Engaging Payors and Primary Care Physicians Together in Improving Diabetes Prevention.
Engaging Payors and Primary Care Physicians Together in Improving Diabetes Prevention.
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DOI：
10.1007/s11606-022-07788-8
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发表时间：
2023-03
影响因子：
5.7
通讯作者：
Smith, Katherine
中科院分区：
文献类型：
--
作者：
Tseng, Eva;Meza, Kayla;Marsteller, Jill A.;Clark, Jeanne M.;Maruthur, Nisa M.;Smith, Katherine
2型糖尿病可以通过糖尿病预防计划（DPP）等生活方式计划来预防，但很少有糖尿病前期患者参与其中，部分原因是他们的保险不可靠地覆盖DPP。以前的研究没有集中在支付者层面的障碍。通过与PCP和支付者的访谈，了解在不同层面（患者、PCP和支付者）存在和交叉的DPP吸收障碍，为改善初级保健环境中糖尿病预防的策略提供信息。从2020年5月至2021年10月，我们对PCP和付款人进行了远程半结构化访谈。PCP来自隶属于一个大西洋中部学术系统的初级保健实践。付款人领导人来自地区商业，医疗保险和医疗补助计划。使用标准化的访谈指南，重点是障碍，促进者和潜在的干预成分，访谈录音使用变焦和专业转录。两名审稿人使用框架分析法对转录本进行双重编码。我们采访了来自13个初级保健诊所的16名PCP和代表6个保险计划的7名支付人领导人。PCP报告中关于患者层面障碍的两个主题：（1）缺乏解决营养和运动问题的方案和资源保险覆盖范围;（2）解决影响糖尿病预防的健康社会决定因素的资源不足。在PCP面临的障碍中，我们确定了两个主题：（1）PCP对DPPs的认识不足，以及对DPPs保险范围的误解;（2）临床工作人员不足以解决糖尿病预防问题。PCP和支付者的共同障碍包括（1）缺乏糖尿病前期质量措施和（2）PCP和患者与支付者的参与不足。与PCP和支付者的讨论揭示了系统性障碍，这些障碍表明改善糖尿病前期临床护理的重要优先事项，包括DPP的普遍覆盖，明确覆盖范围的好处，PCP支付者的数据报告和外展，以及采用适当的糖尿病前期质量措施。在线版本包含补充材料，可通过10.1007/s11606-022-07788-8获得。
Type 2 diabetes can be prevented through lifestyle programs like the Diabetes Prevention Programs (DPP), but few people with prediabetes participate in them, in part because their insurance does not reliably cover DPPs. Prior studies have not focused on payor-level barriers. To understand barriers to DPP uptake that exist and intersect at different levels (patients, PCPs, and payors) to inform strategies to improve diabetes prevention in primary care settings through interviews with PCPs and payors. From May 2020 to October 2021, we conducted remote, semi-structured interviews with PCPs and payors. PCPs were from primary care practices affiliated with one mid-Atlantic academic system. Payor leaders were from regional commercial, Medicare, and Medicaid plans. Using a standardized interview guide focused on barriers, facilitators, and potential intervention components, interviews were audio-recorded using Zoom and professionally transcribed. Two reviewers double-coded transcripts using the framework analytic approach. We interviewed 16 PCPs from 13 primary care clinics and 7 payor leaders representing 6 insurance plans. Two themes emerged from PCP reports of patient-level barriers: (1) lack of programs and insurance coverage of resources to address nutrition and exercise and (2) inadequate resources to address social determinants of health that impact diabetes prevention. Among barriers PCPs faced, we identified two themes: (1) low PCP knowledge about DPPs and misperceptions of insurance coverage of DPPs and (2) inadequate clinical staff to address diabetes prevention. Barriers common to PCPs and payors included (1) absence of prediabetes quality measures and (2) inadequate engagement of PCPs and patients with payors. Discussions with PCPs and payors revealed systemic barriers that suggest important priorities to improve prediabetes clinical care, including universal coverage of DPPs, clarity about coverage benefits, data reporting and outreach by payors to PCPs, and adoption of appropriate prediabetes quality measures. The online version contains supplementary material available at 10.1007/s11606-022-07788-8.
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影响因子：
3.9
作者：
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通讯作者：
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影响因子：
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DOI：
10.3122/jabfm.2016.02.150252
发表时间：
2016-03-01
影响因子：
2.9
作者：
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通讯作者：
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作者：
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