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Public health officials in New York State borrowed a page from drug marketing tactics and found that "academic detailing" can improve the management of people with diabetes in private primary care practices, according to research presented at the 2006 Diabetes and Obesity Conference sponsored by the Centers for Disease Control and Prevention, held May 16–19 in Denver.
Diabetes academic detailing is "useful for raising a consistent standard across practices and identifying populations of underserved patients," says Melissa Jacobson, program co-ordinator of Steps to a HealthierNY for the Rockland County Department of Health.
Over a 1-year period, a team of consultants consisting of a certified diabetes educator and a nurse practitioner made three visits to 26 primary care medical offices in Rockland County, a suburban area of New York City.
In these brief face-to-face sessions, the diabetes academic detailing team discussed specific evidence-based health care practices and showed how improved clinical decision-making enhances the quality and cost-effectiveness of care.
In the first visit, the detailing team completed an assessment of office practices and the interest of providers to implement at least one suggested change. Investigators learned that 23 out of the 26 practices did not use a flagging system on the charts of patients with diabetes, 24 reported that they used no flagging system to identify patients with prediabetes, and 23 said that they did not refer patients with diabetes to an American Diabetes Association self-management education program.
During the second visit, the detailing team provided material developed by the New York Diabetes Coalition, a collaboration of health plans, medical societies, and community organizations focused on improving the health care of people with diabetes.
The material included patient education resources, chart stickers, flow sheets, and other documents for assessing and recording a patient's diabetes-related medical and family history.
On the third visit, the detailing team assessed how well the practice implemented changes to improve diabetes care. Seventeen of the 26 offices made a total of 52 changes in their practices, including using chart stickers to identify patients with diabetes and pre-diabetes; using the term "pre-diabetes" and educating patients about the condition; increasing referrals to ophthalmologists, podiatrists, and diabetes self-management programs; spending more time discussing smoking cessation, diet, and exercise; and distributing free glucose meters to low-income patients.
PROGRAM ASSESSMENT
A convincing majority of practices surveyed reported that the changes helped improve care for patients with diabetes, that the time required to participate was worth the benefit received, and that the program was recommendable to other medical practices.
Ideally, Jacobson says, the medical practices would be best served with a diabetes registry to help guide the care of these patients. "It would have been great if we'd started some diabetes registry systems, but they weren't ready for that," she says. Short of a registry system, an academic detailing program can help medical practices adopt changes to improve the care of patients with diabetes.
Noting that the academic detailing program in New York cost about $1,000 per practice, Jacobson says the program is considering redirecting its effort to public clinics and other settings that care for underserved patients, as improvements are likely to have a greater impact. One of the things researchers learned is that private practice care for people with diabetes is generally good.
"There are always improvements, but primary care in private practice
is pretty much giving the gold standard," Jacobson says. 
Footnotes
Information about Rockland County's Tools for Better Diabetes Care program can be found at www.co.rockland.ny.us/steps/diabetes/tools.htm.
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| DOC News | Diabetes | Diabetes Care | Clinical Diabetes | Diabetes Spectrum |
