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Remote training equips rural primary care providers to treat complex diabetes
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ORLANDO, Fla. — Videoconferencing educational programs led by diabetes specialists help primary care providers gain confidence in their ability to treat patients with complex diabetes, according to findings presented at the Endocrine Society Annual Meeting.
“We know that diabetes is a manageable condition; we can prevent all of the complications of diabetes. Yet, today nearly half of the 30 million Americans with diabetes have ‘uncontrolled’ diabetes by current standards,” Matthew Bouchonville, MD, CDE, endocrinologist and assistant professor at the University of New Mexico School, told Endocrine Today. “These are often the ones with more complex diabetes who are referred to a diabetes specialist. The problem is we are short about 1,500 endocrinologists in the United States — and the ‘access gap’ for these patients is expected to continue widening over the next 10 years. This is not a sustainable system of health care delivery.”
Part of Project ECHO (Extension for Community Healthcare Outcomes) trains primary care clinicians and community health workers in complex disease to provide specialty care in underserved populations.
In the study, primary care providers from 10 rural health care centers in New Mexico were connected with endocrinologists, nurses, certified diabetes educators, behavioral health specialists and social workers, who are part of Endo ECHO, to become a local “endocrine expert” for managing complex diabetes at their center. The program consisted of weekly 2-hour videoconferencing sessions and mentoring on specific cases. The program is designed to progress for 4 years.
Participants were asked to complete a survey at baseline and 1 year into the program.
Survey respondents (n = 23) reported improvement in all measures of self-efficacy for the management of complex diabetes. Self-efficacy measures included confidence in their ability to manage complex insulin regimens and to screen for diabetes complications. Mean scores improved from 2.59 at baseline to 6.02 (P < .0001) at 1 year in community health care workers and from 3.66 to 5.84 (P < .0001) in primary care providers.
“Our study demonstrates we can equip these primary care providers with the skills and confidence needed to manage patients with complex diabetes they would otherwise have referred elsewhere for their care,” Bouchonville said. “We have enrolled almost 900 patients with type 1 and complex type 2 diabetes in Endo ECHO and are tracking their outcomes in collaboration with an external evaluation team at New York University. We believe that Endo ECHO is improving diabetes care in New Mexico and that this model is applicable to underserved regions around the globe.”
The Endo ECHO program sessions are free and open to providers anywhere. – Cassie Homer
Reference:
Bouchonville MF, et al. SH02-5. Presented at: The Endocrine Society Annual Meeting; April 1-4, 2017; Orlando.
Disclosure: Bouchonville reports no relevant financial disclosures. The Endo ECHO program is supported by The Helmsley Charitable Trust.
Perspective
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Saleh Aldasouqi, MD, FACE, ECNU
The traditional format of telemedicine is online communication with patients. However, this study is an innovative application of the technology to help to tackle the shortage of endocrinologists and diabetes specialists at large, but especially in rural communities. As the researchers noted, there currently exists a significant shortage of 1,500 endocrinologists nationwide. Furthermore, it has been observed that the majority of patients with diabetes in the population at large are managed not by endocrinologists, but by primary care providers. This intervention is designed to help fill this access gap in standard diabetes care, especially in rural and underserved communities.
The researchers conducted weekly 2-hour multidisciplinary educational videoconferences with primary care providers and allied clinicians (nurses, diabetes educators, etc) from 10 rural clinical practices. The project has been ongoing since November 2014. The sessions involved discussions of de-identified cases focusing on management of complex diabetes, as well as didactic clinical presentations.
The results are quite positive, as depicted in the before-and-after surveys completed by 23 clinical participants, with significant improvement in diabetes-related skills and comfort with managing cases with complex diabetes. These skills are then implemented in the diabetes management of a collective group of 900 patients with diabetes.
It will be interesting to learn the clinical outcomes of this intervention in the participating patients, which the researchers are still interpreting.
I would like to add an additional tool to tackle the shortage of diabetes specialists in the U.S. and potentially globally. The proposal is to start accredited diabetes fellowship programs across the country within existing endocrinology fellowship programs, or as start-up training programs. The proposed duration is 1 year, both outpatient and inpatient, with a diabetes-only curriculum. I trust this would attract a large number of trainees and would be easy to implement. At Michigan State University, we have been thinking about this for few years, but have not so far overcome the logistics/obstacles. However, I came across two programs that have been in existence for a decade or so, one at East Carolina University in Greenville, North Carolina, and the other at Ohio University, in Athens, Ohio. Unfortunately, both programs are still not accredited, awaiting wider acceptance and application.
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