EBP: Incorporating Best Evidence, Clinical Expertise, and Patient Preferences

Evidence-based practice is one of the latest trends in the field of nursing and healthcare in general. Evidence-based practice is the accurate, direct and informed use of best available evidence in patient care decision making. There are three fundamental building blocks for evidence-based practice. These include the best research evidence that is available, clinical expertise of the caregiver and the patient preferences and values. Therefore, the evidence-based practice needs to be incorporated in case management patient care guidelines and pathways for Diabetes Mellitus Type 2. Case management patient care guidelines and pathways are the rules that govern the collective process of facilitation, assessment, care coordination, planning, evaluation and promotion of services and options to provide a group's or an individual's health needs through the use of available resources and communication to promote quality, safe and cost-effective care to the patients. For this discussion, the group whose health care needs will be discussed is the Diabetes Mellitus Type 2 patients. The paper will be exploring the use of evidence-based practice in case management patient care guidelines for Diabetes Mellitus Type 2 by identifying and discussing current best practices, evaluating published guidelines for treating or addressing the condition, and describing how clinical pathways help to address the importance of basing case management on current practice.

Some of the current best practices in regards to diabetes mellitus type 2 include a combination of therapies in treatment and management and measures that are cost-effective for optimal diabetes care. According to Bunn (2009), the first level of treating type 2 diabetes involves exercise, diet and weight loss. Nursing practices have been emphasizing on those three factors because they play a significant role in the management of type 2 diabetes. Managing the weight, and diet works to complement other procedures and increases their productivity. However, if the methods above prove ineffective, then the nurses can incorporate medication options. Medical options include older drugs such as sulfonylureas, and the newer incretin-based agents like sitagliptin CITATION Wil09 \l 1033 (Bunn, 2009). However, evidence has shown that these treatment and management procedures yield results when used alongside therapies in combination. So far incretin-based therapies have shown the probability of slowing down disease progression in those patients who have type 2 diabetes while preventing the onset of the disease in those at risk CITATION Wil09 \l 1033 (Bunn, 2009). A combination of these therapies is advisable due to their glycemic control properties, along with fewer side effects.

There are also several programs which are part of current best practice that is meant to provide cost-effective measures for optimal diabetes care. One such program is the value-based health management. According to Bunn (2009), this program is intended to control company healthcare costs by targeting employee benefits. The programs use three techniques: focusing on prevention, removing barriers like out of pocket costs and the incorporation of care management. Another example of a program seeking to provide cost-effective measures is the case and disease management programs. The purpose case management according to Bunn (2009) is to improve coordination of care, provide optimal wellness and to provide non-duplicative services that are cost effective. In regards to type 2 diabetes case management programs have been resourceful particularly when it comes to patient satisfaction and process measures AIC testing. Other programs aimed at costs also include the pay for performance and risk sharing. Pay for performance works as per reward basis where the health practitioners are rewarded when their service meets specific criteria and their reimbursements are decreased when the quality of their service fails to meet the set standards. As for risk sharing, a good example is an announcement by the health insurer Cigna. In a bid to increase access and affordability of diabetes drugs, Cigna announced that it would be providing discounts on its diabetes drugs if the members comply to the medications regardless of the sponsoring manufacturer of the drug.

Treatment or management of type 2 diabetes mellitus requires adherence to specific guidelines as stipulated by the American Diabetic Association (ADA). According to ADA (2016), clinical practice guidelines are necessary for improving care among the diabetic population. However, for maximum care, the treatment process or management of diabetes mellitus type 2 needs to be individualized. These standards act as guidance for how and when to adopt recommendations. An evaluation of the guidelines will reveal that they focus on three main themes in regards to diabetes and healthcare.

The first point of focus is patient-centeredness. The ADA stipulates that the recommendations, whether they are based on evidence or expert opinion, should be intended to guide on the overall approach to care. Since the patients with type 2 diabetes have an increased risk for developing cardiovascular disease, a patient-centered approach should have a complete plan to reduce the risk of developing the cardiovascular disease by addressing matters such as physical activity, healthy lifestyle choices, smoking prevention, cessation, weight management, and blood pressure. The second category is advocacy for people who have diabetes type 2 CITATION ADA16 \l 1033 (ADA, 2016). Advocacy is the engagement and support to advance a particular policy. Advocacy is an essential part of treating and managing type 2 diabetes. Advocacy is necessary to make changes at the root cause of the problem such as physical inactivity, smoking, and obesity. The third theme as per the ADA guidelines is the focus on diabetes across the lifespan CITATION ADA16 \l 1033 (ADA, 2016). There is a growing case of type 2 diabetes among children. Patients who have type 2 diabetes are managing to live well into the older age. Unfortunately, old age is a stage in life where there exists little evidence from clinical trials that would guide the therapy. These changes in demographics depict a challenge in high-quality diabetes care. That goes to show the need for more coordination between different clinical teams as the patients move across the various stages of their lifespans CITATION ADA16 \l 1033 (ADA, 2016).

Clinical pathways can help to address the importance of basing case management on current practice through the following ways. Based on the definition provided by Kinsman et al., (2010), clinical pathways are the tools implemented internationally that are used as a guide for evidence-based healthcare. These tools work to support the importance of evidence-based practice in case management by supporting the introduction of evidence-based medicine and the use of clinical guidelines (Campbell et al., 1998). Also, clinical guidelines can also help by providing standards of care that are explicit and well defined.

Based on the article written by Campbell and his team, clinical pathways have improved the participation of patient or carer inpatient care (Campbell et al., 1998). That goes to show that clinical pathways can empower patients as well as caregivers. Patient participation is an essential part of case management. Patient preferences are among the three building principles for evidence-based practice. As a result, the clinical pathway is showing that patient participation is necessary for caregiving by working to empower patients. Case managers would, therefore, integrate evidence-based practice to get patient involvement.

Conclusion

Healthcare for diabetes mellitus type 2 patient requires tailor-made solutions. Case management is capable of providing individualized care to diabetic patients. However, to be able to get the full benefits of case management, case managers need to incorporate evidence-based practice. Some of the current best practices in treating type 2 diabetes include incorporation of therapies in treatment and management as well as cost-effective measures. An evaluation of the published guidelines for type 2 diabetes indicates that patient-centeredness and advocacy are among the main areas of focus for the guidelines. It worth noting that clinical pathways have played an important role in showing the importance of basing case management on the evidence-based practice by including evidence-based practice in the guidelines.

References

BIBLIOGRAPHY \l 1033 ADA. (2016, January). Strategies for Improving Care. American Diabetic Journals, 39(Suppl. 1), S6-S12. doi:10.2337/dc16-S004

Bunn, W. B. (2009, September). Best Practices in the Care of Type 2 Diabetes: Integrating Clinical Needs With Medical Policy and Practice. American Journal of Managed Care, 15(9), S263-S268. Retrieved from https://www.ajmc.com/journals/supplement/2009/a256_09sep_diabetes/a256_09sep_bunns263to68?p=1

Campbell, H., Hotchkiss, R., Bradshaw, N., & Porteous, M. (1998). Integrated care pathways. BMJ (Clinical research ed.), 316(7125), 133-137.

Kinsman, L., Rotter, T., James, E., Snow, P., & Willis, J. (2010). What is the clinical pathway? Development of a definition to inform the debate. BMC Medicine, 8, 31. doi:10.1186/1741-7015-8-31