Increasing Insulin Access Awareness in the Acute Care Setting

Background: Between 2012 - 2016, the price of insulin has doubled, and since 2015 hyperglycemia related hospitalizations have increased 120% for those using insulin. Many patients with diabetes (PWD) are unable to afford the monthly cost of insulin and are turning to online trading, bartering, rationing, and even a "black market" to obtain insulin. There are insulin financial assistance programs available but are underutilized due to a lack of knowledge from PWD and providers. Inpatient care managers were identified as healthcare providers who have a tremendous impact on providing resources and information to PWD upon hospital discharge. Care managers lack knowledge of and engagement in insulin financial programs have been identified as potential gaps that could help reduce the insulin access problem.Methods:A quality improvement project was developed to help increase the University of Utah Hospital (UUH) care manager's awareness of financial insulin access programs and the development of a handout as a tool to help increase referrals to these programs. Care managers were assessed for proper identification of PWD with insulin access problems, knowledge on available finance programs, and the feasibility and usability of a handout. An educational presentation and a handout were developed and presented to UUH care managers that attended the monthly staff meeting. The handout was critiqued from care manager feedback and then set into production in both English and Spanish. Post educational surveys were sent out to care managers that had participated in the pre-survey and educational presentation. The handout tracking log was collected after two months to assess the care manager's utilization and feasibility of the handout in helping to increase referrals to insulin financial assistance programs.Results: The pre-survey (n=18) revealed that the majority of care managers (n=15) were asking PWD if they could afford insulin. However, a vast majority of care managers could not identify national (n=17, 94%) and local (n=16, 89%) financial assistance programs. Results from post-survey (n=7) showed that 71% (n=5) of the care manager's knowledge of financial assistance programs improved. Furthermore, there was at least a 50% improvement in the participants ability to identify all common practices of PWD who have financial access problems. All post-survey participants 9n=7, 100%) could identify the Medication Supportive Service (MSS) and Patient Assistance Program (PAP) local UUH insulin financial assistance programs by name. The handout tracking log that was provided was not feasible for the care manager's utilization. Conclusions: The educational presentation appeared to increase knowledge and awareness about insulin financial assistance programs. The handout that was provided to care managers was not useable or feasible. However, an additional search in the EHR showed 63 entries in care managers notes that suggest the utilization of handout and/or referrals of PWD to financial insulin access programs such as the Medication Supportive Service, and the Patient Assistance Program. Future research should consider tracking utilization and feasibility of a handout through EHR, with a suggestion to create a dot phrase or an attachment to patients discharge paperwork for improved care manager satisfaction.