Primary Care Providers in California and Florida Report Low Confidence in Providing Type 1 Diabetes Care

Lal, Rayhan; Cuttriss, Nicolas; Haller, Michael J.; Yabut, Katarina; Añez-Zabala, Claudia; Hood, Korey K.; Sheehan, Eleni; Basina, Marina; Bernier, Angelina; Baer, Linda G.; Filipp, Stephanie L.; Wang, C. Jason; Town, Marissa; Gurka, Matthew J.; Maahs, David M.; Walker, Ashby F.

doi:10.2337/cd19-0060

Cited by 18 publications

(16 citation statements)

References 22 publications

(17 reference statements)

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“…Data from the initial needs assessment with n=123 PCPs in FL and CA indicate that there are critical knowledge gaps in areas such as diabetes technology; for example, continuous glucose monitoring (CGM) or CGM and insulin pumps. 28 Data from 16 focus groups conducted in English and Spanish with n=86 medically underserved adults with T1D reiterated the need for provider education focused on diabetes technology, as focus group participants listed provider-level factors related to obtaining diabetes technology as one of the greatest barriers to achieving optimal health in T1D. 21 Findings from these preliminary efforts aided in curriculum development for the weekly tele-education ECHO clinics as well as the development of priority areas for the Diabetes Support Coaches to focus on for patient engagement.…”

Section: Methodsmentioning

confidence: 99%

Democratizing type 1 diabetes specialty care in the primary care setting to reduce health disparities: project extension for community healthcare outcomes (ECHO) T1D

Walker

Cuttriss

Haller

et al. 2021

BMJ Open Diab Res Care

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IntroductionProject ECHO (Extension for Community Healthcare Outcomes) is a tele-education outreach model that seeks to democratize specialty knowledge to reduce disparities and improve health outcomes. Limited utilization of endocrinologists forces many primary care providers (PCPs) to care for patients with type 1 diabetes (T1D) without specialty support. Accordingly, an ECHO T1D program was developed and piloted in Florida and California. Our goal was to demonstrate the feasibility of an ECHO program focused on T1D and improve PCPs’ abilities to manage patients with T1D.Research design and methodsHealth centers (ie, spokes) were recruited into the ECHO T1D pilot through an innovative approach, focusing on Federally Qualified Health Centers and through identification of high-need catchment areas using the Neighborhood Deprivation Index and provider geocoding. Participating spokes received weekly tele-education provided by the University of Florida and Stanford University hub specialty team through virtual ECHO clinics, real-time support with complex T1D medical decision-making, access to a diabetes support coach, and access to an online repository of diabetes care resources. Participating PCPs completed pre/post-tests assessing diabetes knowledge and confidence and an exit survey gleaning feedback about overall ECHO T1D program experiences.ResultsIn Florida, 12 spoke sites enrolled with 67 clinics serving >1000 patients with T1D. In California, 11 spoke sites enrolled with 37 clinics serving >900 patients with T1D. During the 6-month intervention, 27 tele-education clinics were offered and n=70 PCPs (22 from Florida, 48 from California) from participating spoke sites completed pre/post-test surveys assessing diabetes care knowledge and confidence in diabetes care. There was statistically significant improvement in diabetes knowledge (p≤0.01) as well as in diabetes confidence (p≤0.01).ConclusionsThe ECHO T1D pilot demonstrated proof of concept for a T1D-specific ECHO program and represents a viable model to reach medically underserved communities which do not use specialists.

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Section: Methodsmentioning

confidence: 99%

Democratizing type 1 diabetes specialty care in the primary care setting to reduce health disparities: project extension for community healthcare outcomes (ECHO) T1D

Walker

Cuttriss

Haller

et al. 2021

BMJ Open Diab Res Care

Self Cite

View full text Add to dashboard Cite

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“…The drivers of disparities are multi-layered with contributions from social determinants of health, structural inequities, insurance policies, and health care providers (1,4). Many individuals with diabetes do not consistently receive subspecialty care from an endocrinologist or diabetologist and rely on primary care providers (PCPs) for their diabetes management (5,6). However, PCPs are not trained on the specifics of diabetes management, including the nuances of insulin dosing and diabetes technology management.…”

