title: A pilot study of diabetes education via telemedicine in a rural underserved community--opportunities and challenges: a continuous quality improvement process.
abstract: Telemedicine technology may offer an avenue to implement diabetes self-management education (DSME) for people with diabetes in underserved rural communities. The continuous quality improvement process was used to identify the problem, collect and analyze data, and develop and implement a DSME program via telemedicine (DSME-T) in an underserved rural community.
  
  
  
  A pilot study was conducted in 2006, implementing a DSME-T utilizing facilities at the University of Arkansas for Medical Sciences and a rural community hospital in Arkansas (Ozark Health, Inc). A total of 38 people were enrolled to receive DSME-T. Participant knowledge, self-efficacy, and self-care practices were assessed before participants began the education program and after they had completed it. Also, select clinical measures (glycosylated hemoglobin, lipid profile, and urine microalbumin) were collected.
  
  
  
  A total of 66% of participants (n = 25) completed the DSME-T program. A significantly greater proportion of participants demonstrated improved knowledge (39% vs 83%; P = .012), endorsed greater self-efficacy (54% vs 86%; P = .016), and reported more frequent self-care practices to manage their diabetes at the conclusion of the study period.
  
  
  
  The results of this pilot study suggest that DSME-T may offer opportunities for DSME among rural residents with diabetes. Plans are in place to explore the possibility of sustaining and expanding the program to other underserved rural communities.
authors.affiliation: The Epidemiology Branch at the Center for Public Health Practice, Arkansas Department of Health, Little Rock, Arkansas (Dr Balamurugan, Dr Phillips)|The University of Arkansas for Medical Sciences, Little Rock, Arkansas (Dr Balamurugan, Ms Hall-Barrow, Dr Phillips, Ms Holley)
authors.forename: Appathurai
authors.initials: A
authors.lastname: Balamurugan
authors.affiliation: The University of Arkansas for Medical Sciences, Little Rock, Arkansas (Dr Balamurugan, Ms Hall-Barrow, Dr Phillips, Ms Holley)
authors.forename: Julie
authors.initials: J
authors.lastname: Hall-Barrow
authors.affiliation: The Arkansas Diabetes Prevention and Control Program, Arkansas Department of Health, Little Rock, Arkansas (Ms Blevins)
authors.forename: Mary Alice
authors.initials: MA
authors.lastname: Blevins
authors.affiliation: Ouachita Baptist University, Arkadelphia, Arkansas (Dr Brech)
authors.forename: Detri
authors.initials: D
authors.lastname: Brech
authors.affiliation: The Epidemiology Branch at the Center for Public Health Practice, Arkansas Department of Health, Little Rock, Arkansas (Dr Balamurugan, Dr Phillips)
authors.forename: Martha
authors.initials: M
authors.lastname: Phillips
authors.affiliation: The University of Arkansas for Medical Sciences, Little Rock, Arkansas (Dr Balamurugan, Ms Hall-Barrow, Dr Phillips, Ms Holley)
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Holley
authors.affiliation: Ozark Health, Inc, Clinton, Arkansas (Ms Bittle)
authors.forename: Kim
authors.initials: K
authors.lastname: Bittle
mesh_terms: D000368:Aged; D001131:Arkansas; D003920:Diabetes Mellitus / Q000523:psychology / Q000534:rehabilitation*; D003922:Diabetes Mellitus, Type 1 / Q000523:psychology / Q000534:rehabilitation; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology / Q000534:rehabilitation; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods* / Q000592:standards; D010865:Pilot Projects; D011785:Quality Assurance, Health Care; D012424:Rural Population; D012648:Self Care; D017216:Telemedicine / Q000592:standards