Assessing Allied Health-Care Professional Time in Pediatric Type 1 Diabetes: Associations With Clinical Factors, Technology and Social Determinants.
OBJECTIVES
The factors associated with allied health-care professional (HCP) time spent face-to-face with patients in clinic have not been well described in type 1 diabetes (T1D) given the introduction of resource-intensive technologies and gaps in socioeconomic circumstances. The objective of this study was to evaluate clinical and social factors associated with nonphysician HCP time in a pediatric T1D practice.


METHODS
Nonphysician HCP workload data, including time spent in direct clinical care over a 1-year period and nonclinic contacts, were linked to data from 723 pediatric subjects with T1D and evaluated in relation to key demographic, social and diabetes treatment factors.


RESULTS
HCPs spent 145.7 min per patient on a median of 3 clinic visits, with certified diabetes educators (CDEs) being responsible for most clinic interactions compared with psychosocial staff. CDE time varied considerably according to T1D duration, with new-onset patients (≤1 year) taking a median of 392.0 min compared with 114.5 min for their established counterparts (p<0.0001). Among the established group (n=629), CDE time was strongly associated with continuous subcutaneous insulin infusion therapy initiation, psychosocial service use, glycated hemoglobin (A1C) and degree of marginalization (p<0.0001). Overall, CDE time increased by 8.6 min for each 1.0% increase in A1C (p=0.022) and by 16.3 min for each 1-U increase in marginalization (p=0.01).


CONCLUSIONS
We observed HCP time was associated with multiple clinical factors in addition to overall marginalization. Although initial investments in education and continuous subcutaneous insulin infusion training were considerable, our results suggest that these lead to a decrease in time spent in clinic over time, and is largely driven by lower A1C.
['Clarke|Antoine B M|ABM|', 'Ahsan|Hanaa|H|', 'Harrington|Jennifer|J|', 'Mahmud|Farid H|FH|']
D000293:Adolescent D002648:Child D002675:Child, Preschool D003695:Delivery of Health Care D003922:Diabetes Mellitus, Type 1 D005260:Female D006442:Glycated Hemoglobin A D000085002:Glycemic Control D006282:Health Personnel D006801:Humans D007004:Hypoglycemic Agents D015918:Infusion Pumps, Implantable D007328:Insulin D007332:Insulin Infusion Systems D016014:Linear Models D008297:Male D009726:Nurses D064686:Nutritionists D011584:Psychology D012923:Social Class D000068217:Social Workers D013997:Time Factors D016526:Workload
pediatric delivery of health care diabète sucré de type 1 déterminants sociaux de la santé facteurs temps prestation de soins de santé pédiatrique social determinants of health time factors type 1 diabetes mellitus