Coordinated primary and specialty care for type 2 diabetes mellitus, guidelines, and systems: an educational needs assessment.

OBJECTIVE: To determine knowledge, competence, and attitudinal issues among primary care providers (PCPs) and diabetes specialists regarding the use and application of evidence-based clinical guidelines and the coordination of care between PCPs and diabetes specialists specifically related to referral practices for patients with diabetes. METHODS: A survey tool was completed by 491 PCPs and 249 diabetes specialists. Data were collected from specialists online and from PCP attendees at live symposia across the United States. Results were analyzed for frequency of response and evaluation of significant relationships among the variables. RESULTS: Suboptimal practice patterns and interprofessional communication as well as gaps in diabetes-related knowledge and processes were identified. PCPs reported a lack of clarity about who, PCP or specialist, should assume clinical responsibility for the management of diabetes after a specialty referral. PCPs were most likely to refer patients to diabetes specialists for management issues relating to insulin therapy and use of advanced treatment strategies, such as insulin pens and continuous glucose monitoring. A minority of PCPs and even fewer specialists reported the routine use of clinical guidelines in practice. CONCLUSION: This research-based assessment identified critical educational needs and gaps related to coordinated care for patients with diabetes as well as the need for quality- and performance-based educational interventions.

The integrated Joslin performance improvement/CME program: a new paradigm for better diabetes care.

Ongoing continuing medical education is an essential component of life-long learning and can have a positive influence on patient outcomes. However, some evidence suggests that continuing medical education has not fulfilled its potential as a performance improvement (PI) tool, in part due to a paradigm of CME that has focused on the quantity of continuing medical education credits attained rather than the quality of outcomes. The Joslin Diabetes Center has undertaken a new performance-based CME program model that offers performance improvement and continuing medical education as a unified entity that is convenient and accessible for the overburdened primary care physician. This paper describes the origins of the Joslin Professional Educational Continuum as well as its infrastructure and intended outcomes.

Usage patterns of devices designed to support diabetes management: an educational needs assessment.

OBJECTIVE: To determine knowledge, competence, and attitudinal issues among diabetes specialists and primary care providers (PCPs) regarding the use of insulin delivery devices such as insulin pens and insulin pumps and the role of glucose monitoring devices and systems in the care of patients with diabetes. METHODS: A quantitative survey tool was developed that contained 51 questions directed to diabetes specialists and 49 questions directed to PCPs. A 5-point, Likert-type scale or multiple-choice format was used. Data were collected from attendees at live symposia across the United States. Results were analyzed for frequency of response and significant relationships among the variables. RESULTS: The survey was completed by 136 specialists and 418 PCPs. There were higher usage rates for insulin pens among specialists than PCPs, although there were higher usage rates among more experienced PCPs. Regarding glucose monitoring, most specialists and PCPs did not recommend "block checking," which has been commonly thought of as a reasonable compromise checking schedule for patients with type 2 diabetes not using insulin. PCPs who were more experienced and used outside educational resources, such as a certified diabetes educator, and specialists who saw more patients on a weekly basis were more likely to prescribe the use of continuous glucose monitoring. There was a general underuse of continuous glucose monitoring in eligible patients. CONCLUSIONS: These findings underscore the discordance between PCPs and specialists with regard to advanced knowledge and confidence required for the use of newer technologies for glucose monitoring and insulin replacement. We have identified important remedial opportunities for quality- and performance-based educational interventions.