title: New direction for enhancing quality in diabetes care: utilizing telecommunications and paraprofessional outreach workers backed by an expert medical team.
abstract: Abstract This article assesses the value of using telecommunications with Promatoras (paraprofessional outreach workers) and an expert medical team of registered nurses (RNs) and endocrinologists in an at-risk type 2 diabetic Hispanic population recruited for a telemedicine feasibility project from a free clinic. Nineteen patients agreed to enter the program and 16 completed the program in 3.5 years of study. A Promatoras is the primary educator and the point of communication to patient or medical personnel overseeing each patient's home glucose monitoring, medical records, and medications, regularly communicating by telephone and e-mail with patients and diabetes specialists. Between clinic visits, all routine care, including body weight, blood glucose, and blood pressure monitoring, was shared over the Internet, and each patient was interviewed by audio and camera. The endocrinologist was in his office, while the primary care physician, patient, and Promotora volunteers were at the free clinic. Four variables were considered in this longitudinal study: weight, systolic blood pressure, diastolic blood pressure, and HbA1c. Estimates of means, correlations, t-tests, and slopes of the repeated measures were obtained, and comparisons were made between first and last values. The most important sign of improvement in the patients' situation was the significant decrease in HbA1c to 7.2% from 9.6% (p = 0.001).
authors.affiliation: Endocrine Metabolic Medical Center, 350 Cambridge Ave., Palo Alto, CA 94306, USA. office@endocrinemetabolic.com
authors.forename: Penelope Ann
authors.initials: PA
authors.lastname: Mayes
authors.forename: Abraham
authors.initials: A
authors.lastname: Silvers
authors.forename: J Joseph
authors.initials: JJ
authors.lastname: Prendergast
mesh_terms: D000328:Adult; D000368:Aged; D000488:Allied Health Personnel; D002140:California; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006630:Hispanic or Latino; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D011787:Quality of Health Care; D013685:Telecommunications
references.citation: Diabetes Care. 1998 Aug;21(8):1230-5
references.pmid: 9702425
references.citation: Diabetes Care. 1999 Feb;22(2):345-54
references.pmid: 10333956
references.citation: Am J Epidemiol. 1988 Jan;127(1):135-44
references.pmid: 3276155
references.citation: Mayo Clin Proc. 2009;84(1):53-64
references.pmid: 19121244
references.citation: Am J Manag Care. 2000 May;6(5):573-84
references.pmid: 10977465
references.citation: Am J Med Qual. 2008 Sep-Oct;23(5):382-8
references.pmid: 18820143
references.citation: Diabetes Care. 2009 Jun;32(6):977-82
references.pmid: 19460913