1
|
Andersen JA, Bogulski CA, Eswaran S, Willis DE, Acharya M, Li J, Marciniak B, Edem D, Selig JP, McElfish PA. Associations Between Sociodemographic Factors And Interest in Remote Patient Monitoring Among Arkansas Residents. Telemed J E Health 2024. [PMID: 39178127 DOI: 10.1089/tmj.2023.0557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2024] Open
Abstract
Introduction: Remote patient monitoring (RPM) has the power to transform health care delivery, as it allows for the digital transmission of individual health data to health care professionals, providing the most up-to-date information to be able to make medical decisions. Although RPM use has grown exponentially during the pandemic, there is limited information on the association between sociodemographic characteristics and interest in RPM use in underserved areas of the United States after the onset of the pandemic. Methods: We conducted a survey via random digit dialing of 2201 adults living in Arkansas in March of 2022. Weighted estimates were generated using rank ratio estimation to approximate the 2019 American Community Survey 1-year Arkansas estimates for race/ethnicity, age, and gender. We fit a partial proportional odds model using weighted generalized ordered logistic regression to examine adjusted odds ratios (ORs) for interest in RPM. Predictors included sociodemographic characteristics, nativity, health care access, and self-rated health. Results: Results indicate respondents who were age 60 or older had lower odds of interest in RPM than those between the ages 18-39 (OR = 0.61). Hispanic adults had lower odds of reporting interest in RPM (OR = 0.68), and non-Hispanic adults of other races/ethnicities had lower odds of reporting any interest at all (OR = 0.67) or interest greater than a little (OR = 0.67) in RPM compared with non-Hispanic White respondents. However, respondents who had previously used telehealth had greater odds of reporting higher levels of interest in RPM than those who had not previously used it (OR = 1.93). Discussion: Interest in RPM use is associated with several sociodemographic factors. Future work is needed to understand and address RPM reluctance and to increase interest in RPM among marginalized and underserved populations who may need these services.
Collapse
Affiliation(s)
- Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, Arkansas, USA
| | - Cari A Bogulski
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Surabhee Eswaran
- Department of Environmental Studies, Tulane University, New Orleans, Louisiana, USA
| | - Don E Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, Arkansas, USA
| | - Mahip Acharya
- Institute for Digital Health & Innovation, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ji Li
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, Springdale, Arkansas, USA
| | - Byron Marciniak
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, Arkansas, USA
| | - Dinesh Edem
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - James P Selig
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences Northwest, Springdale, Arkansas, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Springdale, Arkansas, USA
| |
Collapse
|
2
|
Davis TC, Allen AS, Zhang Y. Long-term Effects of Remote Patient Monitoring in Patients Living with Diabetes: A Retrospective Look at Participants of the Mississippi Diabetes Telehealth Network Study. TELEMEDICINE REPORTS 2022; 3:130-136. [PMID: 35860303 PMCID: PMC9282779 DOI: 10.1089/tmr.2022.0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Remote patient monitoring (RPM) has demonstrated value as a tool to aid patients in management of their chronic illness in the home. Although the Mississippi Diabetes Telehealth Network Study (MSDTNS) was successful in reducing HbgA1c levels for patients participating in RPM in the Mississippi Delta, the long-term effect of RPM on patients and how to support patients to maintain the treatment effect after discharge remain unclear. OBJECTIVE This study evaluated the long-term effectiveness of an RPM program after the intervention was withdrawn. MATERIALS AND METHODS A retrospective review of medical records of patients who completed all phases of the MSDTNS from 2014 to 2016 was performed over a period of 6 months. Data collected included HbgA1c values, demographics, and changes in social determinants of health. RESULTS Of the 31 participants, African Americans displayed a significant difference in HbgA1c values compared with Caucasians since the end of the MSDTNS. No significant effect of other variables, such as income, marital status, insurance coverage, or age, on the change in HbgA1c values was detected since the end of the original study. CONCLUSIONS AND RELEVANCE This limited study implies that African Americans are at higher risk for an increase in hemoglobin A1C after the program is completed. More investigation is needed to identify ways to reduce their risk and equalize the long-term effects of RPM on clinical outcomes of patients in rural or underserved communities.
Collapse
Affiliation(s)
| | - Ashley S. Allen
- University of Mississippi Medical, Center for Telehealth, Jackson, Mississippi, USA
| | - Yunxi Zhang
- Department of Data Science, University of Mississippi Medical Center, John D. Bower School of Population Health, Jackson, Mississippi, USA
| |
Collapse
|
3
|
Saiyed S, Joshi R, Khattab S, Dhillon S. The Rapid Implementation of an Innovative Virtual Diabetes Boot Camp Program: Case Study. JMIR Diabetes 2022; 7:e32369. [PMID: 35029529 PMCID: PMC8800084 DOI: 10.2196/32369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 10/19/2021] [Accepted: 10/25/2021] [Indexed: 12/28/2022] Open
Abstract
Background COVID-19 disrupted health care, causing a decline in the health of patients with chronic diseases and a need to reimagine diabetes care. With the advances in telehealth programs, there is a need to effectively implement programs that meet the needs of patients quickly. Objective The aim of this paper was to create a virtual boot camp program for patients with diabetes, in 3 months, from project conception to the enrollment of our first patients. Our goal is to provide practical strategies for rapidly launching an effective virtual program to improve diabetes care. Methods A multidisciplinary team of physicians, dieticians, and educators, with support from the telehealth team, created a virtual program for patients with diabetes. The program combined online diabetes data tracking with weekly telehealth visits over a 12-week period. Results Over 100 patients have been enrolled in the virtual diabetes boot camp. Preliminary data show an improvement of diabetes in 75% (n=75) of the patients who completed the program. Four principles were identified and developed to reflect the quick design and launch. Conclusions The rapid launch of a virtual diabetes program is feasible. A coordinated, team-based, systematic approach will facilitate implementation and sustained adoption across a large multispecialty ambulatory health care organization.
