Rapid Community Translation in the Colorado CEAL (CO-CEAL) Program: Transcreating Messaging to Promote COVID-19 Vaccination.

Providing communities with COVID-19 vaccination information is essential for optimizing equitable vaccine uptake. Using rapid community translation, adapted from Boot Camp Translation, five community teams transcreated COVID-19 vaccination campaigns. Transcreated messaging incorporated community attitudes, culture, and experiences. Using rapid community translation for the promotion of COVID-19 vaccination demonstrates a successful approach to engaging communities most affected by the pandemic to develop messages that reflect community values, assets, and needs, especially when time is of the essence. (Am J Public Health. 2024;114(S1):S50-S54. https://doi.org/10.2105/AJPH.2023.307456).

Continuous glucose monitoring for primary care patients with diabetes: Barriers, facilitators, & resources to support access.

Context: Continuous glucose monitoring (CGM) for patients with type 1 and type 2 diabetes is associated with improved patient health outcomes including reduced glycated hemoglobin (A1c) and hypoglycemia and is part of ADA Standards of Medical Care. CGM prescription often takes place in endocrinology practices. With limited access to endocrinologists, many patients could benefit from receiving CGM through primary care. Objective: The overall study aims to understand primary care clinicians' CGM prescribing experience and likelihood to prescribe, and identify resources needed to support prescribing CGM. This qualitative phase examines barriers and facilitators to prescribing, and resources to support prescribing. Study Design: Qualitative phase of an explanatory sequential mixed-methods study following a cross-sectional online survey. Respondents were invited to participate in phone/virtual interviews to understand CGM prescribing attitudes and behaviors. Participants were stratified based on factors related to distance to an endocrinologist and prescribing behavior. Rapid qualitative analysis was used to understand relationships and trends, and identify resources to support CGM prescription in primary care. Setting: Two primary care research networks. Population studied: Primary care physicians and advanced practice providers in the U.S. Outcome Measures: Resources needed, barriers, and facilitators to prescribing CGM. Results: 55 interviews were conducted. The following themes emerged in the analysis: Insurance and cost-related barriers were most commonly cited, as well as distance to endocrinology when > 40 miles away. Facilitators included training and experience with CGM and staff to support patient education and insurance navigation. Resources (e.g., webinars, online guides, conferences) to increase knowledge about CGM use and clinical outcomes and guidance with insurance processes/coverage could support CGM prescription in primary care. Conclusions: Increased understanding among primary care clinicians of the use and benefits of CGM can help with confidence in prescribing. CGM management in primary care could benefit patients with diabetes, especially those with access barriers to endocrinologists. Addressing cost and insurance barriers at a policy level can make CGM more attainable to underserved populations and reduce disparities in diabetes control.

Relationship of primary care clinician characteristics with continuous glucose monitoring use and confidence.

Context: Continuous glucose monitoring (CGM) provides clearer readings of blood glucose levels than traditional finger-stick glucose tests and is associated with improved diabetes outcomes such as reduced HbA1c. CGM can inform insulin dosing and diet decisions, and alert patients to hypoglycemia. A lack of endocrinologists in the majority of U.S. counties, particularly rural areas, and long wait times in many endocrinologists' offices create disparities in CGM access for patients with diabetes. Expanding use of CGM in primary care can improve care and patient diabetes outcomes. Objective: Understand primary care clinicians' experience with CGM to determine feasibility and resources needed to prescribe CGM. Study Design: Quantitative phase of explanatory sequential mixed methods study using cross-sectional online survey. Setting: Primary care. Population studied: Primary care physicians and advanced practice providers across the U.S. Outcome Measures: Past CGM prescribing behaviors, future likelihood to prescribe, resources needed to prescribe. Results: 632 respondents. Role: 72% attending physicians. Organization: Federally Qualified Health-Center (or similar) (27%), hospital-owned (27%), private practice (22%). Half (47%) had seen patients with CGM but never prescribed; two-fifths (39%) had prescribed CGM. Three-fifths (62%) moderately or very likely to prescribe CGM in the future. Likelihood to have prescribed CGM: Post-training physicians more likely than residents (OR=0.303, CI=.160-.575) or PA/NPs (OR=0.356, CI=.165-.766), part-time practice less likely than full-time (OR=0.546, CI=.305-.978), <75% time delivering primary care less likely than 75%+ (OR=0.595, CI=.371-.955), and location greater than 40 miles from an endocrinologist more likely than endocrinologist within 10 miles (OR=1.941, CI=1.17-3.21). Likelihood to prescribe with access to various resources greatest for consultation on insurance issues (72% moderately/very likely) and CGM education/training (72% moderately/very likely). Conclusions: Primary care clinicians have interest in prescribing CGM for patients with diabetes. Clinician type, percentage of time spent practicing, portion of time delivering primary care, and distance from endocrinologist are related to likelihood to prescribe CGM. Previous experience prescribing CGM may improve confidence and likelihood of future prescribing. Consultation, education and training on CGM for primary care clinicians may increase access to CGM.

Stakeholder engagement in diabetes self-management: patient preference for peer support and other insights.

Background: Self-management support (SMS) for patients with diabetes can improve adherence to treatment, mitigate disease-related distress, and improve health outcomes. Translating this evidence into real-world practice is needed, as it is not clear which SMS models are acceptable to patients, and feasible and sustainable for primary care practices. Objective: To use the Boot Camp Translation (BCT) method to engage patient, practice, community resource and research stakeholders in translation of evidence about SMS and diabetes distress into mutually acceptable care models and to inform patient-centred outcomes research (PCOR). Participants: Twenty-seven diabetes care stakeholders, including patients and providers from a local network of federally qualified health centres participated. Methods: Stakeholders met in-person and by conference call over the course of 8 months. Subject matter experts provided education on the diabetes SMS evidence. Facilitators engaged the group in discussions about barriers to self-management and opportunities for improving delivery of SMS. Key Results: BCT participants identified lack of social support, personal resources, trust, knowledge and confidence as barriers to diabetes self-management. Intervention opportunities emphasized peer support, use of multidisciplinary care teams and centralized systems for sharing information about community and practice resources. BCT informed new services and a PCOR study proposal. Conclusions: Patients and family engaged in diabetes care research value peer support, group visits, and multidisciplinary care teams as key features of SMS models. SMS should be tailored to an individual patient's health literacy. BCT can be used to engage multiple stakeholders in translation of evidence into practice and to inform PCOR.