Abstract P330: Video-Conference Shared Medical Appointments Improves Rural Diabetes Care
Introduction: Current guidelines recommend the use of multi-disciplinary care models to improve diabetes outcomes. However, this can be difficult to accomplish in rural areas due to limited access to healthcare specialists. It is unknown whether increased access to multi-disciplinary care through Shared Medical Appointments (SMA) and the use of video-conferencing will improve diabetes outcomes in remote rural settings.
Hypothesis: We hypothesize that a non-physician multi-disciplinary SMA care model delivered to a remote rural setting via video-conferencing would improve diabetes outcomes.
Methods: A team consisting of a clinical pharmacist and a nurse practitioner from the VA Medical Center in Hawaii delivered video-SMA (vSMA) to a remote clinic on the island of Guam. Veterans with diabetes with hemoglobin A1c >7% or referred by provider were enrolled into the study. The participants attended 4 weekly group sessions followed by 2 bi-monthly booster SMA visits for a total of 5 months. Each session consisted of self-management education and medication management. Patients with diabetes and A1c >7% that had primary care visits but no vSMA intervention were selected from electronic patient records as controls. We compared changes from baseline in A1c, blood pressure, and lipid levels using mixed effect modeling within and between the vSMA and control groups. We also analyzed differences in phone visits, unscheduled visits, emergency room visits and hospitalizations between the vSMA and the control groups.
Results and Conclusion: Thirty one patients received vSMA and charts of 69 controls were abstracted for a total of 100 patients in the study. Mean age was 61±8.4, and 93% (93 of 100) were males. Sixty one percent of patients had 6-15 years duration of diabetes and 13% (13 of 100) of patients had diabetes for greater than 15 years. Over the 5 month period, the intervention vSMA group showed a significant decline in A1c vs. the control group (9.1 ± 1.9 to 8.3 ±1.8 vs. 8.6 ± 1.4 to 8.7 ±1.6, respectively, p = 0.03). No significant changes over time in blood pressure or lipid levels were found between the vSMA versus the control group. Although changes were not statistically significant, the vSMA group had a trend towards fewer average phone visits (0.72 vs. 0.10), unscheduled visits (0.28 vs. 0.26 visits),ER visits (0.06 vs. 0.03 visits), and hospitalizations (0.04 vs. 0.03) compared to controls. In conclusion, the SMA model appeared to improve diabetes outcomes with potential to reduce healthcare utilization in a rural setting.
Author Disclosures: L.S. Tokuda: None. L.L. Lorenzo: None. L.M. Marquis: None. M. Clayton: None. A.G. Theriault: None. T.H. Taveira: None. H.H. Head: None. D.E. Edelman: None. S.R. Kirsh: None. D.C. Aron: None. W. Wu: None.
- © 2015 by American Heart Association, Inc.