Diabetes Mellitus, Type 1, Diabetes Mellitus Type 2, Primary Care Provider
Conditions
Keywords
Diabetes Mellitus, Telemedicine, Referral, Consultation
Brief summary
This study seeks to evaluate and document the processes of outreach consultation through joint-clinics via teleconferencing as an intervention for system improvement in care delivery and management of diabetes mellitus (DM) at a Community Based Outpatient Center (CBOCs).
Detailed description
Background: Diabetes is a national problem that has reached epidemic proportions, according to the U.S. Centers for Disease Control and Prevention. Diabetes has particular importance for the Department of Veterans Affairs (VA) because the prevalence among VA patients -- one in six, or 16 percent -- is substantially higher than in the general population. Objectives: The objective of this study was to evaluate and document the processes of outreach consultation through the use of joint-clinics via teleconferencing as an intervention for system improvement in care delivery and management of diabetes at CBOCs. The intervention consisted of a teleconferenced joint-clinic consultation session involving the patient, Diabetes Specialist Team, the Primary Care Provider (PCP) and other relevant care team members. The impact of the 16-month intervention was assessed based on patients who were involved in the telemedicine clinic and those who were referred to a specialist to be seen on-site at the Cleveland VAMC. Methods: Study settings include the CBOCs affiliated with the Cleveland Veterans Affairs Medical Center (VAMC) and involve primary care referrals to see diabetes specialists at the Cleveland VAMC. Inclusion criteria patients(N 282)=included: (i) current prescription of insulin or an oral hypoglycemic agent; (ii) A1c \> 7.0%; or (iii) fasting glucose levels\> 130 mg/dl; and (iv) referred to see a consultant (beginning three months prior to the active intervention phase and continuing through enrollment for the last month of the active intervention phase). Patients with either Type l or Type II diabetes will be included. Patients referred will be contacted and asked to participate.
Interventions
BEHAVIORALThe Diabetes Treatment Satisfaction Questionnaire
A six question likert scale questionnaire regarding the patients treatment satisfaction. The responses range from very dissatisfied to very satisfied.
BEHAVIORALDiabetes Empowerment Scale
A twenty-eight question likert scale questionnaire regarding the patients attitude towards diabetes. The responses range from strongly agree to strongly disagree.
BEHAVIORALCBOC's undergo half-day joint-clinics via teleconference
A patient has Diabetes/Endo clinic visit via teleconferencing. A patient is at a CBOC and the Diabetes/Endo physician is at Wade Park.
Sponsors
US Department of Veterans Affairs
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* 1\) Current prescription of insulin or an oral hypoglycemic agent * 2\) A1c \> 7.0% * 3\) fasting glucose levels \> 130 mg/dl * 4\) referred to see a consultant and are seen during the active intervention phase. Patients with either Type I or Type II DM will be included A Primary Care Provider for a Cleveland CBOC
Exclusion criteria
* 1\) primary care obtained at more than one site (based on stop codes with evidence of more than 1 CBOC involved in care during the last 6 months) * 2\) documented dementia, aphasia, and psychosis
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| A1c | baseline and 18 months | Hemoglobin A1c is a measure of glycemic control |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Patient Satisfaction | Base line and at18 months. | Diabetes Treatment Satisfaction Questionnaire (DTSQ) consists of 6 questions and ranges from 0-6. The following aspects of current treatment included were convenience, flexibility, understanding and continuing present form of treatment. The total range of the DTSQ is the sum of the 6 individual questions scores (i.e. 0-36) Higher scores represent greater satisfaction/convenience. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Telemedicine CBOC Designated CBOC's were involved in the intervention phase where their DM patients were asked to participate in a telemedicine visit.
The Diabetes Treatment Satisfaction Questionnaire: A six question likert scale questionnaire regarding the patients treatment satisfaction. The responses range from very dissatisfied to very satisfied.
Diabetes Empowerment Scale: A twenty-eight question likert scale questionnaire regarding the patients attitude towards diabetes. The responses range from strongly agree to strongly disagree.
CBOC's undergo half-day joint-clinics via teleconference: A patient has Diabetes/Endo clinic visit via teleconferencing. A patient is at a CBOC and the Diabetes/Endo physician is at Wade Park.
We did not collect gender and age related data. | 199 |
| Control CBOC The CBOC's not involved in the intervention phase had their patients not be involved in the telemedicine visit, but traditional education. | 83 |
| Provider Interview Qualitative interviews with providers | 22 |
| Total | 304 |
Baseline characteristics
| Characteristic | Telemedicine CBOC | Control CBOC | Provider Interview | Total |
|---|---|---|---|---|
| Age, Customized 18 years and older | 199 participants | 83 participants | 22 participants | 304 participants |
| Sex/Gender, Customized | NA participants | NA participants | NA participants | NA participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — |
| other Total, other adverse events | 0 / 199 | 0 / 83 | 0 / 22 |
| serious Total, serious adverse events | 0 / 199 | 0 / 83 | 0 / 22 |
Outcome results
Primary
A1c
Hemoglobin A1c is a measure of glycemic control
Time frame: baseline and 18 months
| Arm | Measure | Group | Value (MEAN) |
|---|---|---|---|
| Telemedicine CBOC | A1c | baseline | 10.1 percentage of Hb that is glycosylated |
| Telemedicine CBOC | A1c | 18 months | 8.82 percentage of Hb that is glycosylated |
| Control CBOC | A1c | baseline | 9.32 percentage of Hb that is glycosylated |
| Control CBOC | A1c | 18 months | 8.36 percentage of Hb that is glycosylated |
Secondary
Patient Satisfaction
Diabetes Treatment Satisfaction Questionnaire (DTSQ) consists of 6 questions and ranges from 0-6. The following aspects of current treatment included were convenience, flexibility, understanding and continuing present form of treatment. The total range of the DTSQ is the sum of the 6 individual questions scores (i.e. 0-36) Higher scores represent greater satisfaction/convenience.
Time frame: Base line and at18 months.
Population: The number subjects was determined on the size of the CBOC.
| Arm | Measure | Group | Value (MEAN) |
|---|---|---|---|
| Telemedicine CBOC | Patient Satisfaction | baseline | 24.33 units on a scale |
| Telemedicine CBOC | Patient Satisfaction | 18 months | 23.55 units on a scale |
| Control CBOC | Patient Satisfaction | baseline | 23.29 units on a scale |
| Control CBOC | Patient Satisfaction | 18 months | 23.9 units on a scale |
Comparison: Comparisons were made between the intervention and control groups at baselinep-value: >0.153t-test, 2 sided
Comparison: Comparisons were made between the intervention and control groups at 18 monthsp-value: >0.25t-test, 2 sided