Diabetes treatment model integrates primary care physicians, nurses, pharmacists

A primary care team approach to managing diabetes could help patients improve their health measures.

The Enhance Primary Care Diabetes (EPCD) model was designed to use nurses, pharmacists, and existing staff, but without incremental resources, to improve patient conditions, said the study in the Annals of Family Medicine.

Researchers found the model helped patients improve their D5 scores, the composite quality measure of diabetes care with glycemic control, blood pressure control, low-density lipoprotein control, tobacco abstinence, and aspirin use, said the study, “Evaluation of an Enhanced Primary Care Team Model to Improve Diabetes Care.”

Researchers noted primary care physicians and practices manage the majority of Americans living with diabetes, a figure reported at 37.3 million in 2020. But implementing collaborative care models can be difficult due to staff and resource constraints.

The EPCD model aimed to use nurses as leaders with a team-centered and multidisciplinary approach, “allowing all members of the primary care team to work cohesively and in real time to meet the patients’ needs,” the study said. The EPCD model also focused on addressing all the D5 measures, not just glycemic control.

Based on the tests on a large population of patients, in clinics of various sizes in urban and rural areas, it appeared the EPCD model can be a generalizable, efficient, and effective framework for primary care practices to improve diabetes management, the study said.

Formulating a review

There were 32 practices in the Mayo Clinic Rochester (MCR) and Mayo Clinic Health System (MCHS) that were divided into three categories:

• 11 were staff clinician practices with physicians and advanced practice providers (APPs) using the EPCD model, and with 5,761 eligible patients.
• Two were ECPD trainee practices with resident physicians using the EPCD model, with 1,887 patients.
• 19 were non-EPCD staff clinician practices with physicians and APPs not using the EPCD model, with 10,079 patients.

Results were analyzed for a preimplementation phase from August 2018 to February 2019, and a postimplementation period from May 2019 to March 2020.

Once the model was implemented, the proportion of patients meeting the D5 indicator grew from 42.9% to 45 % for the staff clinician group, and from 38.9% to 42% or the trainee group.

The EPCD model promoted multidisciplinary care with decision support tools for nurses, along with pharmacists as team members. Based on the results, “we hypothesize that care team nurses, with the trust of primary care physicians, can effectively manage diabetes panels,” the study said.

The proportion decreased from 36.2% to 35.5% in the non-EPCD group, the study said. The researchers said they knew of no unique practice challenges to support that finding.

“All primary care practices in MCR and MCHS experienced shortages of staff, particularly of nursing staff, during the study period, which further underscored the importance of thoughtful care team redesign to improve care quality without incremental resource allocation,” the study said.

Additional resources

This month, the American Diabetes Association published its “Standards of Care in Diabetes – 2023,” with updates about the latest research, technology, and treatments to improve the health of people with diabetes.

Another review, “Quality and team care response to the pandemic stresses in high performing primary care practices: A qualitative study,” examined how practices adapted care to pursue quality outcomes for patients when in-person visits were restricted during the COVID-19 pandemic. That study was published in PLOS ONE.