Primary care providers' perceptions of home diabetes telemedicine care in the IDEATel project.
BACKGROUND
Few telemedicine projects have systematically examined provider satisfaction and attitudes.


OBJECTIVE
To determine the acceptability and perceived impact on primary care providers' (PCP) practices of a randomized clinical trial of the use of telemedicine to electronically deliver health care services to Medicare patients with diabetes in federally designated medically underserved areas of upstate New York, primarily those in rural areas and small towns with limited access to primary care.


METHODS
A longitudinal phone survey was completed by 116 PCPs with patients with diabetes in the treatment arm of the trial, and conducted 12 and 24 months after a PCP's first patient was randomized to the home telemedicine arm of the trial. The 36-item survey included measures of acceptability (to PCPs, time required), impact (on patient knowledge, confidence, perceived health outcomes), and communication. Six open-ended questions were analyzed qualitatively.


RESULTS
The quantitative data indicated positive responses in terms of acceptability of the telemedicine intervention to the PCPs and of the impact on the PCPs' patients. This was most evident in issues critical to good control of diabetes: patient knowledge, ability to manage diabetes, confidence, and compliance in managing diabetes. Key qualitative themes, on the positive end, were more patient control and motivation, helpfulness of having extra patient data, and involvement of nurses and dieticians. Negative themes were excessive paperwork and duplication taking more PCP time, and conflicting advice and management decisions from the telemedicine team, some without informing the PCP but none involving medications.


CONCLUSIONS
Telemedicine was reported to be a positive experience for predominantly rural PCPs and their Medicare-eligible patients from medically underserved areas; several inefficiencies need to be refined.
Tudiver
Fred
F
Department of Family Medicine, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA. tudiverf@mail.etsu.edu
Wolff
L Thomas
LT
Morin
Philip C
PC
Teresi
Jeanne
J
Palmas
Walter
W
Starren
Justin
J
Shea
Steven
S
Weinstock
Ruth S
RS
D000328:Adult; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006699:Home Care Services / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D011785:Quality Assurance, Health Care; D019035:Rural Health Services / Q000458:organization & administration* / Q000592:standards; D012959:Socioeconomic Factors; D017216:Telemedicine / Q000706:statistics & numerical data*