By: Jerry Meece, BPharm, CDE, FACA, FAADE
Mr. Meece is the Owner, Chief Pharmacist, Diabetes Educator, and Director of ClinicalServices at Plaza Pharmacy and Wellness Center in Gainesville, TX. He has written many articles on diabetes care and insulin use in patients with diabetes. Mr. Meece has also spoken across the country, as well as in Mexico, Canada, and Australia on the subject of diabetes and disease state management in the pharmacy setting.
I’ve recently been working with SimCare Diabetes Case Simulations, an online diabetes education program for healthcare professionals (HCP) that AADE is now offering. It provides a unique and engaging way of learning how to better care for people with diabetes. It uses data gathered from thousands of patients to create 18 composite cases of people with type 1 and type 2 diabetes that the HCP is most likely to encounter in everyday practice.
The simulated cases and program, developed by Health Partners of Minneapolis, MN, challenge the clinician to make treatment decisions on diagnostics, therapeutics, monitoring and referrals to help the person with diabetes reach care goals in A1C, BP and LDL within a six-month period.
While originally offered as a training for primary care providers, the program offers a robust learning experience for the diabetes educator at all practice levels. One key aspect I was impressed with was the “reality” of what took place once recommendations were made from the first encounter with a patient to several encounters later to reach ADA goals.
The participant/clinician is called upon to order labs, “prescribe drugs” or make drug changes, give lifestyle advice, and suggest monitoring schedules for patients using an electronic health record interface. The beauty of the program is the instant feedback received from each encounter by entering the next appointment. For example, if someone only on metformin is started on basal insulin, what is seen is not only an improvement in the fasting blood glucose “two weeks later,” but how much improvement starting the insulin resulted in. The results are shown immediately at the click of a mouse. As therapy is advanced, the clinician is free to call for more frequent and precise self monitoring of blood glucose (SMBG) checks, add or change other drugs such as statins blood pressure (BP) meds etc., and order the labs that are needed to measure their effects.
The program offers a robust learning experience for the diabetes educator at all practice levels
Another advantage of the program is that the participant can work through each patient at his/her own pace, developing confidence in their recommendations. If a person is on metformin and glargine but blood glucose is high after breakfast and dinner, do you want to know how much adding six units of Novolog® before those meals will alter their BG? Plug in the orders (you’ll have to remember to change the checking of SMBG before and two hours after these meals or as often as you feel is needed) and with the click of a mouse, the results are seen “two weeks later.” Do you want to move on with this person or completely start over? It’s all up to you.
If you are timid or new to ordering the required labs or not sure what the latest guidelines are for managing diabetes, again the program has these available at the click of a mouse, a great way to learn and refresh learning when it’s required.
Most importantly, after each encounter and before the next “appointment,” SiMCare offers advice on what was missed in the last patient encounter (needed a larger BP cuff, a statin should have been added, change in BP meds needed, etc).
There are always nuances and ways of improving simulated software programs. For example, I would have liked to see a metformin and basal insulin titration included so that I would have less mouse clicking to do. Overall, I have yet to see anything close to a software program that places the healthcare professional in the driver’s seat and presents as close to “real world learning” as the SiMCare program does.