Collapse
Affiliation(s)
- Salim Saiyed
- University of Pittsburgh Medical Center, Harrisburg, PA, United States
| | - Renu Joshi
- University of Pittsburgh Medical Center, Harrisburg, PA, United States
| | - Safi Khattab
- University of Pittsburgh Medical Center, Harrisburg, PA, United States
| | - Shabnam Dhillon
- University of Pittsburgh Medical Center, Harrisburg, PA, United States
| |
Collapse
|
4
|
Kirkland EB, Marsden J, Zhang J, Schumann SO, Bian J, Mauldin P, Moran WP. Remote patient monitoring sustains reductions of hemoglobin A1c in underserved patients to 12 months. Prim Care Diabetes 2021; 15:459-463. [PMID: 33509728 PMCID: PMC8131229 DOI: 10.1016/j.pcd.2021.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/15/2021] [Accepted: 01/16/2021] [Indexed: 12/18/2022]
Abstract
AIMS We sought to determine whether underserved patients enrolled in a statewide remote patient monitoring (RPM) program for diabetes achieve sustained improvements in hemoglobin A1c at 6 and 12 months and whether those improvements are affected by demographic and clinical variables. METHODS Demographic and clinical variables were obtained at baseline, 6 months and 12 months. Baseline HbA1c values were compared with those obtained at 6 and 12 months via paired t-tests. A multivariable regression model was developed to identify patient-level variables associated with HbA1c change at 12 months. RESULTS HbA1c values were obtained for 302 participants at 6 months and 125 participants at 12 months. Compared to baseline, HbA1c values were 1.8% (19 mmol/mol) lower at 6 months (p < 0.01) and 1.3% (14 mmol/mol) lower at 12 months (p < 0.01). Reductions at 12 months were consistent across clinical settings. A regression model for change in HbA1c showed no statistically significant difference for patient age, sex, race, household income, insurance, or clinic type. CONCLUSIONS Patients enrolled in RPM had improved diabetes control at 6 and 12 months. Neither clinic type nor sociodemographic variables significantly altered the likelihood that patients would benefit from this type of technology. These results suggest the promise of RPM for delivering care to underserved populations.
Collapse
Affiliation(s)
- Elizabeth B Kirkland
- Division of General Internal Medicine, Department of Medicine, Medical University of South Carolina, 135 Rutledge Ave, MSC 591, Charleston, SC, USA.
| | - Justin Marsden
- Section of Health Systems Research and Policy, Department of Medicine, Medical University of South Carolina, 135 Rutledge Ave, MSC 591, Charleston, SC, USA
| | - Jingwen Zhang
- Section of Health Systems Research and Policy, Department of Medicine, Medical University of South Carolina, 135 Rutledge Ave, MSC 591, Charleston, SC, USA
| | - Samuel O Schumann
- Division of General Internal Medicine, Department of Medicine, Medical University of South Carolina, 135 Rutledge Ave, MSC 591, Charleston, SC, USA
| | - John Bian
- Section of Health Systems Research and Policy, Department of Medicine, Medical University of South Carolina, 135 Rutledge Ave, MSC 591, Charleston, SC, USA
| | - Patrick Mauldin
- Section of Health Systems Research and Policy, Department of Medicine, Medical University of South Carolina, 135 Rutledge Ave, MSC 591, Charleston, SC, USA
| | - William P Moran
- Division of General Internal Medicine, Department of Medicine, Medical University of South Carolina, 135 Rutledge Ave, MSC 591, Charleston, SC, USA
| |
Collapse
|
5
|
Munshi KD, Amelung K, Carter CS, James R, Shah BR, Henderson RR. Impact of a diabetes remote monitoring program on medication adherence. J Manag Care Spec Pharm 2021; 27:724-731. [PMID: 34057390 PMCID: PMC10391223 DOI: 10.18553/jmcp.2021.27.6.724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Medication nonadherence in diabetes is well documented to be associated with inadequate glycemic control. Through remote blood glucose (BG) monitoring, unlimited test strip and lancet supplies, personal coaching, and online access to clinical information and educational resources, diabetes remote monitoring (DRM) programs may provide a solution. OBJECTIVE: To examine the relationship between patient participation in a DRM solution and adherence to oral antidiabetic drugs (OAD). METHODS: A retrospective, propensity score-matched cohort study was conducted using deidentified administrative claims data from a large pharmacy benefit manager. Commercially insured patients aged 18 years or older and having 2 or more 30-day adjusted OAD claims comprised the target sample. Patients enrolled in insurance plans that implemented DRM, who had at least 1 BG check (ever engaged) between April 1, 2015, and March 31, 2018 (exposure) were matched to patients enrolled in insurance plans that did not implement DRM (nonexposure). After a 1:2 matching on baseline demographics, disease burden proxy, total pharmacy out-of-pocket costs, previous adherence and insulin use, nonexposure group participants