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Mark Peyrot Part 4, Implementing Psycho-Social Diabetes Guidelines

In part 4 of this Exclusive Interview, Mark Peyrot talks with Diabetes in Control Publisher Steve Freed during the ADA meeting in San Diego, CA about ways healthcare providers can effectively implement these guidelines into their busy appointments with their patients.

Mark Peyrot is Professor of Sociology at Loyola University Maryland and Professor of Health and Social Sciences at Bergen University College (Norway). His 300+ publications include a co-edited collection of diabetes psychosocial care guidelines and a ADA position statement on diabetes psychosocial care recently published by ADA.

Transcript of this video segment:

Steve: As a diabetes educator, I agree one thousand percent to what you’re saying. But, let’s talk about realistic expectations. They come in to see the doctor, and they have 15 minutes. They have to talk about their blood pressure, about their diet, eye care, kidney care, hearing, skin, and just about everything, and the doctor runs out of time. So, how do you implement it?

Dr. Peyrot:  First of all, we say that the thing you have to deal with – you always have time to deal with.  What we want to do is elevate these conditions to the ones that have to be dealt with.  Depression is a very serious disorder. It has massive consequences for complications, for life expectancy, and so forth.  It is what is sometimes called the silent killer. You may not see it on a test result, but that may be something that is shortening someone’s life dramatically, causing them to smoke, to not exercise and gain weight, to not take care of their diabetes. If you don’t address the depression, everything else you do won’t be successful.  We talk about the step approach, one – you can screen before they come in, so when they come in you already know if they are depressed or not.  There are simple questionnaires that can be filled out that will give you a very good idea whether this is a high-risk patient, or a low-risk patient.  There is a number of informal questions you can ask in an interview that will tell you if this is a problem that needs to be followed-up or doesn’t need to be followed-up. There are ways of doing this, that are not only effective, but also efficient. That use the clinician’s time in a way that yields a major return on investment. That is really what is important.  What are the actions that will give you the most impact?  Those are the ones you want to engage in. We believe that these factors are important and that people need to take a very focused approach. We don’t want them to spend a lot of time just chit-chatting if they don’t have the time. There are ways to do this efficiently that yield the results without a lot of time.

Steve: What are some of the potential strategies for implementing the guidelines?

Dr. Peyrot:  I mentioned one of them in my response to the last question. Screenings can be set up, so while the patient is sitting in a doctor’s or whoever’s office, they can fill out these questionnaires and they can be easily and quickly scored. If they are on a computer, the computer will just pop out a score, and it will say this is a high-risk score, or a low-risk score, and this is something that should to be followed-up, or something that doesn’t need to be a focus of the current visit. That would be one strategy, to use the waiting room time to try and gather this data. The other strategies are like I said, ask two quick questions about depression, if the patient answers either those questions yes, that indicates that there is something there and needs additional attention. If you can get something integrated in the electronic health record – that’s golden. That then becomes one of those things the providers need to deal with.  If the practice can commit to doing that, that makes it a part of the standards by which providers are evaluated and becomes a target they address themselves to. There is a number of strategies, there is no a secret magic bullet that is going to solve all the problems, but we want to get people thinking about how they can make progress on this. The most important thing is to move forward from where you are, not whether you are perfect already, but if you are not good enough, how do you take first steps towards making it better.

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