Section: Introductionmentioning

confidence: 99%

“…However, PCPs are not trained on the specifics of diabetes management, including the nuances of insulin dosing and diabetes technology management. Although PCPs report regularly filling insulin prescriptions for individuals with diabetes, they report low confidence in providing diabetes care, including diabetes technology management (6). Lack of provider confidence in diabetes technology management and provider bias are barriers to technology access and utilization for individuals with diabetes (7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Tele-education model for primary care providers to advance diabetes equity: Findings from Project ECHO Diabetes

et al. 2022

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IntroductionIn the US, many individuals with diabetes do not have consistent access to endocrinologists and therefore rely on primary care providers (PCPs) for their diabetes management. Project ECHO (Extension for Community Healthcare Outcomes) Diabetes, a tele-education model, was developed to empower PCPs to independently manage diabetes, including education on diabetes technology initiation and use, to bridge disparities in diabetes.MethodsPCPs (n=116) who participated in Project ECHO Diabetes and completed pre- and post-intervention surveys were included in this analysis. The survey was administered in California and Florida to participating PCPs via REDCap and paper surveys. This survey aimed to evaluate practice demographics, protocols with adult and pediatric T1D management, challenges, resources, and provider knowledge and confidence in diabetes management. Differences and statistical significance in pre- and post-intervention responses were evaluated via McNemar’s tests.ResultsPCPs reported improvement in all domains of diabetes education and management. From baseline, PCPs reported improvement in their confidence to serve as the T1D provider for their community (pre vs post: 43.8% vs 68.8%, p=0.005), manage insulin therapy (pre vs post: 62.8% vs 84.3%, p=0.002), and identify symptoms of diabetes distress (pre vs post: 62.8% vs 84.3%, p=0.002) post-intervention. Compared to pre-intervention, providers reported significant improvement in their confidence in all aspects of diabetes technology including prescribing technology (41.2% vs 68.6%, p=0.001), managing insulin pumps (41.2% vs 68.6%, p=0.001) and hybrid closed loop (10.2% vs 26.5%, p=0.033), and interpreting sensor data (41.2% vs 68.6%, p=0.001) post-intervention.DiscussionPCPs who participated in Project ECHO Diabetes reported increased confidence in diabetes management, with notable improvement in their ability to prescribe, manage, and troubleshoot diabetes technology. These data support the use of tele-education of PCPs to increase confidence in diabetes technology management as a feasible strategy to advance equity in diabetes management and outcomes.

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“…Currently, 85% of people with diabetes are treated by primary care providers (PCPs). Although this represents mostly patients with type 2 diabetes (5), a substantial portion of patients with type 1 diabetes also get their diabetes care from a PCP (6). If currently practicing endocrinologists treated every person with type 1 diabetes in the United States, they would each need to see seven people with type 1 diabetes every day, leaving few appointments available for people with type 2 diabetes or any other endocrine disorder (6).…”

mentioning

confidence: 99%

“…Although this represents mostly patients with type 2 diabetes (5), a substantial portion of patients with type 1 diabetes also get their diabetes care from a PCP (6). If currently practicing endocrinologists treated every person with type 1 diabetes in the United States, they would each need to see seven people with type 1 diabetes every day, leaving few appointments available for people with type 2 diabetes or any other endocrine disorder (6). Fewer than 10% of people with diabetes have type 1 diabetes; however, many PCPs feel ill-prepared to actively manage both type 1 and type 2 diabetes and their complications (7,8).…”

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confidence: 99%

Primary Care Diabetes Fellowship Programs: Developing National Standards

et al. 2021

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The rapid and constant increase in the number of people living with diabetes has outstripped the capacity of specialists to fully address this chronic disease alone. Furthermore, although most people with diabetes are treated in the primary care setting, most primary care providers feel under-prepared and under-resourced to fully address the needs of their patients with diabetes. Addressing this care gap will require a multifaceted approach centering on primary care training in diabetes and its complications. One-year diabetology fellowship programs are well situated to provide this training. Previous research has shown that the higher the diabetes-specific volume of patients seeing a primary care physician was, the better the quality outcomes were across six quality indicators (eye examinations, LDL cholesterol testing, A1C testing, prescriptions for ACE inhibitors or angiotensin receptor blockers, prescriptions for statins, and emergency department visits for hypoglycemia or hyperglycemia). Primary care diabetes fellowships have existed for many years, but the number of fellowships and fellowship positions has recently grown dramatically. This article proposes a standardized curriculum for such programs and makes the case for increasing their number in the United States.

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Primary Care Providers in California and Florida Report Low Confidence in Providing Type 1 Diabetes Care

Cited by 18 publications

References 22 publications

Democratizing type 1 diabetes specialty care in the primary care setting to reduce health disparities: project extension for community healthcare outcomes (ECHO) T1D

Democratizing type 1 diabetes specialty care in the primary care setting to reduce health disparities: project extension for community healthcare outcomes (ECHO) T1D

Tele-education model for primary care providers to advance diabetes equity: Findings from Project ECHO Diabetes

Primary Care Diabetes Fellowship Programs: Developing National Standards

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