Lisa Tokuda1, Lenora Lorenzo2, Andre Theriault3, Tracey H Taveira4, Lynn Marquis5, Helene Head6, David Edelman7, Susan R Kirsh6, David C Aron8, Wen-Chih Wu9. 1. Veterans Affairs Pacific Island Healthcare System, Research & Development Office, Honolulu, HI, United States; Veterans Affairs Pacific Island Healthcare System, Department of Pharmacy, Honolulu, HI, United States. 2. Veterans Affairs Pacific Island Healthcare System, Research & Development Office, Honolulu, HI, United States; Veterans Affairs Pacific Island Healthcare System, Department of Mental Health, Honolulu, HI, United States. 3. Veterans Affairs Pacific Island Healthcare System, Research & Development Office, Honolulu, HI, United States. 4. Veterans Affairs Medical Center, Center of Innovation for Long Term Services & Support, Providence, RI, United States; Department of Medicine, Warren Alpert School of Medicine of Brown University, United States; University of Rhode Island, College of Pharmacy, United States. 5. Veterans Affairs Medical Center, Center of Innovation for Long Term Services & Support, Providence, RI, United States. 6. Veterans Affairs Pacific Island Healthcare System, Primary Care Service, Agana Heights, Guam, United States. 7. Veterans Affairs Medical Center, Center for Health Services Research in Primary Care, Durham, NC, United States. 8. Veterans Affairs Medical Center, Internal Medicine Division, Cleveland, OH, United States. 9. Veterans Affairs Medical Center, Center of Innovation for Long Term Services & Support, Providence, RI, United States; Department of Medicine, Warren Alpert School of Medicine of Brown University, United States; University of Rhode Island, College of Pharmacy, United States. Electronic address: wen-chih.wu@va.gov.
Abstract
AIM: To explore whether Video-Shared Medical Appointments (video-SMA), where group education and medication titration were provided remotely through video-conferencing technology would improve diabetes outcomes in remote rural settings. METHODS: We conducted a pilot where a team of a clinical pharmacist and a nurse practitioner from Honolulu VA hospital remotely delivered video-SMA in diabetes to Guam. Patients with diabetes and HbA1c ≥7% were enrolled into the study during 2013-2014. Six groups of 4-6 subjects attended 4 weekly sessions, followed by 2 bi-monthly booster video-SMA sessions for 5 months. Patients with HbA1c ≥7% that had primary care visits during the study period but not referred/recruited for video-SMA were selected as usual-care comparators. We compared changes from baseline in HbA1c, blood-pressure, and lipid levels using mixed-effect modeling between video-SMA and usual care groups. We also analyzed emergency department (ED) visits and hospitalizations. Focus groups were conducted to understand patient's perceptions. RESULTS: Thirty-one patients received video-SMA and charts of 69 subjects were abstracted as usual-care. After 5 months, there was a significant decline in HbA1c in video-SMA vs. usual-care (9.1±1.9 to 8.3±1.8 vs. 8.6±1.4 to 8.7±1.6, P=0.03). No significant change in blood-pressure or lipid levels was found between the groups. Patients in the video-SMA group had significantly lower rates of ED visits (3.2% vs. 17.4%, P=0.01) than usual-care but similar hospitalization rates. Focus groups suggested patient satisfaction with video-SMA and increase in self-efficacy in diabetes self-care. CONCLUSION: Video-SMA is feasible, well-perceived and has the potential to improve diabetes outcomes in a rural setting. Published by Elsevier Ireland Ltd.
AIM: To explore whether Video-Shared Medical Appointments (video-SMA), where group education and medication titration were provided remotely through video-conferencing technology would improve diabetes outcomes in remote rural settings. METHODS: We conducted a pilot where a team of a clinical pharmacist and a nurse practitioner from Honolulu VA hospital remotely delivered video-SMA in diabetes to Guam. Patients with diabetes and HbA1c ≥7% were enrolled into the study during 2013-2014. Six groups of 4-6 subjects attended 4 weekly sessions, followed by 2 bi-monthly booster video-SMA sessions for 5 months. Patients with HbA1c ≥7% that had primary care visits during the study period but not referred/recruited for video-SMA were selected as usual-care comparators. We compared changes from baseline in HbA1c, blood-pressure, and lipid levels using mixed-effect modeling between video-SMA and usual care groups. We also analyzed emergency department (ED) visits and hospitalizations. Focus groups were conducted to understand patient's perceptions. RESULTS: Thirty-one patients received video-SMA and charts of 69 subjects were abstracted as usual-care. After 5 months, there was a significant decline in HbA1c in video-SMA vs. usual-care (9.1±1.9 to 8.3±1.8 vs. 8.6±1.4 to 8.7±1.6, P=0.03). No significant change in blood-pressure or lipid levels was found between the groups. Patients in the video-SMA group had significantly lower rates of ED visits (3.2% vs. 17.4%, P=0.01) than usual-care but similar hospitalization rates. Focus groups suggested patient satisfaction with video-SMA and increase in self-efficacy in diabetes self-care. CONCLUSION: Video-SMA is feasible, well-perceived and has the potential to improve diabetes outcomes in a rural setting. Published by Elsevier Ireland Ltd.
Entities:
Keywords:
Diabetes mellitus; Group medical visits; Rural medicine; Video-shared medical appointments
Authors: Lidia S van Huizen; Pieter Dijkstra; Gyorgy B Halmos; Johanna G M van den Hoek; Klaas T van der Laan; Oda B Wijers; Kees Ahaus; Jan G A M de Visscher; Jan Roodenburg Journal: BMJ Open Date: 2019-11-07 Impact factor: 2.692