title: Case Management with a Diabetes Team Using Home Telemedicine: Acceptance of Treatment Recommendations by Primary Care Providers in IDEATel.
abstract: BACKGROUND
  The Informatics for Diabetes Education and Telemedicine (IDEATel) project demonstrated that a telemedicine intervention can improve glycemic, lipid, and blood pressure control. The focus of the current study was to evaluate factors associated with primary care providers' (PCPs') decision on whether to follow recommendations from the remote diabetes team in Upstate New York.
  
  
  METHODS
  In the intervention group, diabetes educators videoconferenced with patients monthly to download and review glucose and blood pressure readings, diabetes-related issues, and laboratory data. These were reviewed with an endocrinologist, and recommendations to change therapy were sent to the PCPs. At annual visits, participants completed the Diabetes Symptom Checklist-Type 2 symptom severity score and Impact of Telemedicine surveys.
  
  
  RESULTS
  Factors that increase the acceptance rate of IDEATel recommendations included longer time in the study (p=0.0052), changing medication dose as opposed to starting or stopping a medication (p<0.0001), adjusting glucose-lowering agents compared with antihypertensive or antilipid medications (p<0.0001), higher total Diabetes Symptom Checklist-Type 2 symptom severity score (p=0.045), greater number of glucose readings submitted by participants (p=0.014), and high score on surveys measuring impact of telemedicine on patient's knowledge, adherence, and satisfaction (p=0.0023).
  
  
  CONCLUSIONS
  Recommendations for change in glycemic control medications, delivered remotely by a diabetes team to PCPs, were better accepted over time. Results support the use of a team-based telemedicine program to help PCPs improve diabetes care.
authors.affiliation: 1 Joslin Diabetes Center, SUNY Upstate Medical University , Syracuse, New York.|2 Department of Medicine, SUNY Upstate Medical University , Syracuse, New York.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Izquierdo
authors.affiliation: 3 Center for Research and Evaluation, SUNY Upstate Medical University , Syracuse, New York.
authors.forename: Dongliang
authors.initials: D
authors.lastname: Wang
authors.affiliation: 3 Center for Research and Evaluation, SUNY Upstate Medical University , Syracuse, New York.
authors.forename: Danning
authors.initials: D
authors.lastname: Huang
authors.affiliation: 4 Department of Medicine, Columbia University , New York, New York.
authors.forename: Walter
authors.initials: W
authors.lastname: Palmas
authors.affiliation: 1 Joslin Diabetes Center, SUNY Upstate Medical University , Syracuse, New York.|2 Department of Medicine, SUNY Upstate Medical University , Syracuse, New York.
authors.forename: Ruth S
authors.initials: RS
authors.lastname: Weinstock
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D019090:Case Management; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York; D011320:Primary Health Care; D017216:Telemedicine
keywords: IDEATel study; diabetes case management; diabetes mellitus; telemedicine