Providers voiced a commitment to improve many different facets of their care delivery, including the following: put patients on continuous glucose monitors (CGMs), address psychological issues, improve insulin regimens, educate on diet, strengthen motivational interviewing skills, and address hypoglycemia. Major takeaways among PCP participants included an increase in knowledge and an increase in their comfort level to care for individuals with T1D. There’s nothing, and it took months, and it was just ridiculous.”-Focus group member Reactions from PCP Spoke MembersĮCHO T1D provider participants reported an appreciation for the expertise of the hub teams, especially voicing enthusiasm for the weekly learning didactic and case presentations. “Moving up here, I couldn’t even get a doctor, and I didn’t have a doctor for a good eight months. “I had an excellent insurance-the pump was never mentioned to me in any way, shape, or form.”-Focus group member It’s a constant worry in my head.”-Focus group member “I call but it takes two weeks to get the medication now it’s been the two weeks and now I’ve got nobody, no medication. Provider participation demonstrated statistically significant change and improvement in knowledge and confidence in managing T1D.Focus groups of 86 T1D high-need, high-cost adults found barriers to care, including long wait times for endocrinologist appointments, difficulty affording insulin and supplies, poor access to technology and equipment, a lack of well-rounded care, and a lack of social support for T1D.Participants reported a significant increase in confidence, especially with diabetes technologies, and demonstrated a significant increase in knowledge. A post-pilot study questionnaire and provider focus groups found a high level of satisfaction among spoke providers with improved competencies in T1D and changes in care practices for T1D patients.Despite low confidence, PCPs reported regularly filling insulin prescriptions. A pre-pilot study questionnaire and provider focus groups found a low level of confidence among PCPs in providing T1D care, especially related to diabetes technologies.In California, 30 areas were targeted for ECHO T1D spoke recruitment. To target spoke sites, the Project ECHO T1D team identified areas with low endocrinology provider density (>30-minute drive) and high health risk/poverty, according to the Neighborhood Deprivation Index (NDI). Stanford Medicine enrolled 11 spoke sites representing 37 clinics serving roughly 1,000 adult and pediatric patients with T1D. The ECHO T1D program addressed urgent geographic, racial, and socioeconomic disparities to promote health equity and improve health outcomes within highly vulnerable populations with T1D in Florida and California. The ECHO T1D program offered weekly tele-education clinics and continuing medical education (CME) credits for primary care providers, real-time support with complex diabetes-related medical decision-making, and access to diabetes support coaches for patients. In 2018, Stanford Medicine and the University of Florida Diabetes Institute partnered to launch the first ECHO Type 1 Diabetes (T1D) program in the United States.
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