The following is a summary of “Evaluation of an enhanced primary care team model to improve diabetes care” published in the November 2022 issue of Primary Care by Herges et al.
Most patients with diabetes are under the care of primary care practices, which are under intense pressure from operational, regulatory, and payment factors to enhance the quality of treatment they provide. The goal of the Enhanced Primary Care Diabetes (EPCD) model is to improve diabetes care by using the knowledge of nurses and pharmacists who work as part of a care team. Researchers utilized a retrospective, interrupted-time series methodology to assess the effect of the EPCD model on D5, a publicly reported composite quality indicator of diabetes treatment that includes glycemic control, blood pressure management, low-density lipoprotein control, tobacco cessation, and aspirin use.
Investigators looked at 32 primary care clinics in an integrated healthcare system that treats adults with diabetes, classifying them as either staff clinician practices (with physicians and advanced practice providers) with access to EPCD (5,761 patients), resident physician practices with access to EPCD (1,887 patients), or staff clinician practices without access to EPCD (10,079 patients). The primary outcome was the change from 7 months before implementation to 10 months after in the percentage of patients meeting the D5 metric. In addition, the percentage of patients in staff clinician practices who met the D5 composite quality indicator increased significantly after EPCD was implemented (from 0.995 to 1.005, or a change of P=0.01).
The incidence rate ratio changed from 1.001 to 0.994 (P=.05), while the trends in D5 attainment were not substantially different among resident physician practices with access to EPCD (P=.14). Staff clinicians who had access to the EPCD team model saw a rise in the quality of their patient’s diabetes care after its implementation. Care team nurses and integrated clinical pharmacists are at the forefront of proactive, interdisciplinary chronic illness management, which warrants more investigation.