A pilot study of diabetes education via telemedicine in a rural underserved community--opportunities and challenges: a continuous quality improvement process.
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.
Balamurugan
Appathurai
A
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)
Hall-Barrow
Julie
J
The University of Arkansas for Medical Sciences, Little Rock, Arkansas (Dr Balamurugan, Ms Hall-Barrow, Dr Phillips, Ms Holley)
Blevins
Mary Alice
MA
The Arkansas Diabetes Prevention and Control Program, Arkansas Department of Health, Little Rock, Arkansas (Ms Blevins)
Brech
Detri
D
Ouachita Baptist University, Arkadelphia, Arkansas (Dr Brech)
Phillips
Martha
M
The Epidemiology Branch at the Center for Public Health Practice, Arkansas Department of Health, Little Rock, Arkansas (Dr Balamurugan, Dr Phillips)
Holley
Elizabeth
E
The University of Arkansas for Medical Sciences, Little Rock, Arkansas (Dr Balamurugan, Ms Hall-Barrow, Dr Phillips, Ms Holley)
Bittle
Kim
K
Ozark Health, Inc, Clinton, Arkansas (Ms Bittle)
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