title: The utilization of video-conference shared medical appointments in rural diabetes care.
abstract: To explore whether Video-Shared Medical Appointments (video-SMA), where group education and medication titration were provided remotely through video-conferencing technology would improve diabetes outcomes in remote rural settings.
  
  
  
  We conducted a pilot where a team of a clinical pharmacist and a nurse practitioner from Honolulu VA hospital remotely delivered video-SMA in diabetes to Guam. Patients with diabetes and HbA1c ≥7% were enrolled into the study during 2013-2014. Six groups of 4-6 subjects attended 4 weekly sessions, followed by 2 bi-monthly booster video-SMA sessions for 5 months. Patients with HbA1c ≥7% that had primary care visits during the study period but not referred/recruited for video-SMA were selected as usual-care comparators. We compared changes from baseline in HbA1c, blood-pressure, and lipid levels using mixed-effect modeling between video-SMA and usual care groups. We also analyzed emergency department (ED) visits and hospitalizations. Focus groups were conducted to understand patient's perceptions.
  
  
  
  Thirty-one patients received video-SMA and charts of 69 subjects were abstracted as usual-care. After 5 months, there was a significant decline in HbA1c in video-SMA vs. usual-care (9.1±1.9 to 8.3±1.8 vs. 8.6±1.4 to 8.7±1.6, P=0.03). No significant change in blood-pressure or lipid levels was found between the groups. Patients in the video-SMA group had significantly lower rates of ED visits (3.2% vs. 17.4%, P=0.01) than usual-care but similar hospitalization rates. Focus groups suggested patient satisfaction with video-SMA and increase in self-efficacy in diabetes self-care.
  
  
  
  Video-SMA is feasible, well-perceived and has the potential to improve diabetes outcomes in a rural setting.
authors.affiliation: Veterans Affairs Pacific Island Healthcare System, Research & Development Office, Honolulu, HI, United States; Veterans Affairs Pacific Island Healthcare System, Department of Pharmacy, Honolulu, HI, United States.
authors.forename: Lisa
authors.initials: L
authors.lastname: Tokuda
authors.affiliation: Veterans Affairs Pacific Island Healthcare System, Research & Development Office, Honolulu, HI, United States; Veterans Affairs Pacific Island Healthcare System, Department of Mental Health, Honolulu, HI, United States.
authors.forename: Lenora
authors.initials: L
authors.lastname: Lorenzo
authors.affiliation: Veterans Affairs Pacific Island Healthcare System, Research & Development Office, Honolulu, HI, United States.
authors.forename: Andre
authors.initials: A
authors.lastname: Theriault
authors.affiliation: Veterans Affairs Medical Center, Center of Innovation for Long Term Services & Support, Providence, RI, United States; Department of Medicine, Warren Alpert School of Medicine of Brown University, United States; University of Rhode Island, College of Pharmacy, United States.
authors.forename: Tracey H
authors.initials: TH
authors.lastname: Taveira
authors.affiliation: Veterans Affairs Medical Center, Center of Innovation for Long Term Services & Support, Providence, RI, United States.
authors.forename: Lynn
authors.initials: L
authors.lastname: Marquis
authors.affiliation: Veterans Affairs Pacific Island Healthcare System, Primary Care Service, Agana Heights, Guam, United States.
authors.forename: Helene
authors.initials: H
authors.lastname: Head
authors.affiliation: Veterans Affairs Medical Center, Center for Health Services Research in Primary Care, Durham, NC, United States.
authors.forename: David
authors.initials: D
authors.lastname: Edelman
authors.affiliation: Veterans Affairs Pacific Island Healthcare System, Primary Care Service, Agana Heights, Guam, United States.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Kirsh
authors.affiliation: Veterans Affairs Medical Center, Internal Medicine Division, Cleveland, OH, United States.
authors.forename: David C
authors.initials: DC
authors.lastname: Aron
authors.affiliation: Veterans Affairs Medical Center, Center of Innovation for Long Term Services & Support, Providence, RI, United States; Department of Medicine, Warren Alpert School of Medicine of Brown University, United States; University of Rhode Island, College of Pharmacy, United States. Electronic address: wen-chih.wu@va.gov.
authors.forename: Wen-Chih
authors.initials: WC
authors.lastname: Wu
mesh_terms: D001071:Appointments and Schedules; D001794:Blood Pressure; D003920:Diabetes Mellitus / Q000517:prevention & control*; D004636:Emergency Service, Hospital; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D017060:Patient Satisfaction; D010595:Pharmacists; D010865:Pilot Projects; D011320:Primary Health Care; D011446:Prospective Studies; D012424:Rural Population; D012648:Self Care; D049269:Videoconferencing / Q000706:statistics & numerical data*
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human
keywords: Diabetes mellitus; Group medical visits; Rural medicine; Video-shared medical appointments