Author : Deborah Ann Greenwood
Publisher :
ISBN 13 : 9781321211382
Total Pages : pages
Book Rating : 4.2/5 (113 download)
Book Synopsis Evaluation of a Telehealth Intervention Combining Structured Self-monitoring of Blood Glucose and Nurse Care Coordination Among People with Type 2 Diabetes Noninsulin-treated by : Deborah Ann Greenwood
Download or read book Evaluation of a Telehealth Intervention Combining Structured Self-monitoring of Blood Glucose and Nurse Care Coordination Among People with Type 2 Diabetes Noninsulin-treated written by Deborah Ann Greenwood and published by . This book was released on 2014 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation evaluates the effectiveness of a telehealth remote patient monitoring (RPM) intervention that combines structured self-monitoring of blood glucose (SMBG) and nurse care coordination (NCC) to improve outcomes in persons with type 2 diabetes. The primary aims were to compare differences between glycated hemoglobin (A1C), self-management, self-efficacy, and knowledge compared to usual care after 12 weeks. A two-group randomized clinical trial comparing usual care and RPM--with structured SMBG called paired testing--enrolled 90 people with type 2 diabetes, aged 30-70 years, not taking insulin, in NCC for 12 months with A1C between 7.5%-10.9%. The RPM system includes a computer connected to the Internet to transmit glucose data. Participants received education in paired glucose testing, glucose goals, and problem-solving. Paired testing--checking glucose before and two hours after a meal or physical activity for one week--created action plans for behavioral changes. Glucose data were analyzed weekly using pattern analysis software summarized by premeal, postmeal, and change values, with feedback via electronic health record for asynchronous communication. Nurses telephoned participants monthly to discuss goal achievement. Glucose patterns not reflecting improvement after four weeks required shared decision-making medication options. Separate mixed-effects models were used to determine if intervention or control improved over time, and if intervention showed greater improvement. Data (n = 87) included mean (SD) age 55.7 ± 10.6, mean years with diabetes 8.2 ± 5.4, body mass index 34.1 ± 6.7, and mean A1C 8.3 ± 1.1. There was a significant difference in linear rate of change in A1C indicating the treatment group had on average a faster rate of decline and a faster mean rate of improvement. The treatment group showed greater improvement in summary of diabetes self-care activities subscales of carbohydrate spacing, monitoring blood glucose, and foot care. Neither group improved knowledge or self-efficacy. This intervention shows promise for implementing a complete feedback loop to engage participants in gathering actionable data, using RPM to transmit and analyze structured data, and providing a mechanism for clinicians to virtually communicate to support timely behavior and treatment changes.