A high quality diabetes care in Riverview is not a solitary effort. Instead, it is a combination of forces: the doctor and staff who are familiar with the guidelines of the disease and treatment, a patient who is involved and the power to improve their health, and practice, which has been designed so that they do not harm the treatment process.
The third element, systems practice may very well be the richest area of improvement for most medical practices. One example is Family Medical Care of Riverview, a group in Riverview, FL, without walls, which recently launched an ambitious 13 months diabetes program to improve quality. Soon, the group realized that its meetings for patients, which are essential to providing high quality care for diabetes, has not responded to their full potential. As in many practices, patients arrived for their visit, without having the necessary lab work or other services provided in advance. As a result, doctors do not have complete information for the guidance of the visit, patients gave little thought to what they want to accomplish with regard to their disease. Post-visit, the practice back with the enormous task of monitoring, which included phone calls to make or communicate the results of avoidance tests. In short, the visit was unexpected, and participants were largely prepared.
The solution to this problem for the Family Medical Care of Riverview pilot site was to implement a fairly simple system, called “pre-planning.”
What is preplanning?
Pre-planning involves the creation of systems in place to ensure that staff, doctor and patient are prepared for the visit. “Instead of showing the patient in your calendar and running around trying to get all the information you need, visits are planned in advance, we contacted the patients, and they all have their lab work and testing before reaching his office, “said Samuel C. Martino, DO, medical director of the group.
One of the biggest benefits of pre-planning is to provide medical laboratory results and other current patient data at the time of the visit on which to base their advice and treatment recommendations. Without this information, the physician can focus on diabetes visit incorrectly, for example, by strengthening the control of blood glucose in a patient’s real problem is to control your cholesterol. “With advance planning, the physician has the whole picture, all parts, and can be more focused on specific patient needs, resulting in better interaction,” says a nurse at the Riverview pilot site.
The pre-planning process involves four main steps:
1. Be proactive in finding patients who should undergo diabetes visits. The use of a computerized reminder system, Martino and his nurse colleagues print lists of monthly visits as patients with diabetes. Another practice site used paper “tickler files” kept by each of the nurses to remember when patients require appointments.
2. Encounter patients with clear instructions. The web sites do family care through warning letters, which say they are sick because of an appointment and a list of specific tests to be completed before the visit. (The notice is available for download.) The letter also encourages patients to care for them and do their part in improving their health. If patients do not have appointments, nurses to help them do.
3. Encourage patients to participate in their care. To help patients prepare for visits and to get them thinking about what they hope to achieve, the practice of offering patients an annual survey of diabetes fill the waiting room. A questionnaire to help patients self-assess their success and identify areas that may need help is always beneficial. A reflection on these things before you make the doctor-patient visits more meaningful and productive, says Martino, which ultimately improves the results. “Is this really what it is: Make a healthy patient,” he says.
4. Use standard forms to support the clinical staff. For Family Medical Care of Riverview, one of care centers that follow the “SOAP” format and provide an orderly framework for the visit. The doctor may choose to focus on the visit of the specific needs of a patient, but the form of meeting ensures that the fundamental issues are not neglected.
Start In one experiment
Improving diabetes visits, such as improving the office can make it simpler to break them down into baby steps and small experiments can build a practice. A first step in the practice of Martino was to find a single patient with diabetes who arrived late for an appointment to review the patient, and laboratory work done in advance. Gradually, as the practice has learned what works and what does not pre-planning has been extended to all visits to the diabetes.
But Family Medical Care of Riverview has discovered that pre-planned visits should be done. Physicians will benefit from the information they collection before the time of the appointment. Patients will benefit from the encounter because it helps the doctors become more in touch with their needs. And members of the staff in Riverview, particularly nurses, will benefit from the efficiency and the feeling, so that it works. “With this system, they [the nurses] feel they are getting something done and really makes a difference in patient outcomes,” says Martino. “It requires more work and a lot of time to take care of these patients, but the results are enormous, and that makes the job much more rewarding.”
Most of the asthma patients seen at Family Medical Care of Riverview go through difficult and painful episodes while they are struggling to breathe, and medication is still the most effective way to treat these patients.
