title: Telemedicine consultations: an alternative model to increase access to diabetes specialist care in underserved rural communities.
abstract: BACKGROUND
  Diabetes care in rural communities often suffers because of physician shortages. When patients need to see an endocrinologist, long-distance travel to urban centers can constitute a barrier to care.
  
  
  OBJECTIVE
  To address this problem, we tested whether diabetes telemedicine consultations would be acceptable to rural patients and their primary care providers as an alternative care model.
  
  
  METHODS
  Twenty-five patients with diabetes in a rural, medically underserved community received glycemic management recommendations via videoconferencing-based teleconsultation with an endocrinologist at an urban center. At the rural site, a nurse trained in diabetes care assisted with the visits. Outcomes measured were patient and primary care provider satisfaction (measured by structured questionnaires) and glycosylated hemoglobin (HbA1c) levels.
  
  
  RESULTS
  Patients and providers uniformly reported high levels of satisfaction and acceptability. Mean HbA1c decreased from 9.6% to 8.5% (P < .001).
  
  
  CONCLUSIONS
  Teleconsultations are well accepted by users (patients and primary care physicians) and glycemic control seems to improve in patients with diabetes. This new model of care could potentially expand access to specialist care in isolated rural communities.
authors.affiliation: Div. of Endocrinology and Metabolism, Dept. of Medicine, University of Pittsburgh, Pittsburgh, PA, United States. toledofs@upmc.edu.
authors.forename: Frederico G
authors.initials: FG
authors.lastname: Toledo
authors.forename: Amy
authors.initials: A
authors.lastname: Triola
authors.forename: Kristine
authors.initials: K
authors.lastname: Ruppert
authors.forename: Linda M
authors.initials: LM
authors.lastname: Siminerio
keywords: Rural; diabetes; teleconsultation; telemedicine