October 2021 Lunch and Learn Discussion

October Lunch and Learn Meeting Highlights
Thursday, October 7, 2021
2:00 PM – 3:00 PM ET
 

The Lunch and Learn participants engaged in discussion with primary care researchers Katrina Donahue, professor of Family Medicine at the University of North Carolina School of Medicine; Andrew Bazemore, Senior Vice President of Research and Policy at the American Board of Family Medicine; and Stephen Petterson, former Research Director at the Robert Graham Center.

The group discussed one primary care clinical article and one health services research article. Glucose self-monitoring in non-insulin-treated patients with type 2 diabetes in primary care settings: A randomized trial addresses glucose self-monitoring for patients with type 2 diabetes who are not being treated with insulin, and Higher primary care physician continuity is associated with lower costs and hospitalizations addresses the measurement of primary care physician continuity, one of the “4 Cs” (first contact, comprehensive, coordinated, continuous) of primary care. Read more about PCC's PCORI funded "Bridging the Gap in Primary Care Research" project here.

Policy Discussion Highlights:

  •  Glucose self-monitoring 
    • After 1 year there were no clinically or statistically significant differences in glycemic control or quality of life between patients who engaged in glucose self-monitoring and patients who did not.
    • 2020 standards of medical care in diabetes, published by the American Diabetes Association (ADA), reports that in people with type 2 diabetes not using insulin, routine glucose monitoring may be of limited additional clinical benefit.
    • Policy Implications:
      • In patients with type 2 diabetes not using insulin, the American Academy of Family Physicians (AAFP) and Society of General Internal Medicine (SGIM) don’t recommend daily home glucose monitoring.
      • Explore other recommendations from the Choosing Wisely Campaign.
  • Primary care physician continuity
    • Physicians with the highest level of continuity were associated with declines in total expenditures and hospitalizations. The value associated with a 14% reduction in costs is roughly $1,000/beneficiary/year.
    • Both individual physician- and practice-level continuity are important dimensions of primary care measurement.
      • Non-physician clinicians are essential to establishing continuity as part of the primary care team.
    • Physician continuity should continue to be measured and rewarded (e.g., Medicare’s Quality Payment Program).
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