On May 11th, 2018, Associates In Primary Care Medicine's Dr. Martin Kerzer and Kristin David, PsyD presented at Rhode Island's Care Transformation Collaborative quarterly learning session to share the blueprint and subsequent successes of our pioneering integrated approach to diabetes care.
The ability to lower our diabetic patients' A1C numbers through running group visits was a team effort at APCM. It encompasses a three-step process at its core:
Plan: To identify patients with distress regarding their diabetes.
Action: To outreach to these identified patients and invite them to attend an interdisciplinary group visit.
Follow Up: To collect pre-and-post measures on all of the identified patients regardless on their participation in a group visit using a measure of A1C and the DDS.
What is the DDS? DDS stands for Diabetes Distress Screen, which is a 17-item scale that captures critical dimensions relating to distress. It's a screening tool that is used to identify patient's barriers in their care for this chronic illness and, since its first publication in 2005, has been used as a clinical instrument to open up a dialogue between physician and patient.
The results we've seen due to our outreach, planning, and implementation of our group visits has been impressive. Of the 15 patients identified with diabetes distress based on the results of the screen, 9 attended the group visits with Dr. David. All 9 showed improvement in subsequent diabetes distress screens and 8 of 9 improved their A1C.
Of the 6 patients who declined to attend the group visit, 3 had an increase in their A1C, 2 had no change in their A1c, 1 decreased their A1c, and 1 didn't have a repeat A1c collected.
Associates In Primary Care Medicine is very proud of the innovative measures we've taken, but even more proud with the results our patients have been able to receive. The team effort it takes to achieve these results doesn't just refer back to our hard-working providers and staff, but is inclusive of our patients who identify the positive and supportive benefits of our Diabetic Empowerment Visits and choose to attend and apply the information they gain to achieve fantastic results for the betterment of their health.
"We are so proud of what our patients have been able to accomplish through our Diabetes Empowerment Groups," says Practice Manager Jamie Handy. "Our entire team works hard to ensure the success of these group visits. Our goal is for patients to feel knowledgeable, supported, and comfortable." Jamie attended the collaborative meeting and was instrumental in the success of the group visits.