Blue Care Network Best Practices
Ann Arbor practice keeps diabetics motivated
Peter Paul, M.D., of Partners in Internal Medicine in Ann Arbor, believes frequent visits are the key to caring for diabetic patients.
"I routinely see my diabetic patients every three months. It gives me a chance to go over their medications, make sure they are following an appropriate diet and are doing what they can for exercise," he says.
The patient’s motivation is the most important part of a treatment regimen, says Dr. Paul. "Patients can improve their conditions, but they have to buy into it."
A three-month follow-up visit is important to keep patients moving in the right direction, says Dr. Paul. "If you don’t keep on top of things, they can fall off the track."
At Partners in Internal Medicine, patients are generally diligent about their recommended annual screenings. Still, the practice has electronic health records to help keep track of when certain tests are required. Although Dr Paul says the electronic records make it much easier to track testing, he cautions that doctors still need to focus on patients.
"We have a good handle on when tests are due," he says. "It’s not rocket science. But you have to pay attention to detail."
Attention to detail means making sure the information in the records is accurate.
"Keeping my records up-to-date is a huge undertaking," says Dr. Paul. "The transition to electronic health records has been a huge amount of effort for me and everyone in the office to get the data in there correctly the first time."
The office transitioned to electronic records last October and has begun to see more patient consistency with follow-up visits.
Dr. Paul says caring for diabetic patients includes offering education and making sure important messages about lifestyle are reinforced.
"It’s hard to provide a lot of patient education," says Dr. Paul. "The patient is only going to remember so much from a visit." So he refers patients to St. Joseph’s in Ann Arbor. The hospital conducts diabetes education where topics include basic care and nutrition. "If they attend those education sessions, when I talk about nutrition, the patient can internalize that message," he says.
Dr. Paul believes in the power of his own patients. "When patients internalize those messages about lifestyle, they can do wonderful things on their own," he explains. One of his patients had a hemoglobin A1c level of 10.8 and he was referred to a dietitian.
Dr. Paul explains how the patient fared by managing his own health. "He took the bull by the horns and changed his diet. His A1c dropped to the normal range and the patient lost 40 pounds. I was able to take him off his medications because he’s no longer diabetic." The patient still has scheduled follow-up visits every three or four months so Dr. Paul can continue to monitor him. "When a patient has 34 years of bad habits, I can’t just cut him loose and say see you in a year," Dr. Paul says.
The easiest time to make changes is when patients are pre-diabetic and don’t need medication. The challenges arise when patients have multiple diseases or problems with their medication, says Dr. Paul. "It all goes back to a healthy lifestyle," he says. "Most diseases are self-inflicted. But when you deal with the core issues, the patient’s overall health can improve."