Successful Interventions in the Area of Diabetes Care

1. Successful Interventions in the Area of Diabetes Care Alberto BarcelóRegional Advisor on Diabetes, PAHO/WHO II PAHO-DOTA Workshop on Quality of Diabetes Care Diabetes Research Institute (DRI) University of Miami Miami, Florida, USA 14–16 May 2003

2. Changing Practitioner Behavior:What works? • Audit and Feedback: Particularly effective for prescribing and diagnostic testing. • Reminders: Prompts the provider to perform clinical action. • Outreach Visits: Meeting with providers in practice settings to provide information and feedback. • Patient-mediated Interventions: Educating and informing patients particularly useful when combined with Outreach Visits. • Opinion Leaders: Providers explicitly nominated by their colleagues to be “educationally influential.” II Workshop on Quality of Diabetes Care, Miami, May 2003

3. Cluster Visits for Diabetes Care • A nurse-led monthly group visit for adults focusing on self management of diabetes. • Each visit takes about 2 hours. • Program lasted 6 months, groups consisted of 10–18 patients. • Various team members assisted in groups at intervals. • Nurse contacts some patients via phone as needed. • Primary care-provider reviews cases. II Workshop on Quality of Diabetes Care, Miami, May 2003

4. Cluster Visits for Diabetes Care • Various team members assisted in groups at intervals. • Nurse contacts some patients via phone as needed. • Primary care-provider reviews cases. II Workshop on Quality of Diabetes Care, Miami, May 2003

5. Chronic-Care Clinic • Half-day diabetes clinic with 1:1 time with pharmacist, physician and nurse. • Nurse or social worker runs a self-management focused group visit that all patients are invited to attend. • Visits occur 3-4 times yearly. • Eight patients are in each group. II Workshop on Quality of Diabetes Care, Miami, May 2003

6. Case Management • One-on-one diabetes nurse educator meets with patients twice in first month, quarterly thereafter. • Patients are called weekly if on insulin, twice a month if on oral agents. • Nurse uses protocols to adjust therapy working closely with primary-care physician and specialty support. II Workshop on Quality of Diabetes Care, Miami, May 2003

7. Planned Visits • Each provider proactively calls in patients with diabetes for a longer visit (30-45 minutes) to systematically review diabetes care priorities. • Visits occur at least yearly. • Team members assist with care and coordination of the visit. II Workshop on Quality of Diabetes Care, Miami, May 2003

8. Strategies Reviewed • Update or implement evidence-based clinical guideline. • Implement collective clinic visit. • Implement specialist visit with primary health team. II Workshop on Quality of Diabetes Care, Miami, May 2003

9. Priority Selection II Workshop on Quality of Diabetes Care, Miami, May 2003

10. Priority Selection II Workshop on Quality of Diabetes Care, Miami, May 2003