Disclosures: Cornell reports serving on advisory boards for Bayer, Novo Nordisk and Sanofi, and on the speakers bureau for Novo Nordisk.
April 22, 2022
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Team-based diabetes care is a winning approach

Disclosures: Cornell reports serving on advisory boards for Bayer, Novo Nordisk and Sanofi, and on the speakers bureau for Novo Nordisk.
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The familiar adage that it takes a village to raise a child can be applied to diabetes management, care and education.

It takes a team to manage and care for people with diabetes. Similar to sports teams, there are multiple players with various roles. Each health care team member brings their own unique set of skills, which when used appropriately, can complement the aptitudes of other team members. The patient is the key member of the team. The ultimate goal is to optimize the patient’s management, care and outcomes. Literature and guidelines support the use of a coordinated multidiscipline team.

Susan Cornell, PharmD, CDCES, FAPhA, FADCES
Cornell is an Endocrine Today Editorial Board Member, associate director of experiential education and associate professor in the department of pharmacy practice at the Chicago College of Pharmacy at Midwestern University in Downers Grove, Illinois.

Multidisciplinary means more than physicians

It is common to view a multidisciplinary or interprofessional team as that which consists of physicians within different practice specialties, such as primary care, endocrinology, cardiology, etc. However, nonphysician professionals are often overlooked.

A true diabetes care team will include physician assistants (PA), nurse practitioners (NP), pharmacists, nurses, dietitians, certified diabetes care and education specialists (CDCES), podiatrists, dentists, optometrists, ophthalmologists, audiologists, physical therapists (PT), behavioral health professionals, medical assistants and more.

Health care trends are supporting team-based care and a “one-stop shop” approach to diabetes management. Medical offices that employ the health care professionals listed above can provide more comprehensive care during one extended patient visit.

Obviously, if the patient sees multiple health care professionals during one visit, it will take more of the patient’s time, but less time is required of individual health care team members. Additionally, when team members work side-by-side in this type of format, they can accomplish more during their time in the patient visit, since their focus is on their level of care, and they can hand off tasks outside of their focus or scope to the next team member.

Working as a team allows each practitioner to work to the highest level of their license and provides more reward in what they have achieved. The key to success and efficacy of workflow is knowing what each team member’s role is. It is important to outline exactly what each person is responsible for; for example, who provides diabetes education, who makes a diagnosis, who manages medications, who handles the referrals.

The bottom line is the patient benefits when they have access to and hear the same message from multiple providers.

Team approach in action

The Bolingbrook Christian Health Clinic (BCHC) in Bolingbrook, Illinois, an underserved community clinic, uses this team-based approach to patient care. The routine staff includes a primary care physician, PA, NP, pharmacist, nurse, CDCES, optometrist and PT. BCHC also has a referral base for specialists not on staff who will provide care to this population. This includes dentists, podiatrists, behavioral health and cardiologists, to list a few.

Due to clinic space limitations, only three to four members of the health care team may be scheduled for a shift. Although each team member will have their own schedule of patient appointments, it is common to provide same-day referrals to another provider.

For example, as a pharmacist, I have my own schedule of patients for medication and diabetes management visits. However, the PA may have a person he diagnosed with diabetes today who needs medication and diabetes education. So, upon the completion of the visit with the PA, the patient will be added to my schedule for an initial medication/education appointment.

Conversely, I may discover during a medication management visit that my patient has rhonchi and shortness of breath. In turn, I can have the PA see my patient. Although the patient may need to wait a short time before the added visit, the process still delivers a one-stop-shop approach to health care for the patient.

Because clinic space is the rate-limiting step, many of the nonphysician providers work limited shifts of 1 to 3 days per week. The PT and pharmacist may be scheduled only on Wednesdays, whereas the CDCES may work Tuesdays and Thursdays. Of course, this becomes a challenge when the discipline needed is not scheduled during your shift. If my patient needs eye care and the optometrist’s shift is not for several days, the patient will need a separate appointment and a second trip back to the clinic. However, follow-up visits with the initial team member can be scheduled for the same day and time frame of referral visits. For example, for the patient with newly diagnosed diabetes I saw today immediately following their visit with the PA, I can schedule a follow-up appointment in 1 month on the same day the optometrist is working, allowing the patient their initial eye care visit. The fortunate aspect is BCHC offers access to a variety of health care specialties beyond basic care.

Team-based care by a dedicated multidisciplinary group of health care providers that includes physicians and nonphysician professionals can truly make a different in the management, care and outcomes for people with diabetes. The clear winner in this case is the patient.

For more information:

Susan Cornell, PharmD, CDCES, FAPhA, FADCES, is an Endocrine Today Editorial Board Member. She is associate director of experiential education and associate professor in the department of pharmacy practice at the Chicago College of Pharmacy at Midwestern University in Downers Grove, Illinois. She can be reached at scorne@midwestern.edu.