According to a presentation given during the Managed Care Review Board’s symposium at the AMCP Annual Meeting 2017 on cardiovascular risks in patients with type 2 diabetes, Curtis Triplitt, PharmD, an associate professor of medicine at the University of Texas Health Science Center, discussed how patient-centered strategies can minimize cardiovascular risks in patients in a managed care setting.
Dr Triplitt started by discussing how cardiovascular risks in patients with type 2 diabetes equates to a higher risk of mortality. He cited evidence showing that patients with diabetes, history of myocardial infarction, and history of stroke have a 59.5% risk of mortality at age 60. Additionally, he said more than two-thirds of adults with type 2 diabetes die from cardiovascular disease.
He explained that the risk for myocardial infarction is reduced among patients with type 2 diabetes who have adequate glycemic control. However, patients with uncontrolled glucose levels become more difficult to treat over time.
Dr Triplitt explained that achieving cardiovascular risk reduction is challenging and takes organized care to achieve. He stated that the American Diabetes Association recently updated recommendations for prioritizing timely and appropriate treatment intensification for patients who have not achieved blood pressure, lipid, or glucose goals. According to the presentation, strategies to organize care include having explicit goal setting, identifying and addressing barriers to care, integrating guidelines, and utilizing care management teams.
He also explained that the key to achieving care goals is to consider the patient’s perspective. Understanding the extenuating circumstances that could be causing barriers to care, and questions that the patient could have is crucial to identifying areas of improvement. Addressing questions such as “how long will I have to take these drugs,” and “why do I have to take these drugs If I don’t feel bad,” could make the difference between an adherent and nonadherent patient.
“I want to talk to you about patient-centered strategies—so, do you think that patients in [cardiovascular outcomes trails] are the patients you see in clinics every day?” Dr Triplitt said during the presentation. “These are not simple patients. These are very complex patients… I want to remind you that as these are complex patients, so of course there may be complex ideas that we have to incorporate in our strategies.”
Dr Triplitt emphasized that it is important to develop a common language, common ground, and a partnership with patients in achieving disease control goals.
He showed a slide that highlighted the key elements of a patient-centered approach, which included providing convenient access, a focus on wellness and prevention, personalized care plans, support for self-care, coordinated care, and performance improvement. Patient-centered care encourages shared decision-making and continuity of care across a patient’s lifespan, according to the presentation.
Dr Triplitt outlined the components needed to deliver patient-centered care through a medical home, which included diabetes self-management education, team-based care, case management, cardiologists and endocrinologists as members of the team, and electronic health records capabilities for tracking outcomes.
“Achieving this cardiovascular risk reduction remains challenging, so there is a lot of residual risk in our patient’s with cardiovascular disease—and finally we have something that might whittle away at that particular problem,” Dr Triplitt concluded. “So hopefully some of these different strategies will work for your patients.” —David Costill