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Table 4 Evidence of “mindlines” conversations during practice visits

From: Socializing the evidence for diabetes control to develop “mindlines”: a qualitative pilot study

Type of “mindlines” conversation

Excerpts

Discussion among practice members

Interaction with each other about the registry and how they can work with each other to improve. [Field Note]

No formal meetings: “We constantly have conversations. Fine tuning, tweaking, ever-changing model” PA [Physicians Assistant] and Doc meet weekly and discuss Take 3 [a local literature review newsletter] – friendly educational session. Doc and PA seem on same page, seems mutually respectful. Complete each other’s sentences. They acknowledge each other’s different styles but prioritize care pattern consistency. [Field Note]

Female5: “I would like to see who is on the registry I am associated with.”

Female6: “I have a big ole stack of them. [Laughing]”

Female5: “Good I would like to see it.”

Female 3: “I have a registry on my desk, just printed a brand new one.”

[Transcript]

When female doc said local counselors are really good, the rarely-talking male doc shook head in disagreement rigorously; Disagrees; Silent docs looking down even when solicited for comments (about mental health) [Field Note]

Female4: “I have a list of counselling services available in the area, and I have a friend who is a psychiatrist in another area that has given me resources… If you ever need any, I have a list.”

Facilitator: “So, how does that information get shared across the practice?”

Female4: “I printed it out, cut it out and gave it to front desk for people or if we need a counselor. It was put in the referral area. It was available for anybody that needs it.” [Transcript]

Practice accepts new evidence

Male 5: “Probably [see them] every 3 months or so, or 3–6 months if it’s over 9 you said?”

Facilitator: “Over 9.”

Male 5: “Over 9 probably every 3 months.” [Transcript]

“Yes, I have changed their depression medicine as well as their diabetes medication, plus improved their diabetes.” [Transcript]

“I have a lot of success stories; I have a lot of patients I have dealt with an A1C greater than 9 and metformin and other medications and switching medications and adding agents and it has cut A1C in half.” [Transcript]

“We look at quality metrics and we have started to print list and that type of thing.” [Transcript]

“One of our care coordinators worked in psychiatry and actually did a lot of counseling and so we do that. We also find resources in the community but there is another opportunity with tele-medicine and behavioral health as well.” [Transcript]

Screen for depression, most diabetics already on anti-depressant, it is addressed in follow-up [Field Note]

Try to get people in for diabetic self-management or diabetic education [Field Note]

Practice adapts new evidence

“That’s one of the secrets that I’ve learned coming here is using the NPH instead of the long-acting ones.” [Transcript]

Constantly fine tuning and tweaking and trying things

Interaction with each other about the registry and how they can work with each other to improve. [Field Note]

“Sometimes switch them to NPH or 70/30 something that is less expensive.” [Transcript]

“With counseling we don’t make those appointments any longer, because of the fact we were making them in the beginning and the back and forth of where they’re calling the patient and the patient was like I don’t need this, so they were like we are calling all these patients and they don’t want any of this help so now we give them the information and you contact them and then they don’t contact them.” [Transcript]

Female 16: “Because I am the one, they see at the beginning and I am the one they see for the lab and I am the one they see at check out. So, I am pretty much everything or we are pretty much everything. So, we are the lab and the ones that are checking them in and telling them what the doctor wanted to do…once again they dump it all in the lab. They tell you a lot of things”

Facilitator: “They do? I feel like there is potential here. What if we surrounded her with some sort of resources to be able…”

Female 16: “What’s another job title I could have?” [Transcript]

Practice rejects new evidence

“I honestly, just because of the complexity of it [referral to care coordinator], I almost never do that. I think I have done it one time in 10 months.” [Transcript]

When PI [Principal Investigator, Facilitator] shared resource page, two staff adamantly pointing at page and saying no. [Field Note]

“But I know it’s tele, I think it’s horrible actually, but I mean that’s what’s done so tele-everything. I don’t like it. I think that, that’s what I’m trying to say from the beginning, being in the room with a patient, just trying to understand where they are at. I don’t’ think you can get that over a video screening. I don’t like that at all. That’s what I say about that.” [Transcript]

Wishes

“I have talked to management about having a nutrition class on Saturday once a month and I would want to do that but how do you make a nutrition class that everyone in our area can attend and would comprehend it?” [Transcript]

“What would be nice is if we could have, when they came in for their appointment with us for a comprehensive appointment if we have a care coordinator, “Oh hey, I think, you know what? Why don’t you meet with her while you are here? It’s a one stop shop, we can talk about our diet and your medications more thoroughly than the 15-min visit you had with your provider.” [Transcript]

“This is like I don’t know, but it would be nice to have counseling available in area. A person that I could send people to. You can wish for all kinds of things.” [Transcript]