Physicians' Perceptions of Care for Emerging Adults With T1D
Physicians' Perceptions of Care for Emerging Adults With T1D
The survey was distributed to 265 physicians (79 adult endocrinologists, 94 general internal medicine physicians, and 92 family medicine physicians). Of these, 14 (5%) surveys were undeliverable. Of the remaining surveys, the response rate was 43% (n = 33) for endocrinologists, 10% (n = 9) for general internal medicine physicians, and 16% (n = 13) for family medicine physicians. One respondent did not identify a specialty of medical practice. As demographic characteristics of age, race, sex, and geographic setting of medical practice were not different between general internal medicine and family medicine respondents, these responses were combined and referred to as PCPs. There were no differences in age, sex, race, or geographic setting of practice between endocrinologists and PCPs (Table 1). A higher proportion of endocrinologists practiced in hospital-based settings (P = .002), whereas PCPs reported practicing in community-based group settings (P = .049).
Three main aspects of clinical self-assessed aptitude were considered: (1) managing insulin therapy; (2) screening for and treating diabetes complications and comorbidities; and (3) managing age-related psychosocial health factors. Comfort with insulin management was gauged by 9 questions about insulin therapeutics and education. For all 9 questions, endocrinologists' responses indicated a higher confidence level (P<.001; Table 2).
Eight questions were directed toward screening for and treating hypertension, dyslipidemia, nephropathy, and neuropathy. Endocrinologists reported greater self-aptitude in screening for nephropathy (P = .02) and treating nephropathy (P = .05) than PCPs. Eleven questions inquired about self-confidence in the management of age-related psychosocial health factors, including depression, eating disorders, tobacco, alcohol, reproductive counseling, driving, employment, and diabetes-related medical finances. PCPs reported higher self-aptitude in screening and treating depression than endocrinologists (Table 2). Endocrinologists indicated greater self-confidence to discuss driving issues, employment issues, and medical financial concerns related to diabetes (Table 2).
Endocrinologists and PCPs did not differ in their views of the importance of providing diabetes care through a comprehensive team approach (P = .7). Furthermore, there were no differences between endocrinologists and PCPs when asked to rate the importance of regular appointments with CDEs and RDs (Table 2). However, as would be anticipated, endocrinologists reported greater availability of CDEs and RDs in their practice environments (Table 2).
Endocrinologists and PCPs did not differ in their views of the importance of emerging-adult patients to be able to call for insulin dose adjustments between appointments (P = .5). However, endocrinologists indicated greater availability of a clinical infrastructure for patient calls between appointments (P = .044).
Providers were asked to rate the usefulness of various transition methods for the new emerging-adult patients (Table 3). Both endocrinologists and PCPs rated having a concise medical summary as the most helpful of the listed options. Both groups indicated that having family accompanying the emerging-adult patient at the initial clinic visit as the least helpful. The only group difference that emerged was that PCPs rated referral to a young adult diabetes clinic of higher importance than did endocrinologists (P = .001).
Results
Respondent Characteristics
The survey was distributed to 265 physicians (79 adult endocrinologists, 94 general internal medicine physicians, and 92 family medicine physicians). Of these, 14 (5%) surveys were undeliverable. Of the remaining surveys, the response rate was 43% (n = 33) for endocrinologists, 10% (n = 9) for general internal medicine physicians, and 16% (n = 13) for family medicine physicians. One respondent did not identify a specialty of medical practice. As demographic characteristics of age, race, sex, and geographic setting of medical practice were not different between general internal medicine and family medicine respondents, these responses were combined and referred to as PCPs. There were no differences in age, sex, race, or geographic setting of practice between endocrinologists and PCPs (Table 1). A higher proportion of endocrinologists practiced in hospital-based settings (P = .002), whereas PCPs reported practicing in community-based group settings (P = .049).
Self-assessment of Aptitude in Clinical Aspects of T1D Management
Three main aspects of clinical self-assessed aptitude were considered: (1) managing insulin therapy; (2) screening for and treating diabetes complications and comorbidities; and (3) managing age-related psychosocial health factors. Comfort with insulin management was gauged by 9 questions about insulin therapeutics and education. For all 9 questions, endocrinologists' responses indicated a higher confidence level (P<.001; Table 2).
Eight questions were directed toward screening for and treating hypertension, dyslipidemia, nephropathy, and neuropathy. Endocrinologists reported greater self-aptitude in screening for nephropathy (P = .02) and treating nephropathy (P = .05) than PCPs. Eleven questions inquired about self-confidence in the management of age-related psychosocial health factors, including depression, eating disorders, tobacco, alcohol, reproductive counseling, driving, employment, and diabetes-related medical finances. PCPs reported higher self-aptitude in screening and treating depression than endocrinologists (Table 2). Endocrinologists indicated greater self-confidence to discuss driving issues, employment issues, and medical financial concerns related to diabetes (Table 2).
Importance and Availability of Diabetes Team Members
Endocrinologists and PCPs did not differ in their views of the importance of providing diabetes care through a comprehensive team approach (P = .7). Furthermore, there were no differences between endocrinologists and PCPs when asked to rate the importance of regular appointments with CDEs and RDs (Table 2). However, as would be anticipated, endocrinologists reported greater availability of CDEs and RDs in their practice environments (Table 2).
Endocrinologists and PCPs did not differ in their views of the importance of emerging-adult patients to be able to call for insulin dose adjustments between appointments (P = .5). However, endocrinologists indicated greater availability of a clinical infrastructure for patient calls between appointments (P = .044).
Usefulness of Recommended Transition Methods
Providers were asked to rate the usefulness of various transition methods for the new emerging-adult patients (Table 3). Both endocrinologists and PCPs rated having a concise medical summary as the most helpful of the listed options. Both groups indicated that having family accompanying the emerging-adult patient at the initial clinic visit as the least helpful. The only group difference that emerged was that PCPs rated referral to a young adult diabetes clinic of higher importance than did endocrinologists (P = .001).
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