Face-to-Face by Videoconference: Improving Diabetes Care

Columbia University’s Informatics for Diabetes Education and Telemedicine (IDEATel) project, a 4-year Centers for Medicare and Medicaid Services-sponsored demonstration project, showed that a telemedicine intervention can improve glycemic, lipid, and blood pressure control. A study that appears ahead-of-print in Telemedicine Journal and e-Health evaluated factors associated with primary care providers’ (PCPs’) acceptance of a diabetes team’s recommendations, and reports that PCP’s acceptance of this type of intervention increases with more exposure to the process.

These researchers looked at a specific geographic location: Upstate New York. Researchers coordinated enrollment and intervention at State University of New York (SUNY) Upstate Medical University at Syracuse.

The study involved 2 groups. The intervention group (n=695) included a diabetes educator team (nurse and dietitian case managers) that video conferenced with patients every 4 to 6 weeks. During the session they reviewed glucose and blood pressure readings, diabetes-related issues, and laboratory data. An endocrinologist reviewed the videoconferences and sent any recommendations to change therapy to patients’ PCPs. The usual care group had contact with the diabetes team via telemedicine and telephone, but no videoconferencing or endocrinologist review. Note that most PCPs were unaffiliated with the diabetes team.

PCPs accepted only 26% of the team’s recommendations. However, PCPS came to trust the diabetes more as time went on, and acceptance of the case management team’s recommendations increased.

Another factor increases the acceptance rate of IDEATel recommendation—changing a medication dose as opposed to starting or stopping a medication. The team found that PCPs were more hesitant to start new medications than they were to adjust the dose of a current medication. The IDEATel team lacked access to patients’ medical records—a significant problem—so they were unaware of PCPs did not start new medications because of a potential interaction or contraindication.

Acceptance rates also increase when adjusting glucose-lowering agents (but not antihypertensive or anti-lipid medications), higher symptom severity score, greater number of glucose readings submitted by participants, and more patient involvement and understanding.

The IDEATel team did not have access to patient adherence data, and could not assess this outcome.