12242 Enhancing Continuous Glucose Monitor Utilization In Lower Economic Community Hospital Outpatient Clinics: A Quality Improvement Initiative
Authors: Mehta Vidhi , Deshpande Sohiel , Nieman Meaghan , Pereira Kristal , Agrawal Bhavika , Russell Steven R 
Published: October 2024

Disclosure: V. Mehta: None. S. Deshpande: None. M. Nieman: None. K. Pereira: None. B. Agrawal: None. S.R. Russell: None.

Continuous glucose monitors (CGM) measure the blood glucose level (BGL) and have been used for better glucose control, especially in patients requiring insulin. Primary care physicians (PCP) manage diabetic patients on a large scale in the US, especially in rural settings, and data shows that CGMs are prescribed less in PCP settings than in endocrine clinics. Our study aimed to understand internal medicine (IM) residents' knowledge about CGMs and their application in a community hospital outpatient clinic serving lower-economic populations and demonstrates how a clinical pharmacist (PharmD) led educational intervention successfully increased the adoption of CGMs. A survey was done using a form with multiple-choice questions. 50 residents participated and responded anonymously. Data was analyzed by calculating percentages based on answers, providing understanding of their perspectives on CGMs. 78% knew about and correctly identified CGM. When asked to name indications of CGM, answers varied and included uncontrolled diabetes (34%), insulin-dependent diabetes (34%), elderly and non-compliant patients (14%), any diabetic (12%), and others. Only 14% reported to have had formal training in use and interpretation of CGMs, 70% had prescribed, 34% knew how to apply the device, and 42% knew how to interpret the BGL. More than 95% self-reported having either poor/beginner or fair knowledge about the usage, application, and interpretation, whereas more than 80% professed to need more training to be more confident about prescribing the device. After the survey, our PharmD conducted session demonstrating the indications, types, usage, application, and interpretation of CGM. Following this, an impactful increase in patients who were appropriately prescribed and received CGM was observed. Technologies used in medicine have increased, CGM, being one of them. More than 100 million Americans have prediabetes or diabetes, with more than 10 million using insulin. Hence, access to CGM is crucial for patients for better management. Despite the benefits, many factors play a role in limiting their use, including prescription, cost, insurance coverage, social factors, willingness of the patients, discomfort, and decreased knowledge. Non-compliance, difficulty in application and picking the device from pharmacy was also observed in our clinic. A study by Sherrill et al. on use of CGMs (2014-2020) showed that use of CGM increased almost ten times in 2020 (v/s2014); most patients were younger, employed, and had better insurance coverage.With advances in technology, easier and more efficient devices are available to assess patients' glycemic control. Pharmacists play key role in ensuring continued education among practitioners and trainees. Continued efforts to increase awareness is required to ensure that latest advances are adequately incorporated into graduate medical education.

Presentation: 6/3/2024