A Multidisciplinary Team in Ambulatory Management of Diabetes Mellitus Using Telehealth Among a Sample of Medicaid Patients
DOI:
https://doi.org/10.30953/tmt.v7.309Keywords:
Diabetes, Telemedicine, Telehealth, Pharmacist and Dietitian led intervention, A1c, LDL, cholesterolAbstract
Objectives: Effective treatment of patients with type 2 diabetes mellitus requires a multidisciplinary approach. Our study provided telemedicine healthcare delivery, using a model of collaborative drug therapy management (CDTM) protocol incorporating medical nutrition therapy (MNT) interventions by Dietitians and Pharmacists.
Methods: We conducted a retrospective chart review of patient data collected between December 2014 and December 2015. We compared five intervention groups of patients (n=12,370) receiving different levels of treatment from Pharmacists, Registered Dietitian/Nutritionist, and/or the Call Center, using Telemedicine consultation techniques over a one-year period. The control group received their supplies through the mail without any contacts with the Call Center, Pharmacists, or Dietitians. The cross-sectional data collected for A1c were analyzed using ANOVA to assess for within-group differences in A1c reduction among groups with different risk factors.
Results: Roughly, 18 percent of study participants were identified as high-risk, with a serum A1c level greater than 10%. Lower A1c and low density lipoprotein (LDL) cholesterol levels were reported for patients who received at least four prescription refills over the study period, (-0.113 and -4.931, respectively). Results reveal that average A1c levels for the intervention groups were lower compared to the control group. Overall, interventions led by Dietitians and Pharmacists resulted in a higher reduction in A1c levels in the high-risk group of patients with type 2 diabetes.
Conclusions: This study showed that using Telemedicine consultation, led by Dietitians and Pharmacists, resulted in a more effective intervention for patients with diabetes and resulted in a positive change of lowering plasma A1c levels and LDL cholesterol as a secondary outcome. For future study, using the same multidisciplinary intervention and telehealth format, a longitudinal data collected over a minimum of 6-months would allow for tracking of changes in A1c and LDL cholesterol in the individuals with type 2 diabetes.
Keywords: Diabetes, Telemedicine, Telehealth, Pharmacist and Dietitian led intervention, A1c, LDL cholesterol
Downloads
References
Centers for Disease Control and Prevention. Type 2 diabetes. Available from: https://www.cdc.gov/diabetes/basics/type2.html [cited 29 September 2021].
American Diabetes Association. Statistics: the cost of diabetes: the staggering cost of diabetes Internet]. Available from: https://www.diabetes.org/resources/statistics/cost-diabetes [cited 29 September 2021].
Nathan DM. The diabetes control and complications trial/epidemiology of diabetes interventions and complications study at 30 years: overview. Diabetes Care 2014; 37(1): 9–16. doi: 10.2337/dc13-2112
Campbell L. Diabetes guidelines: easier to preach than to practice? The Med J Australia 2006; 185: 305–9. doi: 10.5694/j.1326-5377.2006.tb00583.x
Housden L, Wong ST, Dewes M. Effectiveness of group medical visits for improving diabetes care: a systematic review and meta-analysis. CMAJ 2013; 185: 635–44. doi: 10.1503/cmaj.130053
Mundt MP, Agneessens F, Tuan WJ, Zakletskaia LI, Kamnetz SA, Gilchrist VJ. Primary care team communication networks, team climate, quality of care, and medical costs for patients with diabetes: a cross-sectional study. Inter J Nurs Studies 2016; 58: 1–11. doi: 10.1016/j.ijnurstu.2016.01.013
Isaksson U, Hajdarevic S, Abramsson M, Stenvall J, Hornsten A. Diabetes empowerment and needs for self-management support among people with type 2 diabetes in a rural inland community in northern Sweden. Scand J Caring Sci 2015; 29: 521–7. doi: 10.1111/scs.12185
Zgibor JC, Songer TJ. External barriers to diabetes care: addressing personal and health system issues. Diabetes Spectrum 2001; 14(1): 23–8. doi: 10.2337/diaspect.14.1.23
Silva-Tinoco R, Cuatecontzi-Xochitiotzi T, De la Torre-Saldena V, Leon-Garcia E, Serna-Alvarado J, Guzman-Olvera E, et al. Role of social and other determinants of health in the effect of a multicomponent integrated care strategy on type 2 diabetes mellitus. Int J Equity Health 2020; 19: 75. doi: 10.1186/s12939-020-01188-2
Davidson MB. How our current medical care system fails people with diabetes: lack of timely, appropriate clinical decision. Diabetes Care 2009; 32(2): 370–2. doi: 10.2337/dc08-2046
Choe HM, Mitrovich S, Dubay D, Hayward RA, Krein SL, Vijan S. Proactive case management of high-risk patients with type 2 diabetes by a clinical pharmacist: a randomized controlled trial. Am J Manag Care 2005; 11: 253–60.
