Practical Telemedicine for Veterans with Persistently Poor Diabetes Control: A Randomized Pilot Trial
Practical Telemedicine for Veterans with Persistently Poor Diabetes Control: A Randomized Pilot Trial
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DOI：
10.1089/tmj.2015.0145
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发表时间：
2016-05-01
影响因子：
4.7
通讯作者：
Bosworth, Hayden B.
中科院分区：
文献类型：
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作者：
Crowley, Matthew J.;Edelman, David;Bosworth, Hayden B.
背景：与临床护理相比，基于远程医疗的糖尿病管理可改善结局，但医疗保健系统很少实施。为了推进基于远程医疗的管理作为一个实用的选择，退伍军人与持续控制不佳的糖尿病（PPDM），尽管临床护理，我们评估了一个全面的远程医疗干预，我们专门设计用于交付使用现有的退伍军人健康管理局（VHA）的临床人员和设备。材料与方法：我们在50名患有PPDM的退伍军人中进行了一项为期6个月的随机试验;尽管进行了基于临床的管理，但所有患者的血红蛋白A1 c（HbA 1c）水平均持续>9.0%> 1年。参与者接受常规护理或结合远程监护、药物管理、自我管理支持和抑郁症管理的远程医疗干预;现有的VHA临床工作人员提供干预。使用线性混合模型，我们检查了HbA 1c，糖尿病自我护理（通过自我护理量表修订版问卷测量），抑郁症和血压。结果：基线时，模型估计的常见HbA 1c截距为10.5%。到6个月时，干预参与者的HbA 1c估计值改善了1.3%，常规护理改善了0.3%（估计差异，-1.0%，95%置信区间[CI]，-2.0%，0.0%; p = 0.050）。干预参与者的糖尿病自我护理（估计差异，7.0; 95% CI，0.1，14.0; p = 0.047），收缩压6个月时，与常规治疗相比，舒张压（-7.7 mm Hg; 95% CI，-14.8，-0.6; p = 0.035）和舒张压（-5.6 mm Hg; 95% CI，-9.9，-1.2; p = 0.013）得到改善。两组的抑郁症状相似。结论：综合远程医疗干预改善了退伍军人PPDM的结果，尽管基于临床的护理。因为我们专门设计了这种干预措施，考虑到可扩展性，它可能代表了一种实用的，现实世界的策略，以减轻退伍军人中糖尿病控制不良的负担。
Background: Telemedicine-based diabetes management improves outcomes versus clinic care but is seldomimplemented by healthcare systems. In order to advance telemedicine-based management as a practical option for veterans with persistent poorly controlled diabetes mellitus (PPDM) despite clinic-based care, we evaluated a comprehensive telemedicine intervention that we specifically designed for delivery using existing Veterans Health Administration (VHA) clinical staffing and equipment. Materials and Methods: We conducted a 6-month randomized trial among 50 veterans with PPDM; all maintained hemoglobin A1c (HbA1c) levels continuously >9.0% for > 1 year despite clinic-based management. Participants received usual care or a telemedicine intervention combining telemonitoring, medication management, self-management support, and depression management; existing VHA clinical staff delivered the intervention. Using linear mixed models, we examined HbA1c, diabetes self-care (measured by the Self-Care Inventory-Revised questionnaire), depression, and blood pressure. Results: At baseline, the model-estimated common HbA1c intercept was 10.5%. By 6 months, estimated HbA1c had improved by 1.3% for intervention participants and 0.3% for usual care (estimated difference, -1.0%, 95% confidence interval [CI], -2.0%, 0.0%; p = 0.050). Intervention participants' diabetes self-care (estimated difference, 7.0; 95% CI, 0.1, 14.0; p = 0.047), systolic blood pressure (-7.7mm Hg; 95% CI, -14.8, -0.6; p = 0.035), and diastolic blood pressure (-5.6mm Hg; 95% CI, -9.9, -1.2; p = 0.013) were improved versus usual care by 6 months. Depressive symptoms were similar between groups. Conclusions: A comprehensive telemedicine intervention improved outcomes among veterans with PPDM despite clinic-based care. Because we specifically designed this interventionwith scalability in mind, it may represent a practical, real-world strategy to reduce the burden of poor diabetes control among veterans.