1. Integrative Medicine Approach to Diabetes Group Visits within a Patient Centered Medical Home
Krishna Desai, MD; Scott Bragg, PharmD; Sarah Winter, PharmD; Rachel Himm, MD
UPMC St. Margaret
Society of Teachers of Family Medicine
Annual Spring Conference
May 4, 2013

2. Objectives
Discuss the Integrative Medicine approach to group medical visits
Identify the benefits and challenges of group medical visits
Apply our lessons learned to your own implementation of group medical visits

3. Your Thoughts…

4. Background Less ED use Fewer hospitalizations Patient satisfaction
Physician satisfaction
Lower A1C
Diabetes knowledge
Weight loss
Improved foot exam, eye exams, and lab testing
Less ED use
Fewer hospital admissions
Greater patient and physician satisfaction
Improved foot exam, lab testing
Reduction in hemoglobin A1C
Weight loss
Increased diabetes knowledge
Davis AM, et al. The Potential of Group Visits in Diabetes Care. Clinical Diabetes. 26: 58-62, 2008.

5. Integrative Medicine (IM)
“ Healing-oriented medicine that takes account of the whole person (body, mind, and spirit), including all aspects of lifestyle. It emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and alternative.”

6. Diabetes: Integrative Approach
Nutrition
Exercise
Stress
Standard
Care
Medications
Herbals
&
Supplements
Comorbidities

7. Lessons Learned
Tracking Progress
Planning Each Group Visit
Gathering Resources

8. Interdisciplinary Care Team Comprehensive Accessible Care
RN, MD, Pharm D, RD, SW
Gathering Resources
Buy-in
Time
Space
Patients
Recruitment: calls, letters, flyers, staff
Providers
IM Providers: Yoga/Massage, Tai Chi
Money
St. Margaret Foundation grant $5800
EHR:
Patient Registry
Communication
Documentation
Patient Experience
Quality Improvement
Comprehensive Accessible Care

9. Group Visit Planning- Every Month
Chart review
Appointment reminder calls
Diabetes management plan
Orders: Rx, referrals, labs
Education activity
Meals
Paperwork
HIPAA, lifestyle review, report card, satisfaction survey, handouts

10. Medication Reconciliation
Vitals
Labs & Shots
Self Care Plan & Goals
Physical Exam
Medication Reconciliation
Forms
5:30-6:30 PM

11. 6:30-7:30 PM Patient Education Integrative Medicine Therapy Sugar Yoga
Fiber
Carbohydrates
Portion Sizes
Foot Care
Exercise
Integrative Medicine Therapy
Yoga
Tai Chi
Aerobics
Massage
Nutrition
Mindfulness
Breath Work
Healthy Meal
Cinnamon, Omega-3 fatty acids, Alpha lipoic acid, B-vitamins, etc…

12. Patient Education
“Fiber”

13. Grocery Store Trip

14. Physical Activity
“Beach Volley Ball”

15. Laughing Yoga
Massage Therapy

16. Tai Chi
Dietician

17. Tracking Progress: Our Data

18. Hemoglobin A1c Baseline
27 Patients
Average A1c baseline: 8.6% (6.0 to 13.8%)

19. Hemoglobin A1c 3 months 27 Patients
Average A1c baseline: 8.6% (6.0 to 13.8%)
Average A1c 3 months: 8.0% (6.3 to 11.0%)
Change: (-4.9% to +3.2%)

20. Hemoglobin A1c 6 months 27 Patients
Average A1c baseline: 8.6% (6.0 to 13.8%)
Average A1c 6 months: 7.3% (6.1 to 9.9%)
Change: (-5% to +0.2%)

21. “I know not to fry my chicken as much as I like fried chicken.”
“When I have a bad day, I still do [laughing yoga]”
“[Diabetes group visits] lifted my spirits and it made me happy”
Patient Perspectives
“Group visits helped me to accept my diagnosis”
“I started watching my calories”

22. Lessons Learned
Buy-in Keep it simple Peer pressure Free food Plan ahead Personal touch

23. What’s In Your Toolbox?

24. Acknowledgements St. Margaret Foundation
Lawrenceville Family Health Center
University of Arizona Center for Integrative Medicine
Dr. Frank D’Amico
Dr. Stephen Wilson
Dr. Linda Hogan
Faculty Development Fellows

25. Thank you.