Telemedicine: A Potential Solution for Patients with Diabetes in Rural Areas

A telemedicine diabetes program was well received by patients and effective at improving patient outcomes, according to a study published online in the North Carolina Medical Journal.

A program sponsored by the Health Resources & Services Administration and Kate B. Reynolds Charitable Trust focused on a diabetes telemedicine program conducted from 2013-2016 in 13 sites in North Carolina. This program offered interdisciplinary care in the patient's primary care provider's office. The program included pharmacists as integral members of the team and targeted underserved adults with uncontrolled type 2 diabetes who lived in rural areas.

The health care team scheduled a series of teleconference appointments with patients, sometimes scheduling 2 or 3 appointments in advance. Pharmacists met with patients using a telemedicine system at the first visit to assess adherence, baseline knowledge, and injection technique. Pharmacists also assessed laboratory values in the medical record, and helped patients understand the relationship between medication and glucose stabilization.

Pharmacists also educated patients about specific medications and self-management. They strategized with patients to improve medication and monitoring adherence and worked with other members of the interdisciplinary team to promote lifestyle interventions.

Often, team members from different disciplines would see a patient together (eg a dietitian and a prescriber). The program leaders indicated that one particularly effective intervention was a joint meeting with the patient, the pharmacist, and the dietitian to discuss diet/basal bolus insulin coordination.

Over 30 months, the team completed more than 1200 telecare visits with 365 patients. The average patient had 3 to 4 appointments with interdisciplinary team members.

The team reported improvements in patients’ weight, hemoglobin A1c, and low density lipoprotein within the first year. At baseline, more than half of patients had symptoms indicative of depression; at the end of the study 67% of these patients reported symptom improvement.

This interdisciplinary team also compared its results with the results achieved by a face-to-face care provision group. In that group, providers saw 262 rural patients in an academic treatment center. The results were similar.

Reference

Nye AM. A Clinical pharmacist in telehealth team care for rural patients with diabetes. N C Med J. 2017;78(3):183-184.