A telemedicine program using Atlanta-based endocrinologists provided suitable type 1 diabetes care to veterans living in rural Alabama and Georgia while saving patients 156 minutes of commute time per visit and cutting travel reimbursement costs paid by the Veterans Health Administration (VHA) by $72.94 per visit.
“Specialty diabetes care delivered via telemedicine was safe and was associated with time savings, cost savings, high appointment adherence rates, and high patient satisfaction,” Timothy Xu, BS, with Mayo Clinic School of Medicine, and colleagues reported in Preventing Chronic Disease. “Our findings support growing evidence that telemedicine is an effective alternative method of health care delivery.”
Approximately 29.1 million Americans have diabetes and there is a nationwide shortage of 1,500 full-time endocrinologists, according to the authors. With roughly 20 percent of the U.S. population living in rural areas where there are fewer specialists, there is a pressing need to remove geographical barriers to care.
Telemedicine is one potential solution, the authors said, because it allows for specialists to aid patients in chronic disease management from remote locations. It can also cut down on travel time for patients and—in the case of the VHA, which provides travel reimbursements—result in direct cost savings.
But is the quality of care equivalent to a face-to-face visit?
It was—at least for this rural veteran population with type 1 diabetes. Xu et al. studied 32 patients, 29 of whom were men.
They found the patients generally received the standards of diabetes care, including diabetic retinopathy eye screenings, statin use and aspirin use (when eligible). Mean hemoglobin A1c levels decreased from 8.7 percent at baseline to 8.2 percent at six months and 8.1 percent at 12 months of follow-up. There was a nonsignificant increase in hypoglycemic episodes.
In addition, Xu et al. reported half of the patients attended all of their telehealth appointments, which required them to go to a local outpatient facility, check in, have their vital signs checked and then meet with an Atlanta-based specialist via teleconference with in-person assistance from a pharmacist. The mean appointment adherence rate was 87.8 percent, and every patient said they “agreed” or “strongly agreed” they were satisfied with telehealth. More than 90 percent said they preferred that treatment method versus traveling long distances to see a provider.
The authors acknowledged patients who enrolled in the telehealth initiative may have been more enthusiastic about the program and therefore more likely to provide positive survey feedback. In addition, the small sample size and the low number of patients completing follow-up visits during the study period may have influenced results.
Despite these limitations, Xu and colleagues said their study adds to the growing body of evidence that telemedicine is a cost-effective way to increase rural patients’ access to care without compromising quality.
“If the VHA implements telemedicine on a broader scale, veterans could receive more accessible patient-centered care, and the VHA could benefit from significant cost savings,” the researchers wrote. “Future studies with larger, more representative samples of patients with type 1 diabetes are needed to elucidate telemedicine’s effectiveness in providing health care to broader patient populations.”