15 Jun Uncontrolled Diabetes: Implementation of an Intensive Telehealth Intervention for Rural Patients
MedicalResearch.com Interview with:
Matthew J. Crowley, MD
Core Investigator, Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT)
Affiliated Investigator, VA Office of Rural Health
Staff Physician, Endocrinology Section, Durham VA Health Care System
Elizabeth Kobe, BS
Durham VA Health Care System
Duke University School of Medicine
MedicalResearch.com: What is the background for this study? With whom were the telehealth sessions performed? (MDs, PAs, Dieticians etc).
Response: Diabetes management in rural populations is especially challenging due to limited access to specialty care and self-management programs. Telehealth is a potential strategy for extending high-quality diabetes care to rural areas. The Veterans Health Administration (VHA) has a robust Home Telehealth (HT) system that is currently used for telemonitoring patient blood glucose values. In order to address the challenges of managing diabetes in rural areas in a clinically feasible manner, we strategically designed an intensive diabetes management intervention – Advanced Comprehensive Diabetes Care (ACDC) – for delivery using existing VHA HT infrastructure and clinical staffing. ACDC is a 6-month telehealth intervention that combines telemonitoring with module-based self-management support and medication management.
ACDC is delivered entirely by existing clinical staff (a clinical HT nurse and a medication manager (typically a PharmD)) through bimonthly, 30-minute calls. Our initial randomized controlled trial found that ACDC improved HbA1c by a clinically and statistically significant -1.0% relative to usual care at 6 months, while also improving blood pressure and diabetes self-care.
Our goal with the present work was to improve diabetes care in clinical practice for rural Veterans whose type 2 diabetes remained uncontrolled despite receiving available services. To this end, we partnered with the VA Office of Rural Health to implement ACDC into VA sites across the country with large rural populations.
MedicalResearch.com: What are the main findings?
Response: Between 2017 and the present, we have implemented ACDC in clinical practice at 7 VA sites serving rural Veterans across the country. Our most recent analysis of 125 Veterans found ACDC reduced hemoglobin A1c by a highly significant -1.36% at 6 months (p<0.001), and that most of this benefit persisted at 18 months (-1.07%, p<0.001).
MedicalResearch.com: What should readers take away from your report?
Response: ACDC is an effective telehealth-based strategy for managing difficult-to-control diabetes in rural populations, where diabetes management is especially difficult. Because ACDC was specifically designed to leverage existing clinical staffing and equipment within VA, implementation for rural patients has been successful with minimal adaptation to original design. As such, ACDC is ideally suited for further widespread use in clinical practice across the VA system.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: ACDC is making a strong impact within VA, but one important question is whether the ACDC approach can be translated beyond VA. We are engaged in work to help answer this question.
MedicalResearch.com: Is there anything else you would like to add?
Response: Some of our sites have now been delivering ACDC in clinical practice for up to four years, which indicates that this approach can be sustained in clinical practice. Also, despite the drastic changes COVID-19 has forced healthcare systems like VA to make, ACDC delivery has continued unabated during the pandemic.
Implementation of an Intensive Telehealth Intervention for Rural Patients with Uncontrolled Diabetes
ELIZABETH A. KOBE, ALLISON LEWINSKI, SUSANNE DANUS, ELISABETH L. SIDOLI, BETH GRECK, LEANNE C. HORNE, DAVID SAXON, SUSAN D. SHOOK, LINA E. AGUIRRE, CLARENE EVENSON, CHRISTOPHER S. ELIZAGARAY, GEORGE L. JACKSON, HAYDEN B. BOSWORTH, DAVID EDELMAN, MATTHEW CROWLEY
Diabetes Jun 2020, 69 (Supplement 1) 21-OR; DOI: 10.2337/db20-21-OR
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