Primary Care Doctors, Endocrinologists Feel Ill-Equipped to Provide Ideal, Multi-Disciplinary Team Care

This press release is an announcement submitted by PRNewswire, and was not written by Diabetes Health.

Doctors Cite Time, Low Reimbursement As Barriers To Providing Comprehensive Diabetes Care, Survey Results Show

Nov 20, 2009

PRINCETON, N.J., Nov. 19 /PRNewswire/ -- Nearly one-third of doctors surveyed said they did not have enough time and did not receive sufficient reimbursement to provide comprehensive care to their patients with diabetes, according to the results of a study of endocrinologists and primary care doctors published in American Health & Drug Benefits.

An online survey of 300 physicians and online discussion group of 12 physicians conducted by Abt Associates, Inc. and sponsored by the National Changing Diabetes® Program (NCDP) found that 32 percent of physicians felt unable to provide comprehensive diabetes care, and most cited time or reimbursement as the major barrier. Furthermore, 83 percent of physicians surveyed said Medicaid reimbursement was inadequate, while 67 percent said private insurance reimbursement was inadequate.

More than 24 million Americans have been diagnosed with diabetes and another 57 million have prediabetes, which puts them at high risk for developing the debilitating disease. In 2007, diabetes and prediabetes cost the U.S. healthcare system an estimated $218 billion in medical expenses and lost productivity and is a leading cause of disability. Despite advances in treatment and education, the incidence of diabetes continues to rise at an alarming rate each year.

"People who have diabetes or are at high risk for developing diabetes need the best possible care to effectively manage their disease. This includes comprehensive education so that they can make the lifestyle changes that could avert or reverse the course of diabetes," said Dana Haza, senior director of NCDP, an initiative created by Novo Nordisk to drive systems change at the national and local level. "Clearly, we need to make some changes to the health care system if time and reimbursement levels are impacting the quality of care these people receive."

The web-based survey polled 200 primary care physicians and 100 endocrinologists. On average, each doctor treated 239 patients per month. Endocrinologists who participated in the survey treated significantly more patients diagnosed with diabetes than primary care physicians, while primary care physicians had more patients deemed at high risk for developing diabetes.

Doctors surveyed said they did not feel they had adequate time with each patient to provide all the necessary care and education. "Diabetes is a complex disease," Haza said. "By spending just 10 additional minutes with a patient, doctors believe they can have a significantly greater impact on the quality of health outcomes."

"Without appropriate reimbursement in place, it is difficult or nearly impossible for doctors to provide their patients with the level of support they both require and deserve, let alone sustain a medical practice today," said Dr. Anne Peters, former chairperson of the American Diabetes Association Council on Health Care Delivery and Public Health and director of the USC Clinical Diabetes Programs. "As a result, physicians spend less time with each patient and end up addressing only the most immediate aspects of diabetes care on a given visit rather than the broad spectrum of care they deserve," Dr. Peters said.

"Diabetes requires multidisciplinary care and a team-based approach for the best outcomes," Lana Vukovljak, Chief Executive Officer of the American Association of Diabetes Educators, said. "In addition to aggressively managing their blood glucose levels and monitoring their overall health, these patients benefit when provided substantial education on nutrition and the importance of weight loss, physical activity and smoking cessation," said Ms. Vukovljak.

Physicians surveyed said they did not have adequate resources -- including medical and administrative time, facilities, staff and materials -- to ensure multi-disciplinary team care (32 percent), to provide lifestyle and behavior modification counseling (28 percent), or patient education on self-care and preventing complications (15 percent). Fewer than half (47 percent) of doctors surveyed said they had adequate resources to provide psychological and social status assessments.

The most common service that doctors provided their patients with diabetes was instruction in, and evaluation of, self-monitoring blood glucose levels. Blood glucose monitoring is critical for patients to prevent serious complications such as hypoglycemia, the leading cause of diabetes-related hospitalizations. While 89 percent of all doctors surveyed said they or their staff provided this service, fewer than half provided other services important to managing diabetes, such as medical nutrition therapy (36 percent) and multi-disciplinary care coordination (49 percent). Nearly three-quarters of all doctors surveyed said their practices provided annual eye exams and blindness education (74.5 percent) and weight loss counseling and physical activity instruction (76 percent).

