The Need to Focus on Diabetes

Transcription

1 Presentation title The Need to Focus on Diabetes Marilyn Staniland, CDE, MBA, MSN Executive Director, Field Medical Affairs West

2 AGENDA 1 Current state of diabetes 2 Stages of the disease continuum & interventions 3 Barriers to diabetes treatment 4 Importance of two specific NDHI components

3 Presentation Slide no 3 Why we need to address diabetes Human Toll 29.1 million with diabetes 8.1 million are undiagnosed 86 million with prediabetes One in eight knows they have it By 2050, one in three Americans will have diabetes

4 Presentation title Why we need to address diabetes Economic Toll Date Diabetes costs the U.S. $322 billion annually 1 in 3 Medicare dollars is spent on people with diabetes Healthcare lh costs are times higher for people with diabetes

5 Despite Improvement in Glycemic Control, 48% of Patients Are Not at ADA A1C Goal of <7% Patients (%) < A1C (%) Figure adapted with permission. Ali MK et al. N Engl J Med. 2013;368(17):

6 Gaps in the quality of diabetes care persist: treatment goals 100% % of diabetes patients who met treatment goals from % 60% 40% 57% 46% 47% Another analysis found that complications resulting from inadequate control of these parameters may account for as much as 20% of total diabetes spending 2 20% 12% 0% A1C BP LDL-C Composite Defined Goals: A1C<7%; BP<130/80 mmhg; LCL-C<100 C<100 mg/dl; Composite: Combined all three 1.Cheung BM, Ong KL, Cherny SS, Sham PC, Tso AW, and Lam KS. Am J Med. 2009;122: Milliman. The cost and quality gap in diabetes care: An actuarial analysis Available at

7 Why aren t patients achieving their goals? FEAR POOR FAMILY SUPPORT LANGUAGE BARRIERS NEEDLE PHOBIA INJECTION ANXIETY SOCIAL STIGMA PATIENT-PHYSICIAN DISCONNECT DIETARY CUSTOMS MYTHS ABOUT INSULIN TIME INSURANCE COVERAGE LACK OF EDUCATIONAL RESOURCES PHYSICIAN LACK OF KNOWLEDGE 1. Nam S, et al. Diabetes Res Clin Pract. 2011;93(1):1-9; 2.Kuritzky L. J Fam Pract. 2009;58(suppl 8):S25-S Hu J, et al. Diabetes Educ. 2013;39(4): ; 4. Fukunaga LL, et al. Accessed January 5, 2015.

8 Component 1.2: Comprehensive care planning should include the use of care coordinators to address the multitude of daily issues facing persons with diabetes. Assess treatment adherence Coordinate with providers about patient treatment t t needs Provide health education Manage care transitions Reduce hospital readmissions

9 High Adherence is Associated with Lower Diabetes Related Medical Costs and Hospitalization Risk Diabetes-Related Medical Care Costs Diabetes-Related Hospitalization Risk Tot tal Costs, $ $10,000 $8,000 $6,000 $4,000 $2,000 $8,812 * * $6959 * * 35% * * 30% * 30% * 26% 25% $6,237 $5,887 25% $3,808 % lization Risk, Hospita 20% 20% 15% 10% 5% 13% $ % Adherence Rate, % Adherence Rate, % * Indicates a value that is significantly higher than the % adherence group (p< 0.05) Sokol MC, et al. Med Care. 2005;43: [pg 525 table 2-data].

10 Presentation title Improving Adherence and Outcomes in Individuals id with Diabetes and Depression 12 week- Randomized Controlled Trial (n=180) Interventional group vs Usual Care Inclusion Criteria: Type 2 Diabetes Mellitus and Depression Current antidepressant therapy and oral hypoglycemic agent Interventional Group: Integrated care manager as supplement to primary care visits Addressed patient level non-adherence factors such as depression, chronic medical conditions, function, cognition, social support, cost of medications, side effects, and past experiences with medications Date Bogner, et al. Ann Fam Med. 2012;10:15-22.

11 Presentation title Date Improving Adherence and Outcomes in Individuals with Diabetes and Depression 100 Patients who received the intervention were more adherent to OADs Patients who received the intervention were more likely to achieve A1c < 7% 80% Adher rence to Oral Hypogly cemic, % * * 30.7 % 60.9 % ** 0 Baseline 6 Weeks 12 Weeks OAD: Oral Anti-Diabetic Usual Care Intervention *p<0.01 ** <0.001 Bogner, et al. Ann Fam Med. 2012;10:15-22

12 Manage Care Transitions To improve transitions of care, efforts have been made to re-engineer the discharge process via a variety of interventions One classification of interventions includes Pre-discharge interventions ti Patient education, discharge planning, medication reconciliation, scheduling a follow-up appointment 1 Post-discharge interventions ti Follow-up phone calls, communication with ambulatory health care providers, home visits 1 and Telemonitoring 2 Bridging interventions Transition coaches, patient-centered discharge instructions, physician continuity between inpatient and outpatient settings (i.e., transition clinics) 1 1. Hansen. Annals of Internal Medicine. 2011:155(8): Chaudhry S et al, J Card Fail. 2007;13(1):56

13 Component 2.1: Care planning should promote screening and identification of risk factors for patients all along the disease spectrum USPSTF risk factors 2015 USPSTF risk factors High blood pressure & overweight/obese Family history GDM or PCOS Ethnic/racial minority

14 New USPSTF guideline Details and Implications Health plans must cover cost of screening test with no co-pay USPSTF guideline is now more closely aligned with ADA and other guidelines, which means less confusion at the practice level. A1c is now recognized as a valid screening test: Because hemoglobin A1c measurements do not require a fasting state, it is more convenient than using fasting plasma glucose or the oral glucose tolerance test. For the first time ever, USPSTF recommends screening for prediabetes. Lifestyle intervention is recognized as evidence-based resource and the first line of therapy for the prevention of IFG, IGT, and diabetes

15 New USPSTF guideline Millions More Could Get Screened Number screened ed UDM detected UPDM detected 2015 USPSTF ADA 2008 USPSTF Source: Analysis by Tim Dall for NNI, IHS Global insights, November 2014, Based on study published in American Journal of Preventive Medicine

16 Presentation title Date 16 Thank You d