Implementation of Diabetes Prevention in Health Care Organizations: Best Practice Recommendations.

Approximately 1 in 3 American adults has prediabetes, a condition characterized by blood glucose levels that are above normal, not in the type 2 diabetes ranges, and that increases the risk of developing type 2 diabetes. Evidence-based treatments can be used to prevent or delay type 2 diabetes in adults with prediabetes. The American Medical Association (AMA) has collaborated with health care organizations across the country to build sustainable diabetes prevention strategies. In 2017, the AMA formed the Diabetes Prevention Best Practices Workgroup (DPBP) with representatives from 6 health care organizations actively implementing diabetes prevention. Each organization had a unique strategy, but all included the National Diabetes Prevention Program lifestyle change program as a core evidence-based intervention. DPBP established the goal of disseminating best practices to guide other health care organizations in implementing diabetes prevention and identifying and managing patients with prediabetes. Workgroup members recognized similarities in some of their basic steps and considerations and synthesized their practices to develop best practice recommendations for 3 strategy maturity phases. Recommendations for each maturity phase are classified into 6 categories: (1) organizational support; (2) workforce and funding; (3) promotion and dissemination; (4) clinical integration and support; (5) evaluation and outcomes; (6) and program. As the burden of chronic disease grows, prevention must be prioritized and integrated into health care. These maturity phases and best practice recommendations can be used by any health care organization committed to diabetes prevention. Further research is suggested to assess the impact and adoption of diabetes prevention best practices.

Physician offered prayer and patient satisfaction.

OBJECTIVE: While there is ongoing debate about the role of physician-offered prayer during the physician-patient encounter, many physicians feel inclined to include prayer in their practices. This randomized-controlled trial evaluated patients' acceptance of physician-offered prayer in a family practice setting, and the impact of physician-offered prayer on patient satisfaction with the physician-patient encounter. METHOD: Subjects were 137 patients in an urban, largely African American, Southeastern family medicine practice who were randomized to receive usual care plus an offer of physician-led prayer or usual care alone. Satisfaction surveys were administered following the clinical encounter. The outcomes of interest were the rate of acceptance of physician-offered prayer and the impact of the prayer offer on patient satisfaction. Personal characteristics and satisfaction scores for patients accepting prayer were compared to those for patients declining prayer. RESULTS: Over 90% of patients accepted the offer of prayer. The offer of prayer had no significant impact on patient satisfaction scores. The number of patients declining prayer was too low to permit comparison of prayer decliners with acceptors. CONCLUSIONS: This small pilot trial demonstrated that patient responses to spiritual interventions by physicians can be evaluated using randomized study designs. A large majority of patients accepted an offer of physician-led prayer, but no significant short-term impact on patient satisfaction was detected. Future research with larger sample sizes and more diverse patient populations should evaluate the effects of physician-offered prayer on the physician-patient relationship. Difficulties in conducting such research are discussed.