Frontiers in Endocrinology (Dec 2022)

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

  • Ananta Addala,
  • Stephanie L. Filipp,
  • Lauren E. Figg,
  • Claudia Anez-Zabala,
  • Rayhan A. Lal,
  • Rayhan A. Lal,
  • Matthew J. Gurka,
  • Michael J. Haller,
  • David M. Maahs,
  • David M. Maahs,
  • Ashby F. Walker,
  • for the Project ECHO Diabetes Research Team,
  • Michael Haller,
  • Eleni Sheehan,
  • Angelina Bernier,
  • Sarah Westen,
  • Hannah Stahmer,
  • William Troy Donahoo,
  • Xanadu Roque,
  • Gabby Malden,
  • Melanie Hechavarria,
  • David Maahs,
  • Rayhan Lal,
  • Ananta Addala,
  • Lauren Figg,
  • Katarina Yabut,
  • Noor Alramahi,
  • Ana Cortes,
  • Dessi Zaharieva,
  • Marina Basina,
  • Katie Judge,
  • Lety Wilke,
  • Korey Hood,
  • Jessie Wong,
  • Jason Wang,
  • Suruchi Bhatia,
  • Eugene Lewit

DOI
https://doi.org/10.3389/fendo.2022.1066521
Journal volume & issue
Vol. 13

Abstract

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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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