In VOICE Vol. 12, No. 2, I wrote of the need to move diabetes care away from the “primary caregiver/general practitioner as gatekeeper” model of health service delivery. I pointed out that expecting one GP to be "up" on all the latest treatment modalities of diabetes (or any other serious and specialized condition) is unfair to both the patient and the GP.
Now the HMO, the “health maintenance organization,” was founded to control America's rocketing health costs. Its goal was to cut out the unnecessary treatments (33%, according to the insurance industry) routinely provided to lawsuit-waving hypochondriacs. Commendable, but such “gatekeeping” assumes omniscience on the part of the gatekeeper. That's unrealistic.
When someone has diabetes (especially after they've been diagnosed), the best results come from the tried and true "health care team" approach. Such a team ideally includes ophthalmologist, dietitian, diabetes educator, perhaps nephrologist, urologist and exercise physiologist, along with the diabetologist and the patient. And they all work together.
THE NATIONAL DIABETES EDUCATION PROJECT (NDEP), a joint effort of the National Institutes of Health (NIH)and the Centers for Disease Control and Prevention (CDC) has just issued a report titled: TEAM CARE: COMPREHENSIVE LIFETIME MANAGEMENT FOR DIABETES. In this text they argue the benefits of aggressive, pro-active, team-based diabetes care outweigh the initial savings inherent in the HMO “gatekeeper” model. For example, they cite a study in which the average length of hospital stay (for patients with a primary diagnosis of diabetes) was 56% lower for the team-managed patients compared to those managed by an internist alone. At least 90% of all diabetes is type 2. Good diabetes self management, especially of type 2, requires control of many factors. No one generalist, or even one diabetes specialist, can master it all. We NEED this group approach!
For copies of the report, contact the NDEP at telephone: 1-800-438-5385;
website: http://ndep.nih.gov or the CDC website:
www.cdc.gov/diabetes