Louisville Medicine Volume 63, Issue 9 - Page 13

in helping patients to be accountable. I had no idea how I would achieve it, but I was convinced, and from that moment my paradigm was transformed. I no longer believed that it was just a matter of the patient following or choosing not to follow recommendations. A couple years ago our practice started working on Patient Centered Medical Home (PCMH) Certification. A few months ago we received NCQA recognition as a level 3 PCMH. During the process of becoming PCMH certified, I realized that there were many, many things the practice had to do, but almost none, if any, had anything to do with patient responsibilities and their compliance. There was nothing that I saw that addressed patient accountability and responsibility directly, or even indirectly. It seemed as though this part was avoided, and completely left up to the provider/practice to figure out on their own. I decided at that moment that I was not going to work so hard and diligently to get all of the other pieces of PCMH in place and not include (create myself and add in on my own) some type of patient accountability to be embedded in the PCMH process/model. After thinking long and hard, I decided that the one place I knew for sure that I had solid ground to stand on was requiring our diabetic patients to bring a blood sugar log to their appointments. We all know the excuses that patients make and the continuous avoidance of bringing the logs to us. We know they don’t check their blood sugar like they are supposed to, and we know that it is impossible to control your blood sugar if you don’t know what your blood sugar level is. The A1C has been a wonderful blessing, and a game-changer for sure. But it isn’t enough by itself. We need more. So, I made a policy for all diabetic patients in our practice, that they must bring a written blood sugar log to their diabetic follow-up appointments. I kept talking with each diabetic patient about the importance of checking the finger stick blood sugar regularly in order to control it, until the patient was in agreement with me that it was vital and critical to controlling their diabetes. In order for me to help them, I needed to see the log. Once we were in agreement, we moved forward. I told them all very clearly that if they don’t bring their log the first time, that