Primary care physicians (92.5 percent) and their staff were more likely than endocrinologists (54 percent) to provide smoking cessation counseling. Yet endocrinologists were more likely (95 percent) to provide intensive insulin therapy instruction than primary care doctors (58.5 percent).

"Physicians who cannot provide comprehensive diabetes services within their own practices can and do refer patients elsewhere," said Alyssa Pozniak, PhD, study co-author. "But this fragments the care of the diabetes patient, as we learned from the research."

Data for the study was collected via a web-based survey of primary care physicians and endocrinologists as well as during a follow-on, online discussion group of a sample of physicians representing the two specialties. All participants treated adult patients with diabetes and were whole or part owners of their medical practice, and survey responses were based on the physicians' perceptions and knowledge of their practice and patients.

About the National Changing Diabetes® Program

The National Changing Diabetes® Program (NCDP) is a multi-faceted initiative that brings together leaders in diabetes and policy to improve the lives of people with diabetes. NCDP strives to create change in the U.S. health care system to provide dramatic improvement in the prevention and care of diabetes. Launched in 2005, NCDP is a program of Novo Nordisk. For more information, please visit

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Source: press release

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Categories: Blood Glucose, Diabetes, Diabetes, Doctors & Nurses, Government & Policy, Health Care, Health Insurance, Insulin, Low Blood Sugar, Novo Nordisk, Politics

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Posted by Anonymous on 22 November 2009

This data does not surprise me regarding the primary docs, but is concerning when it pertains to the endocrinologists! Isn't that whe we go to specialists? BJS

Posted by dorisjdickson on 22 November 2009

There is a solution that is staring them right in the face - after they get insurance companies on board that is.

Let us do it! As a juvenile onset diabetic of 33 years who is not over weight and who has no major complications (and there are more of us), I am example of someone who wants to work in the field who can't. I don't want to go get a masters degree and I don't need it (just as my endo). Yet my endo wants to clone me and get her other patients to do what I do. I test 15 times a day. I just many small amounts of insulin - recreating a pump scenario and I consistently have an A1C of 5.1 without ending up an emergency room. I can teach other diabetics and it's a lot more cost effective than the current alternatives. Give us "mini" certifications and let us at it! There is no way on this planet that the current stock of endos and even CDEs can do it by themselves and we can do the teaching and day by day mentoring as well if not better in conjunction with fully certified physicians. So there is a lot more to this "rethinking" and "reshaping" than just doctors' time and reimbursement. There are more options if they'd just think outside the box a bit. I realize not all diabetics are exemplary but there are a lot of us out there willing to help.

Posted by Dekep on 22 November 2009

Those with diabetes live with it 24 hours/day and keep it in focus 24/7. Nobody in the medical field can provide that sort of support. Diabetes education is the key for good control and it doesn't have to be provided by professionals who in some cases offer methods that
seem designed to simply make it easier for the patient.
Many of us with excellent control learned about the importance of carbohydrates from others with the disease, especially those posting on the Internet. You don’t need professional training for that, but if you want to know more, the information can be had from books like those by Dr. Richard Bernstein. I’m not sure that his immense contribution to the field of diabetes is fully recognized by the medical profession, but I and many others have greatly benefitted from his work.

Posted by cjensen61 on 23 November 2009

I agree with what dorisjdickson had to say. I went to college and received a degree in health promotion with a nutrition minor. I found out that the field I wanted toi get into was hiring young women half my age. So I got into another field and although I'm glad to have a job, it wasn't what I originally set out to do.
I would love to educate other people with diabetes. Yet every time I look at the requirements, it sickens me. No wonder not many are going into the field of endocrinology. The requirements are staggering! Until insurance companies start to reimburse doctors the way they should, ti won't get better in this country. After having the disease some 37 years, I think I could help others enormously but how many of us with longstanding diabetes get that chance? Very few (if any) and that is a crying shame. We should not be made to feel that we have no contributions to make to society. If we were able to help others, it would benefit the endocrinologists and primary care physicians as well. I have never seen even one doctor or medical professional willing to "think outside the box," unfortunately. If they did, it could benefit so many thousands of people (if not millions)!!

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