An intervention to enhance hypoglycemia communication and preventive action in primary care

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PROJECT SUMMARY / ABSTRACT To achieve optimal care for the half of U.S. adults with diabetes who are treated with insulin or insulin secretagogues, it is crucial to prevent hypoglycemia, which causes substantial morbidity and hospital utilization. However, limited evidence – including our own preliminary analyses – suggests that clinicians do not routinely assess for hypoglycemia and rarely take preventive actions such as modifying diabetes therapy or providing anticipatory guidance for hypoglycemia prevention. The Endocrine Society has called for interventions to improve hypoglycemia prevention in clinical encounters, yet no evidence-based interventions exist. In this proposal, we will fill major gaps in understanding hypoglycemia prevention and patient-provider communication in primary care encounters, and develop a scalable intervention to prevent hypoglycemia that can be integrated into the primary care workflow. Patient-provider communication is especially important for hypoglycemia prevention because it requires clinicians to gather detailed history, convey complex information, and motivate patients to make behavior change. The proposed intervention will build upon effective interventions that improve chronic disease care by using patient reported outcome measures (PROMs) to routinely assess patient symptoms and prompt clinicians to take action addressing them. The specific research aims are: Aim 1) Determine the frequency of hypoglycemia assessment and prevention practices in a national sample of Veterans Affairs primary care visits, and develop a framework for hypoglycemia communication quality. Aim 2) Develop an intervention that integrates PROMs for hypoglycemia assessment into the primary care workflow, linked to a provider toolkit to enhance hypoglycemia communication and prevention practices. Aim 3) To conduct a pilot study to evaluate the feasibility, fidelity, and acceptability of the hypoglycemia prevention intervention developed in Aim 2. These aims lay the groundwork for an R01 application to conduct a definitive clinical trial of the intervention developed here, and address the urgent need for scalable interventions that translate evidence- based practices for hypoglycemia prevention into the primary care setting. Dr. Scott Pilla’s long-term career goal is to become an independent clinician investigator developing and leading interventional research that improves the health of patients with diabetes and their management in primary care. He seeks a K23 mentored career development award to obtain critical skills and experience to lead an independently-funded research program. His career development plan includes didactics and mentored research experience in qualitative and communication research methods, patient reported outcomes research, and the conduct and leadership of clinical trials. This training will occur in the rich environment at Johns Hopkins, including the Division of General Internal Medicine and the Bloomberg School of Public Health. Dr. Pilla will receive guidance from an experienced team of mentors and advisors with expertise in patient-provider communication, qualitative research, and clinical trials, who have a track record of mentoring and funding.