Dataset Information

Implementation of an Intensive Telehealth Intervention for Rural Patients with Clinic-Refractory Diabetes.

ABSTRACT:

Background

Rural patients with type 2 diabetes (T2D) may experience poor glycemic control due to limited access to T2D specialty care and self-management support. Telehealth can facilitate delivery of comprehensive T2D care to rural patients, but implementation in clinical practice is challenging.

Objective

To examine the implementation of Advanced Comprehensive Diabetes Care (ACDC), an evidence-based, comprehensive telehealth intervention for clinic-refractory, uncontrolled T2D. ACDC leverages existing Veterans Health Administration (VHA) Home Telehealth (HT) infrastructure, making delivery practical in rural areas.

Design

Mixed-methods implementation study.

Participants

230 patients with clinic-refractory, uncontrolled T2D.

Intervention

ACDC bundles telemonitoring, self-management support, and specialist-guided medication management, and is delivered over 6 months using existing VHA HT clinical staffing/equipment. Patients may continue in a maintenance protocol after the initial 6-month intervention period.

Main measures

Implementation was evaluated using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. The primary effectiveness outcome was hemoglobin A1c (HbA1c).

Key results

From 2017 to 2020, ACDC was delivered to 230 patients across seven geographically diverse VHA sites; on average, patients were 59 years of age, 95% male, 80% white, and 14% Hispanic/Latinx. Patients completed an average of 10.1 of 12 scheduled encounters during the 6-month intervention period. Model-estimated mean baseline HbA1c was 9.56% and improved to 8.14% at 6 months (- 1.43%, 95% CI: - 1.64, - 1.21; P < .001). Benefits persisted at 12 (- 1.26%, 95% CI: - 1.48, - 1.05; P < .001) and 18 months (- 1.08%, 95% CI - 1.35, - 0.81; P < .001). Patients reported increased engagement in self-management and awareness of glycemic control, while clinicians and HT nurses reported a moderate workload increase. As of this submission, some sites have maintained delivery of ACDC for up to 4 years.

Conclusions

When strategically designed to leverage existing infrastructure, comprehensive telehealth interventions can be implemented successfully, even in rural areas. ACDC produced sustained improvements in glycemic control in a previously refractory population.

SUBMITTER: Kobe EA

PROVIDER: S-EPMC8722663 | biostudies-literature | 2022 Sep

REPOSITORIES: biostudies-literature

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Publications

Implementation of an Intensive Telehealth Intervention for Rural Patients with Clinic-Refractory Diabetes.

Kobe Elizabeth A EA Lewinski Allison A AA Jeffreys Amy S AS Smith Valerie A VA Coffman Cynthia J CJ Danus Susanne M SM Sidoli Elisabeth E Greck Beth D BD Horne Leanne L Saxon David R DR Shook Susan S Aguirre Lina E LE Esquibel Mary G MG Evenson Clarene C Elizagaray Christopher C Nelson Vivian V Zeek Amanda A Weppner William G WG Scodellaro Stephanie S Perdew Cassie J CJ Jackson George L GL Steinhauser Karen K Bosworth Hayden B HB Edelman David D Crowley Matthew J MJ

Journal of general internal medicine 20220103 12

<h4>Background</h4>Rural patients with type 2 diabetes (T2D) may experience poor glycemic control due to limited access to T2D specialty care and self-management support. Telehealth can facilitate delivery of comprehensive T2D care to rural patients, but implementation in clinical practice is challenging.<h4>Objective</h4>To examine the implementation of Advanced Comprehensive Diabetes Care (ACDC), an evidence-based, comprehensive telehealth intervention for clinic-refractory, uncontrolled T2D. ...[more]

PMID: 34981358

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Dataset Information

Implementation of an Intensive Telehealth Intervention for Rural Patients with Clinic-Refractory Diabetes.

Background

Objective

Design

Participants

Intervention

Main measures

Key results

Conclusions

Publications

Implementation of an Intensive Telehealth Intervention for Rural Patients with Clinic-Refractory Diabetes.

Similar Datasets

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