New study aims to identify barriers to care for people living with diabetes in underserved communities

By Jill Pease

Project PI Dr. Ashby Walker (third from right) and team member Ben Churba, a UF Ph.D. student (second from right), recently traveled to Miami to meet with Health Choice Network collaborators, including, from right, Antoinette Anwar, Stephanie Smith, Angel E. Rivas, Dr. Timothy Long, Stephanie Tejo Martinez and Crystal Walker.

A new University of Florida College of Public Health and Health Professions study seeks to better characterize populations living with insulin-requiring diabetes, including Type 1 diabetes, seen at a Federally Qualified Health Center, or FQHC, and to identify challenges faced by primary care physicians delivering diabetes care to underserved communities.

Ashby Walker, Ph.D., an assistant professor in the UF PHHP department of health services research, management and policy and director of health equity initiatives at the UF Diabetes Institute, leads the new study, which is supported by a grant to UF from The Leona M. and Harry B. Helmsley Charitable Trust.

“Underserved communities that are seen for care in FQHCs are often underrepresented in research about diabetes which often rely on data collected from endocrinology settings,” Walker said. “Gaining more information about people with insulin-requiring diabetes who receive care at FQHCs will allow us to better understand the unique challenges and risks they face, and also will allow us to develop more targeted strategies for interventions to reduce those risks.”

FQHCs provide care to more than 30 million medically underserved people in the United States and they play a critical role in caring for people living with Type 1 diabetes and other forms of insulin-requiring diabetes who are medically underserved. For the new study, researchers will conduct a needs assessment that will include analysis of state-level summary statistics characterizing the demographic profile of people living with insulin-requiring diabetes, including Type 1 diabetes, in addition to diabetes-related health outcomes, technology use, hospitalizations and subspecialty referrals. UF researchers will collaborate with partners at two large health center controlled network organizations, Health Choice Network and AllianceChicago. This unique partnership will allow investigators to leverage a national enterprise data warehouse that includes data from more than 160 FQHCs across 29 states that are part of the Health Choice Network and AllianceChicago’s networks.

The needs assessment will also involve national survey research and focus groups with primary care physicians practicing at FQHCs. This effort to understand provider-level barriers is vital to developing multi-layered interventions to reduce disparities in diabetes care and outcomes. Primary care physicians in the FQHC setting represent one of the most diverse cohorts of medical providers in the U.S., yet they are often underrepresented in national survey efforts that benchmark important topics like career satisfaction and unique workplace challenges. This research will allow an unprecedented understanding of provider experiences within the FQHC setting and will help identify diabetes-specific barriers they face.

“The collaboration between Health Choice Network, Helmsley Charitable Trust and the University of Florida Diabetes Institute embodies the fusion of expertise, resources and commitment toward advancing health care solutions,” said Tim Long, M.D., chief clinical officer of Health Choice Network. “Together, we create a synergistic force driving innovation, research and the delivery of transformative care, ultimately improving the lives of individuals affected by diabetes.”

UF co-investigators include Nicole Marlow, Ph.D., a research assistant professor, and Young-Rock Hong, Ph.D., an assistant professor, both of the department of health services research, management and policy; Sarah Westen, Ph.D., a clinical assistant professor in the department of clinical and health psychology; Michael Haller, M.D., a professor of pediatrics and chief of the division of pediatric endocrinology; and Ben Churba, M.P.H., a doctoral student in health services research.