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

2020 ◽  
Vol 38 (2) ◽  
pp. 159-165 ◽  
Author(s):  
Rayhan A. Lal ◽  
Nicolas Cuttriss ◽  
Michael J. Haller ◽  
Katarina Yabut ◽  
Claudia Anez-Zabala ◽  
...  
Keyword(s):  
Primary Care ◽  
Type 1 Diabetes ◽  
Diabetes Care ◽  
Primary Care Providers ◽  
Care Providers

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

2021 ◽  
Vol 9 (1) ◽  
pp. e002262
Author(s):  
Ashby F Walker ◽  
Nicolas Cuttriss ◽  
Michael J Haller ◽  
Korey K Hood ◽  
Matthew J Gurka ◽  
...  
Keyword(s):  
Primary Care ◽  
Type 1 Diabetes ◽  
Diabetes Care ◽  
Primary Care Providers ◽  
Health Centers ◽  
Medical Decision ◽  
Diabetes Knowledge ◽  
Healthcare Outcomes ◽  
Community Healthcare

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.

scholarly journals Diabetes in Appalachia: providers’ perspectives

2020 ◽  
Vol 21 ◽  
Author(s):  
Elizabeth A. Beverly ◽  
Marilyn D. Ritholz ◽  
Karie Cook ◽  
Lesli K. Johnson ◽  
Anirudh Ruhil ◽  
...  
Keyword(s):  
Primary Care ◽  
Diabetes Care ◽  
Healthcare Providers ◽  
Primary Care Providers ◽  
Cultural Humility ◽  
Care Providers ◽  
Post Traumatic Stress ◽  
Appalachian Culture ◽  
Patients With Diabetes ◽  
Appalachian Ohio

Abstract Background: Southeastern Appalachian Ohio has more than double the national average of diabetes and a critical shortage of healthcare providers. Paradoxically, there is limited research focused on primary care providers’ experiences treating people with diabetes in this region. This study explored providers’ perceived barriers to and facilitators for treating patients with diabetes in southeastern Appalachian Ohio. Methods: We conducted in-depth interviews with healthcare providers who treat people with diabetes in rural southeastern Ohio. Interviews were transcribed, coded, and analyzed via content and thematic analyses using NVivo 12 software (QSR International, Chadstone, VIC, Australia). Results: Qualitative analysis revealed four themes: (1) patients’ diabetes fatalism and helplessness: providers recounted story after story of patients believing that their diabetes was inevitable and that they were helpless to prevent or delay diabetes complications. (2) Comorbid psychosocial issues: providers described high rates of depression, anxiety, incest, abuse, and post-traumatic stress disorder among people with diabetes in this region. (3) Inter-connected social determinants interfering with diabetes care: providers identified major barriers including lack of access to providers, lack of access to transportation, food insecurity, housing insecurity, and financial insecurity. (4) Providers’ cultural understanding and recommendations: providers emphasized the importance of understanding of the values central to Appalachian culture and gave culturally attuned clinical suggestions for how to use these values when working with this population. Conclusions: Evidence-based interventions tailored to Appalachian culture and training designed to increase the cultural competency and cultural humility of primary care providers may be effective approaches to reduce barriers to diabetes care in Appalachian Ohio.

scholarly journals Development of an eHealth Program for Parents of Adolescents With Type 1 Diabetes

2017 ◽  
Vol 44 (1) ◽  
pp. 72-82 ◽  
Author(s):  
Robin Whittemore ◽  
Rebekah M. Zincavage ◽  
Sarah S. Jaser ◽  
Margaret Grey ◽  
Julia L. Coleman ◽  
...  
Keyword(s):  
Health Care ◽  
Type 1 Diabetes ◽  
Health Care Providers ◽  
Diabetes Care ◽  
Multiple Time ◽  
Hormonal Changes ◽  
Care Providers ◽  
Personal Time ◽  
Multiple Time Points

Purpose The purpose of this study was to understand the experience of parenting an adolescent with type 1 diabetes (T1DM), to develop a prototype of an eHealth program for parents of adolescents with T1DM, and to evaluate the prototype content and acceptability from the perspective of parents and health care providers. Methods A multiphase method was used generating both qualitative and quantitative data at multiple time points. There were 27 parents of adolescents aged 12 to 18 years with T1DM and 16 health care providers who participated in semistructured interviews to identify parental challenges; 53 parents and 27 providers evaluated the prototype. Thematic content analysis was used to analyze interview transcripts, and descriptive statistics were used to summarize survey data. Results Challenges experienced by parents of adolescents with T1DM included understanding the developmental and hormonal changes of adolescence that affect diabetes care, feeling tension between adolescent independence and parent control, communicating without nagging or conflict, transferring diabetes care responsibility safely, dealing with feelings of stress and distress, and perceiving a lack of resources for T1DM care and insufficient personal time for self-care. In the prototype evaluation, both parents and providers found content to be relevant and provided feedback to guide the development of the full program. Conclusions Parents of adolescents with T1DM and providers expressed a need for parents to have more support in transitioning diabetes care from parent to adolescent. eHealth programs offer an ideal way to address these needs and ultimately can be linked to electronic medical records improving quality and efficiency of health care in this population.

scholarly journals Strengths-Based Behavioral Intervention for Parents of Adolescents With Type 1 Diabetes Using an mHealth App (Type 1 Doing Well): Protocol for a Pilot Randomized Controlled Trial (Preprint)

