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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 www.ncdp.com.
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