Saying that people with diabetes and depression too often receive poor care, a local coalition of employers, doctors and insurers is providing new tools to help physicians provide better service to these patients.
Initially, the program is targeting employees at 12 major corporations that have agreed to participate in the Pittsburgh Regional Healthcare Initiative effort.
Doctors at 50 primary care practices that treat the workers will have access to a database that gives them real-time information about whether diabetic and depression patients have received needed tests and prescriptions. Doctors often don't have that information at the time of an appointment and, consequently, can't provide the best care, said Dr. Ralph Schmeltz, an endocrinologist at the University of Pittsburgh Medical Center and a leader of the diabetes initiative.
Companies involved in the program include Bayer, Giant Eagle, Mellon Bank and PPG Industries. Eventually, the program also will be used at six community health centers in the region and at practices that treat Medical Assistance patients.
At a Downtown news conference yesterday to announce the program, Dr. Alberto Colombi, medical director for PPG Industries, said the program was needed because employers increasingly feel that they aren't getting their money's worth when it comes to chronic care.
"Poor quality is very expensive," Colombi said. "It's expensive in terms of suffering, expensive in waste, expensive in costs. We cannot sustain paying for poor quality."
Although employers are supporting the program, they will not learn about any employee's private health information through the initiative, organizers stressed. Companies will sponsor workplace education events about diabetes and stress, but, "There will be no attempt at the workplace to identify patients as depressed or diabetic," said Schmeltz, the diabetes doctor.
The new database will bring together claims data and pharmacy records from four health plans so that doctors can get a current snapshot of whether a patient is getting optimum care. The information will allow doctors, for example, to see if a diabetic patient has had a recent blood glucose test to check sugar levels.
Currently, the database is being made available to 10 physician practices, said Geoff Webster, associate director of the Pittsburgh Regional Healthcare Initiative. It allows doctors to receive reports on individual patients that can then be inserted into medical charts before patient visits. If the report shows that tests they ordered have been completed since the patient's last visit, that should cue office staff to track down the results before the patient and doctor meet.
"It's been estimated that in an average 15-minute office visit, five minutes of the time is often spent looking for information," said Dr. Nicholas DeGregorio, a primary care physician in the South Hills and a leader of the diabetes program.
The system also will be able to generate alerts that will tell a physician when a prescription hasn't been refilled or when a patient hasn't been seen recently. Health plans and some doctors' offices have taken steps in recent years to do just this sort of thing for diabetic patients, but the new database will provide information in a more timely and comprehensive fashion, said DeGregorio.
With depression, doctors know medicines can help treat the disease, but only if patients take all their drugs for the prescribed length of time, said Dr. Alan Axelson, president and medical director of Intercare Psychiatric in Bethel Park and a leader of the depression program. The new database will help doctors track compliance, particularly by detecting when patients fail to get refills of prescribed medications.
The depression initiative is asking primary care doctors to perform depression screenings on all their patients. The physicians also are receiving guidance on how to make an accurate diagnosis of the disease.
A related project being funded with $800,000 over three years from the Jewish Healthcare Foundation is helping identify system failures that prevent diabetic and psychiatric patients from getting optimum care. Melissa Somma, a pharmacist working on the project at UPMC St. Margaret Family Health Center of Lawrenceville, related a story during the news conference that shows one such failure.
She spoke of a diabetic patient who wasn't taking care of his disease because he was clinically depressed. Realizing that the mental health problem needed prompt attention, Somma offered to help the patient make calls for a psychiatry appointment.
But it took Somma and a nurse in the practice numerous calls placed between 10 a.m. and 4:30 p.m. before they finally succeeded in getting the appointment scheduled. The problem was a combination of unanswered phones, endless waits on hold and the health plan directing the referral to a practice that was no longer in business.
If the man had tried to get help himself, he might not have had the patience or tenacity to make so many calls, Somma said.
And unfortunately, added PPG's Colombi, such barriers to quality care have become increasingly routine.
Christopher Snowbeck can be reached at csnowbeck@post-gazette.com or 412-263-2625.
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