A recent UNC Center for Aging and Health workforce enhancement effort introduced speciality expertise from the division of endocrinology to Piedmont Health Services (PHS). Led by Marvin McBride, MD, MBA, Jennifer Hubbard, and Cristine Henage, EdD, in the division of geriatric medicine, “Diabetes Management for Older Adults Series for Piedmont Health Services” was one of several CGWEP ECHO Projects designed to provide education and training in geriatric medicine through community partnerships. PHS provides care to a large population of low-resource individuals in central NC, many with limited English proficiency and low health literacy, and utilizes interdisciplinary teams extensively in the care of patients with diabetes, including physicians, nurse practitioners, pharmacists, dieticians, and case managers, and offers low-cost medication for their patients.
PHS focused on the “Merit-based Incentive Payment System Clinical Quality Measure” as part of an ongoing quality improvement effort, which looks at the percentage of patients 18-75 years of age with diabetes who had Hgb A1c > 9.0% or did not have a Hgb A1c obtained in the measurement period (that metric currently stands at 34%). In response, faculty from the division of endocrinology and metabolism joined geriatric medicine for a six-part ECHO series of telementoring sessions focused on diabetes management in older adults.
“Although the project was led by us, the stars were faculty from the division of endocrinology and metabolism,” said McBride. “I would like to thank you John Buse, Sue Kirkman, Laura Young, Jean Dosteau and Beth Harris for your community service.”
Endocrinology faculty provided brief summaries of various drug classes available in the treatment of diabetes and fielded outstanding questions. They also discussed challenging cases from primary care learners across the state.
“The attendees seem to be very engaged and were obviously excellent and caring providers,” said John Buse, MD, MPH, chief of the division of endocrinology. “The support from ECHO staff and Dr. McBride was outstanding. The endocrinology faculty really enjoyed the experience.”
About one in four people over aged 65 years has diabetes according to Sue Kirkman, MD, professor of medicine in the division of endocrinology, and describes them as quite heterogeneous in terms of duration of diabetes, co-morbidities, functional status, and life expectancy.
“Treatments have to be individualized in anyone with diabetes, but particularly in older people. It was interesting and informative to interact with our geriatrics colleagues to discuss difficult management issues they face regularly.”
Laura Young, MD, PhD, explained how being able to interact with community primary care providers builds upon the outreach that UNC provides to the surrounding community.
“Discussing complicated cases and advising our community colleagues on how to best manage them allows us to not only give back to our community but also establishes UNC as a leader in contemporary diabetes management.”
PHS recently requested that the ECHO series be repeated with diabetes lifestyle components added to the curriculum.
The UNC Center for Aging and Health (UNC CAH) Carolina Geriatric Workforce Enhancement Program (CGWEP) is supported in part by a HRSA Geriatric Workforce Enhancement Program grant. The CGWEP’s mission is to establish partnerships with primary care sites and community-based organizations across North Carolina, to provide education and training in geriatric medicine. The UNC CAH CGWEP uses Project ECHO (ECHO = Extension for Community Healthcare Outcomes) established by the University of New Mexico to telementor healthcare professionals. The CGWEP’s ECHOs for geriatric medicine projects include COVID-19 mentoring for skilled nursing facilities, Age Friendly Healthcare Systems (AFHS), serious illness and comorbid conditions, and other common geriatric concerns.