Cohen LB, Taveira TH, Wu WC, Pirraglia PA. Pharmacist-led telehealth disease management program for patients with diabetes and depression. J Telemed Telecare 2020; 26(5): 294–302. doi: 10.1177/1357633X18822575
Daly A, Michael P, Johnson EQ, Harrington CC, Patrick S, Bender T. Diabetes white paper: defining the delivery of nutrition services in Medicare medical nutrition therapy vs Medicare diabetes self-management training programs. J Am Diet Assoc 2009; 109(3): 528–39. doi: 10.1016/j.jada.2008.11.004
Campbell, RK. Role of the pharmacist in diabetes management. Am J Health-Syst Pharm 2002; 59(Suppl 9): S18–21. doi: 10.1093/ajhp/59.suppl_9.S18
Bains SS, Egede LE. Association between health literacy, diabetes knowledge, self-care behaviors, and glycemic control in a lower income population with type 2 diabetes. Diabetes Tech Therap 2011; 13: 335–41. doi: 10.1089/dia.2010.0160
Osborn CY, Baines SS, Egede LE. Health literacy, diabetes self-care, and glycemic control in adults with type 2 diabetes. Diabetes Tech Therap 2010; 12: 913–19. doi: 10.1089/dia.2010.0058
Nigam S. Telehealth and telemedicine: using technology to extend the reach and offset the insufficient supply of healthcare professionals. TMT [Internet]. 2018 [cited 2021 September 30];1(1). Available from: https://telehealthandmedicinetoday.com/index.php/journal/article/view/68
Taylor AM, Bingham J, Schussel K, Axon D, Dickman DR, Boesen K, et al. Integrating innovative telehealth solutions into an interprofessional team-delivered chronic care management pilot program. J Manag Care Spec Pharm 2018; 24(8): 813–18. doi: 10.18553/jmcp.2018.24.8.813
Greenwood DA, Hankins AI, Parise CA, Spier V, Olveda J, Buss KA. A comparison of in-person, telephone, and secure messaging of type 2 diabetes self-management support. Diabetes Educ 2014; 40(4): 516–25. doi: 10.1177/0145721714531337
Davis RM, Hitche AD, Salaam MM, Herman WH, Zimmer-Galler IE, Mayer-Davis EJ. Telehealth improves diabetes self-management in an underserved community: diabetes telecare. Diabetes Care 2010; 33(8): 1712–17. doi: 10.2337/dc09-1919
Xu J, Hamadi HY, Hicks-Roof KK, Zeglin RJ, Bailey CE, Zhao M. Healthcare professionals and telehealth usability during COVID-19. TMT [Internet]. 2021 [cited 2021 September 30];6(3). Available from: https://telehealthandmedicinetoday.com/index.php/journal/article/view/270
Published
Versions
- 2022-03-08 (5)
- 2022-03-08 (4)
- 2022-02-17 (3)
- 2022-02-17 (2)
- 2022-01-31 (1)
How to Cite
Issue
Section
License
Copyright (c) 2022 Nicole Henley, Dorothy Chen-Maynard, Erin Pablo-Bandong
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors retain copyright of their work, with first publication rights granted to Telehealth and Medicine Today (THMT).
THMT is published under a Creative Commons Attribution-NonCommercial 4.0 International License.
