A Type 1 diabetes specialist might as well be half a world away for many underserved people living with the disease.
These patients often live in rural areas where endocrinologists don’t practice. Some might lack transportation to travel to a distant physician or can’t get a day off work. Others living near the poverty line might not be able to afford a doctor or are simply intimidated by visiting a large medical center even if they live in an urban area. As a result, the local family medical practice is their bulwark against poor health.
Earlier this month, University of Florida researchers launched an effort to improve access to care for underserved children and adults living with Type 1 diabetes, an autoimmune disease that results in the destruction of insulin-producing cells in the pancreas. Using a $1.6 million pilot grant from The Leona M. & Harry B. Helmsley Charitable Trust, the program aims to help primary care physicians in Florida and California attain a greater level of expertise on a complicated disease by addressing the racial, socioeconomic and geographic disparities that affect health outcomes for these patients.
At the kickoff event held at the University of Florida College of Public Health and Health Professions, project leaders provided orientation and training to medical directors and primary care physicians representing 11 medical centers or other health facilities from Miami to Pensacola who, through dozens of clinics, treat more than 1,000 patients with Type 1 diabetes.
The 18-month pilot project is headed by Dr. Michael J. Haller, a professor and chief of pediatric endocrinology in the UF College of Medicine, and Dr. Ashby Walker, an assistant professor in the UF College of Public Health and Health Professions’ department of health services research, management and policy, in addition to collaborators at Stanford University.
“We have been able to demonstrate in our research that, even when a visit to a specialist is covered by Medicaid, for example, that does not mean a person will actually use those services,” said Dr. Walker, the director of health equity initiatives at the UF Diabetes Institute.
The researchers will work with primary care physicians and patients who aren’t using an endocrinologist to determine their needs and the health care barriers they face. Health care providers who treat Type 1 diabetes patients will receive virtual training and tele-education each week from diabetes “hubs” at UF and Stanford. The physicians also will get real-time help with challenging medical decision-making issues from diabetes professionals as well as a diabetes care liaison assigned to their clinic and opportunities to enroll their patients in research projects and initiatives at their hubs.
The effort uses the Extension for Community Health Care Outcomes model, also known as Project ECHO®, which has been adapted for a range of diseases, from hepatitis C to chronic pain. Dr. Walker said the hope is that the program, once established, will eventually be expanded to serve even more patients.
“This empowers primary care providers to better serve their patients,” she said.