The Diabetes Epidemic ― PA's Can Be Practice Leaders

On May 27, my fellow Physicians' Practice blogger Melissa Young MD wrote about her overly full practice, long times between patient visits and the need to hire another practitioner to help with the patient loads. (See "A Busy Medical Practice is a Blessing and a Curse.")

I applaud you Dr. Young for the success of your practice and also your willingness to share your challenge, and yet I want to address a misperception and provide helpful information. In your article, you write with regard to your statement that a physician assistant would be a possibility for hire, but that your perception was that most PAs specialize in surgery and that you had not met a PA with an interest in diabetes.

My fellow PAs are working in every setting and specialty, from family practice to surgery. And, increasingly, PAs are contributing to the healthcare team by assuming a leadership role in helping patients address one of the preeminent preventable causes of illness and death in the country: diabetes.

At the American Academy of Physician Assistants (AAPA) annual conference last month, the Academy announced a new education initiative called "The Diabetes Leadership Edge" ― a call to action for more PAs to address diabetes and improve diabetes patient care.

According to the CDC (2011 Fact Sheet and Data and Trends), almost 26 million Americans have Type 2 diabetes today, and another 79 million are pre-diabetic. That is almost 25 percent of the U.S. population at risk for Type 2 diabetes. The prevalence of Type 2 diabetes in youth jumped 21 percent between 2001 and 2009. We now know that the progression of insulin resistance in youth is faster than in adults, putting young people at higher risk for comorbidities. But wait ― there's more.

With the passage of the Affordable Care Act, almost 35 million uninsured Americans will be entering the healthcare system with new insurance coverage, and many of them will be visiting physician offices with advanced stages of disease. Of this number, it is estimated that 2 million are diabetics, the majority of which have had no previously managed diabetes care. Add to this the aging of the Baby Boomers, who will develop geriatric diabetes. Finally, according to the American Academy of Family Physicians, and several documented studies, today in the U.S., we have a shortage of 16,000 primary-care physicians. In just 12 years by 2025, the primary-care physician shortage is expected to top 50,000.

No single provider group can tackle the challenges that diabetes presents alone. That's why PAs and a team-based approach to healthcare can, and will, play such an important role in correcting the diabetes epidemic.

For more than 30 years, I have worked in multiple specialties, most recently in plastic surgery,  staffing an inpatient burn unit. I know that diabetes needs to be handled in the primary-care office, but many times I'm confronted with a newly diagnosed or out of control diabetic. Diabetic control is critical to wound care and healing. Even a surgical PA needs to know how to manage diabetes. The days of regular referral out to endocrine specialists are over, as endocrinologists too are in short supply and out-of-office referrals result in long delays in care, and suboptimal teamwork between the specialist and primary provider. Diabetes can be handled in the primary-care office effectively and efficiently, with the proper knowledge and tools.

PAs are the perfect practitioners to head up diabetes care. Numerous studies have shown that team-based and patient-centered care (inter-disciplinary teams of PCPs and diabetes specialists) result in better control over critical diabetes measures (glycemic levels, lipids, blood pressure), better adherence to ADA recommendations, lower risk for diabetes complications, and importantly, higher patient satisfaction and self-care.

AAPA recently launched the Diabetes Leadership Edge to equip all PAs with key resources that will make them leaders in diabetes care:

• Leadership Roles: PAs will know about taking leadership and creating practice teams to oversee diabetes patient cases. With resources from the Diabetes Edge, PAs can practice effective screening and diagnostic procedures for pre-diabetes and diabetes. They will also stay current on the latest available therapeutics, selecting the right treatment for each patient, and proper dosing.

• Care coordination: Unfortunately, diabetes is accompanied by numerous other conditions and diseases. PAs will be on the look-out for high risk patients who have comorbidities, contraindications, possible adverse effects of medications, and will know how to educate the patient toward self-care across cultural spectrums.

• Prevention: Trained PAs will establish treatment goals for their patients, identify and teach healthy lifestyles, and will motivate patients through creative strategies to own their conditions and take care of themselves. This can all be accomplished with attention toward providing information in culturally sensitive and appropriate manners.

You can learn more about AAPA's Diabetes Edge here.

This blog was provided in partnership with the American Academy of Physician Assistants.