Heather Zacker Shares Processes for Making Primary Care More Diabetes-Friendly

Heather Zacker, MS, senior director of Care Alliances of Joslin Innovation at Joslin Diabetes Center, discussed several ways primary care offices can transform their practices to provide optimal diabetes care. These include quality improvement, data analysis, and benchmarking initiatives to make the office more diabetes-friendly.

Transcript (slightly modified)

What is the importance of the primary care provider when caring for patients with diabetes?

85 to 90% of people with diabetes are cared for in the primary care setting, as opposed to an endocrinologist’s office, and that’s people who are diagnosed with diabetes. Clearly, the primary care provider is the person with the most influence, the clinician with the most influence on how the patient manages his or her diabetes. Yet, primary care physicians have to be masters of, or experts in, so many different conditions and diseases, and it’s really not something that’s easy to do.

One of the things we’ve done at the Joslin Diabetes Center, where I direct our Care Alliances program, is develop initiatives to certify primary care physicians in diabetes. What we do is look at the data, do a chart audit of a subset of their patients with diabetes, and try to understand where would there be opportunities to advance treatment further. Where are somebody on one agent where they should be on a second oral agent, or advanced insulin sooner, or something like that.

Then try to bring that data to show the PCPs and show them benchmarked, how they’re doing compared to others, because doctors can often tend to be a competitive bunch and that can be a useful tool. Then do an assessment of the office, take a look at the office staff, at the office systems, find ways that we can put QI projects, quality improvement projects in place. Create a sense of ownership among everyone from the medical assistants to the nurses, et cetera, and through that mechanism really make the practice a diabetes-friendly practice.

So we did a couple of programs like this over the years through Joslin in collaboration with sponsorships from some industry leaders. We did one maybe about 8 or 9 years ago where we trained something like 1600 primary care physicians, half in New York City and half in Detroit. We did very many of the things I was just describing, and we tracked A1Cs, patient knowledge, optimism, empowerment, all those kinds of things, and they all went in the direction that you would want them to go in. So how could you roll something like that out on a large scale basis, I think that’s really the challenge.