Tokuda Lisa, Lorenzo Lenora, Theriault Andre, Taveira Tracey H, Marquis Lynn, Head Helene, Edelman David, Kirsh Susan R, Aron David C, Wu Wen-Chih
Veterans Affairs Pacific Island Healthcare System, Research & Development Office, Honolulu, HI, United States; Veterans Affairs Pacific Island Healthcare System, Department of Pharmacy, Honolulu, HI, United States.
Veterans Affairs Pacific Island Healthcare System, Research & Development Office, Honolulu, HI, United States; Veterans Affairs Pacific Island Healthcare System, Department of Mental Health, Honolulu, HI, United States.
Int J Med Inform. 2016 Sep;93:34-41. doi: 10.1016/j.ijmedinf.2016.05.007. Epub 2016 Jun 2.
To explore whether Video-Shared Medical Appointments (video-SMA), where group education and medication titration were provided remotely through video-conferencing technology would improve diabetes outcomes in remote rural settings.
We conducted a pilot where a team of a clinical pharmacist and a nurse practitioner from Honolulu VA hospital remotely delivered video-SMA in diabetes to Guam. Patients with diabetes and HbA1c ≥7% were enrolled into the study during 2013-2014. Six groups of 4-6 subjects attended 4 weekly sessions, followed by 2 bi-monthly booster video-SMA sessions for 5 months. Patients with HbA1c ≥7% that had primary care visits during the study period but not referred/recruited for video-SMA were selected as usual-care comparators. We compared changes from baseline in HbA1c, blood-pressure, and lipid levels using mixed-effect modeling between video-SMA and usual care groups. We also analyzed emergency department (ED) visits and hospitalizations. Focus groups were conducted to understand patient's perceptions.
Thirty-one patients received video-SMA and charts of 69 subjects were abstracted as usual-care. After 5 months, there was a significant decline in HbA1c in video-SMA vs. usual-care (9.1±1.9 to 8.3±1.8 vs. 8.6±1.4 to 8.7±1.6, P=0.03). No significant change in blood-pressure or lipid levels was found between the groups. Patients in the video-SMA group had significantly lower rates of ED visits (3.2% vs. 17.4%, P=0.01) than usual-care but similar hospitalization rates. Focus groups suggested patient satisfaction with video-SMA and increase in self-efficacy in diabetes self-care.
Video-SMA is feasible, well-perceived and has the potential to improve diabetes outcomes in a rural setting.
探讨通过视频会议技术远程提供集体教育和药物滴定的视频共享医疗预约（video-SMA）是否能改善偏远农村地区的糖尿病治疗效果。
我们开展了一项试点项目，来自檀香山退伍军人事务医院的一名临床药剂师和一名执业护士组成的团队通过远程方式为关岛的糖尿病患者提供video-SMA。2013年至2014年期间，糖化血红蛋白（HbA1c）≥7%的糖尿病患者被纳入研究。6组，每组4至6名受试者参加了为期4周的课程，随后进行了为期5个月的每月2次的强化video-SMA课程。选择在研究期间进行初级保健就诊但未被转诊/招募参加video-SMA的HbA1c≥7%的患者作为常规治疗对照组。我们使用混合效应模型比较了video-SMA组和常规治疗组之间HbA1c、血压和血脂水平相对于基线的变化。我们还分析了急诊科就诊情况和住院情况。开展焦点小组讨论以了解患者的看法。
31名患者接受了video-SMA，69名受试者的病历被提取作为常规治疗对照。5个月后，与常规治疗相比，video-SMA组的HbA1c显著下降（9.1±1.9降至8.3±1.8，而常规治疗组为8.6±1.4降至8.7±1.6，P=0.03）。两组之间血压和血脂水平无显著变化。video-SMA组患者的急诊科就诊率显著低于常规治疗组（3.2%对17.4%，P=0.01），但住院率相似。焦点小组讨论表明患者对video-SMA满意，且糖尿病自我护理的自我效能有所提高。
Video-SMA是可行的，患者认可度高，并且有可能改善农村地区的糖尿病治疗效果。