were assigned the same first BG check date as their matched DRM participants. Medication adherence measured as proportion of days covered (PDC) in the 365 days following first BG check was examined as a continuous and binary outcome measure (PDC > 80% or adherent vs < 80% or nonadherent). Multivariable linear and logistic regression were conducted to examine differential magnitude in adherence and likelihood of being adherent, respectively. RESULTS: The final sample consisted of 6,002 exposure and 12,004 nonexposure group patients. DRM participants who were ever engaged had a 4.5% higher adherence rate (P < 0.001) and 42% higher odds of being adherent (P < 0.001) in the period after engagement compared with non-DRM participants. Sensitivity analyses showed that patients engaged continuously (> 1 BG check per week) for 3, 6, and 12 months had 5.1%, 5.2%, and 6.4% higher adherence rates, respectively (P < 0.001), and 52%, 64%, and 98% higher odds of being adherent, respectively (P < 0.001), compared with non-DRM participants. CONCLUSIONS: The study findings offer evidence that DRM engagement is associated with higher odds of medication adherence. DRM solutions that provide access to glucose test results, personalized coaching, educational resources, and lower testing supply cost can also influence adherence. Our findings have important implications for payers and patients related to improved health outcomes due to higher medication adherence. DISCLOSURES: Funding for this study was provided by Express Scripts. Munshi, Amelung, Carter, and Henderson are employed by Express Scripts. James and Shah are employed by Livongo, which provided the DRM solution.
Collapse
Affiliation(s)
| | - Kyle Amelung
- Clinical Solutions, Express Scripts, Memphis, TN
| | - Callie S Carter
- Office of Clinical Evaluation & Policy, Express Scripts, Memphis, TN
| | | | - Bimal R Shah
- Chief Medical Officer, Livongo, Mountain View, CA, and Duke University School of Medicine, Durham, NC
| | | |
Collapse
|
6
|
Shafi KA, Fortson K, Iyer S. Adoption of Telemedicine: A Debrief for the Orthopedic Practitioner. HSS J 2021; 17:99-105. [PMID: 33967651 PMCID: PMC8077978 DOI: 10.1177/1556331620977429] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/23/2020] [Indexed: 01/09/2023]
|
7
|
Michaud TL, Hill JL, Estabrooks PA, Su D. Cost analysis of a remote patient monitoring programme for post-discharge patients with type 2 diabetes. J Telemed Telecare 2021:1357633X20985393. [PMID: 33497310 DOI: 10.1177/1357633x20985393] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Assessing costs of an evidence-based health promotion programme is crucial to understand the economic feasibility of adopting or sustaining the programme. This study conducted a cost analysis of a remote patient monitoring (RPM) programme to enhance the post-discharge management of type 2 diabetes. METHODS Using retrospective data collected during RPM implementation from September 2014 to February 2018, we estimated the costs of implementing an RPM in the primary care setting. Measures included total and average annual costs, costs per participant who was enrolled or completed the programme, and costs per person-day. We further conducted sensitivity and scenario analyses to examine variations in estimated programme costs associated with varying programme efficiencies and alternative personnel compositions of the RPM team. RESULTS The total RPM implementation costs were estimated at US$4,374,544 with an average annual programme costs of US$1,249,870, which translated to US$3207 per participant (n = 1364) completing the three-month programme. The per person-day cost was averaged at US$24 (182,932 person-days). Sensitivity and scenario analyses results indicate that the sustainment costs were approximately US$1.6 million annually and the per-person-day costs were between US$21 and US$29 with each nurse coach on average serving a panel of 62-93 patients. CONCLUSION The implementation and sustainment costs of an RPM programme, estimated under various assumptions of programme efficiency and care team compositions, as exemplified in this study, will help healthcare organizations make informed decisions in budgeting for and sustaining telehealth programmes to enhance diabetes management.
Collapse
Affiliation(s)
- Tzeyu L Michaud
- Center for Reducing Health Disparities, University of Nebraska Medical Center, USA.,Department of Health Promotion, University of Nebraska Medical Center, USA
| | - Jennie L Hill
- Department of Epidemiology, University of Nebraska Medical Center, USA
| | - Paul A Estabrooks
- Center for Reducing Health Disparities, University of Nebraska Medical Center, USA.,Department of Health Promotion, University of Nebraska Medical Center, USA
| | - Dejun Su
- Center for Reducing Health Disparities, University of Nebraska Medical Center, USA.,Department of Health Promotion, University of Nebraska Medical Center, USA
| |
Collapse
|