Zgibor, Janice Christine, RPh, PhD
Redesigning diabetes care delivery in primary care using medication algorithms
General Research Subject: Type 2 Diabetes
Focus: Health Care Delivery/Economics
Type of Grant: ADA-Sanofi-Aventis U.S Award in Health Services Research in Clinical Care Delivery
Project Start Date: January 1, 2012
Project End Date: December 31, 2014
Diabetes Type: Type 2 diabetes
Although guidelines for the medical care of people with diabetes are extensively available from the American Diabetes Association, disappointingly most patients with diabetes receive sub-optimal care. The way we care for diabetes now isn't working and it may cost more than it should. We hope to change this by studying if applying Nurse-Directed Diabetes Management Protocols (NDMPs) leads to improved clinical outcome and process measures, quality of life, treatment satisfaction, and medication adherence for adults with diabetes. By using the NDMPs, nurses will follow methods approved by the physicians to manage glycemic, blood pressure and lipid control and urine protein. Furthermore, we will determine if changing care to this method be worth it compared to usual diabetes care. This proposed study will take place in 20 practices. The practice will either be in the intervention group or the control group during a total study period of 12 months. The study population will be recruited from University of Pittsburgh Medical Center Community Medicine Inc. (CMI) primary care practices in urban and suburban communities surrounding Pittsburgh, PA. Among these, ten practices will be assigned to the intervention group and another ten practices will be assigned to the usual care group. Assessments will be done at baseline, and three months, and 12 months after study entry. Results of the study may influence diabetes care in the primary care setting. Further, in the climate of health care reform, using nurses to deliver diabetes care may be a more cost-effective approach.
What area of diabetes research does your project cover? What role will this particular project play in preventing, treating and/or curing diabetes?
The proposed study is a multi-practice, cluster design, prospective, randomized controlled trial with a study intervention period of 12 months using practices as the unit of analysis. The study will use Nurse Directed Diabetes Management Protocols (NDMP) to implement treatment. Practices will be matched on geographic location (urban or suburban), practice type (teaching or not), and % Medicaid in order to minimize confounding. We will enroll 20 primary care practices in the Pittsburgh, PA region. Ten practices will be in the intervention group (NDMP intervention performed by a registered nurse), while the other 10 practices will comprise the usual care group (performed by the physician). One-hundred and fifty adults with diabetes will be recruited within each arm (300 in total). Specific Aim 1: Compared to usual care, intervening at the practice level, we will a) Determine if those who receive care using NDMP will have better clinical outcomes (e.g., A1C levels, blood pressure, and low-density lipoprotein cholesterol (LDLc) levels), b) determine if those who receive care using NDMP will have better process measures (e.g., frequency of measuring A1C levels and lipids levels; evaluating serum creatinine and microalbuminuria/clinical proteinuria; recording eye and foot examinations; and receiving diabetes education and nutritional counseling), c) Determine if those who receive care using NDMP will have improved quality of life, treatment satisfaction, and medication adherence. Specific Aim 2: Determine if using NDMP is cost-effective compared to usual diabetes care in primary care.
If a person with diabetes were to ask you how your project will help them in the future, how would you respond?
Because there are more and more people with diabetes in the United States, we need to find a way to give quality health care to as many as possible. Nurses are the ideal health professionals to facilitate expansion of this care to many. If they follow treatment plans, preapproved by the physicians, people they treat will likely do as well or perhaps even better than those treated by the physician.
Why is it important for you, personally, to become involved in diabetes research?
As a pharmacist, I came across many patients that were in need of quality diabetes care and a deeper understanding of their treatment regimens. For the past 16 years, I have been researching diabetes care and systems for delivering diabetes care so that people with diabetes can realize the best outcomes possible.
What role will this award play in your research efforts?
This award will allow us to implement a treatment program that will likely enhance current levels of care and increase efficiency of that care.
In what direction do you see the future of diabetes research going?
I am starting to see a movement toward the acceptance of team-based care. Further, the treatment of diabetes seems to be considering the whole person approach and not a disease focus which is encouraging. It is important for us to appreciate how people live with diabetes not just how they are treated for it.
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