Posted: 1/18/2017
Group visits provide diabetes patients better access, peer support
This won’t be a lecture,” the physician said with a smile to the six patients seated around a table in a small conference room at Parkland Health & Hospital System’s Vickery Health Center. “Instead of me doing all the talking, you’re going to learn from one another. You already know if you don’t control your diabetes, there will be complications.”
Maria Rivera, diagnosed with diabetes one year ago, nodded in agreement, then said in Spanish, “I had a friend with diabetes who got a piece of glass in his foot. It got infected and he lost his toe.”
Maria Cozares, who has had diabetes for eight years, added, “One of my family members with diabetes lost their vision.”
Through an interpreter, Sentayehu Kassa, MD, senior lead physician at Vickery, responded, “Amputation and blindness are serious complications of diabetes. That’s why it’s so important that you manage your blood sugar.”
According to the Dallas County Health Needs Assessment report, diabetes in Dallas County is at epidemic levels. Nearly 11 percent of the population has the disease. It’s the seventh leading cause of death in the U.S. and the leading cause of kidney failure, lower-limb amputations and adult-onset blindness. In the state of Texas, African Americans and Hispanics are twice as likely to die from diabetes-related causes as Caucasians.
Providing timely care for this chronic and debilitating disease is stressing healthcare systems across the nation. For Parkland, which currently has more than 50,000 patients with diabetes, ensuring access to treatment is a high priority.
To address the need, Parkland launched a program in 2013 to improve access to treatment, education and preventive care for patients with diabetes by offering shared medical appointments, known as SMAs. Parkland was one of the first in Texas to offer SMAs beginning in 2007 with a group medication refill SMA. The program has steadily grown and Parkland now offers SMAs for newborn checkups, 2-to-4-month-old infant checkups and behavioral health at various Parkland outpatient facilities.
“SMAs have become increasingly popular across the U.S. as one way to improve the quality and efficiency of care. At Parkland, we’ve found SMAs offer quicker access to primary care and foster group learning that our patients find beneficial. SMAs also help reduce the overall cost of care,” said Noel Santini, MD, Senior Medical Director, Ambulatory Services at Parkland.
More than 20 percent of healthcare spending in the U.S. is for people with diagnosed diabetes, according to the Centers for Disease Control and Prevention.
“A traditional one-on-one appointment between a patient and doctor usually takes 15-20 minutes. Shared appointments often last 60 to 90 minutes and during that time a doctor can see 10 or more patients,” Dr. Santini explained. “Parkland patients who qualify are offered the opportunity to enroll in an SMA but they are not required to do so. If they prefer a traditional appointment, that is always an option. But for many patients, SMAs better meet their needs and they find the interaction with other patients and their healthcare providers in a group setting is valuable.”
Dr. Kassa was one of the first Parkland physicians to see patients in SMAs and says the program has been extremely successful. She is assisted by a diabetes educator who leads group discussions and provides nutrition and exercise counseling. During this time, Dr. Kassa meets with each patient individually behind a privacy curtain to review lab results, make sure they have had a recent foot and eye exam, are current on vaccines and cancer screenings, order medication refills if needed and talk about any concerns the patient has.
During the group session, patients share experiences and discuss their vital numbers, from fasting blood sugar to cholesterol levels, which are posted on a whiteboard in the room so all patients can see the progress they’ve made.
Cozares says it helps to know that other people with the disease struggle with the same issues she faces – and that they can all learn from one another.
“Patients often hear information in response to questions they forgot to ask – or didn’t think to ask – that can benefit their self-management of the condition,” Dr. Kassa said.
“I like hearing what other people are doing to take care of themselves,” Rivera said after the SMA. “I learn a lot from the group as well as from the doctor and educator.”
To learn more about Parkland services, visit www.parklandhospital.com.