Issue 110 Item 8 ADA: Using the Diabetes Educator to Decreasing Physician Worklo

A nurse practitioner and clinical pharmacist-directed diabetes center improved clinical measures and decreased physician workload. As the prevalence of diabetes mellitus continues to increase to near epidemic levels in this country, the impact on the United States healthcare system is significant. Patients with new-onset and uncontrolled diabetes require considerable time requirement to understand the nature of the disease and develop self-management skills to prevent acute and chronic complications. Over 30 million physician office visits for diabetes are reported annually.

Harbor Medical Associates, a multi-specialty physician group in South Weymouth, MA and CVS Health Connection collaborated to implement the Center for Wellness and Education. The center integrates medical care with diabetes education and monitoring. The nurse practitioner and clinical pharmacist, both trained as diabetes educators, provide general wellness programs, comprehensive diabetes management services including initial and follow-up physical examination, laboratory test ordering, and medication adjustment and monitoring, working together with the group’s physicians. The diabetes individual and group education program incorporates behavioral change to improve diabetes knowledge, self-monitoring skills and lifestyle modification to decrease diabetes and cardiovascular risk.

Currently over 200 patients are managed with approximately 30 new referrals per month. At follow-up, participants with two or more results reported average decrease in HbA1c of 0.93% (p=0.001), decrease in systolic and diastolic blood pressure by 7.4 mm Hg (p<0.0001) and 4.2 mm Hg (p=0.001), respectively, and decrease in triglycerides by 51.7 mg/dL (p=0.04). The proportion of patients with HbA1c > 8.0% at baseline decreased at follow-up (p=0.001). Physician workload has decreased by referring patients to the center for routine diabetes follow-up.

In summary, implementation of a nurse practitioner and clinical pharmacist-directed diabetes center improved clinical measures and decreased diabetes and cardiovascular risk while reducing physician workload. American Diabetes Association’s 62nd Annual Scientific Sessions