Teaching Health Professionals How to Treat Type 2 Diabetes - PowerPoint PPT Presentation

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Teaching Health Professionals How to Treat Type 2 Diabetes

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Title: Teaching Health Professionals How to Treat Type 2 Diabetes


1
Teaching Health Professionals How to Treat Type 2
Diabetes
  • Jennifer Larsen, MD
  • Professor and Chief,
  • DEM, University of Nebraska Medical Center

2
Implementing a diabetes treatment paradigm or
guideline
  • Define or refine the science
  • Hone a clear message or guideline
  • Disseminate the message
  • Specialty physicians endocrinologists,
    ophthalmologists, cardiologist, nephrologists
  • Primary care providers internists, family
    physicians, mid-levels
  • Diabetes educators and other health care
    providers pharmacists, dieticians, nurses
  • Patients

3
Diabetes care and education assumptions
  • More than 20 million with diabetes in the U.S.
  • 170-180,000 Family medicine or internal medicine
    physicians (2005 Bureau of Labor and Statistics)
  • 4000 Endocrinologists (2008 recent workstudy
    estimate)
  • Most diabetes care is administered by primary
    care physicians, independent of endocrinologists
  • Training of diabetes care begins in training
    programs

4
Learning to manage diabetes
  • Facts
  • Diagnostic criteria diabetes, pre-diabetes,
    metabolic syndrome
  • Standards of care
  • Medicines efficacy, side effects,
    contraindications
  • Trial outcomes
  • Achieving the goals requires management
    strategies
  • Early and late disease, with complications
  • Outpatient ltgt inpatient

5
Education venues open to all physicians
  • Publications, news academic and lay press
    (articles, editorials, reviews, interviews)
  • Continuing education (live or prepared audio,
    video, web-based, journals, other periodicals)
  • Mandated management/education activities group
    practice, hospital, board for certification (self
    study modules)
  • Member broadcasts (e.g., web or mail) hospitals,
    professional societies, insurance co
  • Pharma reps

6
Strategies within primary care training programs
  • Training program specific venues (variable
    teachers)
  • Lectures
  • Endocrine Rotation
  • Morning report, journal clubs, case conferences
  • Education through consultation (or not)
  • Learning by doing observing and taking care of
    patients, with or without input from attendings
  • In-service exam- what boards think important
  • Diabetes facts learned easily--usually with
    lectures or other didactic opportunities
  • Diabetes management is a process and not so
    clearly taught

7
UNMC Training Model
  • Didactic lectures provided through specific
    training program-diabetes physicians involved in
    both
  • 1/2 day teaching day/year in Family Medicine (FM)
  • 2-3 hours lectures by DEM physicians in IM
  • All FM and IM residents required1 month DEM
    rotation/3 years
  • DEM has didactic lectures 3 for diabetes care
  • Residents involved in both inpatient and
    outpatient care 50 or more is diabetes care
  • Diabetes center work alongside educators

8
Learning challenges
  • A lot of guidelines, a lot of drugs involved in
    diabetes care
  • Guidelines appear to compete with one another
  • AACE vs ADA on A1C goal
  • ADA vs NCEP on LDL goal
  • Strategies to achieve those goals taught by
    example
  • Primary care setting patients early in disease
    but less likely to use new drugs
  • Endocrinology practice patients late in disease
    so ideal for teaching insulin initiation but not
    for early oral medication management

9
How is management taught?
  • Case-based who is the patient you see today
  • Necessarily will be colored by the biases of the
    teacher, and concerns of the patient
  • Focused on today rather than the longterm
  • Also limited by practice issues
  • Time can pit the patient against the trainee
  • Cost to the patient (drug) and/or the practice
    (time to teach)
  • Limitations of the insurer, co-morbidities,
    motivation
  • Available data (e.g., trends, current labs)
  • Resources available (e.g., A1C already done, a
    nurse who can teach insulin or the device)

10
Diabetes management paradigms can be reinforced
with other education methods
  • Inservice exams or Board review self-study
    modules useful but occur too infrequently focus
    on testable facts more than management
  • Continuing education programs Cost and time a
    greater barrier to trainees
  • Member broadcasts trainees often not members
  • Pharma reps still valued in many primary care
    offices, although role is diminishing

11
Education opportunities
  • To develop training program specific educational
    materials that consolidate diabetes facts
    including published guidelines
  • To develop cases or other strategies that better
    translate guidelines or provide management
    approaches for both inpatient and outpatient
    settings
  • To develop expert systems needed to monitor or
    achieve ideal diabetes care
  • To develop strategies that effectively
    disseminate new information

12
Summary
  • The facts of diabetes care will continue to
    increase with more medicines and more trials
  • Primary care physicians need to stay engaged in
    diabetes care--some already opt out
  • Even with the best training models, primary care
    residents dont learn all they need to know about
    diabetes to be effective in their own practice,
    now or into the future
  • Translating new facts into changing practice
    paradigms will require educational interventions
    beyond what we have in place today
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