According to the American Diabetes Association, 25.8 million people in the United States -- 8.3 percent of the population -- have diabetes, with the overall cost of diagnosed disease estimated at $245 billion, including $176 billion in direct medical costs and $69 billion in reduced productivity. These figures do not account for the millions of people who have not been diagnosed.
Reuben McBrayer, M.D. (far left), Brian Grimard, M.D. (second from left, back row), Elizabeth Burns, M.D. (third from left, back row), and the rest of the team at the Mayo Clinic's Department of Family Medicine in St Augustine all participated in the Diabetes Master Clinician Program.
Since 2003, the Florida AFP (FAFP), through the FAFP Foundation, has been arming family physicians in their fight against the disease via its Diabetes Master Clinician Program(www.diabetesmasterclinician.org) (DMCP).
According to family physician Edward Shahady, M.D., medical director of the program, the DCMP uses a Web-based diabetes registry in conjunction with a team approach and group visits to offer physicians an edge that translates into enhanced care.
"The physicians who use this (program), I think, are the ones who want to do a better job for their patients," Shahady said. "They realize that diabetes is the most challenging of all chronic diseases because (successfully managing) it takes all the biological, social, psychological, emotional, financial and organizational skills that a patient possesses and asks the same of the physician, as well.
- The Florida AFP Foundation's Diabetes Master Clinician Program (DMCP) uses a Web-based diabetes registry in conjunction with a team approach and group visits to help family physicians offer better quality care to patients with diabetes.
- The DMCP's registry generates a report for the physician, allowing him or her to track each patient's hemoglobin A1c LDL cholesterol and blood pressure levels.
- A total of 115 practices are enrolled in the DMCP, 90 percent of which are in Florida, with the remainder scattered throughout Georgia, North Carolina, Illinois, Missouri and Oklahoma.
"Physicians have to have a command of the pathophysiology of the disease, a command of how patients deal with the disease on an individual level, and a command of all the guidelines and medications. We now have 20-some different medications available to treat this disease, whereas, 20 years ago, we only had four or five."
In addition, said Shahady, the more patients with diabetes a practice sees, the more difficult it becomes to stay on top of all that information.
"Most physicians, if I were to ask them how well they were doing with their diabetic patients, would tell me they are doing pretty well, but the key is, how do they know?" Shahady said.
"This is where a registry is a big help, because it answers that question."
How It Works
The DMCP's registry generates a report for the physician, allowing him or her to track each patient's hemoglobin A1c, LDL cholesterol and blood pressure levels, which Shahady calls "the big three" of diabetes care measures.
"Physicians can look at the registry and they can print out a report on demand, so there's no going back to the IT (information technology) people or to an EHR (electronic health record) for the information," he said. "I know it's not a popular sentiment, but EHRs have failed miserably in creating good, usable registries for chronic disease management.
How-to on Conducting Group Visits
Family physician Edward Shahady, M.D., medical director of the Florida AFP Foundation's Diabetes Master Clinician Program(www.diabetesmasterclinician.org), (DMCP) has long been an advocate of using group visits -- one aspect of the DMCP -- to optimize management of patients with diabetes and other chronic diseases. Based on findings from the program's early years, he created an overview on planning, conducting and evaluating the success of group visits(www.fafp.org) for patients with diabetes that includes resources and tools for members of the clinical team, as well as patients.
Shahady said the registry also allows participating practices to use a population management approach in treating diabetes.
"Now, if I'm the physician, I know that I have 50 patients with their A1cs out of control," Shahady said. "The registry identifies these folks and I print out the names and then I get together with my staff and we discuss what we need to do about these 50 people. At that point, everyone in this office becomes a population manager with their diabetics, and they are all thinking of ways to improve care.
"Once they (office staff) have seen an improvement in a handful of those folks, they can look at the data and figure out what they did to help those patients and continually refine and improve their program," he added.
When it comes to enlisting patients in safeguarding their own health, one approach that works well, according to Shahady, is using a "patient report card," which lists patient weight and blood pressure, hemoglobin and cholesterol levels, among other indicators, and empowers patients to better self-manage their diabetes. However, he said, it is impossible for physicians to implement and maintain this kind of program alone because takes a whole team to manage a patient population of any size.
"This information is not just for the physician," said Shahady. "It's for the whole office."
In addition to all the good work the DMCP does inside the borders of the Sunshine State, it's also working its magic in other regions.
"There are 115 practices in the DMCP now -- up from four in 2003 -- but not all of them are in Florida," Shahady said. "Ninety percent are in Florida, while the others are scattered throughout Georgia, North Carolina, Illinois, Missouri and Oklahoma."
Through an agreement with the GO! Diabetes program(www.godiabetes.org), founded in 2008 by the Academy's Georgia and Oklahoma chapters, eight DMCP practices in those two states are supported via grants, Shahady said.
Kelly Humpherys, M.D., (far right, back row) and the team at Caney Valley Medical Center in Ramona, Okla., make up one of several family medcine practices outside of Florida that participate in the Diabetes Master Clinician Program.
"That's been a very successful partnership," he said. "Overall, it costs about $8,000 for a practice to get started over a two-year period, so we have grant money available for (these Georgia and Oklahoma practices) to hire nursing or other health care students to go in and do the data entry. After the initial data entry by the students, practices are responsible for entering their own data."
Shahady said the FAFP Foundation also offers small grants that allow the DMCP to produce short webinars for each participating practice.
"We talk about different aspects of diabetes and maybe have a guest speaker," he said. "There are family physicians from all over the country who are doing a lot of interesting stuff in terms of the medical home and diabetes, and we have them come out and share their stories with these folks."
FAFP EVP Jay Millson said it was only natural for the chapter and its foundation to support the DMCP.
"Knowledge is power, and this program obviously provides an excellent resource for our members to provide the best quality care in the area of diabetes," he told AAFP News Now. "We get excellent feedback from the FAFP members who participate.
"I think the program's success is very evident when you consider the fact that additional grants have been funneled into it to expand the program outside the borders of Florida."
Facts About the Florida AFP
Chapter EVP: Jay Millson
Date chapter was chartered: May 24, 1948
Number of chapter members: 4,000
Location of chapter headquarters: Jacksonville
FAFP Family Medicine Summer Forum 2013 date/location: July 19-21, Hilton Orlando
According to Shahady, the DMCP continues to improve the quality and quantity of the tools it provides to its member practices and their patients.
"This Foundation program was started because we wanted to help our members offer better quality to their patients," Shahady said. "Now we can show better quality data than anyone when it comes to managing diabetes, and we are able to help patients attain better control of their diabetes than the national averages in the big three (care measure) categories.
"But we didn't stop there, and we now offer Diabetes University(www.diabetesuniversitydmcp.com), a website we created for nurses, medical assistants and patients that features 75 slides that educate them on the disease. From there, they take an online test."
Because the online test is a teaching tool, said Shahady, the program shows test-takers the correct information when an incorrect response is given. Users then are allowed to reanswer the question and must garner an overall score of 70 percent or above to pass.
The DMCP is available at no charge to FAFP members and includes use of the registry, as well as training for all clinicians and office staff on how to use it. Participants also receive training on the standards of diabetes care and how to conduct group visits. Practices that wish to participate in the DMCP can contact Shahady by e-mail.