|
||||||
|
|
|
|
|||||||||||
|
|||||||||||||
| ||||||||||||||||||||||||||||||||||||
An unrestricted $9.3 million educational grant will allow the American College of Physicians (ACP) and the ACP Foundation to pursue a 3-year diabetes initiative aimed at improving diabetes care nationwide and recognizing physicians who measurably succeed toward that end.
ACP launched the program, funded by Novo Nordisk, at its annual meeting in San Francisco April 14–18. The diabetes project is the largest partnership of its kind between the college and a pharmaceutical company, according to ACP President Charles K. Francis, MD, who goes so far as to call it "earth-shattering" for the college's members and for diabetes.
"We're looking at diabetes care as a whole, not dividing it up among the medical turfs," Francis says. "We're advancing a team approach in which the physicians, particularly internal medicine physicians, play a key role."
Internists, including subspecialists, provide most diabetes care in the U.S., Francis says, noting that about 6.3% of the population, or 18 million people, have diabetes, but nearly one-third of them don't yet know they have it.
"No single individual, no single company, no single organization is equipped to tackle this mammoth health care issue alone," says Alan C. Moses, MD, Novo Nordisk's associate vice president for clinical research and medical affairs in endocrinology. "The program developed by ACP will address the complicated issue of diabetes care through programming that is high quality, evidence-based, testable, and that will work."
The initiative also will concentrate on developing interdisciplinary education for diabetes educators, nurses, physicians' assistants, physician practices, and patients, with materials in Spanish and English.
|
Vincenza Snow, MD, clinical director of the diabetes initiative and director of clinical programs for ACP, outlined the program's three primary goals:
"What's been shown is that multifaceted programs are what works," Snow says. "We recognize that not everyone learns the same way."
ACP will use multiple sources of clinical guidelines, Snow says, including its own and those of the American Diabetes Association. "We're trying to bring the whole of health care's parameters higher," she says.
|
Some of the goals will be achieved by building on existing ACP programs, she says, such as the medical knowledge self-assessment program (MKSAP), a Web-based, point-of-care clinical decision support tool known as PIER, and a new portal on ACP's Web site, ACPOnline.org, that will offer one-stop shopping for all ACP diabetes information.
ACP also plans to develop new materials that focus on team-based care, including a new self-assessment program on diabetes, a diabetes patient-safety module, a program that addresses measuring outcomes and quality improvement, and ACPNet, an ongoing research project to study patient care in practice settings. Also in the works is a tutorial for health care professionals to help them install a diabetes patient registry in their practice and to learn how to treat those patients as a population.
"It's not that [ACP] members don't know what to do, but we need to show them how to do it in practice," Snow says, paraphrasing quality-improvement guru Donald Berwick, MD, of the Boston-based Institute for Health-care Improvement: Knowledge is necessary but not sufficient for change.
Snow says she hopes the new provider recognition programs based on measured improvement will be used for pay-for-performance projects and to help physicians negotiate better contracts with payers.
"The value of these interventions is not just in providing education,
but in putting tools in the hands of physicians and patients that can change
the way they practice and manage this disease," says Eric B. Larson, MD,
chair of the ACP Board of Regents.
DYSLIPIDEMIA COURSE SHOWCASES NEW ACP DIABETES TRACK
Age and statin use illustrate need to weigh multiple risk factors
As provider of most of the continuing education to internists, the American
College of Physicians (ACP) unveiled a distinct diabetes educational track at
its annual meeting in San Francisco April 14–18. It is the first
tangible component of ACP's new 3-year diabetes initiative and featured 16
courses and workshops related to diabetes care, including programs on
inpatient and outpatient diabetes care, kidney disease, diabetes care quality
improvement, and dyslipidemia.
In his session on managing lipid disturbances, Robert A. Kreisberg, MD, dean of the University of South Alabama College of Medicine, opened the floor to topic suggestions from the audience. His was an example of the give-and-take style of the annual session diabetes workshops, most of which employed case studies and animated probing into specific clinical issues and practice solutions.
Whether the question was about age factors influencing statin treatment, abnormal liver function tests, or combination drug therapy, Kreisberg emphasized the importance of controlling obesity, the metabolic syndrome, and diabetes for reduction of cardiovascular risk, in addition to treating dyslipidemia.
He suggested physicians try an "experiment" when treating each patient, in which "n = 1." For example, hyperlipidemia is presenting in younger patients, which, if allowed to persist throughout life, will increase their risk for cardiovascular disease (CVD). But Kreisberg points out that in the short term, prescribing a statin may mean the patient is using a drug for a disease that does not yet exist.
He says he usually defers statin use for young patients until they reach their 20s, with the exception of those who have a strong family history of coronary heart disease. Otherwise, a patient gets the risk of a drug's adverse effects without its benefit, Kreisberg says.
On the other hand, he says he "wouldn't hesitate" to use drugs to lower lipids in older people because "the older you are, the greater the risk." Looking at the overall rates of heart disease in men and women, Kreisberg says he gets more aggressive in treating men at age 40, women at age 50, and others who have additional CVD risk factors.
But in each of these generalized groups, he stresses the importance of looking at family history and of close monitoring for two possible extremes that may influence individuals. Kreisberg calls these "exquisite resistance" and "exquisite sensitivity" of the vessels to the disease process.
Like many of his peers leading courses at the ACP annual meeting, Kreisberg made a concerted effort to connect medical evidence gathered from controlled studies with the complexity of day-to-day practice, urging his internist colleagues to look at both the big picture and the individual patient.
Kreisberg notes that the information from large, single-dimensional statin trials shows about a 35% reduction in relative risk. But that leaves a high residual risk for patients with other CVD risk factors, such as diabetes, hypertension, smoking, or other forms of dyslipidemia.
"Until we as physicians address all of the risk factors, we cannot
hope to reach 90% [risk reduction]," he says.
CiteULike 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
| ||||||||||||||||||||||||||||||||||||
|
||||||
|
| DOC News | Diabetes | Diabetes Care | Clinical Diabetes | Diabetes Spectrum |
