title: Using telehealth to provide diabetes care to patients in rural Montana: findings from the promoting realistic individual self-management program.
abstract: OBJECTIVE
  The objectives of this study were to demonstrate the feasibility of telehealth technology to provide a team approach to diabetes care for rural patients and determine its effect on patient outcomes when compared with face-to-face diabetes visits.
  
  
  METHODS
  An evaluation of a patient-centered interdisciplinary team approach to diabetes management compared telehealth with face-to-face visits on receipt of recommended preventive guidelines, vascular risk factor control, patient satisfaction, and diabetes self-management at baseline and 1, 2, and 3 years postintervention.
  
  
  RESULTS
  One-year postintervention the receipt of recommended dilated eye exams increased 31% and 43% among telehealth and face-to-face patients, respectively (p=0.28). Control of two or more risk factors increased 37% and 69% (p=0.21). Patient diabetes care satisfaction rates increased 191% and 131% among telehealth and face-to-face patients, respectively (p=0.51). A comparison of telehealth with face-to-face patients resulted in increased self-reported blood glucose monitoring as instructed (97% vs. 89%; p=0.63) and increased dietary adherence (244% vs. 159%; p=0.86), respectively. Receipt of a monofilament foot test showed a significantly greater improvement among face-to-face patients (17% vs. 35%; p=0.01) at 1 year postintervention, but this difference disappeared in years 2 and 3.
  
  
  CONCLUSIONS
  Telehealth proved to be an effective mode for the provision of diabetes care to rural patients. Few differences were detected in the delivery of a team approach to diabetes management via telehealth compared with face-to-face visits on receipt of preventive care services, vascular risk factor control, patient satisfaction, and patient self-management. A team approach using telehealth may be a viable strategy for addressing the unique challenges faced by patients living in rural communities.
authors.affiliation: Billings Clinic Center for Clinical Translational Research, Billings, Montana 59107, USA. eciemins@billingsclinic.org
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ciemins
authors.forename: Patricia
authors.initials: P
authors.lastname: Coon
authors.forename: Rory
authors.initials: R
authors.lastname: Peck
authors.forename: Barbara
authors.initials: B
authors.lastname: Holloway
authors.forename: Sung-Joon
authors.initials: SJ
authors.lastname: Min
mesh_terms: D003920:Diabetes Mellitus / Q000628:therapy*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009009:Montana; D017060:Patient Satisfaction; D012423:Rural Health; D012648:Self Care / Q000379:methods* / Q000523:psychology; D017216:Telemedicine / Q000379:methods / Q000458:organization & administration*; D014504:Urban Health