Billings Clinic Center for Clinical Translational Research, Billings, Montana 59107, USA.
Telemed J E Health. 2011 Oct;17(8):596-602. doi: 10.1089/tmj.2011.0028. Epub 2011 Aug 22.
The objectives of this study were to demonstrate the feasibility of telehealth technology to provide a team approach to diabetes care for rural patients and determine its effect on patient outcomes when compared with face-to-face diabetes visits.
An evaluation of a patient-centered interdisciplinary team approach to diabetes management compared telehealth with face-to-face visits on receipt of recommended preventive guidelines, vascular risk factor control, patient satisfaction, and diabetes self-management at baseline and 1, 2, and 3 years postintervention.
One-year postintervention the receipt of recommended dilated eye exams increased 31% and 43% among telehealth and face-to-face patients, respectively (p=0.28). Control of two or more risk factors increased 37% and 69% (p=0.21). Patient diabetes care satisfaction rates increased 191% and 131% among telehealth and face-to-face patients, respectively (p=0.51). A comparison of telehealth with face-to-face patients resulted in increased self-reported blood glucose monitoring as instructed (97% vs. 89%; p=0.63) and increased dietary adherence (244% vs. 159%; p=0.86), respectively. Receipt of a monofilament foot test showed a significantly greater improvement among face-to-face patients (17% vs. 35%; p=0.01) at 1 year postintervention, but this difference disappeared in years 2 and 3.
Telehealth proved to be an effective mode for the provision of diabetes care to rural patients. Few differences were detected in the delivery of a team approach to diabetes management via telehealth compared with face-to-face visits on receipt of preventive care services, vascular risk factor control, patient satisfaction, and patient self-management. A team approach using telehealth may be a viable strategy for addressing the unique challenges faced by patients living in rural communities.
本研究旨在展示远程医疗技术为农村患者提供糖尿病团队护理的可行性，并确定与面对面的糖尿病就诊相比，其对患者结果的影响。
通过对患者为中心的跨学科糖尿病管理团队方法进行评估，将远程医疗与面对面就诊进行比较，比较基线、1 年、2 年和 3 年后接受推荐的预防指南、血管风险因素控制、患者满意度和糖尿病自我管理的情况。
干预后 1 年，远程医疗组和面对面组接受推荐的散瞳检查的比例分别增加了 31%和 43%（p=0.28）。两种或两种以上危险因素的控制比例分别增加了 37%和 69%（p=0.21）。远程医疗组和面对面组的患者对糖尿病护理的满意度分别增加了 191%和 131%（p=0.51）。与面对面组相比，远程医疗组自我报告的按指示进行血糖监测的比例增加（97%对 89%；p=0.63），饮食依从性增加（244%对 159%；p=0.86）。在干预后 1 年，接受单丝足部检查的患者中，面对面组的改善更为显著（17%对 35%；p=0.01），但在第 2 年和第 3 年，这种差异消失。
远程医疗被证明是为农村患者提供糖尿病护理的有效模式。通过远程医疗提供团队式糖尿病管理与面对面就诊相比，在接受预防保健服务、血管风险因素控制、患者满意度和患者自我管理方面，差异较小。使用远程医疗的团队方法可能是解决农村社区患者面临的独特挑战的可行策略。
