Diabetes Telemedicine Consultation: A Systems Improvement Intervention

Not Applicable

Completed

• Conditions: Diabetes Mellitus Type 2; Primary Care Provider; Diabetes Mellitus, Type 1
• Interventions: Behavioral: The Diabetes Treatment Satisfaction Questionnaire; Behavioral: Diabetes Empowerment Scale; Behavioral: CBOC's undergo half-day joint-clinics via teleconference

• Registration Number: NCT00119041
• Lead Sponsor: US Department of Veterans Affairs

Brief Summary

This study seeks to evaluate and document the processes of outreach consultation through joint-clinics via teleconferencing as an intervention for system improvement in care delivery and management of diabetes mellitus (DM) at a Community Based Outpatient Center (CBOCs).

Detailed Description

Background:

Diabetes is a national problem that has reached epidemic proportions, according to the U.S. Centers for Disease Control and Prevention. Diabetes has particular importance for the Department of Veterans Affairs (VA) because the prevalence among VA patients -- one in six, or 16 percent -- is substantially higher than in the general population.

Objectives:

The objective of this study was to evaluate and document the processes of outreach consultation through the use of joint-clinics via teleconferencing as an intervention for system improvement in care delivery and management of diabetes at CBOCs. The intervention consisted of a teleconferenced joint-clinic consultation session involving the patient, Diabetes Specialist Team, the Primary Care Provider (PCP) and other relevant care team members. The impact of the 16-month intervention was assessed based on patients who were involved in the telemedicine clinic and those who were referred to a specialist to be seen on-site at the Cleveland VAMC.

Methods:

Study settings include the CBOCs affiliated with the Cleveland Veterans Affairs Medical Center (VAMC) and involve primary care referrals to see diabetes specialists at the Cleveland VAMC. Inclusion criteria patients(N 282)=included: (i) current prescription of insulin or an oral hypoglycemic agent; (ii) A1c \> 7.0%; or (iii) fasting glucose levels\> 130 mg/dl; and (iv) referred to see a consultant (beginning three months prior to the active intervention phase and continuing through enrollment for the last month of the active intervention phase). Patients with either Type l or Type II diabetes will be included. Patients referred will be contacted and asked to participate.

Basic Information
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Recruitment & Eligibility
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Study & Design
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Trial Locations

Study Timeline

• Study First Submitted: 2005-07-01
• Study First Submitted QC: 2005-07-01
• Study First Posted: 2005-07-12
• Study Start: 2005-09
• Primary Completion: 2007-12
• Study Completion: 2008-12
• Results First Submitted: 2014-07-02
• Results First Submitted QC: 2015-04-23
• Status Verified: 2015-05
• Results First Posted: 2015-05-12
• Last Update Submitted: 2015-05-18
• Last Update Posted: 2015-06-15

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 304

Inclusion Criteria

• 1. Current prescription of insulin or an oral hypoglycemic agent
• 2. A1c > 7.0%
• 3. fasting glucose levels > 130 mg/dl
• 4. referred to see a consultant and are seen during the active intervention phase. Patients with either Type I or Type II DM will be included

A Primary Care Provider for a Cleveland CBOC

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Exclusion Criteria

• 1. primary care obtained at more than one site (based on stop codes with evidence of more than 1 CBOC involved in care during the last 6 months)
• 2. documented dementia, aphasia, and psychosis

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Telemedicine CBOC	CBOC's undergo half-day joint-clinics via teleconference	Designated CBOC's were involved in the intervention phase where their Diabetes Mellitus (DM) patients were asked to participate in a telemedicine visit. The Behavioral: The Diabetes Treatment Satisfaction Questionnaire given during this phase along with the Behavioral: Diabetes Empowerment Scale and the Behavioral: CBOC's undergo half-day joint-clinics via teleconference.
Telemedicine CBOC	The Diabetes Treatment Satisfaction Questionnaire	Designated CBOC's were involved in the intervention phase where their Diabetes Mellitus (DM) patients were asked to participate in a telemedicine visit. The Behavioral: The Diabetes Treatment Satisfaction Questionnaire given during this phase along with the Behavioral: Diabetes Empowerment Scale and the Behavioral: CBOC's undergo half-day joint-clinics via teleconference.
Telemedicine CBOC	Diabetes Empowerment Scale	Designated CBOC's were involved in the intervention phase where their Diabetes Mellitus (DM) patients were asked to participate in a telemedicine visit. The Behavioral: The Diabetes Treatment Satisfaction Questionnaire given during this phase along with the Behavioral: Diabetes Empowerment Scale and the Behavioral: CBOC's undergo half-day joint-clinics via teleconference.

Primary Outcome Measures

Name	Time	Method
A1c	baseline and 18 months	Hemoglobin A1c is a measure of glycemic control

Secondary Outcome Measures

Name	Time	Method
Patient Satisfaction	Base line and at18 months.	Diabetes Treatment Satisfaction Questionnaire (DTSQ) consists of 6 questions and ranges from 0-6. The following aspects of current treatment included were convenience, flexibility, understanding and continuing present form of treatment. The total range of the DTSQ is the sum of the 6 individual questions scores (i.e. 0-36) Higher scores represent greater satisfaction/convenience.

Trial Locations

Locations (2)

VA Ann Arbor Healthcare System; 🇺🇸 Ann Arbor, Michigan, United States

Louis Stokes VA Medical Center; 🇺🇸 Cleveland, Ohio, United States