Work

SAT-202 Increasing Equitable Access in Use of Smart Insulin Pens Among Patients With Diabetes Using Multiple Daily Injections

Year: 2024

Type: article

Abstract: S.J. Ogyaadu: Research Investigator; Self; Abbott Laboratories, Dexcom, Tandem Diabetes Care. C. Levister: Research Investigator; Self; Tandem Diabetes Care, Abbott Laboratories, Mannkind Corporation, Dexcom. M. Rouviere: None. A. Witzke: None. C.J. Levy: Consulting Fee; Self; Dexcom. Research Investigator; Self; Abbott Laboratories, Mannkind Corporation, Insulet Corporation, Tandem Diabetes Care, Dexcom. G. O'Malley: Research Investigator; Self; Abbott Laboratories, Insulet Corporation, Mannkind Corporation, Tandem Diabetes Care, Dexcom. Objective: Disparities exist in technology use in diabetes management. Despite the benefits of smart insulin pens (SIP) at improving dosing accuracy and logs, prescription rates are low. As part of a T1DX QI Collaborative project, we aimed to increase insulin pen technology prescription and use rates in an urban academic center serving an ethnically diverse population over 9 months. Pre-post implementation design was used to determine effectiveness of changes, outcomes, and satisfaction. Methods: Using quality improvement methodology, we implemented and tracked 4 main interventions at 2 clinic locations from July 2022-Feb 2023: use of the Diabetes Technology Assessment (DTA) tool to structure discussions on diabetes technology use, creation of a technology handout at an appropriate medical literacy to promote patient awareness, education and EMR smartphrases to guide provider prescribing, and overhaul of pharmacy and prior authorization (PA) process focusing on Medicaid coverage. Each intervention was assessed through the Plan, Do, Study, Act (PDSA) change model. Results: For patients using multiple daily injections (MDI) at baseline from Nov 2021-June 2022, 5.5% of patients with type 1 diabetes and 0% with type 2 diabetes were using SIP. Provider (HCP) surveys identified major barriers as focus on other technologies, lack of insurance coverage, and cumbersome PA processes. HCP DTA use improved from 0% to 20% after HCP education on SIP prescription process along with pre visit planning during a 6-week period. Among 5 HCP, out of 20 eligible patients, DTA use resulted in technology discussion in 4 patients (20%) and 1 (5%) SIP prescription. DTA use did not affect discussions for HCP already comfortable with diabetes technology and was limited by appointment cancellations and conversions to telehealth. Development of a single-paged, illustrated handout at a sixth grade literacy level, along with provider education and EMR smartphrases, over an additional 8-week period improved technology discussions with high HCP and patient satisfaction. Use of an external pharmacy providing prescription and durable medical equipment services reduced prescription and PA process from 4 weeks to 1 week. After 6 months, the rates of SIP use in patients with type 1 diabetes using MDI remained stable above 5% and SIP prescriptions increased to 15%. Conclusion: Improvement in SIP discussions, provider knowledge, and PA process increased prescription rates of SIP, however patient use and equitable access due to insurance coverage remain. Streamlined PA process was most effective at expanding access to those with Medicaid/Medicare. Institutional inequalities exist and greater effort is needed to bridge the gap and provide equal access to diabetes technology. Saturday, June 1, 2024

Source: Journal of the Endocrine Society

DOI: 10.1210/jendso/bvae163.2360

Authors: Selassie J Ogyaadu, Camilla Levister, Madeleine Rouviere, Anabel Witzke, Carol Joan Levy, Grenye O’Malley

Institution: Icahn School of Medicine at Mount Sinai

Language: English

Topic: Diabetes Management and Research

Subfield: Endocrinology, Diabetes and Metabolism

Field: Medicine

Domain: Health Sciences

SDGs: Good health and well-being, Reduced inequalities

Open Access status: gold

Estimated APC paid: $3,418