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Detection and remediation of medically urgent situations using telemedicine case management for older patients with diabetes mellitus

Authors Roberto Izquierdo, Suzanne Meyer, Justin Starren, Robin Goland, Jeanne Teresi, et al

Published 15 July 2007 Volume 2007:3(3) Pages 485—489

Roberto Izquierdo1, Suzanne Meyer1, Justin Starren3, Robin Goland4, Jeanne Teresi5, Steven Shea6, Ruth S Weinstock1,2

1Department of Medicine and Pediatrics, SUNY Upstate Medical University, Syracuse, NY, USA; 2Veteran Affairs Medical Center, Syracuse, NY, USA; 3Department of Biomedical Informatics, Columbia University, New York, NY, USA; 4Naomi Berrie Diabetes Center and Department of Medicine, Columbia University, New York, NY, USA; 5Hebrew Home for the Aged at Riverdale, Bronx, NY, USA; 6Departments of Medicine, Epidemiology, and Biomedical Informatics, Columbia University, New York, NY, USA

Introduction: Detection and response to medically urgent situations in patients with diabetes mellitus can improve the process and outcomes of care and potentially decrease morbidity and mortality. We examined the detection and remediation of medically urgent situations among older patients receiving telemedicine case management for diabetes.

Methods: In the setting of a randomized trial, 338 patients in the intervention group and living in upstate New York received a home telemedicine unit to transmit blood glucose and blood pressure values to a nurse case manager, videoconference with a nurse or dietitian every 4–6 weeks and access educational websites. The educators met with a supervising endocrinologist 4–5 times weekly and clinical recommendations were proposed to the primary care providers via mail, fax, or phone.

Results: Over a 36 month period, 67 medically urgent situations were identified and addressed (1.9 events/month). Some of these situations were potentially life-threatening, including major drug contraindications (N = 24), other medically urgent situations (N = 19), and medical urgent conditions (ie, unstable angina) (N = 24).

Conclusion: The interaction via telemedicine in rural upstate New York between patients with diabetes mellitus, a diabetes care team, and primary care providers can successfully identify and remediate medically urgent situations.

Keywords: telemedicine, diabetes mellitus, medically urgent situations

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