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									                     NOTES FROM TEAM CARE COMMITTEE TELECON 9/19/08

   Attendees:
        o Roger Chene
        o Sanaa Ligons, MD
        o Barbara Livermore, MD
        o Nathan Painter
        o Sandy Pieschel
        o Evelyn Rupp
        o Stephen Schubert
        o Irving Spratt, MD

   Introductions

   Roger Chene discussed focus of Team Care Committee and suggestions for upcoming teleco topics.

   Presentation “Effective Glycemic Management: It Takes a Team”, Sandy Pieschel, RN, BSW, CDE,
    FAACVPR, Supervisor of Cardiac Rehabilitation & Diabetes Care, Torrance Memorial Medical Center:
       o Sandy has been a Diabetes Educator for 27 years
       o Cardiac Rehab is her co-specialty
       o Sandy discussed glycemic management and how we are moving from Experience Based Practice
           towards Evidence Based Practice
                It takes 17 years to change care and get it into practice
                Overall death rate from cardiovascular disease has decreased 33% for people without diabetes
                   over the last 30 years
                        For men with diabetes, death rate decreased only 13% vs. 37% for men w/o diabetes
                        For women with diabetes, death rate actually increased 23% vs. 27% decrease for
                           women w/o diabetes!!
                Medicare started covering Diabetes Self-Management Education and blood glucose monitoring
                   supplies in July 1998 as part of the 1997 Balanced Budget Act
                        There are now over 3,000 ADA approved Self Management Education sites
       o AACE motto is early and aggressive treatment for people with diabetes
       o Sandy discussed the AADE 7 keys of Diabetes Self Management
       o Diabetes Educators working with patients results in individualized treatment
                Monitoring should be purposeful
                        Cardiovascular complications are the most life threatening effects
                Effective problem solving should be based on numbers, medications, activities, etc.
                Sandy gave an example of a patient who was taking his meds based on his wife’s glucose levels
                   because he ate the same foods she ate!
       o Sliding scales alone are ineffective and may cause harm
                Continuous monitoring is best
       o ADA ABCs are the focus for Diabetes Educators
                Sandy added the “s” to ABC to cover smoking
       o Discussion of how different foods affect blood glucose
       o One slide showed a woman who was on a scale saying, “My blood sugar was 300? I’ll just cut back on
           the candy and eat more fruit.”
                Cutting back on candy and eating more fruit doesn’t work as fruit turns into glucose too
       o Many patients are visual learners and need to see how medicine works
       o Exercise & proper diet are considered prescriptions also
       o The best prescription for success is to minimize variables
                Find out what the patient’s diet is normally like and go from there
       o Dispel the old concept that many patients have “Grandma just took more insulin”
       o Thank you for an excellent presentation Sandy!!

                      NOTES FROM TEAM CARE COMMITTEE TELECON 9/19/08

   Questions & Answers

   1. What to do about patients who don’t have Medicare or other insurance and cannot afford supplies?
        a. Everyone agreed that this is definitely a problem; Sandy gave suggestions
        b. Nathan gave us the link to a resource that is available to assist patients: Partnership for Prescription
             Assistance: www.pparx.org

   2. Are there circumstances where patients don’t need to test as often?
          a. Sandy said to test with a purpose, not just to test

   3. Does your background in Social Work help you as an educator?
         a. Yes. It helps with assessing readiness to learn; counseling background very valuable

   4. How do you get MD’s to stop calling patients “Diabetics”?
         a. Can be difficult, but we are moving in this direction

   5. I’m so glad you discussed the importance of the Chronic Care Model. Do many family members come in
      with patients and if so, does it help?
          a. Yes they do and it definitely helps.

Next Team Care Teleconference is on October 17, 2008, 12:30-1:30PM

ER 10/8/08


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