Teamwork is often vital to improving patient outcomes. And while most healthcare professionals are in favor of working together, the biggest obstacle appears to be simply finding the time to team up.
In a survey conducted last summer by the market research and analytics company The Harris Poll for Boehringer Ingelheim and Eli Lilly and Company, a majority of healthcare providers agreed that collaboration among specialties treating patients with type 2 diabetes result in better medical outcomes. The biggest challenge, according to respondents was actually finding the time to connect with their colleagues.
The survey of a group of 1,000 U.S.-based providers including primary care physicians, cardiologists, endocrinologists, nephrologists, and nurse practitioners. The results are the foundation of a new website called Unleashing The Truth About Diabetes + Heart Disease (https://unleashingthetruth.com), which helps providers understand how working together can better help patients with type 2 diabetes uncover and prevent cardiac and renal complications. More than four in five providers surveyed agreed that collaboration was “absolutely essential, extremely important, or very important” to help improve the health of their patients with type 2 diabetes.
Why Teamwork Works
When surveyed, providers said that “producing higher-quality patient care” and “consistency in treatment” were the greatest upsides of collaborating to help their type 2 patients. “Reducing communication gaps” and “minimizing medical errors” were also mentioned as significant collaboration advantages.
“When people do collaborate and you have the full information about the patient, you can offer the best care. When care is discordant, it is hard to know if the patient’s medication list is accurate, or if patients are receiving the most current information. Collaboration is essential.” – Rachel Pessah-Pollack, MD, clinical associate professor, Division of Endocrinology, Diabetes & Metabolism, NYU Langone Health, New York, N.Y.
“When you work with other people, all of those things align,” says Rachel Pessah-Pollack, MD, clinical associate professor in the Division of Endocrinology, Diabetes & Metabolism at NYU Langone Health in New York, N.Y., and an endocrinologist who helped interpret the findings. “The survey shows that everyone wants to collaborate, but time is the issue. I think that as endocrinologists, we are really recognizing the important role of cardiac protection in our diabetes patients. It relates to cardiovascular, renal, and glucose levels, and the question of who is the one that is going to manage that? The endocrinologist? The primary care physician? We are recognizing that this may be all our roles. The general consensus is that when people do collaborate and you have the full information about the patient, you can offer the best care. When care is discordant, it is hard to know if the patient’s medication list is accurate, or if patients are receiving the most current information. Collaboration is essential.”
Collaboration also helps patients and their providers know what their diabetes management plan is, which has several benefits, says Javed Butler, MD, MPH, MBA, a professor of medicine at the University of Mississippi Medical Center in Jackson, Miss., and a cardiologist involved in the initiative. “First, consistent messaging to patients and caregivers allows for a uniform plan of action,” Butler explains. “Second, a common plan of care individualized to a given patient avoids ever-changing medical regimens as patients navigate the healthcare environment. Third, issues related to comfort and self-efficacy among clinicians can be overcome, e.g., a cardiologist may not be comfortable initiating a drug mostly prescribed by an endocrinologist and vice versa, but the patient needs both. In this way, rather than avoiding or delaying best care, patients can get optimal care fast. Lastly, in a well-coordinated healthcare system, collaboration can help a patient avoid making multiple visits to the healthcare system at different times and different places. Instead, the care can be coordinated around patients’ needs.”
Finding Time to Connect
Just about every survey respondent said they didn’t have as much time as they would like to collaborate more. A lack of time being able to help collaboration happen. Others mentioned lacking tools or the resources to make interaction easier.
When many providers work within the same medical or healthcare system, it is more likely they all use the same electronic health record. Pessah-Pollack cited the ease of using the Epic medical record system at NYU/Langone to be able to communicate with other providers overseeing her type 2 patients’ care.
“I can see the notes of other providers in Epic, and I also have the ability to chat with providers in real time, and I can get an answer back,” she says. “With technology, we have the ability to interface, but it’s not perfect, because how many patients see healthcare providers outside of our systems?”
