[acb-diabetics] national survey says docs do not have enough time for comprehensive care

[Patricia LaFrance-Wolf]

Primary Care Doctors, Endocrinologists Feel Ill-Equipped to Provide Ideal,
Multi-Disciplinary Team Care

Nov 20, 2009 

 

This press release is an announcement submitted by PRNewswire, and was not
written by Diabetes Health.

 

PRINCETON, N.J., Nov. 19 /PRNewswire/ -- Nearly one-third of doctors
surveyed said they did not have enough time and did not receive sufficient
reimbursement

to provide comprehensive care to their patients with diabetes, according to
the results of a study of 

endocrinologists

 and primary care doctors published in American Health & Drug Benefits.

 

An online survey of 300 physicians and online discussion group of 12
physicians conducted by Abt Associates, Inc. and sponsored by the National
Changing

DiabetesR Program (NCDP) found that 32 percent of physicians felt unable to
provide comprehensive diabetes care, and most cited time or reimbursement as

the major barrier. Furthermore, 83 percent of physicians surveyed said
Medicaid reimbursement was inadequate, while 67 percent said private
insurance reimbursement

was inadequate.

 

More than 24 million Americans have been diagnosed with diabetes and another
57 million have prediabetes, which puts them at high risk for developing the

debilitating disease. In 2007, diabetes and prediabetes cost the U.S.
healthcare system an estimated $218 billion in medical expenses and lost
productivity

and is a leading cause of disability. Despite advances in treatment and
education, the incidence of diabetes continues to rise at an alarming rate
each

year.

 

"People who have diabetes or are at high risk for developing diabetes need
the best possible care to effectively manage their disease. This includes
comprehensive

education so that they can make the lifestyle changes that could avert or
reverse the course of diabetes," said Dana Haza, senior director of NCDP, an

initiative created by Novo Nordisk to drive systems change at the national
and local level. "Clearly, we need to make some changes to the health care
system

if time and reimbursement levels are impacting the quality of care these
people receive."

 

The web-based survey polled 200 primary care physicians and 100
endocrinologists. On average, each doctor treated 239 patients per month.
Endocrinologists

who participated in the survey treated significantly more patients diagnosed
with diabetes than primary care physicians, while primary care physicians

had more patients deemed at high risk for developing diabetes.

 

Doctors surveyed said they did not feel they had adequate time with each
patient to provide all the necessary care and education. "Diabetes is a
complex

disease," Haza said. "By spending just 10 additional minutes with a patient,
doctors believe they can have a significantly greater impact on the quality

of health outcomes."

 

"Without appropriate reimbursement in place, it is difficult or nearly
impossible for doctors to provide their patients with the level of support
they both

require and deserve, let alone sustain a medical practice today," said Dr.
Anne Peters, former chairperson of the American Diabetes Association Council

on Health Care Delivery and Public Health and director of the USC Clinical
Diabetes Programs. "As a result, physicians spend less time with each
patient

and end up addressing only the most immediate aspects of diabetes care on a
given visit rather than the broad spectrum of care they deserve," Dr. Peters

said.

 

"Diabetes requires multidisciplinary care and a team-based approach for the
best outcomes," Lana Vukovljak, Chief Executive Officer of the American
Association

of Diabetes Educators, said. "In addition to aggressively managing their
blood glucose levels and monitoring their overall health, these patients
benefit

when provided substantial education on nutrition and the importance of 

weight loss

, physical activity and smoking cessation," said Ms. Vukovljak.

 

Physicians surveyed said they did not have adequate resources -- including
medical and administrative time, facilities, staff and materials -- to
ensure

multi-disciplinary team care (32 percent), to provide lifestyle and behavior
modification counseling (28 percent), or patient education on self-care and

preventing complications (15 percent). Fewer than half (47 percent) of
doctors surveyed said they had adequate resources to provide psychological
and social

status assessments.

 

The most common service that doctors provided their patients with diabetes
was instruction in, and evaluation of, self-monitoring blood glucose levels.

Blood glucose monitoring is critical for patients to prevent serious
complications such as 

hypoglycemia

, the leading cause of diabetes-related hospitalizations. While 89 percent
of all doctors surveyed said they or their staff provided this service,
fewer

than half provided other services important to managing diabetes, such as
medical nutrition therapy (36 percent) and multi-disciplinary care
coordination

(49 percent). Nearly three-quarters of all doctors surveyed said their
practices provided annual eye exams and blindness education (74.5 percent)
and weight

loss counseling and physical activity instruction (76 percent).

 

Primary care physicians (92.5 percent) and their staff were more likely than
endocrinologists (54 percent) to provide smoking cessation counseling. Yet

endocrinologists were more likely (95 percent) to provide intensive 

insulin

 therapy instruction than primary care doctors (58.5 percent).

 

"Physicians who cannot provide comprehensive diabetes services within their
own practices can and do refer patients elsewhere," said Alyssa Pozniak,
PhD,

study co-author. "But this fragments the care of the diabetes patient, as we
learned from the research."

 

Data for the study was collected via a web-based survey of primary care
physicians and endocrinologists as well as during a follow-on, online
discussion

group of a sample of physicians representing the two specialties. All
participants treated adult patients with diabetes and were whole or part
owners of

their medical practice, and survey responses were based on the physicians'
perceptions and knowledge of their practice and patients.

 

About the National Changing DiabetesR Program

 

The National Changing DiabetesR Program (NCDP) is a multi-faceted initiative
that brings together leaders in diabetes and 

policy

 to improve the lives of people with diabetes. NCDP strives to create change
in the U.S. health care system to provide dramatic improvement in the
prevention

and care of diabetes. Launched in 2005, NCDP is a program of Novo Nordisk.
For more information, please visit www.ncdp.com.

 

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