804-P: How Barriers Affect Primary Care Providers’ Referral to the National Diabetes Prevention Program Lifestyle Change Program

Primary care providers’ (PCP) referral of participants to the National Diabetes Prevention Program lifestyle change program (National DPP LCP) needs to be amplified or increased. Using data from 2016, 2017, and 2018 DocStyles surveys, we examined how barriers affect PCPs’ referral and how their practice patterns change over time. Barriers were measured by survey questions regarding PCPs’ perspectives on the importance of 1) claim adjudication processes/payment for the service; 2) interconnectivity of electronic health records (EHRs) with other systems; 3) incentives for referrals; and 4) awareness of prediabetes and National DPP LCP. A logistic model was used to analyze the trend, and the full model controlled for age, gender, practice type, and practice regions. Our analytic cohorts consist of PCPs who were selected repeatedly in two years. The 2016-2018 cohort had 502 PCPs, and the 2017-2018 cohort had 462 PCPs. In the first cohort, the referral rate decreased by 38.5%, from 23.3% in 2016 to 14.3% in 2018 (P<0.05). In the second cohort, the rate decreased by 37.8%, from 24.0% in 2017 to 14.9% in 2018 (P<0.05). Not realizing the importance of the above 4 barriers contributed significantly to the decreased referral rate. Referral rates for those who did not realize barriers 1 and 2 in 2016 did not differ significantly from those who did; however, by 2018 those who did not realize the barriers had lower referral rates (odds ratio (OR) 2.26 (95% confidence interval: 1.31-3.91) for barrier 1 and 1.78 (1.05-3.00) for barrier 2). Similarly, for barriers 3 and 4 differences were not significant in 2017, but ORs increased to 1.89 (1.02-3.51) and 2.91 (1.62-5.20) in 2018. Our findings suggest that lack of realizing the importance of claim/payment, EHR usage, incentives for referrals, and awareness of National DPP LCP discouraged PCP referral practice and the negative effect amplified over time. Future interventions need to focus on how to overcome these barriers.