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Patient perceptions of a comprehensive telemedicine intervention to address persistent poorly controlled diabetes

Authors Andrews SM, Sperber NR, Gierisch JM, Danus S, Macy SL, Bosworth HB, Edelman D, Crowley MJ

Received 25 October 2016

Accepted for publication 27 December 2016

Published 3 March 2017 Volume 2017:11 Pages 469—478

DOI https://doi.org/10.2147/PPA.S125673

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Lucy Goodman

Peer reviewer comments 2

Editor who approved publication: Dr Johnny Chen

Sara M Andrews,1 Nina R Sperber,1,2 Jennifer M Gierisch,1,2 Susanne Danus,1 Stephanie L Macy,1 Hayden B Bosworth,1,2 David Edelman,1,2 Matthew J Crowley1,3

1Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 2Division of General Internal Medicine, Department of Medicine, 3Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Duke University, Durham, NC, USA

Objective: We studied a telemedicine intervention for persistent poorly controlled diabetes mellitus (PPDM) that combined telemonitoring, self-management support, and medication management. The intervention was designed for practical delivery using existing Veterans Affairs (VA) telemedicine infrastructure. To refine the intervention and inform the delivery of the intervention in other settings, we examined participants’ experiences.
Methods: We conducted semistructured interviews with 18 Veterans who completed the intervention. We analyzed interview text using directed content analysis and categorized themes by hemoglobin A1c (HbA1c) improvement (<1% or ≥1%).
Results: Participants generally reported greater awareness of their blood glucose levels; however, they described dissatisfaction with the telemonitoring interface and competing demands during the intervention. Participants with <1% HbA1c improvement reported that these challenges interfered with their engagement. Participants with ≥1% HbA1c improvement reported new self-management routines despite challenges.
Conclusion: Despite competing demands and frustration with the telemonitoring interface, many participants demonstrated intervention engagement and substantial improvement in HbA1c (≥1%). Differences in engagement may reflect differing capacity to manage treatment burden. Because it relies on existing infrastructure, this intervention is a promising model for addressing PPDM within VA. Future work should focus on optimizing systems’ telemedicine infrastructure; while reliance on existing infrastructure may facilitate practical delivery, and it may also limit intervention engagement by excessively contributing to treatment burden.

Keywords: telemedicine, persistent poorly controlled diabetes, type 2 diabetes, patient perspectives, treatment burden

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