| PATIENT NAME:__________________________________________ | DOB:_____/_____/_____ |
| There are several Star Ratings quality measures that are related to improving care for patients with diabetes. These include adherence to diabetes medications, statins, and ACE inhibitors or ARBs; controlling blood glucose and blood pressure levels; vaccinations; annual eye exams; and improving physical activity. Use this sheet as a guide to start conversations with your diabetes patients during comprehensive medication reviews (CMRs), medication synchronization appointments, or during any patient interaction. Tackle one or two topics at a time, but don't overwhelm your patients or yourself by doing too much too fast. Start with these ideas and build on the topics below. |
| 1. Assess adherence to diabetes medications and emphasize importance. | (Date discussed:____________) |
- Ask open-ended questions, such as:
- I know it must be difficult to take all your medicines regularly. How many doses did you miss in the past week?
- How do you think these medicines are working?
- What are your biggest challenges with taking your medicines?
- Have patients explain how they take their medications and make sure your records match.
- Look at prescription refill information to help assess adherence.
- Assess barriers to adherence: cost, lack of patient buy-in or understanding, forgetfulness, etc.
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| 2. Ensure recommended vaccinations are up to date. | (Date discussed:____________) |
- Annual flu shot
- Pneumococcal vaccination with Pneumovax 23 for immunocompetent adult diabetes patients aged 19 to 64 years. Then at age 65 years, give Prevnar 13 (if not previously given) followed by a 2nd shot of Pneumovax 23 at least one year later (and at least five years after previous dose).
- Hepatitis B vaccination is recommended for patients with diabetes younger than 60 years of age.
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| 3. Talk about the importance of optimizing glucose control. | (Date discussed:____________) |
- A1C goal should be individualized (6.5% to 8%). Aim for <7% for most patients. Consider 7.5% to 8% for those with a history of severe hypoglycemia, limited life expectancy, advanced diabetes complications, or excessive comorbid complications.
- Optimal A1C slows progression of microvascular complications such as kidney disease, retinopathy, neuropathy, etc.
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| 4. Discuss prevention of cardiovascular complications. | (Date discussed:____________) |
- Blood pressure goal of <140/90 mmHg for most. Recommend an ACEI or ARB if appropriate.
- Moderate- to high-intensity statin therapy is recommended for all diabetes patients age 40 to 75 years. Consider a high-intensity statin dose for patients with cardiovascular disease or additional risk factors.
- Ensure patient is a nonsmoker or support kicking the habit.
- Consider aspirin 75 to 162 mg once daily in those with increased cardiovascular risk.
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| 5. Discuss self-management. | (Date discussed:____________) |
- Encourage regular examination of feet, proper care of nails and skin, and appropriate footwear.
- Recommend home glucose monitoring for all type 1s and some type 2 diabetes patients, especially if newly diagnosed, changing medications, have an acute illness, or are pregnant.
- Discuss signs and symptoms of hypoglycemia (e.g., tremor, palpitations, sweating, etc), and review treatment (e.g., taking 15 to 20 g of simple carbs) and prevention strategies.
- Advise getting an annual dilated eye exam.
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| 6. Discuss healthy lifestyle choices (e.g., diet, physical activity, etc). | (Date discussed:____________) |
- Even modest weight loss (5% to 10%) can provide clinical benefits.
- Seven hours of brisk walking per week may reduce seven-year mortality by 50%.
- Encourage patients to eat vegetables, drink water rather than soda, and limit sweets and sodium.
- Carbohydrate intake monitoring is critical to achieving glycemic control.
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