Transitioning to Telehealth during COVID-19: Experiences and Insights from Diabetes Prevention and Management Program Providers in Los Angeles County

Abstract

The onset of the COVID-19 pandemic in March 2020 accelerated the efforts of several organizations providing the National Diabetes Prevention Program (National DPP) and the Diabetes Self-Management Education and Support (DSMES) program to rapidly transition from in-person service delivery to program administration via telehealth. Semi-structured interviews were conducted with 35 National DPP and DSMES experts and providers in Los Angeles County to gain a better understanding of the challenges and benefits associated with this transition. Interviews were completed during June to October 2021. Thematic analyses were performed using the Social-Ecological Model as a guiding framework. The analyses revealed several factors that influenced the transition, including at the individual (e.g., technology and health behaviors), interpersonal (e.g., social connections and support), organizational (e.g., provider workload and program enrollment and retention), community (e.g., recruitment), and policy (e.g., government support and reimbursement for telehealth services) levels. Findings suggest that the transition to telehealth was challenging for most National DPP and DSMES providers. However, because of its lower cost, ability to reach long distances virtually, and potential efficiency when employed as part of a hybrid approach, this delivery modality remains viable, offering benefits beyond the traditional program models.

Enhancing access and impact of the Medicare Diabetes Prevention Program using telehealth: a narrative review

“…Although MDPP suppliers reported that older adults had initially hesitated when considering telehealth delivery, suppliers also perceived how telehealth facilitated access and social support for older adults during the pandemic ( 47 ). Suppliers in Los Angeles County also reported that telehealth delivery increased access for individuals who would otherwise have difficulty with in-person attendance in the NDPP ( 54 ). Interviewees further described examples of older adults and low-income participants who were “very tech-savvy” and “quickly able to adjust to telehealth” ( 54 ).…”

“…Suppliers in Los Angeles County also reported that telehealth delivery increased access for individuals who would otherwise have difficulty with in-person attendance in the NDPP ( 54 ). Interviewees further described examples of older adults and low-income participants who were “very tech-savvy” and “quickly able to adjust to telehealth” ( 54 ). However, as described in detail below, a remaining concern is that suppliers have reported needing better reimbursement rates for providing the MDPP.…”

Staff resilience and innovation essential to New York City diabetes prevention programs going virtual during COVID-19 pandemic lockdowns

“…Across the US, various degrees of pandemic lockdowns soon followed. Studies examining the effect of the pandemic on DPPs include a national qualitative case study by the CDC [ 16 ], a qualitative study of Los Angeles Couty DPPs [ 17 ], and a survey of community pharmacies [ 18 ]. These studies showed that DPPs across the United States shared the following challenges a) COVID-19 related staff shortages; b) organizational and individual lack of access to and/or knowledge of technology; c) data collection hampered by lack of access to safe online platforms and/or poor internet access; d) extraordinary efforts were needed to collect data from and to connect with participants, including loaning digital devices; e) participants and lifestyle coaches lamented the absence of personal interaction both for recruitment and retention purposes; and f) reporting/reimbursement were onerous, reimbursement rates are inadequate to sustain the program [ 19 , 20 ], and therefore a majority of programs did not report to the CDC nor did they bill Medicare/Medicaid or private insurance [ 18 ].…”

“…Furthermore, they found that enrollment was affected initially, but as telehealth options became desirable and more convenient enrollment improved. Findings suggest that the transition to telehealth was challenging in similar ways for most United States DPP providers [ 17 ]. Because of its lower cost, ability to reach long distances virtually, and potential efficiency when employed as part of a hybrid approach, all three studies concluded that online or hybrid delivery modalities remain viable, offering benefits beyond the traditional program models.…”