Access to specialty care and intensive self-management programs can be beneficial to patients living with diabetes and can help them improve their overall diabetes management. Unfortunately, these programs are lacking in rural areas and can lead to poor diabetes outcomes for those patients. With telehealth emerging as our new normal, this gives rural areas the opportunity to have better-specialized diabetes care.
This week at the American Diabetes Association 80th Scientific Sessions, the results of a study that examined the implementation of an intensive telehealth intervention in a rural area were presented. The researchers used the infrastructure of already existing Veterans Health Administration (VHA) and Home Telehealth (HT). This study took into account that the services provided would be in addition to already receiving in-person care.
Study Methods
Elizabeth A. Kobe led the 6-month telehealth intervention for patients with “poor glycemic control” (typically an A1c>8.5%), which was earlier found to be effective in a randomized trial.
The Advanced Comprehensive Diabetes Care (ACDC) combined telemonitoring, self-support management and medication management guided by a clinician. From 2017-2019, the ACDC was implemented in five rural VHA sites with guidance from the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework.
Key Findings
- A1c improved from an average of 9.25% at baseline to 7.89% at six months
- Implementation at each site was well-received with an average of 8-10 of 12 scheduled ACDC calls complete
- ACDC improved patient engagement and awareness of their diabetes management
Conclusions
There is no question that intensive telehealth interventions, when properly designed using already existing infrastructure, is a much-needed addition to standard care for many and can lead to improved and sustainable glycemic control improvements, especially for people living with diabetes in rural areas, who may have less access to traditional care and diabetes education approaches.
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