The effect of remote patient monitoring on the primary care clinic visit frequency among adults with type 2 diabetes

Conditions for successful implementation of couple-based collaborative management model of diabetes among community-dwelling older Chinese: a qualitative comparative analysis

BACKGROUND

Diabetes mellitus is a prevalent and potentially devastating chronic illness affecting many older adults. Given spousal involvement in many aspects of diabetes management, coping with their partners is increasingly seen as a potential solution to make up for limited resources. This study aimed to identify the key conditions for optimal implementation of couple-based collaborative management model (CCMM) among Chinese older couples with type 2 diabetes mellitus.

METHODS

Older couples and community healthcare practitioners were selected according to couples' joint intervention attendance rate and community's average attendance rate. This mixed methods research consisted of a qualitative phase and a quantitative phase. In the qualitative phase, in-depth interviews were conducted among 12 pairs of couples in the intervention group and 4 corresponding practitioners, in the follow-up period of the multicentered RCT from January to April 2022. Qualitative comparative analysis (QCA) in the quantitative phase to identify conditions influencing CCMM's implementation and to explore necessary and sufficient combinations of conditions (i.e., solutions) for improving patients' glycated hemoglobin (HbA1c) control (outcome).

RESULTS

Key conditions included implementation process, couple's role in diabetes management, their belief and perception of CCMM, as well as objective obstacles and subjective initiative for behavior change. Accordingly, major barriers in CCMM's implementation were patients' strong autonomy (particularly among husbands), misbelief and misperception about diabetes management as a result of low literacy, and mistrust of the practitioners. QCA further revealed that no single condition was necessary for effective HbA1c control, while three types of their combinations would be sufficient. Solution 1 and 2 both comprised the presence of spousal willingness to help, plus correct belief and perception of diabetes management, well embodying the utility of couple collaborative management in supporting patients' HbA1c control. On the other hand, solution 3 indicated that high-quality implementation even without spousal support, can promote the patient's subjective initiative to overcome objective obstacles, suggesting enhanced self-management for HbA1c control.

CONCLUSIONS

Tailored CCMM should be implemented in reference to older couple's preferences and literacy levels, to ensure intervention fidelity, and establish correct understanding of collaborative management among them.

Long-term Effects of Remote Patient Monitoring in Patients Living with Diabetes: A Retrospective Look at Participants of the Mississippi Diabetes Telehealth Network Study

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.