Improving Telemedicine to Extend Specialized Care to Rural Veterans

Research published in Preventing Chronic Disease indicates that telemedicine may be a safe and effective method of delivering specialty diabetes care to rural veterans, resulting in time and cost savings, high appointment adherence rates, and patient satisfaction. 

An ongoing shortage of endocrinologists is a key challenge in the US diabetes epidemic, creating a disparity in specialty diabetes care. This issue magnifies the disparity for patients in rural areas who face barriers such as travel distances and expenses. To address this, the Atlanta VAMC Endocrinology Telehealth Clinic was established, utilizing telemedicine to improve access to specialty diabetes care for patients with type 1 diabetes. The study aimed to evaluate the effectiveness of this telehealth clinic in improving diabetes outcomes and patient satisfaction. 

“We conducted a retrospective chart review of patients who were enrolled in the Atlanta VAMC Endocrinology Telehealth Clinic from June 2014 to October 2016,” explained researchers. “Outcomes of interest were hemoglobin A1c levels, changes in glycemic control, time savings for patients, cost savings for the US Veterans Health Administration, appointment adherence rates, and patient satisfaction with telehealth.” 

Of the 54 patients participating in the Atlanta VAMC Endocrinology Telehealth Clinic, 32 had type 1 diabetes who were provided with telehealth care and generally adhered to recommended diabetes care procedures. Most of the cohort were male (n=29, 91%) and white (n=27, 84%). The average age of the patients was 53.5 years, and their average body mass index was 27.6 kg/m2. Notably, comorbidities and complications related to diabetes were prevalent among this patient population at the beginning of the study, with most patients experiencing hyperlipidemia (n=26, 81%) and diabetic neuropathy (n=23, 72%). Patients tended to experience a nonsignificant increase in hypoglycemic episodes and a decrease in mean hemoglobin A1c and glucose variability.  

On average, patients saved approximately 78 minutes of their one-way traveling time. Furthermore, the VHA saved an average of $72.94 per patient visit in travel reimbursement. Patients also maintained 88% of their scheduled telehealth appointments, and all surveyed patients unanimously endorsed telehealth use for other veterans. 

“Specialty diabetes care delivered via telemedicine was safe and was associated with time savings, cost savings, high appointment adherence rates, and high patient satisfaction,” said researchers. “Our findings support growing evidence that telemedicine is an effective alternative method of health care delivery.” 

Reference  

Xu T, Pujara S, Sutton S, Rhee M, et al. Telemedicine in the management of type 1 diabetes. Preventing Chronic Disease. 2018; 15(E13). Doi:10.5888/pcd15.170168