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Three-year Project to Improve Diabetes Care in The U. S. is On Time and Delivering, Says ACP and its Foundation

PHILADELPHIA -- (April 6, 2006) Diabetes affects more than 20 million Americans, and the numbers are growing: about 1.3 million new cases of diabetes are diagnosed each year in the United States. The American College of Physicians (ACP) and the American College of Physicians Foundation (ACPF) are concerned about this costly and dangerous disease and are working on an ambitious three-year project to engage both physicians and patients to improve diabetes care in the United States.

Physicians often struggle to have the time, resources and appropriate levels of patient participation to effectively treat diabetes. Patients can struggle with understanding the complexities of the disease, areas such as diet, blood glucose monitoring, medications and complications. The three-year diabetes initiative, funded by an unrestricted grant from Novo Nordisk, is putting practical tools and information in both the doctors' and patients' hands. An update on the project's progress was issued at the ACP Annual Session in Philadelphia.

"Several new education pieces developed by this initiative are already being implemented here at the Annual Session," said Vincenza Snow, MD, director of clinical programs and quality of care at ACP, and clinical director of the diabetes initiative. "We're excited to have made this much progress since the project was launched last year."

The ACP-ACPF initiative, which began in January 2005, aims to increase awareness of the gap between current practice and acceptable standards of diabetes care; provide educational interventions to improve diabetes care; increase physician awareness of what constitutes high quality, evidence-based diabetes care; and recognize medical practices that improve their diabetes care.

The education programs target practicing internists who are ACP members, other health professionals on clinical practice teams, and their patients. "Optimal diabetes care requires a team effort," says Snow. "ACP members are internists, trained to give adult care, but we know that in order to achieve success, no single caregiver -- the doctor, the diabetes educator, the eye doctor, the nurse, even the patient who acts as caregiver when he selects meals, gives himself insulin, etc. -- can tackle this disease alone." At the briefing, Snow listed some accomplishments of the project during its first year.

  • Creation of (16) educational sessions for the more than 6,000 physicians attending ACP's Annual Session in Philadelphia. Some of these are offered more than once during the meeting, providing physicians with 23 opportunities to learn new facets of diabetes care. The sessions range from workshops on interpretation and utilization of blood glucose records to managing a wound on a diabetic's foot. ACP members and other physicians earn continuing medical education (CME) credit for attending these sessions.

  • New clinical skills modules. Several of the workshops at Annual Session, such as "Gizmos: Diabetes Devices made Simple," will be evaluated to determine appropriateness for ACP Clinical Skills modules. ACP's clinical skills modules are a collection of interactive materials for teaching small groups various procedures and skills needed in practice. Other ACP clinical skills modules include examining the musculoskeletal examination for sports injuries, common skin biopsy techniques, and counseling for behavior change.

  • A new self-assessment program on diabetes for the multidisciplinary team to use to update skills in team-based care, assess their knowledge of diabetes care, and earn CME at their own pace. Based on ACP's MKSAP (Medical Knowledge Self-Assessment Program), the new diabetes module will focus on core and new information on diabetes care information, in addition to including best team-based practices. The audience for the diabetes module is the entire medical team involved in diabetes care.

  • A new "Closing the Gap" module specifically for diabetes. "Closing the Gap" is a practice-based, team-oriented program that trains teams of doctors, nurses and office administrators to improve the quality of their care for patients with chronic diseases. The program seeks to close the gap between clinical evidence and best practices and the care actually provided in the office. ACP has created "Closing the Gap" modules for cardiovascular risk and is working on modules for other diseases. The new diabetes module, developed during the first year of the project, debuted in Philadelphia in March 2006, with about 60 participants from 19 medical practices across the United States. Three members from each practice -- usually a physician, a nurse, and a staff assistant learned the fundamentals of the Chronic Care Model for systems' change, how to measure their practices and what they can do to change and improve their diabetes care.

  • Patient Safety modules on diabetes. Using an ongoing ACP program aimed at reducing medical errors in the ambulatory setting, project staff are developing two new modules specifically for diabetes care. The new diabetes modules will be designed to take on the road to ACP chapter meetings or to workshops set up by a diabetes care team.

At the project update, Terry Davis, PhD, an expert in the field of health literacy, showed and discussed the project's new patient guide. Chapters in the guide address eating, physical activity, keeping track of pills, using insulin and understanding and checking blood sugar. These topics were selected after a survey of existing diabetes patient literature and results of 16 focus groups of patients, physicians, diabetes educators and others.

Information in the guide, written at a fourth or fifth grade reading level, will be illustrated and translated into Spanish. A moderator's manual is being developed so that the patient guide can be used in teaching situations. Other patient materials include information for vulnerable populations, such as the elderly, racial and ethnic minorities, non-English speakers, and those with low literacy levels -- groups for whom existing diabetes education materials are particularly limited.

Donna Rice, MBA, BSN, RN, CDE, talked at the project update about the importance of the multidisciplinary team approach in diabetes care. Rice, who is president-elect of the American Association of Diabetes Educators and a member of the ACP-ACPF's Diabetes Initiative Advisory Board, outlined the crucial aspects of diabetes education.

Dr. Snow, clinical director of the diabetes initiative, said that the first year of the broad, three-year initiative was busy, as the project ramped up and materials were adjusted to reflect research results. "Data from our focus groups helped us refine some of our initial ideas. For instance our data showed the physicians need help coaching patients on changing harmful behaviors and helping them develop better self-management skills. So we are developing materials to help physicians in their offices motivate patients to implement lifestyle changes and self-management techniques.

The American College of Physicians is the largest medical-specialty organization and the second-largest physician group in the United States. The ACP Foundation exists to support the mission of the American College of Physicians and to improve the health of the public through the creation and support of programs in education, research, service, and professionalism.

Susan Anderson at 215-351-2653; 1-800-523-1546, ext. 2653

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