359-OR: CGM in Primary Care—Practice Characteristics and Choice of CGM Implementation Strategy in PREPARE 4 CGM

Introduction & Objective: Most diabetes care occurs in primary care (PC). Continuous glucose monitoring (CGM) is associated with clinical and psychosocial benefits. While CGM uptake in PC is rising, understanding models to support CGM use in diverse PC practices is needed. The PREPARE 4 CGM study evaluates strategies to implement CGM in PC. We compared characteristics among practices choosing a practice-led, self-paced CGM implementation plan or referral to a virtual CGM implementation service.

Methods: Colorado PC practices interested in implementing CGM were recruited and chose to use the American Academy of Family Physicians CGM implementation modules or refer patients to a virtual CGM initiation and education service with dietitian, pharmacist, diabetes care and education specialist (DCES), and physician. Baseline practice characteristics (staffing, specialty, size, payer mix, etc) were compared across study arms using descriptive statistics (frequencies, means, SDs), chi-square tests, Fisher’s exact tests and independent two sample t-tests, using SAS 9.4 (Cary NC). Associations were considered significant at p<0.05.

Results: Of 76 practices, 46 chose self-paced implementation, 16 of which (35%) had a DCES; 30 chose the virtual service, none (0%) of which had a DCES, X²(2, N=62)=11.05, p <.001. Besides having a DCES, no differences in 50 other practice characteristics were seen between groups.

Conclusion: PC practices were eager to implement CGM. While other practice characteristics were not associated with implementation strategy choice, having a DCES was highly associated: all practices with a DCES chose to implement CGM on their own. DCESs may have potential as technology champions in PC practices. Referral to virtual CGM implementation service allowed access to a DCES and multidisciplinary team for practices without them. As many practices without a DCES also chose to implement CGM on their own, multiple models may be necessary to foster CGM implementation in PC.