Paul Revere Memorial Association

Despite guideline recommendations to offer continuous glucose monitoring (CGM) to all patients with diabetes using insulin, prescription rates for CGM remain low in primary care. This quality improvement project aimed to improve access to CGM in primary care for patients with type 2 diabetes on insulin. This was a quality improvement project conducted by a joint endocrinology/primary care team at a single primary care community health clinic. After defining the problem through process mapping, driver diagrams, and Pareto charts, several interventions were trialed through Plan-Do-Study-Act (PDSA) cycles. The study team consisted of four endocrinologists, two primary care providers (MD/NP), the lead primary care nurse, and the primary care population health specialist. Interventions included a directory for durable medical equipment (DME) suppliers, nursing education with device company representatives, a new electronic ordering system for DME, and a nursing outreach program to patients eligible for CGM. The primary outcome was percentage of eligible patients using CGM. Process measures included the number of CGM orders started weekly. Nursing comfort with CGM, knowledge of CGM, and perceptions of communication with DME suppliers were also measured. The percentage of eligible patients using CGM increased from 28 to 42%, and the percentage of patients using CGM started in primary care increased from 8 to 14%. Weekly orders increased from 0.3 per week to 2.3 per week. Nursing reported feeling more comfortable and knowledgeable about CGM after the interventions and reported improved communication with DME suppliers. CGM is known to improve outcomes for patients with diabetes but is an underutilized tool in primary care. Collaborative quality improvement projects between endocrinology and primary care can rapidly build capacity within primary care to prescribe CGM and expand access for patients with diabetes who do not have endocrinologists.

BackgroundMetabolic Syndrome (MetS) and Non-communicable diseases (NCDs) are alarmingly increasing in low-income countries. Yet, very limited is known about the prevalence and risk factors associated with MetS in Ethiopia.MethodsA cross-sectional study was conducted among adult outpatients (N = 325) at St. Paul’s Hospital Millennium Medical College in Addis Ababa, Ethiopia. The study was conducted in accordance with STEPwise approach of the World Health Organization. MetS was defined using modified National Cholesterol Education Program’s Adult Treatment Panel III criteria. Univariate and multivariate analyses were performed.ResultsThe overall prevalence of MetS was 20.3%. Among the 325 participants, 76.9% had at least one MetS components. Reduced high-density lipoprotein cholesterol was the most common MetS component at 48.6%, followed by elevated blood pressure at 36.3%, and elevated fasting glucose at 32.6%. Older age (odds ratio [OR] = 4.15; 95% confidence interval [CI] = 1.43–12.04), Amhara ethnicity (OR = 2.36; 95%CI = 1.14–4.88), overweight status (OR = 2.21; 95%CI = 1.03–4.71), higher income (OR = 3.31; 95%CI = 1.11–9.84) and higher education levels (OR = 2.19; 95%CI = 1.05–4.59) were risk factors for MetS.ConclusionThe disease burden of MetS among Ethiopians is high, and is associated with age, weight, income, education and ethnicity. Comprehensive screening and assessment of MetS is needed along with effective preventive and treatment strategies in low-income countries, such as Ethiopia.

Research–practice partnerships (RPPs) are ripe contexts for school counselors to employ data-driven practices to improve student outcomes. We leveraged an RPP between two universities and a high school to assist the latter’s school counseling department in examining students’ satisfaction with their counselor interactions. The RPP created the capacity for the counselors to gather and use data to implement targeted interventions for improving students’ awareness and perceptions of their school counselors.

Members of the Secondary Section Steering Committee comment on topics of importance to English language arts educators.