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Why PCPs need to captain, not just quarterback, the preventive care team | Viewpoint

Article

The health system must rethink its strategy to enable primary care providers to develop better game plans for chronic disease patients, such as people living with type 2 diabetes.

With millions of people gearing up for the Super Bowl, it’s a perfect time to revisit the parallels between the beloved game and the equally complex dynamics of the healthcare system.

The linkages are clear and the tropes are familiar by now. Everyone understands the basics of team-based care, and it’s common to hear primary care providers (PCPs) described as the “quarterback” of that team, with PCPs calling the shots on offensive plays by triaging concerns and directing patients to specialists when needed.

But just like football, healthcare is a game of defense as well as offense — increasingly so as value-based care further incentivizes proactive, holistic, and preventive care. With more financial accountability on the line, primary care providers can no longer just send the ball down the field and hope the rest of the play goes as planned.

In this new environment, patients need more than just an offensive leader. They need a team captain and maybe even a head coach with equal insight and authority around both sides of the game plan.

PCPs are still the go-to player to take on this expanded role. They are perfectly positioned to do so and are largely eager to do more than just refer patients out to others.

But the health system as a whole will need to rethink its strategy to enable primary care providers to achieve this goal, especially in regard to chronic disease patients, such as people living with type 2 diabetes and its potential complications.

The risks of playing a one-sided game with chronic diseases

Diabetes is the perfect example of why a strong defense is significantly more important than even the best offensive play.

If not managed well, diabetes can lead to serious, expensive, and often deadly complications, including foot ulcers, peripheral artery disease, and even amputations. The five-year mortality rate for foot ulcers and lower limb amputations is shocking, reaching an average of 50% and surpassing the death rate for breast cancer or prostate cancer.

Black and Hispanic people experience these negative events at dramatically higher rates than white patients, a consequence of continued challenges with health equity across communities.

Yet 85% of diabetic foot ulcers are preventable. With the right care, we can change the equation. Instead of spending $10 on treatment for every $1 spent on prevention, we can leverage the PCP-patient relationship to flip the script and prioritize proactive management of a disease that affects more than 37 million people in the U.S. alone.


Defining a new approach to coordinated preventive care for diabetes

The best coaches and captains know that they can’t win the game all on their own. Instead, they identify and leverage the unique strengths of everyone on the team and use their leadership position to orchestrate a shared victory.

To achieve this goal in preventive diabetes care, we might actually want to borrow some ideas from someone else’s playbook. In oncology, providers from across the care team huddle up as a tumor board, examining the patient’s condition from every angle and developing a holistic treatment plan together.

People with diabetes could benefit from a similarly coordinated, multidisciplinary approach. When a patient is at risk for amputation, their primary care provider might convene an “amputation board” with medical specialists, social workers, the patient themselves, caregivers, and others to take a closer look at comprehensive strategies for avoiding a devastating outcome.

Previous studies have demonstrated that this type of multidisciplinary care can reduce major amputations by up to 80%, allowing many more patients to avoid a traumatic and life-altering event.

Using these team-based approaches to build advocacy and create strong and trusted relationships between PCPs and their patients is a promising way to maximize the delivery of preventive care and empower primary care providers with the right insights to appropriately manage patients with complex conditions.

Simple changes add up to a winning formula for people with diabetes

PCPs can start taking on an enhanced role in diabetes management with just a few manageable, patient-centered action steps.

They can begin by reviewing ADA guidelines for diabetes risk assessment and care, including conducting regular foot exams and A1C checks, screening individuals for socioeconomic risks like food insecurity, and promptly connecting patients with the appropriate specialists when necessary.

PCPs may also want to consider expanding the use of telemedicine, digital health apps, and home-based medical devices to strengthen ties with patients in between visits and improve monitoring capabilities for providers, patients, and caregivers alike.

These strategies can have a quick and clear payoff for patients. For example, the Miami VA Medical Center has invested in a coordinated, community-based approach to diabetes care that included educating outpatient clinics about the burdens of diabetes and offering remote monitoring to veterans.

Using a telemedicine clinic, the Miami VA was able to triage patients, provide enhanced monitoring for patients in their homes, and expedite care access for veterans.

In addition to the patient-focused benefits, providers had better experiences, too. Primary care providers and nurses gained direct support from their specialist partners and felt better equipped to manage people with diabetes in a holistic, informed manner.

With these and other proactive approaches, we can start actively transforming the role of primary care providers from care coordinators to an active first-line of defense. As a result, people with diabetes could see fewer foot ulcers, less frequent amputations, and a higher quality of life over time.

Jon Bloom, MD, is CEO and co-founder of Podimetrics, and Robert A. Gabbay is chief science and medical officer with the American Diabetes Association.

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