Steven Shea, Rafael A. Lantigua, and Walter Palmas are with the Department of Medicine, Columbia University, New York, NY. At the time of this study, Dhruva Kothari was with the College of Physicians & Surgeons, Columbia University. Jeanne A. Teresi, Jian Kong, and Joseph P. Eimicke are with the Research Division of the Hebrew Home at Riverdale, Bronx, NY. Jeanne A. Teresi is also with the Morris W. Stroud, III, Center for Studies on Quality of Life, Columbia University. Ruth S. Weinstock is with Joslin Diabetes Center and Division of Endocrinology, Diabetes and Metabolism, SUNY Upstate Medical University, Syracuse, NY.
Am J Public Health. 2013 Oct;103(10):1888-94. doi: 10.2105/AJPH.2012.300909. Epub 2013 Mar 14.
We examined the social impact of the telemedicine intervention effects in lower- and higher-socioeconomic status (SES) participants in the Informatics for Diabetes Education and Telemedicine (IDEATel) study.
We conducted a randomized controlled trial comparing telemedicine case management with usual care, with blinded outcome evaluation, in 1665 Medicare recipients with diabetes, aged 55 years or older, residing in federally designated medically underserved areas of New York State. The primary trial endpoints were hemoglobin A1c (HbA1c), low-density lipoprotein cholesterol, and systolic blood pressure levels.
HbA1c was higher in lower-income participants at the baseline examination. However, we found no evidence that the intervention increased disparities. A significant moderator effect was seen for HbA1c (P = .004) and systolic blood pressure (P = .023), with the lowest-income group showing greater intervention effects.
Lower-SES participants in the IDEATel study benefited at least as much as higher-SES participants from telemedicine nurse case management for diabetes. Tailoring the intensity of the intervention based on clinical need may have led to greater improvements among those not at goal for diabetes control, a group that also had lower income, thereby avoiding the potential for an innovative intervention to widen socioeconomic disparities.
我们研究了糖尿病教育和远程医疗信息学（IDEATel）研究中社会经济地位（SES）较低和较高的参与者中远程医疗干预效果的社会影响。
我们进行了一项随机对照试验，比较了远程医疗病例管理与常规护理，在纽约州联邦指定的医疗服务不足地区的 1665 名年龄在 55 岁及以上的医疗保险患者中进行了盲法结局评估。主要试验终点是血红蛋白 A1c（HbA1c）、低密度脂蛋白胆固醇和收缩压水平。
在基线检查中，低收入参与者的 HbA1c 更高。然而，我们没有发现干预措施增加差异的证据。HbA1c（P =.004）和收缩压（P =.023）存在显著的调节效应，最低收入组的干预效果更大。
IDEATel 研究中的低 SES 参与者从糖尿病远程医疗护士病例管理中获益至少与高 SES 参与者一样多。根据临床需要调整干预强度可能导致那些未达到糖尿病控制目标的患者（这组患者的收入也较低）有更大的改善，从而避免了创新干预措施扩大社会经济差异的潜在风险。
