Using Telehealth to Help Veterans

A clinical trial to study ways to provide comprehensive diabetes care for veterans with persistent poorly-controlled diabetes is being initiated by the Veterans Administration at the Durham VAMC. The clinical trial will look at how to effectively advance comprehensive diabetes care for these veterans by using existing home telehealth services.

The study will demonstrate whether home telehealth-based treatment will improve A1C, patient self-management and co-morbid depressive symptoms in this high-risk high-cost veteran population.

Fifty veterans will be included in the study. Twenty five of the veterans in the study will be enrolled in the Home Telehealth program and will receive telehealth-based medication management, self-care behavior support, and depressive symptom management for six months.

The other twenty five veterans with no depression baseline assessment will not initially receive the depressive symptom management component, but will be monitored for new symptoms throughout the intervention.

The study “Advanced Comprehensive Diabetes Care for Veterans with Poorly-Controlled Diabetes” (NCT01778751) is not yet open for participant recruitment.  For more information, email Mathew Crowley MD at matthew.crowley@va.gov.

Another VA study “Video-Conference Shared Medical Appointments to Improve Rural Diabetes Care” currently being conducted by Wen-Chih Hank Wu M.D at the Providence VA Medical Center is studying the effectiveness of telehealth used in combination with Share Medical Appointments (SMA) referred to as video-SMAs.

The VHA’s goal is to improve diabetes care in VA sites without local expertise through video- SMAs and conduct a quasi-experimental trial to evaluate the efficacy and processes needed to deliver this intervention.

The fact is that despite showing success in using SMAs in the VA to improve diabetes care, access to this service is still limited in rural areas due to lack of healthcare specialists with the discipline and skill sets needed to conduct SMAs.

The plan is to deliver the video-SMA program in diabetes from the VA’s Honolulu main site to the Guam Community-Based Outpatient Clinic (CBOC) and then evaluate the delivery of the program. Veterans will receive four weekly group sessions followed by two bimonthly booster SMA visits to prevent relapse for a total duration of five month.

The study will compare the risk-adjusted change of A1C, blood pressure, and lipid values for veterans between the main site versus a similar size CBOC control site without using SMAs. Each outcome noted with changes in A1C, blood pressure, and lipids will be analyzed separately with a site indicator as the main exposure variable.

Qualitative data analysis will be ongoing throughout the study as surveys, interviews, and focus groups are conducted. Data will be examined for themes by multiple coders and examine how the intervention has changed patient behaviors and treatment patterns

The study will not only look at the improvement in diabetes care using SMAs but also local providers and participants of the video-SMA will have increased interaction with off-site experts in diabetes care to help make it easier to make decisions.

Go to www.hsrd.research.va.gov/research/abstracts.cfm?Project_ID=2141702627 for more information on (RRP 12-452). No findings are available at this time.