The utilization of video-conference shared medical appointments in rural diabetes care

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. usualcare (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.3

Rural Mental Health Training: an Emerging Imperative to Address Health Disparities

“…While the diversity of practice activities may be a positive aspect for recruitment, there is an important need to address professional isolation through technology and purposeful collaboration [33]. Using videoconferencing technology for medical appointments has shown promise in managing conditions such as diabetes in rural settings [34], and this approach appears to be particularly applicable for psychiatric care as well. The principle of Project Extension for Community Healthcare Outcomes (Project ECHO) is to de-monopolize specialized medical knowledge and expertise and to increase access to this specialized knowledge and expertise in rural and underserved areas through videoconferencing technology and case-based learning [35].…”

How do nurse practitioners work in primary health care settings? A scoping review

“…This included ethnic groups identified as being at risk (Marion, Finnegan et al 2009, Choi and Rush 2012, Barrett , Salem et al 2015, Murphy, Coke et al 2015, individuals and groups from rural areas (Wright, Purdy et al 2007, Jessee and Rutledge 2012, Murfet, Allen et al 2013, Barrett , Salem et al 2015, Kozlowski, Lusk et al 2015, Tokuda, Lorenzo et al 2016, Tyler and Horner 2016, areas of socio-economic disadvantage (Speck, Hines-Martin et al 2007, Marion, Finnegan et al 2009, Lynam, Loock et al 2010, Stines, Perman et al 2011, Wong, Lynam et al 2012, Walker, Marshall et al 2013, Ritten, Waldrop et al 2015, Berry, Williams et al 2016 or frail elderly (Wajnberg, Wang et al 2010, Prasad, Dunn et al 2014, Ritchie, Andersen et al 2016. In this way, nurse practitioners practiced to improve the health of hard to reach populations challenged with access and acceptability of traditional health care services.…”

“…In some cases, the nurse practitioner provided a service that individuals would otherwise have difficulty accessing for reasons including affordability, geographical isolation or extended waiting times (Sarro, Rampersaud et al 2010, Kozlowski, Lusk et al 2015, Lucatorto, Watts et al 2016, Tokuda, Lorenzo et al 2016. Nurse practitioners also increased the quality of care as measured by adherence to relevant best practice recommendations (Conlon 2010, Lawson, Dicks et al 2012, Reuben, Ganz et al 2013.…”

Shared medical appointments

“…3 Technology, including video conferencing, has also been used to provide SMAs for patients living in rural areas or those with mobility difficulties. 9 Researchers have considered a range of patient related outcomes of SMAs, suggesting that they can facilitate effective information giving, improving patients' knowledge about their condition and its management, 3 5 and leading to more effective self care. 10 Patients participating in SMAs report fewer symptoms 10 and express greater satisfaction with and perceived access to care 3 11 ; quality of care and quality of life are also more highly rated in SMAs.…”