2017 ◽  
Author(s):  
Marisa E Hilliard ◽  
Sahar S Eshtehardi ◽  
Charles G Minard ◽  
Rana Saber ◽  
Debbe Thompson ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Behavioral Intervention ◽  
Family Relationships ◽  
Family Conflict ◽  
Diabetes Care ◽  
Controlled Trial ◽  
Text Messages ◽  
Care Providers ◽  
Diabetes Outcomes

BACKGROUND Supportive parent involvement for adolescents’ type 1 diabetes (T1D) self-management promotes optimal diabetes outcomes. However, family conflict is common and can interfere with collaborative family teamwork. Few interventions have used explicitly strengths-based approaches to help reinforce desired management behaviors and promote positive family interactions around diabetes care. OBJECTIVE The aim of this protocol was to describe the development of a new, strengths-based behavioral intervention for parents of adolescents with T1D delivered via a mobile-friendly Web app called Type 1 Doing Well. METHODS Ten adolescent-parent dyads and 5 diabetes care providers participated in a series of qualitative interviews to inform the design of the app. The 3- to 4-month pilot intervention will involve 82 parents receiving daily prompts to use the app, in which they will mark the diabetes-related strength behaviors (ie, positive attitudes or behaviors related to living with or managing T1D) their teen engaged in that day. Parents will also receive training on how to observe diabetes strengths and how to offer teen-friendly praise via the app. Each week, the app will generate a summary of the teen’s most frequent strengths from the previous week based on parent reports, and parents will be encouraged to praise their teen either in person or from a library of reinforcing text messages (short message service, SMS). RESULTS The major outcomes of this pilot study will include intervention feasibility and satisfaction data. Clinical and behavioral outcomes will include glycemic control, regimen adherence, family relationships and conflict, diabetes burden, and health-related quality of life. CONCLUSIONS This strengths-based, mobile health (mHealth) intervention aims to help parents increase their awareness of and efforts to support their adolescents’ engagement in positive diabetes-related behaviors. If efficacious, this intervention has the potential to reduce the risk of family conflict, enhance collaborative family teamwork, and ultimately improve diabetes outcomes. CLINICALTRIAL ClinicalTrials.gov NCT02877680; https://clinicaltrials.gov/ct2/show/NCT02877680 (Archived by WebCite at http://www.webcitation.org/6xTAMN5k2)

scholarly journals Type 1 Diabetes in Athletes

2017 ◽  
Vol 13 (02) ◽  
pp. 51
Author(s):  
Jane Yardley ◽  
Keyword(s):  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Diabetes Care ◽  
Carbohydrate Intake ◽  
Insulin Dosage ◽  
Care Providers ◽  
Careful Planning ◽  
Record Keeping ◽  
Fitness Levels

Managing training and competition with type 1 diabetes is complicated, but not impossible. Athletes, and their diabetes care providers, should be aware of everything that might impact blood glucose responses to exercise. These factors include the type, timing, intensity and duration of exercise, as well as the timing and size of insulin dosage adjustments and carbohydrate intake. Due to differences in physiology (age, sex, fitness levels, etc.) there is no “one size fits all” solution, however, with careful planning and record-keeping, athletes with type 1 diabetes have the same opportunities for success in their sport as everyone else.

scholarly journals Health Care Transition in Youth With Type 1 Diabetes and an A1C >9%: Qualitative Analysis of Pre-Transition Perspectives

2020 ◽  
Author(s):  
Elise Schlissel Tremblay ◽  
Jessica Ruiz ◽  
Tess Buccigrosso ◽  
Taylor Dean ◽  
Katharine C. Garvey
Keyword(s):  
Type 1 Diabetes ◽  
Young Adults ◽  
Qualitative Analysis ◽  
Diabetes Care ◽  
Gradual Transition ◽  
Special Focus ◽  
Care Providers ◽  
Adult Care ◽  
Gradual Process

<b>Objective. </b>To explore expectations for transition to adult care and experiences with transition planning among adolescents and young adults with type 1 diabetes and an A1C >9% at a tertiary care U.S. pediatric center. <p><b> Methods. </b>We conducted semi-structured interviews in a purposive sample of patients 14–23 years of age who had had type 1 diabetes for at least 1 year and had an A1C >9%. A multidisciplinary team conducted iterative thematic analysis with deductive and inductive coding aided by NVivo software.</p> <p><b> Results. </b>Fourteen subjects participated (nine adolescents and five young adults, mean age 17.1 ± 3.2 years, 57% male, 79% Caucasian, 14% Hispanic, diabetes duration 8.2 ± 4.6 years, mean A1C 10.0 ± 0.8% for adolescents and 10.1 ± 0.7% for young adults). Qualitative analysis yielded four key themes. The first was lack of formal preparation; participants of all ages demonstrated a lack of preparation for transition and ignorance about the process, describing it as coming “out of the blue.” The second was a desire for delayed and gradual transition; participants wanted to defer being “serious” about transition to a later/uncertain date, with a preference to “wait until I’m older” among all ages. Participants described ideal transition as a gradual, process taking place “a little at a time.” The third was attachment to pediatric providers; participants demonstrated a nearly universal attachment to and “familiarity” with their pediatric diabetes care providers and expressed worries about an “uncomfortable” transition to adult providers. The fourth was concern about an impersonal adult care setting: participants perceived adult care as “formal,” “scarier,” and “tougher,” with increased criticism about poor control; participants expressed fear that adult providers would not “know me” or appreciate “my diabetes journey.”</p> <p><b> Conclusion. </b>We demonstrated a lack of transition preparation and anxiety about transition and adult care among youth with type 1 diabetes and elevated A1C. Our results may help guide early, iterative pediatric transition counseling, with a special focus on addressing attachment and fears about adult diabetes care. </p>

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