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Structure, process, and outcomes of care in a telemonitoring program for patients with type 2 diabetes

Authors Nocella J, Vaughan Dickson V, Cleland C, D'Eramo Melkus G

Received 29 July 2015

Accepted for publication 14 October 2015

Published 1 March 2016 Volume 2016:7 Pages 19—28


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 5

Editor who approved publication: Dr Robert Howland

Jill M Nocella,1 Victoria Vaughan Dickson,2 Charles M Cleland,2 Gail D’Eramo Melkus2

1Department of Nursing, William Paterson University, Wayne, NJ, 2College of Nursing, New York University, New York, NY, USA

Background: Using Donabedian's structure-process-outcomes (SPO) framework, this descriptive, exploratory study examined the structure of a telemonitoring program in a population of patients with type 2 diabetes (T2D), the process of nurse–patient telephonic interactions, and patients’ clinical outcomes.
Methods: Secondary data analysis was conducted using data from 581 patients who participated in a home telemonitoring program for 12 months. Three point-biserial and six Pearson correlations were estimated to determine how patient demographics related to clinical characteristics. Mixed model regressions were conducted predicting hemoglobin A1c (HbA1c), systolic blood pressure (SBP), and diastolic blood pressure (DBP) levels at 6, 9, and 12 months based on the frequency of contact in the earlier 3 months. Analysis of variances were conducted to assess if the frequency of contact was significantly different by change in HbA1c levels from 3 to 6, 6 to 9, and 9 to 12 months.
Results: Significant negative correlations were found between age and HbA1c (r=–0.10, P=0.015) and DBP (r=–0.16, P<0.001), a significant positive correlation was found between age and SBP (r=0.15, P=0.001). A significant correlation was found between sex and DBP (rpb=–0.11, P=0.015); female participants had lower DBP levels than males. Frequency of contact was not related to the change in clinical outcomes. However, the frequency of contact for the time period 3 to 6 months was associated with change in HbA1c for the 6- to 9- month period and frequency of contact during the 6- to 9- month period was associated with change in HbA1c from 9 to 12 months.
Conclusion: Examination of the SPO measures in the telemonitoring environment assisted in understanding the effectiveness of this type of unique intervention and the need for further in-depth exploration of self-management techniques among individuals with T2D.

Keywords: telemonitoring, type 2 diabetes, telephonic care, telehealth, telecare

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