Naval Hospital Guam: Controlling Diabetes, Reducing Healthcare Costs Pt. 2

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The diabetes clinic is available to patients through family medicine and internal medicine. The clinics have been successful helping patients reduce blood glucose levels, A1C in type II diabetes patients.

Because NH Guam is a high reliability organization, it was important that staff measure quality by tracking patient outcomes. Tracking a patient it lets the hospital’s decision makers monitor the effectiveness, quality and value of any given health care service. It also gives NH Guam’s management the ability to compare the cost of medical treatments or services.

There are approximately 960 patients with diabetes.  Fewer than 40 have uncontrolled diabetes, and are enrolled in the clinic.  Because staffing ratios are important to safety and quality care, the clinic is only open to patients with uncontrolled diabetes..

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Registered Nurse, Cheryl Buckley discusses diabetes management with patients.

The internal medicine diabetes clinic is led by Lt. Nancy Lentz, an internal medicine physician  and Cheryl Buckley, a registered nurse.  Patients admitted to the clinic are initially seen by Lentz and Buckley. A patient’s first visit focuses on them learning how to manage their diabetes, determine what complications they may have, and evaluate their current diet and exercise regimen.

Afterward a plan to help reduce their A1C is developed. Much of the appointment is patient oriented and designed to put the patients back in control of their own healthcare.  The patients make their own goals.  Lentz and Buckley help them think about which aspect of their diabetes management is the biggest struggle, and what changes they would like to make.

Patients are encouraged to attend classes once a month.  The class curriculum was developed by Buckley, based on principles established by the American Association of Diabetes Educators. Discussion topics include nutrition, physical activity and monitoring. The patients also keep a log of their food intake and blood sugars. The log effectively helps patients manage their diabetes.

With diabetes, if a patient modifies their lifestyle, they can possibly be taken them off their medications or greatly reduce their prescribed amount.
With diabetes, if a patient modifies their lifestyle, they can possibly be taken them off their medications or greatly reduce their prescribed amount.

When a patient reaches their goal, they are inspired to stay with the clinic for at least a year, because according to Buckley, “It’s more than just getting to a goal, it is also earning how to maintain that goal.”

Lentz says that a patient’s empowerment is ultimately derived by a lifestyle change.  There are many diseases that require medication to treat a patient.  With some of these diseases she has little or no opportunity to cut back on prescribing  medication, but with diabetes, if a patient modifies their lifestyle, they can possibly be taken them off their medications or greatly reduce their prescribed amount.

It isn’t just blood sugar levels, or medications that get reduced, but costs as well. Studies show that diabetes disease management programs experience lower overall paid insurance claims due to decreased inpatient use, fewer admissions, fewer inpatient days, and fewer emergency room visits. Money is also saved in terms of specialty care, such as endocrinology, nephrology (dialysis), podiatry, and ophthalmology. Reports also show patients that control their diabetes can save approximately 500 dollars a year. There are also other cost benefits, such as reduced sick days for patients.

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Since the clinic opened in October 2014 the team has seen a great deal of improvement in 90 percent of their patients.

Lentz and Buckley agree that the backbone of the diabetes clinic is education.   They want to provide their patients with the knowledge and skills to take back and share with their families.

Since the clinic opened in October 2014 the team has seen a great deal of improvement in 90 percent of their patients. According to Lentz, the average A1C at the start of the clinic was 11.5; currently the average is 8.4. The American Diabetes Association recommends the goal to be less than 7 percent in most patients; though it may be slightly higher in the elderly and chronically ill population.

Many of the patients participating in the clinic agree that they no longer feel run down, tired and thirsty all the time. They have more energy and realize for the first time how much their diabetes was affecting them.