32-OR: First Impact on A1C of Medically Underserved Patients with Type 2 Diabetes Using a Hybrid Chronic Care Model

Timely access to care is crucial for effective diabetes management, but social determinants of health often present significant obstacles. A hybrid chronic care model (h-CCM), which combines pharmacist-conducted telemedicine visits with in-person provider visits, was established to minimize health disparities through enhanced options for healthcare delivery. This study was designed to compare the first A1C changes among medically underserved patients with T2D who received diabetes care from h-CCM versus usual care. This was a prospective intervention study conducted at a FQHC located in Southern California between Oct 2021 and Dec 2022. Patients ≥ 40 years with T2D who received h-CCM (intervention) were compared to the control or usual care which included in-person provider visits only. The control data were generated from UCI Data Warehouse (UCI IRB#2636), matched 1:1 by age, gender, ethnicity, and baseline A1C of the intervention arm during the same time period. Descriptive statistics and Student’s t-test were utilized to compare the demographics and clinical characteristics between the two arms. A total of 208 patients (I: 104, C: 104) were included in the analysis. The average age for both arms was 61.0 SD ±10.5 years with majority being female (57.7%) and Latinx (70%), and a mean A1C of 9.4 ±1.5%. The mean baseline 10-year ASCVD score (%) was comparable (I:19.6 ±16.6 vs. C:22.6 ±17.2; p=0.202). At 3 months, the A1C for the intervention and control arms were 8.74 ±1.89% and 9.41 ±0.12%, respectively, with an average A1C reduction of 0.7% (95% CI: 0.3-1.0, p <0.001%) observed in the intervention arm and no change in the control. A minimal mean (±SD) % reduction for the ASCVD score was observed in the intervention arm (-0.6 ±5.5) with worsening trend observed in the control (0.2 ±1.9).

In conclusion, h-CCM appeared to effect a quicker improvement in A1c during the first three months of care implementation when compared to usual care in medically underserved patients.