New Study Reveals Significant Gaps in Guideline-Based Management at the Primary Care Level
I’ve had many conversations with clinicians and thought leaders across the healthcare industry over past months about the fact that we still aren’t getting the basics right. Patients aren’t receiving appropriate screenings at an acceptable rate and we are still struggling to get the fundamentals like blood glucose and blood pressure under control. Why are these gaps in care happening? What can we do better as physicians, as health systems, as entrepreneurs, as a united industry striving for better outcomes?
What’s the problem?
A recent national study of Primary Care Physicians’ (PCPs’) adherence to diabetes monitoring guidelines reveals that less than 60% of diabetic patients are getting the basic recommended screenings of hemoglobin A1c (HbA1c) and lipid tests at least annually. Only 58% of patients with diabetes in the 2013 National Ambulatory Medical Care Survey (NAMCS) received a HbA1c test annually and only 57% of patients with diabetes received an annual lipid screening. Hispanic patients were even less likely to receive a HbA1c test in the previous 12 months.
That is a huge number of missed opportunities to identify complications, monitor effectiveness of current treatment, and triage patients to the right level of clinical intervention.
It’s a problem the World Health Organization has taken notice of. The 2016 WHO Global Report on Diabetes highlighted improving guideline-based monitoring of diabetes in primary care as a priority for reducing the impact of diabetes globally.
The onus doesn’t fall on PCPs alone—not by a long shot. This is an industry-wide issue. For example, I suspect that PCPs ordered laboratory tests for some of the 40% of patients who didn’t receive them, but due to inconvenience (no onsite lab, payer constraints, etc) those patients didn’t follow through with the order. We have to address barriers that make doing the right thing so hard for patients at times.
What do guidelines say?
The American Diabetes Association Standards of Medical Care in Diabetes includes testing HbA1c at least twice per year and lipids annually as a pillar of diabetes management. These tests are used diagnostically for diabetes and hyperlipidemia (HbA1c and lipids, respectively) and as key metrics for clinical decision-making in treatment of patients with diabetes. Decisions about dosing, treatment escalation and cardiovascular risk-reduction are all tied to the availability of this basic data.
So, what’s to be learned from this study and where do we go from here?
One highlight was the observation that a strong patient – PCP relationship (‘continuity of care’) was associated with increased odds of adhering to guidelines for the HbA1c test (odds ratio 1.36, 95.0% confidence interval 0.98–1.88, P= 0.06). This confirms what other studies have demonstrated, a strong patient-PCP relationship is the foundation of diabetes (and other chronic disease) management.
Let’s make it easier to do better
Empowering PCPs with technology that makes it easier to do the right thing can help close this gap and facilitate a guideline adherence. Systems like Rimidi’s diabetes management platform that integrates directly into clinician workflow inside of their EHR are key to addressing these opportunities systematically and at scale.
Rimidi’s solution makes it easier for patients to manage their conditions, too. The technology platform supports both continuity of care and a continuum of care, meaning connectivity to that patient within the clinic and at home. From education about self-management, to self-monitoring, remote patient monitoring, and clinical decision support, we are here to make the system better for patients and providers.
We’re addressing patient convenience as well. As earlier noted, several PCPs may have ordered labs for patients, but due to inconvenience, the patient didn’t follow through. We’ve partnered with point of care diagnostics company, PTS Diagnostics, to bring POC testing to our clients in the most integrated, frictionless way possible—making it easy for clinicians and patients alike to do the right thing for the best possible outcomes.
As one physician recently told me, “I want a tool that makes it easy to do the right thing for my patients, and hard to do the wrong thing.” Shouldn’t we all?