Telemedicine in the Management of Type 1 Diabetes 公开

Abstract

Background: Veterans with Type 1 Diabetes who live in rural Alabama and Georgia face barriers to receiving specialty diabetes care due a lack of endocrinologists in the Central Alabama VA Health Care System. Telemedicine is a promising solution to help increase access to needed health care. We evaluated the effectiveness of telemedicine in delivering endocrinology care from Atlanta-based endocrinologists to patients in Central Alabama VA clinics that lack endocrinology specialty care.

Methods: We conducted a retrospective chart review of patients who were enrolled in the Atlanta VA Telehealth Endocrine Clinic from June 2014 to October 2016. Outcomes of interest include diabetes outcomes, changes in glycemic control, time-savings for patients, cost-savings for the Veterans Health Administration, telehealth appointment adherence rates, and patient satisfaction with telehealth.

Results: 32 patients with Type 1 Diabetes received telehealth care, and in general received the recommended processes of diabetes care. Patients trended toward a decrease in mean hemoglobin A1c and glucose variability, as well as an increase in hypoglycemic episodes (p = n.s.). Patients saved 78 minutes of travel time (one-way) and the VA saved $72.94 in travel reimbursements per patient visit. Patients adhered to 88% of scheduled telehealth appointments on average, and 100% of surveyed patients stated they would recommend telehealth to other veterans.

Conclusions: Diabetes specialty care delivered via telemedicine to veterans in rural Alabama and Georgia was safe and non-inferior to in-person care. Telemedicine is also associated with time-savings, cost-savings, high appointment adherence rates, and high patient satisfaction. Our findings suggest that the Veterans Health Administration should implement telemedicine on a broader scale.

Table of Contents

Introduction………………………………………………………………………………………………….………......1

Background……………..……..……………………………….……………………………………….……….………….1

Specific Aims………………………………………………………………………………………………………………….3

Hypotheses…………………………………………………………………………………………………………………….3

Methods………………………..………………………………………………………………….………………………...4

Atlanta Veterans Affairs Medical Center Endocrinology Telehealth Clinic Structure.….4

Study Design…...……..…….…………………………………………………………………………………………....5

Diabetes Management, Clinical Outcomes, and Glycemic Control………………..…………….5

Veterans Health Administration Cost-Saving and Patient Time-Saving………………………6

Patient Adherence to Telehealth Appointments…………………………………………………………...7

Patient Satisfaction with Telemedicine……………………………………………………………….………..7

Statistical Analysis………………………………………………………………………………………………………...8

Results…………………………………………………………………………………………………………………….…….8

Demographics………………………………………………………………………………………………………………..8

Diabetes Outcomes and Glycemic Control………………………………………..………………………….9

Patient Time-Saving and Veterans Health Administration Cost-Saving……………..…..…10

Telehealth Appointment Adherence………………………………………………………………………….….11

Patient Satisfaction with Telemedicine………………………………….……..…………………………….11

Discussion……………………………………………………………………….………………………………………….11

Limitations……………………………………………………………………………………………………….……………13

Strengths……………………………………………………………………………………………………………….………14

Conclusion…………………………………………………………………………………………………………………..15

Figures………………………………………………………………………………………………………………………...16

Figure 1………………………………………………………………………………………………………………………...16

Figure 2…………………………………………………………………………………………………………….…………..17

Figure 3………………………………………………………………………….……………………………………………..18

Figure 4…………………………………………….…………………………………………………………………………..19

Figure 5………………………………………………………………………………….……………………………………..20

Figure 6……………………………………………….………………………………………………………………………..21

Figure 7………………………………………………………………………….……………………………………………..22

Figure 8…………………………………………………………………………………………………………………….....23

References………………………………………………………………………………………….……………………...24

About this Honors Thesis

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School	Emory College
Department	Biology
Degree	BS
Submission	Honors Thesis
Language	English
Research Field	Biology, Endocrinology Health Sciences, Health Care Management
关键词	Health Disparities Type 1 Diabetes Mellitus Telemedicine
Committee Chair / Thesis Advisor	Rhee, Mary, Emory University
Committee Members	Batisky, Donald Lee, Emory University Yedvobnick, Barry, Emory University

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