Ann Fam Med. 2022 Apr 1;20(20 Suppl 1):2745. doi: 10.1370/afm.20.s1.2745.
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.
连续血糖监测（CGM）提供了比传统指尖血糖测试更清晰的血糖读数，与改善糖尿病结果相关，如降低 HbA1c。CGM 可以为胰岛素剂量和饮食决策提供信息，并提醒患者低血糖。在美国大多数县（特别是农村地区）缺乏内分泌专家，以及许多内分泌医生办公室的长时间等待，导致糖尿病患者的 CGM 获得存在差异。在初级保健中扩大 CGM 的使用可以改善护理和患者的糖尿病结果。目的：了解初级保健临床医生使用 CGM 的经验，以确定为患者开具 CGM 所需的可行性和资源。研究设计：使用横断面在线调查的解释性顺序混合方法研究的定量阶段。设置：初级保健。研究人群：美国各地的初级保健医生和高级执业医师。结果测量：过去的 CGM 处方行为、未来的处方可能性、开具处方所需的资源。结果：632 名受访者。角色：72%的主治医生。组织：合格的联邦健康中心（或类似机构）（27%）、医院所有（27%）、私人诊所（22%）。一半（47%）见过使用 CGM 的患者，但从未开过处方；五分之三（39%）曾开过 CGM。五分之三（62%）在未来很可能或非常可能为患者开具 CGM。开具 CGM 的可能性：接受培训的医生比住院医生（OR=0.303，CI=.160-.575）或 PA/NP（OR=0.356，CI=.165-.766）更有可能，兼职行医比全职行医更不可能（OR=0.546，CI=.305-.978），提供初级保健的时间少于 75%比 75%+更不可能（OR=0.595，CI=.371-.955），距离内分泌医生超过 40 英里的位置比距离内分泌医生 10 英里以内的位置更有可能（OR=1.941，CI=1.17-3.21）。有各种资源的情况下，最有可能对保险问题（72%中度/非常可能）和 CGM 教育/培训（72%中度/非常可能）进行咨询。结论：初级保健临床医生有兴趣为糖尿病患者开具 CGM 处方。医生类型、执业时间百分比、提供初级保健的时间百分比以及与内分泌医生的距离与开具 CGM 的可能性有关。以前开具 CGM 的经验可能会提高信心并增加未来开具处方的可能性。为初级保健临床医生提供 CGM 的咨询、教育和培训可能会增加 CGM 的可及性。
