German Jashalynn, Eldridge Madeleine R, Esteve Lucy, Alexopoulos Anastasia-Stefania, Drake Connor, Lewinski Allison, Bosworth Hayden B, Edelman David, Steinhauser Karen, Crowley Matthew J
Department of Medicine, Duke University, Durham, USA.
Durham Veterans Affairs Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham, USA.
J Clin Transl Sci. 2025 Jun 25;9(1):e153. doi: 10.1017/cts.2025.10082. eCollection 2025.
To understand participant perspectives on an effective, practical, comprehensive telehealth intervention for persistently poorly controlled diabetes mellitus and examine how its components contributed to improved outcomes, with the goal of informing broader telehealth-based diabetes management strategies.
We conducted semi-structured interviews of a purposive sample of patients and staff in the comprehensive telehealth arm of the Practical Telehealth to Improve Control and Engagement for Patients with Clinic-Refractory Diabetes Mellitus study. Using the lens of patient engagement, we applied directed content analysis to categorize themes across the five components of the intervention.
The purposive sample included 19 patients (79% male, 53% Black, varying levels of intervention engagement) and 8 staff. The telemonitoring component was associated with encouragement and motivation among patients; staff found satisfaction in providing metrics of success for participants. For the self-management component, patients saw staff as helpful with problem-solving; staff felt patients were receptive to education. Medication management supported medication adherence and optimization and was acceptable to patients. Diet/activity support motivated behavioral changes among patients. Staff felt that depression support allowed for responsiveness to medical and behavioral factors influencing self-management. Identified areas for improvement included staff time constraints, patient difficulties with taking and transmitting data, and challenges with patient adherence among those with mental health conditions.
Findings from this study provide insights that may inform the design, implementation, and scalability of comprehensive telehealth models for diabetes management across diverse healthcare settings.
了解参与者对一种针对持续性控制不佳的糖尿病的有效、实用且全面的远程医疗干预措施的看法，并研究其各个组成部分如何促成更好的结果，旨在为更广泛的基于远程医疗的糖尿病管理策略提供信息。
我们对“实用远程医疗改善门诊难治性糖尿病患者的控制与参与度”研究中远程医疗综合组的患者和工作人员进行了有目的抽样的半结构化访谈。我们从患者参与度的角度，应用定向内容分析法对干预措施的五个组成部分中的主题进行分类。
有目的的样本包括19名患者（79%为男性，53%为黑人，干预参与程度各异）和8名工作人员。远程监测部分与患者的鼓励和动力相关；工作人员在为参与者提供成功指标方面感到满意。对于自我管理部分，患者认为工作人员在解决问题方面很有帮助；工作人员觉得患者乐于接受教育。药物管理有助于药物依从性和优化，患者也能接受。饮食/活动支持促使患者行为改变。工作人员认为抑郁症支持能够应对影响自我管理的医疗和行为因素。确定的改进领域包括工作人员的时间限制、患者在获取和传输数据方面的困难，以及心理健康状况患者在依从性方面的挑战。
本研究结果提供了一些见解，可能为不同医疗环境下糖尿病管理的综合远程医疗模式的设计、实施和可扩展性提供参考。
