1125-P: Provider Experience Caring for Elderly Patients with Uncontrolled Type 2 Diabetes and Hospitalization

Introduction & Objective: Hospitalization may serve as an opportune time to address uncontrolled type 2 diabetes (T2D) in elderly patients. Our objective was to examine hospitalist and primary care provider (PCP) experience caring for patients > age 65 with T2D during or after hospitalization.

Methods: Utilizing the electronic medical record, we identified patients age >65 with T2D and A1c> 8%, with hospital discharge November 2022-April 2023 and identified the hospitalists and PCPs caring for these patients. Sixteen semi-structured interviews were conducted with providers within 90 days of patient discharge. Interviews were audio recorded, transcribed, and transcripts were thematically analyzed using an inductive approach.

Results: Hospitalists and PCPs both viewed hospitalization as an opportunity to make therapeutic changes for patients with uncontrolled T2D. A hospitalist described “an opportunity to ‘reassess’ medications previously set "on cruise control." Providers use blood sugar and A1c to inform decisions, but reported variation in data prompting medication change. Hospitalists expressed trepidation around “making drastic changes,” or one stating “⋯ I might tweak things a little bit and say⋯ ‘follow up with your PCP,” while PCPs draw upon their relationships with patients and see “the outpatient setting [as] where the care of diabetic patients takes place most of the time.” Yet PCPs may appreciate when changes are made in the hospital, one stating "It’s psychologically a little easier, if they’ve already started [medicines prescribed by hospitalists]."

Conclusion: PCPs and hospitalists both appreciate hospitalization as an opportune time to make T2D therapeutic changes but therapeutic inertia was identified among both provider types. Efforts to improve hospitalist-PCP communication about diabetes treatment as well as standardized protocols for treatment adjustment should be explored for older patients with uncontrolled T2D at the time of discharge.