Getting help following doctor's orders

2011-12-17T23:15:00Z Getting help following doctor's ordersBy MARA VAN ELLS | Bismarck Tribune Bismarck Tribune

When diabetic Dan Getz went to see his doctor in September, he was told he was a heart attack waiting to happen.

"They said, you need to take control of it right now," Getz said. "Not in a week or a month, but right now. That's how bad it was."

That day, Getz was added to a growing program at Medcenter One in which he is in weekly correspondence with a registered nurse. The process, called Patient Centered Medical Home, an initiative through Blue Cross Blue Shield, is designed to help medical practitioners follow up with patients via letters and phone calls. So far, Medcenter has been focused on patients with chronic illnesses such as diabetes, hypertension and congestive heart failure.

"It's a concept that's been around for a little time but (this is) more of a pilot project to try to see if we can make a difference in those things," Dr. David Field, Getz's physician, said.

St. Alexius does not have the Patient Centered Medical Home program yet, but is looking to implement the program in the near future.

Getz said he documents his blood sugar level four times a day and, once a week, his wife turns the record in to Medcenter. After Field and a nurse analyze his glucose levels, primary care specialty nurse Stacey Will contacts Getz and instructs him to adjust his level of injected insulin and reminds him to eat right.

"Every Monday I get a call from her. ‘Dan, you need to do this,' or ‘You're doing a good job; keep it up,'" Getz said. "And if I have any questions, I have her direct number and I can call her."

Besides focusing on patients with chronic illnesses, Will said the program also focuses on preventative care by reminding people to come in for things like mammograms and colonoscopies. However, she only makes in-depth follow ups, such as the weekly phone calls to Getz, to about five patients at any given time. Will is one of two primary care specialty nurses working with Field and one of 19 at Medcenter - two are at clinics in Jamestown and Dickinson. Will said she sends out about 25 reminder letters per week.

The program does not cost anything extra and she is constantly on the lookout for more opportunities to provide follow up care for patients, she said.

"It allows us to offer better health care and increase patient satisfaction, with improvement in their health as well," she said.

Getz, a Bismarck native, is 57 and has been diabetic for nearly 25 years. Although he still goes to the doctor every three months to have his A1C, his average blood sugar level, checked, he said, since starting this program, he feels safer - it has helped him stay on track and even forced him to to take his condition more seriously.

"I figure, if she's taking the time to do this, maybe I should be taking the time to be getting it under control better," he said.

Field said the program encourages an environment where patients can become involved and energized in their care.

"We want proactive care," he said. "We're working together to make sure everybody does better."

Field said that, according to research, the program can reduce hospitalization by up to 15 percent per year, reduce doctor visits by 20 percent per year and save patients between $200 and $600 per year.

An automated notifications company published a study in November saying that 82 percent of Midwesterners admit they don't follow treatment plans they've been given by their doctor exactly as prescribed. The study also found that patient follow up can help.

Scott Zimmerman, president of Televox that published the findings, said Kelton Research, an external research firm, did the national research for Televox, which involved 2,200 physicians and more than 1,000 patients over a two- to three-week period.

"Physician support stops at the point that treatment begins and patients are expected to go it alone. Yet, when you look at the biggest frustrations to health care providers, it is patients not following through on treatment protocal," he said.

Televox reported that more than one-third (39 percent) of people living in the Midwest who feel they could better follow their prescribed plans would be likely to do so if they received encouragement from their doctors between visits to stay on course. Thirty-eight percent of Midwesterners said they would follow instructions better if they received reminders from their doctors via email, voicemail or text telling them to do something specific, like take medication or check blood sugar levels.

Dr. Laura Archuleta, a family medicine physician at St. Alexius Medical Center, said that getting patients to follow her recommendations can be challenging.

"I tell a lot of patients that if people actually followed my advice, I'd be out of a job. Most of what we see is lifestyle-induced," she said.

"Some diseases don't have a lot of symptoms. High blood pressure, diabetes, cholesterol," she said. "It's hard to convince (patients) to stay on medication for something when they feel OK."

Getz had difficulty listening to doctor recommendations when he was first diagnosed with diabetes because it was hard to change his diet and he felt healthy.

"I'm a meat and potatoes guy. I worked on farms all my life," he said.

"Most people my age figure, ‘I feel healthy, so I'm healthy,'" he added, laughing. "I wasn't."

Dr. Shraz Hyder of St. Alexius said that although the hospital does not have this particular program yet, they have other ways of following up with patients.

"We have staff who check on patients to see how they're doing subsequent to ER visits in terms of medication and compliance," he said.

Hyder said the hospital will implement Patient Centered Medical Home in the "near future" and has already hired a new physician whose roles will include helping to implement the program.

"I think we've always found this is something that would benefit the community ... the time has to be right for any project to be successful, and we feel this is the right time," he said.

Getz said the program has benefitted him so far.

"You can tell me something one day, and a month later I'm gonna forget it. I'm probably going to walk out the door and forget it," he said. "But here, it's every Monday."

When Getz started the program in September, his A1C level was "out of control" at 10.7. Now, it's 7.5. The blood sugar range for a person without diabetes is between 4.2 and 6, Will said.

"If it helps me live another year," Getz said, "that's super good."

Reach reporter Mara Van Ells at 250-8251 or

Copyright 2015 Bismarck Tribune. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

(1) Comments

  1. JEngdahlJ
    Report Abuse
    JEngdahlJ - December 19, 2011 9:44 am
    Medical homes face a public awareness problem. The solution? Scenarios that work.
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