In those cases, Pessah-Pollack uses her cell phone and will reach out to the patient’s cardiologist and/or nephrologist to share her cell number to be able to make and receive quick calls directly. “Bypassing going through the office makes everything much more efficient,” she admits. “Over the past two to three years I have spoken to cardiologists more than I ever have in my life, especially about SGLT-2 inhibitors and their cardiovascular benefit.”
She will also forward her notes to other specialists who are within Epic or will fax them to providers outside the system so that everyone on the patient’s healthcare team has as much knowledge as possible about the patient’s history and reason for the visit. “I always ask the patient if they have a cardiologist or another specialist involved in their care,” she says.
Patient information is never shared via text, she emphasized, choosing to text to schedule future phone calls to collaborate.
Butler, the cardiologist, agrees.
“Any significant change even between clinicians with a common healthcare environment may be better communicated by a quick phone call,” he says. “Include patients and family caregivers in such discussions so that everyone is on the same page. Include the extended healthcare team beyond physicians, including, for example, nutritionists, certified diabetes educators, pharmacists, etc.”
“Bypassing going through the office makes everything much more efficient. Over the past two to three years I have spoken to cardiologists more than I ever have in my life, especially about SGLT-2 inhibitors and their cardiovascular benefit.” – Rachel Pessah-Pollack, MD, clinical associate professor, Division of Endocrinology, Diabetes & Metabolism, NYU Langone Health, New York, N.Y.
Helping patients along by sending a patient history ahead of time to other providers can help encourage patients to be more involved, says Pessah-Pollack. “We have to help our patients along and encourage them to be a part of their care because that ultimately winds up with more collaborative care,” she says. “A lot of patients go to specialists and don’t know why they are there. Providing the nephrologist with that information, giving the patient copies of their labs, or having my office fax it over, all helps. There is so much room to help make it a smoother first visit, if possible.”
Following Standards of Medical Care
Professional guidelines are how physicians stay up to date, and collaboration among professional organizations can help develop one place for doctors to look to for how to provide the best care, says Pessah-Pollack.
The Unleashing the Truth website offers links to guidelines from the American Diabetes Association and the American College of Cardiology’s practice standards for treating patients with type 2 diabetes. It’s a way to share knowledge among different providers caring for this patient group.
“Who is responsible for the care of the patient, especially with reducing cardiac risk,” Pessah-Pollack asks. “Providers don’t want to step on the toes of others and ask if it is ok to prescribe a type of insulin as a primary care physician. Who is the one who should be prescribing which medication? We are all invested in reducing the risk of cardiovascular disease. When you have that collaboration, you’re able to be on the same team. The theme of working together is really the goal.”
Alkon is a Massachusetts-based freelance writer who is the author of the book, Balancing Pregnancy with Pre-Existing Diabetes: Healthy Mom, Healthy Baby. She wrote about good habits for being on call in the November 2020 issue.
A Closer Look at Diabetes and Cardiovascular Disease
Preventing cardiac problems in patients with type 2 diabetes is a bigger concern than ever before, says Rachel Pessah-Pollack, MD, a clinical associate professor in the division of endocrinology, diabetes & metabolism at New York University’s Langone Health. “I have definitely changed my focus and with every visit with my diabetic patients, I am always talking about cardiovascular risk and how to reduce that risk,” she says. She emphasizes it more now because of newer diabetes medications available that help prevent cardiac events. These include GLP-1 receptor agonists and SGLT-2 inhibitors; study sponsors Boeringer Ingelheim produces GLP-1 drug Trulicity and Eli Lilly and Company manufactures Jardiance, a SGLT-2 drug.
“Prevention is a major issue going forward; like having elevated blood pressure readings, it’s the same for cardiovascular events. People don’t feel bad if their levels are slightly elevated. I think it resonates with people, that it’s important not just to lower their sugar levels, but you’re also adding an additional benefit. I’ve had people say to me, ‘You’re telling me this, but I have a cardiologist.’ I say, ‘We don’t want you to have to get a stent.’ I’m an endocrinologist but a lot of what I do overlaps with other specialties.”