Advancing Diabetes Self Management
St. Peter Family Medicine Residency Program

Project Director: Devin Sawyer, MD
Administrator: Joseph Wall, MHA, CHE

525 Lilly Rd. NE
Olympia, WA 98506

jwall@providence.org

The St. Peter Family Medicine (SPFM) residency is one of 14 family medicine residency programs affiliated with the University of Washington. The hospital serves 300,000 residents in Thurston County and four adjacent counties in western Washington. The residency program emphasizes physician training for small town and rural practice, with special attention to the poor and vulnerable.

The Advancing Diabetes Self Management project at SPFM is centered on expanding the training of the provider-medical assistant (MA) team and engaging patients in their care. The goal of the project is to create a primary care system that supports healthy self management for people with chronic conditions.

A “Self Management Goal Cycle” model is used to redefine medical team-patient interaction. This model expands the role of the MA, allowing the primary care provider (PCP) to spend more quality time with each patient. Prior to a PCP visit, the MA conducts a “planned visit” with each patient in which vital signs, labs, referrals, and immunizations are completed under standing physician orders. The concepts of patient self management goal setting are introduced and, if appropriate, the patient sets a goal. The MA follows up with a phone call to the patient two weeks later to offer support and reinforcement and review and update goals. The MA repeats the process three to four months later.

Following a planned visit, a patient can choose the format of his or her PCP clinical visit. One option is a one-on-one PCP visit that will include medical management and self management goal coaching. A second option is a mini-group medical visit in which two or three patients meet with their PCP-MA team for a one-hour group medical/ self management goal setting session. Patients in the mini-group medical visit consent to share their medical information with the group so that medical management can occur openly with input not only from the provider team, but also from the other patients. The patients explore barriers and successes with lifestyle change and review self management goals. They set new goals and, if patients are willing, they also exchange contact information. After each visit, the same set of patients is offered a scheduled mini-group medical visit every three to four months.

Open office group visits offer an open forum for further discussion among the provider team and patients. Seven to 12 patients attend each session staffed by a faculty preceptor and a resident physician. The agenda is unstructured with the provider team coordinating the discussion, providing medical expertise when appropriate, and taking notes on each patient. The stress and distress of suffering from a chronic illness is a frequent topic of discussion. Patients support and encourage each other while the providers facilitate discussion of stress management and healthy coping strategies. The open office visits are supplemental to the traditional individual or mini-group medical visits.

As a result of offering choices to patients for their care, SPFM has improved provider and patient satisfaction as well as the quality of care for people with chronic conditions.

Summary

Key Interventions

• Medical assistant (MA) planned visits with phone follow up
• Mini-group medical visits
• Open office drop-in clinic
• Walking club
• Project newsletter

Key Accomplishments

• Redesigned diabetes care to offer patient choices for their clinic visits: mini-group medical visit, traditional office visit and/or open office visit
• Developed a curriculum for an enhanced role for MAs that includes planned visits with patients prior to their clinic visit
• Served as a training site for primary care settings working toward improved chronic illness care
• Rebuilding Chronic Care Providence: Diabetes Initiative grantee, St. Peter Family Medicine Residency Program is profiled on RWJF website. Read More >
• DOC News Feature -- What it Takes to Make Group Visits Work. Support Staff, Planning Prove Key to Group-Visit Success in Primary Care. DOC News. Dec 2007. Vol 4(12): 8.
• DOC News Feature -- A Group Hug Proves Galvanizing. DOC News. Dec 2007. Vol 4(12): 9.

Lessons Learned

• Group and mini-group medical visits are promising alternatives for delivering quality diabetes care in primary care settings
• The medical assistant plays a critical role in providing comprehensive diabetes self management services in a family medicine practice
• Collaborative goal setting in a primary care setting improves diabetes self management

Grantee Presentations

• Medical Assistants and Diabetes Planned Care: More Than Just the Vital Signs (5/2008)
• Harnessing the Cascade of Change in Family Medicine: The Critical Role of Behavioral Science (9/2007)
• CDE Role in Redesigning Primary Care: Training Medical Assistants in the Chronic Care Model (8/2007)
• Planned, Mini-Group and Open Office Group Visits as Solutions to Chronic Care Delivery I Abstract (4/2007)
• Interview with Dr. Devin Sawyer (March-April/2007)
• Group Medical Visits: The Case “For”… (12/2006)
• Four Steps to Patient Self Management Support in Primary Care: What We Have Learned (11/2006)
• Primary Care Re-Designed: Four Steps to Patient Self-Management Support (10/2006)
• Primary Care: Redefined (8/2006)
• Diabetes and “Pre-Diabetes” Who is in Control? (5/2006)
• Managing Chronic Disease in the Primary Care Setting Through Patient Self-Management (3/2006)
• Diabetes Self-Management Support in Primary Care: Building the proactive and prepared health care team (5/2005)
• Group Visits; What Could Be… (4/2005)
• Primary Care & Diabetes: Changing Care Through Collaboration and Self Management (11/2004)
• Diabetes and You! (4/2003)