Using Telehealth to Provide Diabetes Care to Patients in Rural Montana: Findings from the Promoting Realistic Individual Self-Management Program

Abstract

Objective: The objectives of this study were to demonstrate the feasibility of telehealth technology to provide a team approach to diabetes care for rural patients and determine its effect on patient outcomes when compared with face-to-face diabetes visits. Materials and Methods: An evaluation of a patient-centered interdisciplinary team approach to diabetes management compared telehealth with face-to-face visits on receipt of recommended preventive guidelines, vascular risk factor control, patient satisfaction, and diabetes self-management at baseline and 1, 2, and 3 years postintervention. Results: One-year postintervention the receipt of recommended dilated eye exams increased 31% and 43% among telehealth and face-to-face patients, respectively (p = 0.28). Control of two or more risk factors increased 37% and 69% (p = 0.21). Patient diabetes care satisfaction rates increased 191% and 131% among telehealth and face-to-face patients, respectively (p = 0.51). A comparison of telehealth with face-to-face patients resulted in increased self-reported blood glucose monitoring as instructed (97% vs. 89%; p = 0.63) and increased dietary adherence (244% vs. 159%; p = 0.86), respectively. Receipt of a monofilament foot test showed a significantly greater improvement among face-to-face patients (17% vs. 35%; p = 0.01) at 1 year postintervention, but this difference disappeared in years 2 and 3. Conclusions: Telehealth proved to be an effective mode for the provision of diabetes care to rural patients. Few differences were detected in the delivery of a team approach to diabetes management via telehealth compared with face-to-face visits on receipt of preventive care services, vascular risk factor control, patient satisfaction, and patient self-management. A team approach using telehealth may be a viable strategy for addressing the unique challenges faced by patients living in rural communities.

Sustained Effects of a Nurse Coaching Intervention via Telehealth to Improve Health Behavior Change in Diabetes

“…5 Several studies using telehealth in rural areas have reported improved knowledge of diabetes, self-efficacy, dietary adherence, glucose monitoring, and glycemic control. [18][19][20][21] A large body of evidence supports a short-term effect of diabetes self-management education. [22][23][24][25] In a systematic review of randomized controlled trials, Norris et al 26 reported that, in general, the effectiveness of diabetes interventions was short-lived; improvements in glycemic control, knowledge of diabetes, and diet were observed in the short term, with no significant differences observed between the intervention versus control group long term ( >6 months postintervention).…”

Healthcare Engagement and Encounters in a Rural State: A Focus Group Study

“…3 Montana also used telehealth to help improve diabetic management. 2 Telepharmacy specifically has helped to decrease the need for acute care visits after hospital discharge.…”

“…In general telehealth has the potential to address many healthcare barriers and has been successful in other rural states, such as Montana, West Virginia, and Pennsylvania, for improving medication adherence, selfcare behaviors, and disease state outcomes for diabetes and hypertension. 2,3,27 The telepharmacy program in Maine allowed follow up of VA residents after their hospital discharge and medications and discharge instructions were reviewed over the phone resulting in a 70% decrease in the need for an acute care visit in the first 30 days after hospital discharge. 28 A lack of providers in Wyoming was a substantial problem cited by the study participants, and programs such Telehealth/Telepharmacy may be a way to address this lack of access to care.…”

“…1 Rural populations suffer more from decompensated chronic diseases such as diabetes, asthma, hypertension, cardiovascular disease, and obesity than urban populations. [2][3][4][5][6][7] People in rural areas experience more barriers to quality health care including lack of access to primary care, specialty care, lower socioeconomics, and a greater likelihood of being underinsured or uninsured. Rural residents are also less likely to use preventive screening, and less likely to participate in self-care and engage in their health, leading to nonadherence to medication.…”

“…Rural residents are also less likely to use preventive screening, and less likely to participate in self-care and engage in their health, leading to nonadherence to medication. [2][3][4]8,9 In addition, patients admitted to rural hospitals with diseases, such as congestive heart failure, are more likely to be readmitted to the hospital than patients in urban areas. 10,11 Studies have shown that rural areas have their own cultural patterns, which can influence their health care attitudes and health outcomes.…”