The Informatics for Diabetes and Education Telemedicine (IDEATel) project.
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Date
2008-06-05
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Abstract
Telemedicine is a promising but largely unproven technology for providing case management services to patients with chronic conditions who experience barriers to access to care or a high burden of illness We conducted a randomized controlled trial comparing telemedicine case management to usual care with blinding of those obtaining outcome data in 1 665 Medicare recipients with diabetes aged 55 years or greater and living in federally designated medically underserved areas of New York State In New York City 98 of participants were black or Hispanic 69 were Medicaid eligible and 93 reported annual household income Under or 20 000 In upstate New York 91 were white 14 Medicaid eligible and 50 reported annual household income Under or 20 000 A baseline survey found that 95 of participants in New York City and 67 in upstate New York reported that they did not know how to use a computer The primary endpoints were HgbA1c blood pressure and low density lipoprotein LDL cholesterol levels In the intervention group N 844 mean HgbA1c improved over 1 year from 7 35 to 6 97 and from 8 35 to 7 42 in the subgroup with baseline HgbA1c or 7 N 353 In the usual care group N 821 mean HgbA1c improved over 1 year from 7 42 to 7 17 Adjusted net reductions 1 year minus baseline mean values in each group compared between groups favoring the intervention were as follows HgbA1c 0 18 p 0 006 systolic and diastolic blood pressure 3 4 p 0 001 and 1 9 mmHg p Under 0 001 and LDL cholesterol 9 5 mg dl p Under 0 001 In the subgroup with baseline HgbA1c or 7 net adjusted reduction in HgbA1c favoring the intervention group was 0 32 p 0 002 Mean LDL cholesterol level in the intervention group at one year was 95 7 mg dl The intervention effects were similar in magnitude in the subgroups living in New York City and upstate New York A satisfaction survey of intervention group participants N 346 respondents showed high levels of satisfaction with major intervention components A satisfaction survey of participating primary care physicians N 116 respondents showed positive perceptions for acceptability impact on patients and communication Telemedicine case management improved glycemic control blood pressure levels and total and LDL cholesterol levels at 1 year of follow up Telemedicine is an effective method for translating modern approaches to disease management into effective care for underserved populations