3. Addressing the Problem: iPDM
Integrated personalised diabetes management, or iPDM, is a therapeutic approach which structures the treatment process [8], connects healthcare professionals (HCPs) and patients, and integrates digital tools that visualize and analyse data. In this regard, iPDM has the potential to address several different aspects of clinical inertia.
Specifically, iPDM is built upon five guiding principles
Assessment
Where does a patient stand? What goals does a patient have? What would he/she like to achieve? What would he/she (not) like to change?...
Collaborative Care and Participative Decision Making
Inclusion of the patient in the evaluation and adaptation or modification of the therapy as required
Feedback
Regular feedback on the achievement of therapeutic goals and adherence (compliance with self-monitoring of blood glucose recommendations)
Training and Counselling
Joint, structured analysis of the course of therapy
Written Agreements
Written agreement on therapeutic measures until the next appointment
iPDM consists of six steps that are repeated iteratively throughout the care practice.
Step 1: Structured assessment and training
The medical team assesses the diabetes-related health status and skills of the patient and instructs him/her in the performance of correct blood glucose measurements.
Step 2: Structured and therapy-adapted self-management of blood glucose
For example using connected devices rather than manually documenting blood glucose values.
Step 3: Structured documentation of clinical information
Self-measured blood glucose data is evaluated and visualised as an electronic report with selectable elements, including graphics, tables and statistics.
Step 4: Systematic analysis of patient generated data using digital tools
The patient and the physician collaboratively analyse blood glucose data in detail (e.g. daily curve, weekly curve, special events) and abnormal glycaemic patterns and glycaemic risks are identified.
Step 5: Joint decision making about personalized treatment strategies
Based on the results of the systematic analysis of the measured blood glucose values, patients and physicians discuss whether, and if so, how, the diabetes therapy should be adapted. If the self-measured blood glucose testing regime is changed, the new regime is documented and provided to the patient as a printout.
Step 6: Regular Treatment effectiveness assessments
During the next visit, patients and physicians analyse measured blood glucose values and assess whether previous measures have been sufficient to achieve the jointly agreed-upon therapy objectives or if therapy has to be further adjusted. By doing so, a new iPDM cycle starts.
The iPDM process
The iPDM process should be followed at each visit that the patient has with her doctor. Several steps of the cycle can be performed during each one of these visits.
- Step 1: Structured assessment and training
- Step 2: Structured and therapy-adapted self-management of blood glucose
- Step 3: Structured documentation of clinical information
- Step 4: Systematic analysis of patient generated data using digital tools
- Step 5: Joint decision making about personalized treatment strategies
- Step 6: Regular Treatment effectiveness assessments
- The iPDM process
[8] Ceriello et al. Diabetes as a case study of chronic disease management with a personalized approach: the role of a structured feedback loop. Diabetes Res Clin Pract. 2012 Oct; 98(1):5–10O'Connor et al. Clinical Inertia and Outpatient Medical Errors. In: Henriksen K et al., editors. Advances in Patient Safety: From Research to Implementation (Volume 2: Concepts and Methodology). Rockville (MD), USA: Agency for Healthcare Research and Quality (US) 2005; pp. 293–308.
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