Virtual Primary Care for Diabetes

February 1, 2022

Dr. Eric Bricker

Virtual primary care offers an opportunity for employers to deliver evidence-based diabetes care.  

Research from the University of Minnesota Medical School found that 3 systems of care led to superior diabetes management: 

Shared Decision Making with Patients 

According to researcher from the Mayo Clinic, “Shared decision making is a collaborative process by which patients and clinicians work together in a deliberative dialogue. The purpose of this dialogue is to identify reasonable management options that best fit and address the unique situation of the patient.” 

Here is a personal example of shared decision making: I had a patient with diabetes who could not read, but his wife could. He and I could not get his diabetes under control until we agreed it was best to have his wife come to the appointments as well. When I wrote instructions down or provided informational handouts, I would give them to the patient’s wife so that she could read them and help her husband at home with his diabetes care. 

Virtual primary care gives patients and doctors the opportunity to collaborate and have a dialogue whenever and wherever is most convenient for the patient. Phone and video conversations in virtual primary care facilitate shared decision making by reducing the time and space barriers to patient communication. 

Diabetes Care Checklists 

As famous doctor Atul Gawande found in his research, checklists in healthcare save lives. There are many tasks that a doctor needs to accomplish for proper diabetes care. For example, a doctor must check a patient’s Hemoglobin A1c every 3 months, refer them to an ophthalmologist for a retina exam yearly, check their kidney function with urine and blood tests regularly.  

A checklist is a vital tool to ensure those tasks are performed. Relying only on a doctor’s memory does not work. Doctors are human and fallible. 

Virtual primary care enabled by checklists built into the electronic medical record and workflow of the doctor allow them and the diabetic patient to accomplish these care tasks. In our work and home lives, we collaborate on tasks via phone, video chat and electronic messaging. Our health tasks should be accomplished in a similar 21st-century manner and not solely in an old, 20th-century in-person way. Virtual primary care is consistent with how we live our lives. 

Guideline-Based Age-Appropriate Screening 

Like checklists specific to diabetes care, guideline-based, age-appropriate screening is vital to keeping people with diabetes healthy. Patients must be screened for hypertension, high cholesterol, depression, cigarette use, alcohol abuse and many other health concerns. 

Diabetes affects the entire body and keeping all aspects of a patient healthy is key to preventing the progression of diabetes. Checklist tools for the large number of screenings are necessary for their completion. Again, relying only on a doctor’s — or a patient’s — memory does not work. 

Virtual primary care is an effective tool for coordinating these screening activities. Patients can check their blood pressure at home and many labs perform blood pressure checks as well. Blood tests must be performed in person, but virtual primary care allows the doctor to order the tests at a lab location near the patient and eliminates the need for two in-person visits. Questionnaire-based screening for depression and healthy behaviors can also effectively be performed via virtual primary care. 

Summary 

Having a primary care physician does not magically make a person healthy. The care the doctor provides must be effective. The study by the University of Minnesota Medical School illustrates 3 aspects of care that improve diabetes outcomes. Virtual primary care is a fantastic way to put these evidence-based approaches into practice. 

Sources: https://care.diabetesjournals.org/content/43/3/549, https://pubmed.ncbi.nlm.nih.gov/26458383/, https://www.nejm.org/doi/full/10.1056/nejmsa0810119 

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Originally published Feb 1, 2022 3:00:00 PM.