Rural veterans with type 2 diabetes face limited access to specialty care and diabetes education. Many rural veterans maintain an elevated HbA1c because they lack access to effective diabetes management approaches that are amenable to rural delivery.
The Veterans Health Administration (VHA) https://va.gov/health, has made the Advanced Comprehensive Diabetes Care (ACDC) telehealth program available. The ACDC telehealth program includes telemonitoring, module-based self-management support, and medication management.
The telemonitoring and self-management support components are delivered by a clinical VHA home telehealth nurse during biweekly phone encounters over 6 months. The home telehealth nurse manages contact with veterans including managing their medication.
The home telehealth nurse collaborates with a clinical pharmacy specialist medication manager. After each phone call, the home telehealth nurse adds a summary of the veteran’s clinical data into the EHR which the medication manager updates with recommendations for changes in medication.
ACDC has proven to lower HbA1c among veterans with refractory poor control. It has proven to be effective enough to reduce VHA type 2 diabetes costs and complications. Since ACDC is ideally suited for use in clinical practices including in rural areas, ACDC is broadly disseminated across VHA.
VHA is also working to provide a model of care to help veterans living with HIV. Today, more than 6,000 rural veterans living with HIV face problems accessing high quality HIV care as HIV specialty care is generally concentrated in urban centers.
To help rural veterans, telehealth modalities such as the HIV Telehealth Collaborative Care (HIV TCC) solution is being used to help veterans by:
- Using clinical video telehealth and video on demand to deliver HIV specialty care
- Providing targeted team conference calls
- Tracking the number of rural veterans living with HIV
- Providing continuity of care between HIV infectious disease specialists and primary care PACT teams
- Making it possible for veterans to have access to services and laboratories during the pandemic
- Using data to facilitate population management across sites
- Providing monthly strategic calls where and when needed
- Helping veterans during COVID-19 by enabling communicating specialty care and primary care providers to establish a robust network in order to communicate
The results from using HIV TCC taken from a randomized controlled trial showed that there is better antiretroviral adherence among veterans participating in the HIV TCC solution.
The VA Office of Rural Health https://www.ruralhealth.va.gov publishes the newsletter The Rural Connection. The summer issue on page 4 has information on ACDC and HIV TCC.