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. 2022 Dec 16:13:1066521.
doi: 10.3389/fendo.2022.1066521. eCollection 2022.

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

Ananta Addala  1 , Stephanie L Filipp  2 , Lauren E Figg  1 , Claudia Anez-Zabala  2 , Rayhan A Lal  1   3 , Matthew J Gurka  2 , Michael J Haller  2 , David M Maahs  1   4 , Ashby F Walker  5 ; Project ECHO Diabetes Research Team
Collaborators, Affiliations

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

Ananta Addala et al. Front Endocrinol (Lausanne). .

Abstract

Introduction: In 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.

Methods: PCPs (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.

Results: PCPs 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.

Discussion: PCPs 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.

Keywords: disparities; equity; health; primary care provider education; tele-education; type 1 diabetes.

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Conflict of interest statement

DM has received research support from the National Institutes of Health, JDRF, NSF, and the Helmsley Charitable Trust; and his institution has received research support from Medtronic, Dexcom, Insulet, Bigfoot Biomedical, Tandem, and Roche. He has consulted for Abbott, the Helmsley Charitable Trust, Sanofi, Novo Nordisk, Eli Lilly, and Insulet, and is supported by grant number P30DK116074. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References

    1. Hill-Briggs F, Adler NE, Berkowitz SA, Chin MH, Gary-Webb TL, Navas-Acien A, et al. Social determinants of health and diabetes: A scientific review. Dia Care (2021) 44(1):258–79. doi: 10.2337/dci20-0053 - DOI - PMC - PubMed
    1. Lipman TH, Hawkes CP. Racial and socioeconomic disparities in pediatric type 1 diabetes: Time for a paradigm shift in approach. Diabetes Care (2021) 44(1):14–6. doi: 10.2337/dci20-0048 - DOI - PubMed
    1. CDC. Advancing Health Equity . Centers for disease control and prevention. Available at: https://www.cdc.gov/diabetes/health-equity/index.html.
    1. Ogunwole SM, Golden SH. Social determinants of health and structural inequities–root causes of diabetes disparities. Diabetes Care (2020) 44(1):11–3. doi: 10.2337/dci20-0060 - DOI - PubMed
    1. Walker AF, Cuttriss N, Haller MJ, Hood KK, Gurka MJ, Filipp SL, et al. Democratizing type 1 diabetes specialty care in the primary care setting to reduce health disparities: project extension for community healthcare outcomes (ECHO) T1D. BMJ Open Diabetes Res Care (2021) 9(1):e002262. doi: 10.1136/bmjdrc-2021-002262 - DOI - PMC - PubMed

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