Title: Improving access to continuous glucose monitoring for patients with type 2 diabetes in primary care
Abstract:
Background: Use of continuous glucose monitoring (CGM) improves glycemic control and is now standard of care in diabetes management. Due to recent changes in Medicare coverage requirements, a large cohort of patients with type 2 diabetes is newly eligible for CGM, with the majority receiving diabetes care in the primary care setting. Despite guideline recommendations to offer CGM to all patients with diabetes using insulin, prescription rates for CGM remain low in primary care.
Aim: This quality improvement project aimed to improve access to CGM in primary care for patients with type 2 diabetes on insulin.
Methods: A multidisciplinary endocrinology/primary care team at an academic primary care community health clinic used process mapping, driver diagrams, and Pareto charts to delineate the drivers of limited access to CGM in primary care. Interventions including the creation of a durable medical equipment (DME) directory, nursing education with device company representatives, implementation of a new electronic ordering system for DME, and a nursing outreach program to patients eligible for CGM were trialed over a two- month period. The primary outcome measure was the percentage of eligible patients in the primary care clinic using CGM. Process measures included the number of CGM orders started weekly. Nursing comfort with CGM, knowledge of CGM, and perceptions of communication with DME suppliers were also measured.
Results: In this cohort of 130 patients with diabetes using insulin with Medicare coverage at the primary care clinic, the percentage of patients using CGM overall increased from 28% to 42% over the five- month intervention period, and the percentage of patients using CGM started by primary care increased from 8% to 14%. Weekly CGM orders increased from 0.3 per week to more than 2 per week. Nursing reported feeling more comfortable and knowledgeable about CGM after the interventions and reported improved communication with DME suppliers.
Conclusions: CGM is known to improve outcomes for patients with diabetes but is an underutilized tool in primary care. Collaborative quality improvement projects between endocrinology and primary care can rapidly build capacity within primary care clinics to prescribe CGM and expand access for patients with diabetes.
