Patient perceptions of a comprehensive telemedicine intervention to address persistent poorly controlled diabetes
Patient perceptions of a comprehensive telemedicine intervention to address persistent poorly controlled diabetes
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DOI：
10.2147/ppa.s125673
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发表时间：
2017-01-01
影响因子：
2.2
通讯作者：
Crowley, Matthew J.
中科院分区：
文献类型：
--
作者：
Andrews, Sara M.;Sperber, Nina R.;Crowley, Matthew J.
目的：我们研究了一种结合远程监护、自我管理支持和药物管理的持续性糖尿病控制不良（PPDM）的远程医疗干预。该干预措施旨在使用现有的退伍军人事务部（VA）远程医疗基础设施进行实际交付。为了完善干预措施，并告知在其他环境中的干预措施的交付，我们研究了参与者的experiences.Methods：我们进行了半结构化的采访，18退伍军人谁完成了干预。我们使用定向内容分析来分析采访文本，并根据血红蛋白A1 c（HbA 1c）改善（，= 1%）对主题进行分类< 1% or >。结果：参与者普遍报告对其血糖水平有更好的认识;然而，他们对远程监护界面和干预期间的竞争需求表示不满。HbA 1c改善<1%的受试者报告称，这些挑战干扰了他们的参与。HbA 1c改善>= 1%的参与者报告了新的自我管理例程，尽管存在挑战。结论：尽管有竞争的需求和挫折与远程监护界面，许多参与者表现出干预参与和HbA 1c的大幅改善（>= 1%）。参与度的差异可能反映了管理治疗负担的能力不同。由于它依赖于现有的基础设施，这种干预是一个有前途的模式，解决PPDM在VA。未来的工作应侧重于优化系统的远程医疗基础设施;而对现有基础设施的依赖可能会促进实际交付，也可能会限制干预参与，过度增加治疗负担。
Objective: We studied a telemedicine intervention for persistent poorly controlled diabetes mellitus (PPDM) that combined telemonitoring, self-management support, and medication management. The intervention was designed for practical delivery using existing Veterans Affairs (VA) telemedicine infrastructure. To refine the intervention and inform the delivery of the intervention in other settings, we examined participants' experiences.Methods: We conducted semistructured interviews with 18 Veterans who completed the intervention. We analyzed interview text using directed content analysis and categorized themes by hemoglobin A1c (HbA1c) improvement (,< 1% or >= 1%).Results: Participants generally reported greater awareness of their blood glucose levels; however, they described dissatisfaction with the telemonitoring interface and competing demands during the intervention. Participants with,1% HbA1c improvement reported that these challenges interfered with their engagement. Participants with >= 1% HbA1c improvement reported new self-management routines despite challenges.Conclusion: Despite competing demands and frustration with the telemonitoring interface, many participants demonstrated intervention engagement and substantial improvement in HbA1c (>= 1%). Differences in engagement may reflect differing capacity to manage treatment burden. Because it relies on existing infrastructure, this intervention is a promising model for addressing PPDM within VA. Future work should focus on optimizing systems' telemedicine infrastructure; while reliance on existing infrastructure may facilitate practical delivery, and it may also limit intervention engagement by excessively contributing to treatment burden.