A statewide effort to support diabetes prevention efforts with a physician champion initiative resulted in increased physician outreach, patient identification resources, and referrals to the National Diabetes Prevention Program, suggesting this work with physician champions can be further translated and applied to other states’ prevention efforts.
To increase referrals to the Centers for Disease Control and Prevention’s (CDC) evidence-based National Diabetes Prevention Program (DPP) in North Carolina, the American Medical Association (AMA) and the North Carolina Medical Society (NCMS) tried a novel tactic, a grassroots influence campaign driven by a team of hand-picked physician champions. A new study, “A Statewide Physician Champion Initiative to Prevent Diabetes: Lessons Learned from North Carolina,” details the successes and challenges of this effort as well as lessons learned.
The National DPP lifestyle change programs were developed by the CDC in partnership with public and private organizations to build a delivery system to target type 2 diabetes prevention in adults with prediabetes. The program is built on evidence-based research that clearly demonstrates that intensive lifestyle change focused on healthy eating, physical activity, and stress reduction is the most effective intervention for preventing the onset of diabetes.
The initiative- Diabetes Free NC, sought to enroll 5,000 patients in the National DPP between January 2020 and January 2023 and was successful thanks to the financial support provided by AMA and NCMS and close coordination between those organizations and the champions. The physician champions led efforts in educating other physicians in peer-to-peer settings to increase referrals to the program and dispatched within their communities to raise awareness about diabetes treatment and diagnosis.
The six physician champions selected for the initiative were all board-certified primary care physicians specializing in family medicine, internal medicine, or geriatrics who held current or previous leadership roles and had an existing relationship with NCMS. Champions were chosen not just for their clinical expertise but also for their ability to be leaders, advocates, coalition-builders, and presenters.
Once selected, champions went through orientation training and received quarterly coaching from AMA team members to review evidence and guidelines and receive feedback on key messages to use with a physician audience. An important aspect of the program was clearly defining the roles and responsibilities expected of the champions and remaining in constant contact with the support teams from AMA and NCMS.
The champion’s responsibilities included supporting diabetes prevention awareness efforts and disseminating clinical content. They served as ambassadors for the program in their health care organizations and community while attending events and conferences where they could speak to peers and decision-makers. Champions participated in events such as a panel discussion at the virtual CPP Annual Meeting/Lifestyle Medicine Summit, and East Carolina University Family Medicine Grand Rounds and gave a presentation at the North Carolina Ophthalmology Annual Meeting. Champions were encouraged to leverage any opportunity to connect with and educate other physicians and community leaders. They established relationships with church leaders and YMCA coaches, conducted physician-led educational sessions in a community dinner series, and partnered with the local YMCA and health clinics to hold a diabetes prevention event that included blood glucose testing with referrals to the YMCA diabetes program for those who qualified, and a healthy cooking class sponsored by a local nonprofit organization. Champions kept in regular contact with AMA and NCMS leadership to share updates on their activity and progress.
Champions leveraged social media and gave interviews for articles from AMA news, NCMS Morning Rounds and some local newspapers in Fayetteville, NC, which were then highlighted in email campaigns directed at primary care physicians. All champions promoted the removal of barriers to care and encouraged more funding opportunities to increase physician engagement in diabetes prevention efforts.
Successes reported by the physician champions include increased awareness of prediabetes through outreach and clinical education. It also enabled collaborations with community-based organizations, adopting shared learnings and best practices, and availability of statewide referral platforms that aided champions in engaging peers. Overall, there was an increase in prediabetes identification and management, which led to increased referrals to the National DPP. Program success would not have been possible without leveraging the NCMS member network to build a grassroots awareness campaign, which was then supported by the AMA.
The approach and strategies outlined in “A Statewide Physician Champion Initiative to Prevent Diabetes: Lessons Learned from North Carolina” can be used to promote other public health initiatives as it has proven to be very effective in raising awareness and increasing treatment uptake. This effort proved effective, so much so that the AMA is using a similar strategy to promote its state-based efforts to increase prevalence and coverage of Self Measured Blood Pressure programs.
Acknowledgments:
I would like to gratefully acknowledge all the co-authors of this study, colleagues at NCMS, and the physician champions who participated in this initiative with their respective organizations. A special thanks to Valerie Lapointe for her assistance with the blog post.
Author Profile
- Dr. Tamkeen Khan is a Senior Economist for the American Medical Association’s ‘Improving Health Outcomes’ strategic focus area. Dr. Khan’s research focuses on the economics of chronic disease and her work helps establish a strong evidence base for cardiovascular disease prevention. Dr. Khan holds PhD in Economics from the University of Illinois at Chicago.