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

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

Your Thoughts…

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.

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.”

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

Lessons Learned Tracking Progress Planning Each Group Visit Gathering Resources

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

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

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

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…

Patient Education “Fiber”

Grocery Store Trip

Physical Activity “Beach Volley Ball”

Laughing Yoga Massage Therapy

Tai Chi Dietician

Tracking Progress: Our Data

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

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%)

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%)

“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”

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

What’s In Your Toolbox?

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

Thank you.