41(suppl 1):S28-S37.
3. Wan EY, Fung CS, Wong CK, et al. Effectiveness of a multidisciplinary risk assessment and management programme-diabetes mellitus (RAMP-DM) on patient-reported outcomes. Endocrine 2017;55:416-426.
4. Chwastiak LA, Jackson SL, Russo J, et al. A collaborative care team to integrate behavioral health care and treatment of poorly-controlled type 2 diabetes in an urban safety net primary care clinic. Gen Hosp Psychiatry 2017;44:10-15.
5. Goff SL, Murphy L, Knee AB, et al. Effects of an enhanced primary care program on diabetes outcomes. Am J Manag Care 2017;23:e75-e81.
6. Bright DR, Kroustos KR, Thompson RE, et al. Preliminary results from a multidisciplinary university-based disease state management program focused on hypertension, hyperlipidemia, and diabetes. J Pharm Pract 2012;25:103-135.
7. Pimazoni-Netto A, Rodbard D, Zanella MT. Rapid improvement of glycemic control in type 2 diabetes using weekly intensive multifactorial interventions: structured glucose monitoring, patient education, and adjustment of therapy-a randomized controlled trial. Diabetes Technol Ther 2011;13:997-1004.
8. Rasekaba TM, Graco M, Risteski C, et al. Impact of a diabetes disease management program on diabetes control and patient quality of life. Popul Health Manag 2012;15:12-19.
9. Derrett S, Gunter KE, Nocon RS, et al. How 3 rural safety net clinics integrate care for patients: a qualitative case study. Med Care 2014;52(11 suppl 4):S39-S47.
10. Nye AM. A clinical pharmacist in telehealth team care for rural patients with diabetes. N C Med J 2017;76:183-184.
11. Douthit N, Kiv S, Dwolatzky T, et al. Exposing some important barriers to health care access in the rural USA. Public Health 2015;129:611-620.
12. Brems C, Johnson ME, Warner TD, et al. Barriers to healthcare as reported by rural and urban interprofessional providers. J Interprof Care 2006;20:105-118.
13. Pieh-Holder KL, Callahan C, Young P. Qualitative needs assessment: healthcare experiences of underserved populations in Montgomery County, Virginia, USA. Rural Remote Health 2012;12:1816.
14. Narayan KM, Boyle JP, Geiss LS, et al. Impact of recent increase in incidence on future diabetes burden: U.S., 2005-2050. Diabetes Care 2006;29:2114-2116.
15. Centers for Disease Control and Prevention. National Diabetes Statistics Report., 2017. Estimates of diabetes and its burden in the United States. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf. Accessed January 31, 2019.
16. World Health Organization. Global report on diabetes. http://www.who.int/diabetes/global-report/en. Published 2016. Accessed March 20, 2018.
17. Schmitt A, Reimer A, Hermanns N, et al. Assessing diabetes self-management with the Diabetes Self-Management Questionnaire (DSMQ) can help analyse behavioural problems related to reduced glycaemic control. PLoS One 2016;11:e0150774.
18. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001;16:606-613.
19. McGill M, Blonde L, Chan JCN, et al. The interdisciplinary team in type 2 diabetes management: challenges and best practice solutions from real-world scenarios. J Clin Transl Endocrinol 2017;7:21-27.
20. Bayless M, Martin C. The team approach to intensive diabetes management. Diabetes Spectrum 1998;11:33-37.
21. Wagner EH, Sandhu N, Newton KM, et al. Effect of improved glycemic control on health
care costs and utilization. JAMA 2001;285:182-189.
22. Ragucci KR, Fermo JD, Wessell AM, et al. Effectiveness of pharmacist-administered diabetes mellitus education and management services. Pharmacotherapy 2005;25:1809-1816.
