CCE: Cardiometabolic disorders management strategies

September 18, 2009

Each patient with a cardiometabolic disorder is likely to have an additional related disorder.

Each patient with a cardiometabolic disorder is likely to have an additional related disorder. The patient may be seeing one or more specialists for diabetes, heart disease, obesity, or hypertension, although many have yet to be referred for specialty care. Regardless of specialty intervention, individuals with cardiometabolic disorders will continue to be a daily presence for primary care physicians.

Patients taking multiple medications are commonly encountered, and the likelihood of nonadherence or an inability to tolerate an agent is greater. Some patients may require substantially more office visit time in order to learn self-monitoring and testing procedures, while others might present with other medical conditions that make managing their cardiometabolic disorders even more challenging.

"Patients are getting younger and younger as well. That's one particular hurdle we've had to cross over," says Honey East, MD, associate professor of medicine and a cardiometabolic clinic physician at the University of Mississippi Medical Center in Jackson. Medical Economics has gathered management tips from the cardiometabolic experts interviewed for this series.

Keep a copy of the specialists' report on the patient's chart, says Sharlene Emerson, CRNP, BC-ADM, an advanced practice nurse at the University of Pittsburgh Diabetes Institute. "Many times patients tell me they have seen a specialist, but there is no report." She suggests having patients carry your business card with instructions to share your contact information with the specialty center staff.

"Well-prepared office staff can flag or pull any specialists' reports that have been received since the last primary care visit," she says. "This way the specialty reports are not lost, and primary care practitioners and patients can follow through with recommendations."

Patients with multiple cardiometabolic disorders often take multiple medications, and primary care physicians need to devise ways to keep track of regimen changes. "There must be a continually updated medication flow sheet on the patient's medical record so that there is clarity about what the patient is actually taking," says Emerson. Best practice is to have a patient medication flow sheet and determine at each visit the patient's adherence to the regimen, she adds. "I have gotten in the habit of asking, for example, 'Out of the seven times a week that insulin is scheduled-how many times of those seven do you take it? When do you take it?' "

A medication flow sheet is easily found on an electronic health record and must be updated at each patient visit and when changes are made between visits. "A paper chart is a different animal," says Emerson. "When the medication sheet is hard to find, it is often not updated, forgotten, or ignored," she says. "This is a dangerous practice. It should be front and center on the chart."

DURING EACH VISIT

Primary care physicians should accomplish several things at each office visit: