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Nashville Medical Group Onsite Diabetes Educator, Judy Carden, working with a patient.

Helping Patients Take Better Care of Themselves

Nashville-based AmMed Direct, a supplier of direct-to-consumer diabetes products, medications and services, has sought to distinguish itself in the marketplace by offering customers something extra … important educational and lifestyle information at no additional charge.

Through the company's signature Better Care Program®, clients receive numerous free products and services including healthy lifestyle and activity guidelines, a diabetic cookbook and access to additional online recipes, product samples, a meal planning guide, Better Care Magazine, the Test & Feel Better guide, a personal test log, Diabetes Directions newsletter, and perhaps most important of all … access to a Certified Diabetes Educator or Registered Dietician.

Lorraine Farrar, RN, CDE, joined AmMed Direct two years ago as director of the Better Care Program. Board certified in advanced diabetes management, she has spent much of her career working with diabetic patients in various roles at Saint Thomas Hospital, where she was on staff from 1989-2006, and prior to that at Southern Hills Medical Center. Drawn equally to teaching and clinical work, her current position allows her to reduce the burden of diabetes and its co-morbidities through health prevention and promotion.

"People need to understand why they need to do what they need to do … that's where I come in as a teacher," she said.

The Better Care Program is the brainchild of General Manager Tom Milam. "He wanted to provide value … added services … that actually enhanced the lives of people with diabetes," Farrar explained, adding that when she arrived, the program was still in the conceptual stages. "My job was to put the leaves on the tree," she said with a laugh.

Although the public face of the Better Care Program is visible through the company's marketing campaign, Farrar said the actual scope of the program infuses the entire corporation. She said her job is to help everyone in the company realize the Better Care Program impacts each of the company's core values. The first step, she continued, is to ensure knowledgeable, compassionate employees are on staff. To that end, every employee … no matter what the function or department … attends the Better Care Diabetes University.

When it comes to helping their clients, the basic premise is simple, she noted, "more education … fewer complications."

This year, Farrar launched a quality improvement project using the quarterly newsletter to promote routine checks that are vital to diabetics. Last quarter, she focused on kidney health; this quarter it's vision screening; next quarter will focus on the feet; and then she plans to hone in on A1c blood sugar levels. In addition to the written reminder, an outbound call group of 3,000 people receive pre-recorded messages. This quarter's group is being reminded to have their eyes checked.

While everyone benefits from the educational offerings, newly diagnosed patients in particular often have more questions than answers.

"That is so common … people have no idea what the doctor said when they leave the office," she said of patients that are too overwhelmed to fully understand instructions.

Farrar noted a company survey also revealed 38 percent of their customers had never talked to a diabetes educator before. The certified diabetes educators on staff send letters to physicians after phone sessions to include in the patient file.

"Physicians really like that because they need to have diabetes education documented in their patient's charts," she said of an increasing emphasis on chart audits by payers.

She stressed that AmMed's staff doesn't try to take the place of their client's medical team but rather hopes to provide added support.

"Our company is the bridge to better care," she said. "We are the bridge between the patient and the physician."

Taking an Integrated Approach

With diabetes, healthcare professionals can only do so much. At some point, patients must take charge of their own health and become active participants in managing this chronic illness. While this certainly isn't a novel idea, finding an effective way to turn the concept into concrete action has eluded many healthcare providers.

Clinicians with Baptist Hospital Diabetes Center and Nashville Medical Group (NMG) hope they have hit on a solution by embedding specialists in the busy practice for a truly integrated approach.

"Tennessee is number one in incidence of diabetes and third with obesity," said Mary Gaines, RN, MSN, director of the Baptist Hospital Diabetes Center. "We wanted to find a way to capture patients and be able to get them the resources they need."

Gaines noted patients can live with the disease for years without being diagnosed and that even when they do receive confirmation of the disease, they tend to get the "ostrich effect" and go into denial.

"People don't want to hear that your greatest prevention modality is eating right, exercising, reducing your stress … people want to go to the doctor and get a pill … the quick fix," she said of the struggle to change behaviors that exacerbate the disease.

Gaines said she sees good success rates with patients who attend a diabetes education course, which typically takes eight hours to complete. Unfortunately, getting patients to commit to the class isn't always easy.

"This is the reason we partnered with Nashville Medical Group. We wanted to find a way to reach out to patients and get them through the door."

Parminder Bolina, MD, an internist and director of ancillary services for NMG, explained the pilot program allowed the practice to leverage their close relationship with the hospital to provide a certified diabetes educator and registered dietician on site. He said it is always a struggle in the time allotted to see patients to manage medication issues and fully cover the educational component. Having a dedicated professional to answer questions and go over behavioral modifications is a true benefit to patients.

"Hearing it from myself, as well as a specialist, goes a long way into helping them buy into these changes they need to make," he pointed out.

Although it's too early to have quantitative data on outcomes, Bolina did say, "Since we've implemented this onsite program, out patients' attendance to formal diabetes education classes has markedly improved."

Gaines, concurred, noting they have seen a decrease in the "no show" rate of the courses at Baptist Hospital since having an onsite diabetes educator at NMG.

While the service, which is currently offered at no charge and doesn't require a pre-set appointment, is clearly important to newly diagnosed patients. Bolina said those who have been living with the disease for years also benefit, particularly when dealing with changing aspects of diabetes. He explained the educational component is there for "any opportunity to help a person get through that transition and cope with it."

Judy Carden, RN, CDE, is the diabetes educator working onsite at NMG. She relayed the story of a patient who has been diabetic for many years and has long struggled to keep her blood sugar under control. Despite this, the patient was unwilling to go on insulin. After Carden spent a little time talking through the patient's concerns and showing her how to give an insulin shot, the patient did an about face. "She walked out saying, 'Oh, I don't know what I've been fighting the doctor about all these years,'" Carden said.

Based on the feedback from patients and physicians, the plan is to expand the pilot program to provide an onsite educator full time by late November. Bolina said around that same time frame, the plan is to begin weekly exercise and weight loss classes through a partnership with Baptist Sports Medicine.

In addition to helping diabetics mitigate co-morbid conditions, the hope is to delay or prevent the onset of the disease in those diagnosed as pre-diabetic. An onsite athletic trainer will help patients begin a safe and effective exercise program and will also counsel patients on healthy lifestyle choices. Bolina said the practice would also soon offer classes on smoking cessation and stress management in recognition of the impact these factors have on overall health.

By making it easy and affordable to get specialized educational assistance and reinforcement of physicians' orders, Bolina said, "We think the outcome of managing the targets and goals is much more likely to be met."

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