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Proactive, one-on-one approach drops risk by 30 percent

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William Lustig sees a patient at Doctors Park Family Medicine every 15 minutes.

That’s long enough to check a chart, ask a few questions and write a prescription or a referral.

But it’s not long enough to coach or inspire, which is especially important for diabetic patients.

So Columbus Regional Health Foundation decided to experiment by hiring four health coaches, spending $400,000 to create the diabetes health coaching demonstration project.

“When you only have a few minutes, you can’t delve into why they’re not doing what they know they should be,” coach Heather Johnson said.

The health coaches spend time with patients, one-on-one, to encourage healthy eating, being active, taking medication and blood sugar monitoring — and it’s working.

The nearly 1,000 patients in the program have seen an average 13.3 percent drop in their blood-sugar levels — and a 30 percent relative risk reduction.

“It’s such an improvement from the traditional way,” Lustig said.

Patient-centered approach

Health care professionals across the country are recognizing the traditional way — a complicated maze of referrals and visits to several disconnected doctors’ offices — isn’t efficient.

The current model of health care delivery is designed for acute health problems, such as diagnosing an allergy or bronchitis, Lustig said. That model doesn’t work as well with a chronic illness such as diabetes, he said.

Nearly half of all Americans suffer from at least one chronic condition, and 75 cents of each dollar spent on health care goes to treat those patients, according to the Centers for Disease Control and Prevention.

Based on those statistics, the health care industry has realized a need for a change — especially in diabetes care, Lustig said.

Laurie Reed, executive director of the physician practice group affiliated with Columbus Regional Health, said that’s where the patient-centered medical neighborhood comes in.

In 2012, Columbus Regional Health was selected to participate in a 15-hospital initiative to transform the health experience.

The new patient-centered model connects providers in eight primary-care offices with all other health care providers that comprise a patient’s care team for a more coordinated experience.

As a result of the initiative, physicians are able to:

Book more same-day appointments.

Provide electronic clinical summaries at each visit and offer patient portal access.

Coordinate care delivery across all health care settings.

Collaborate with Columbus Regional Health to reduce readmission after an ER or inpatient visit.

Improve patient self-management support and education.

Diabetes health coaches focus on the last point — support and education.

“I think patients just tend to open up with the coaches more because there’s more access with them,” Reed said. “What we wanted was just a customer service, a person who could create a relationship with a person, a bond.”

Coach’s role

Just a few years ago, Lustig would diagnose patients with diabetes and send them to the hospital to take a class about managing their condition.

Diabetes educators at Columbus Regional Health would teach about the right diet and exercise regimen, monitoring techniques, why blood sugar spikes and potential complications.

“That’s a lot to learn at one time,” Lustig said. “It’s easy to forget some of the stuff, and it’s also easy to be frightened at first. If you’re frightened, you’ll do really well and then fall back to old patterns.”

He schedules checkups every three to six months, but what about if issues or questions come up in between?

He used to try to answer questions if he had time — which wasn’t often. But now he can pass the concern along to a health coach. And in return, the health coach refers clinical issues back to the licensed doctor.

“Rather than waiting and scheduling an appointment with the doctor, they can come right over and get started that day,” Johnson said.

Health coaches focus on seven behaviors: eating healthy, being active, taking medication, monitoring, problem solving, reducing risk and healthy coping.

She said initial appointments are one-on-one and typically last about an hour.

Amanda Luse, the resident health coach at Doctors Park Family Medicine, uses that time to create a personal connection with her patients.

She knows what they are going through. Luse was diagnosed with diabetes at the age of 35, attended a diabetes class and was thrown a packet of material.

“I didn’t know what to do with it,” she said.

She finally met someone who was able to motivate her to change for her children, and now she does the same for her patients.

Wake-up call

While Luse used her kids as motivation, Ric Loper uses his motorcycle.

His diabetes caused problems with his knees, and he knew if he didn’t keep his blood sugar under control he wouldn’t be able to ride his BMW or Suzuki this spring.

“I know I’ll get old, but I refuse to grow up,” he said.

And he does not want his diabetes to force him to.

Loper was diagnosed with diabetes about a year and a half ago, and he said Luse is a blessing.

Luse knows she cannot change people. She can only motivate them to change themselves, and that’s what Loper appreciates.

Rather than giving Loper a weight-loss or blood-sugar goal, Luse helps him change his diet and exercise in moderation.

“If you tell yourself all the things you can’t have, you’re going to fail,” he said. “It’s going to happen, because Oreos taste good.”

But even with the occasional cookie or slice of peach pie, Loper has cut his blood-sugar levels and lost 60 pounds.

“I certainly cannot say diabetes has been good to me, but it’s been a wake-up,” he said. “The changes have been subtle, but I’m healthier now than I’ve ever been.”

Life-changing experience

Michele Martin, who was diagnosed with diabetes in April 2011, has seen dramatic results.

“I wouldn’t have been motivated to do any of this,” she said. “I wouldn’t have known where to start, so why start?”

As a result, her blood sugar levels decreased significantly — and that’s not all that dropped.

She also lost more than 100 pounds, and it has changed her life.

“I was very depressed but I didn’t know what to do,” she said. “I had tried it all and nothing worked. My weight robbed me of enjoying life.”

She works out two hours a day Monday through Friday — one hour of cardiovascular activity and one of weightlifting — and she’s training for a mini-marathon.

The evidence of success is more than anecdotal.

Measuring impact

On a satisfaction survey delivered to 44 patients, a majority reported their blood sugar levels had decreased, they lost weight and their habits improved.

According to the foundation, there is a 30 percent relative risk reduction for every percentage point decrease in blood-sugar levels — and Lustig said that could transform health care entirely.

Risk reduction means fewer heart problems, fewer kidney problems and avoiding blindness and vascular disease — and that means less cost.

Although the foundation funding only covers the health coaches until May 2014, Reed said she is confident insurance agencies will recognize the benefits and begin to provide the service to patients with no co-pay.

“We do have the results; now we can go to payers and say, ‘This is something we need to continue doing,’” she said.

“Along with improving the health of the patient, this should reduce health care costs to the system,” she said. “It keeps people out of the hospital. Sometimes people are completely able to get off their medicine. It’s the absolute right thing to do.”

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