Telehealth program for type 2 diabetes: usability, satisfaction, and clinical usefulness in an urban community health center.
BACKGROUND
We examined the usability, satisfaction, and clinical impact of a 3-month diabetes telehealth intervention for poorly controlled type 2 diabetes (T2D) patients. The urban community health center sample (n=30) was 56.7% female, mean age of 60.6 years, 56.7% high school education or higher, and 73% African American and 26% Latino.


METHODS
We integrated an electronic pillbox into an existing diabetes remote home monitoring (RHM) device suite comprising a Bluetooth(®) (Bluetooth SIG, Kirkland, WA)-enabled blood glucose meter and an automatic blood pressure monitor connected to a cellular hub for data upload to our clinical application. This telehealth program involved minimal clinician training and functioned as a nonurgent patient self-management support service to increase the scope of clinic services. Telehealth nurse interventionists received regular RHM data alerts and called patients by phone at scheduled intervals. A graphical report summarizing patient RHM data was sent to providers to inform clinical decision making during a scheduled clinic visit at the 3-month follow-up.


RESULTS
The results showed consistently high levels of RHM device use during the intervention period, high ratings of usability and program satisfaction from patients, and high ratings of provider satisfaction with the program. There was a clinically and statistically significant improvement in blood glucose control at 3 months, such that hemoglobin A1c improved 0.6% from a baseline level of 8.3% (p<0.05).


CONCLUSIONS
These findings provide encouraging empirical support for the usability and clinical value of a diabetes telehealth program integrating a user-friendly cellular pillbox and clinical decision support tools that was delivered to an urban poor T2D clinic population.
1 Silver Fern Healthcare , West Hartford, Connecticut.
Garry
G
Welch
Andrew
A
Balder
Sofija
S
Zagarins
D000367:Age Factors; D000368:Aged; D015190:Blood Glucose Self-Monitoring / Q000295:instrumentation* / Q000379:methods; D003151:Community Health Centers; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007328:Insulin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D015397:Program Evaluation; D018570:Risk Assessment; D012494:Sampling Studies; D012648:Self Care / Q000592:standards / Q000639:trends; D012720:Severity of Illness Index; D012737:Sex Factors; D017216:Telemedicine / Q000458:organization & administration*; D014481:United States; D014505:Urban Population
D007328:Insulin
home health monitoring; mobile health; telehealth; telenursing