By bringing comprehensive, patient-centered care together in single locations, SDC centers can offer both quality and convenience to patients. The “one-stop” approach is a major benefit for patients who would not otherwise have time to attend separate appointments to have required laboratory work and diagnostic tests, and to see physicians, nutritionists, and CDEs. Furthermore, these health centers accept most insurance plans, with only 1 insurance co-payment for all services rendered, which can provide substantial patient cost-savings compared with noncentralized providers. Many of these clinics are patient-friendly and may provide amenities such as ample parking, free coffee, wireless Internet access, and comfortable waiting rooms.
Financial constraints, which can limit the size of the MDT, are an ongoing challenge of providing care within a centralized model. Patients are taught self-care principles that encourage them to become involved in their own disease management. To achieve goals, team members must have good interpersonal skills, as well as a clear understanding of specific and shared responsibilities. To ensure success, management needs to be proactive in clarifying these responsibilities. Lastly, training provided to the team must be tailored to the clinical environment and community needs (eg, training on cultural sensitivity).
Conclusions
The SDC center model provides highly individualized, quality care to patients. The model is exemplified in the choice not to rely on generalized algorithms for treatment decisions; instead, clinical decision-making takes into account multiple factors about an individual patient. Each provider (physician, NP, or PA) sees a limited number (approximately 15–18) of patients per day, giving providers sufficient time to discuss with them the complexities of diabetes management, as well as the opportunity to individualize therapies. Patient involvement in treatment decisions is solicited, which is especially important when working with patients from diverse ethnic and cultural backgrounds on topics such as individualized approaches to diet. In addition, compared with individual primary care providers, we are early adopters of newer medications and advocate with insurers for full patient coverage. We believe that all of these steps help to ensure successful diabetes management for our patients.
Education is the cornerstone to diabetes care18; our patients are empowered by the education they receive, and often give positive feedback about the educational aspect of our care centers. Providers at SDC center clinics (physicians, NPs, and PAs) offer diabetes care and education options in a “menu” format for patients, and steer them toward the appropriate treatments, diagnostic tests, and education based on their individual needs. In our centers we take the time to explain to patients the pros and cons of various treatment options, how medications work, and our goals for their overall treatment plan. With an increased understanding of the pathophysiology of diabetes and the mechanisms through which their therapies work, patients can have more say in, and ownership of, their treatment decisions. Because of time constraints, integrative discussions can be difficult for many primary care physicians to accommodate. However, having patient care and education provided at the same clinic helps unite treatment decisions and education goals, enabling patients to increase both their understanding of diabetes management and their own self-efficacy and ability to follow their treatment plan.
It is important for payers and employers to continue to evaluate their goals for diabetes care and ensure that the proper administrative policies are put in place to support diabetes care in a comprehensive manner. Patients respond to incentives to improve care if they can be implemented. With the chronic nature of diabetes and insidious onset of diabetes complications, patient barriers to care must be identified and addressed to continually engage the patient in good diabetes care. We encourage increased collaboration between employers, providers, patients, and payers so that all incentives can be aligned. In particular, it is important that all parties involved understand the nature of, and need for, ongoing diabetes education.
Lastly, SDC centers may provide early intervention to prevent the worsening of diabetes-related conditions and comorbidities that will cost patients and payers more in the long term. Going forward with chronic disease management in the United States, it will be increasingly important to focus on both long- and short-term outcomes if we wish to see both positive and cost-effective results.