SUN-LB116 Improved Family Medicine Resident Diabetes Care Through Participation in a Diabetes Clinic

As the population ages and the prevalence of diabetes increases, the demand for endocrinology services, especially in underserved areas, will continue to exceed availability. Primary care residency training programs must prepare residents to care for high risk patients with diabetes who cannot access specialists. We hypothesized that resident participation in an inter-professional diabetes clinic run by primary care physicians would lead to improved diabetes care in resident patient panels. A diabetes clinic was created in an existing primary care practice at a Federally Qualified Health Center in Eastern Kentucky. All non-pregnant, adult, Type II diabetes patients with a HgbA1C of 8.0% or greater were invited to participate in the clinic. Initial visits included evaluations by a dentist, mental health counselor, social worker, nutritionist, primary care provider, and pharmacist. Four first-year and four second-year family medicine residents rotated through the diabetes clinic and followed the patients as they saw each member of the health care team. On follow-up visits, a resident served as the primary care provider for each patient and participated in post-clinic meetings of the entire healthcare team. Resident patient charts were reviewed 3 months prior to the year-long intervention and data collected was compared to resident patient charts 3 months following the intervention. Ninety patients served as the pre-intervention sample and 108 were in the post-intervention sample. Chi-square analysis showed a statistically significant increase in patients with A1C less than 8.0% pre (57.7%) to post (71.3%) p=0.0468. Overall, there were significant increases in all health-associated behaviors. Patients receiving eye exams increased from pre (29%) to post (66%) intervention significantly; z=-5.2, P<.001. Patients receiving a urine microalbumin test increased from pre (61%) to post (82%) intervention; z=-3.2, P<.001. Patients receiving dietary counseling increased from pre (54%) to post (79%) intervention; z=-3.6, P<.001. Patients receiving foot exams increased from pre (34%) to post (48%) intervention, z=-1.9; p=.03. Resident involvement in a multidisciplinary diabetes clinic led by primary care physicians resulted in a statistically significant increase in HgbA1Cs < 8 among patients in their regular clinic and resulted in a statistically significant increase in their diabetic patients receiving eye exams, dietary counseling, foot exams, and urine microalbumin tests. This study suggests that teaching family medicine residents important diabetes care skills with an inter-professional team approach through the use of a diabetes clinic may be superior to standard educational practices.