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Chang HC, Wang LU, Chiou HY, Chen RC, Chen HF, Yao CW, Liu SL, Chen KC, Liao YT, Lin TC, Chuang WP, Wang JK. Impact of Telemedicine on Blood Glucose Control and Ophthalmic Screenings for Patients with Diabetes in Remote Areas During the COVID-19 Pandemic: A Real-World Study in Northern Taiwan. Telemed J E Health 2024. [PMID: 38739447 DOI: 10.1089/tmj.2024.0147] [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: 05/15/2024] Open
Abstract
Introduction: The purpose of this study was to assess the impact of telemedicine on ophthalmic screening and blood glucose control for patients with diabetes in remote areas of Northern Taiwan during the coronavirus disease 2019 (COVID-19) pandemic. Methods: Telemedicine was implemented in Shiding and Wanli Districts using a 5G platform from April 2021 to December 2022. Patients with poorly controlled diabetes received real-time consultations from endocrinologists at Far Eastern Memorial Hospital, 50 km away, for medication adjustment, diet control, and lifestyle recommendations. The study also provided cloud-upload blood glucose meters for self-monitoring and regular medical advice from hospital nurses. Ophthalmic screenings included fundus imaging, external eye image, and intraocular pressure measurement, with instant communication and diagnosis by ophthalmologists through telemedicine. A satisfaction questionnaire survey was conducted. Results: The study enrolled 196 patients with diabetes. Blood glucose and glycosylated hemoglobin levels were significantly reduced after applying telemedicine (p = 0.01 and p = 0.005, respectively). Ophthalmic screenings led to hospital referrals for 16.0% with abnormal fundus images, 15.6% with severe cataract or anterior segment disorders, and 27.9% with ocular hypertension or glaucoma. Fundus screening rates remained high at 86.3% and 80.4% in 2022, mainly using telemedicine, comparable with the traditional screening rate in the past 5 years. The overall satisfaction rate was 98.5%. Conclusions: Telemedicine showed effectiveness and high satisfaction in managing diabetes and conducting ophthalmic screenings in remote areas during the COVID-19 pandemic. It facilitated early diagnosis and treatment of ocular conditions while maintaining good blood glucose control and fundus screening rates.
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Affiliation(s)
- Hao-Chun Chang
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Ling-Uei Wang
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hung-Yi Chiou
- Institute of Population Health Sciences, National Health Research Institute, Zhunan, Taiwan
| | - Ran-Chou Chen
- Department of Health, New Taipei City Government, New Taipei City, Taiwan
| | - Hua-Fen Chen
- Department of Endocrinology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chih-Wei Yao
- Shiding District Health Center, Department of Health, New Taipei City Government, New Taipei City, Taiwan
| | - Shang-Lin Liu
- Wanli District Health Center, Department of Health, New Taipei City Government, New Taipei City, Taiwan
| | - Kuo-Cheng Chen
- Far EasTone Telecommunications Co., Ltd., Taipei City, Taiwan
| | - Yu-Ting Liao
- Institute of Population Health Sciences, National Health Research Institute, Zhunan, Taiwan
- Center for Community Health Development, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Tzu-Chun Lin
- Center for Community Health Development, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Wen-Po Chuang
- Center for Community Health Development, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Jia-Kang Wang
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Electrical Engineering, Yuan Ze University, Taoyuan City, Taiwan
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Luo H, Cummings DM, Xu L, Watson A, Payton C. Diabetes Self-management Education and Support Completion Before and During the COVID-19 Pandemic: Results From Local Health Departments in North Carolina. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:686-690. [PMID: 37071075 DOI: 10.1097/phh.0000000000001749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
OBJECTIVE To assess diabetes self-management education and support (DSMES) completion rate and explore the differences in DSMES completion by different delivery models. METHODS We conducted a retrospective analysis of 2017-2021 DSMES data at 2 local health departments (LHDs) in Eastern North Carolina. We evaluated DSMES completion by 2 delivery models. RESULTS From 2017 to 2021, the overall DSMES completion rate was 15.3%. The delivery model of two 4-hour sessions was associated with a higher completion rate than the delivery model of four 2-hour sessions ( P < .05). Patients with less than a high school education and without health insurance were less likely to have completed their DSMES training ( P < .05). CONCLUSION The DSMES completion rate at LHDs in North Carolina is very low. A delivery model consisting of 10 hours of education delivered in fewer sessions may contribute to a higher DSMES completion rate, but more research is needed. Targeted programs are needed to engage patients and improve DSMES completion.
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Affiliation(s)
- Huabin Luo
- Department of Public Health, Brody School of Medicine (Drs Luo and Cummings), and Department of Health Education & Promotion, College of Health and Human Performance (Dr Xu), East Carolina University, Greenville, North Carolina; Diabetes Program, Pitt County Health Department, Greenville, North Carolina (Ms Watson); and Community and Clinical Connections for Prevention and Health Branch, Chronic Disease and Injury Section, NC Division of Public Health, Raleigh, North Carolina (Ms Payton)
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Anderson JA, Kimmel B, Sansgiry S, Venkatasubba Rao CP, Ovalle AP, Cerra-Stewart CA, Kent TA. Using Mobile Video-Teleconferencing to Deliver Secondary Stroke Prevention Interventions: A Pilot Study. TELEMEDICINE REPORTS 2022; 3:175-183. [PMID: 36204701 PMCID: PMC9531882 DOI: 10.1089/tmr.2022.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/05/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Patient self-management support (SMS) interventions help stroke survivors control stroke risk factors and assist with secondary prevention. We examined utility and preliminary effectiveness of mobile video-teleconferencing (VT) to deliver SMS to stroke survivors in rural and low-income urban Texas communities. METHODS We applied a within-subjects design to assess improvement in self-management behaviors and stroke risk factors among stroke survivors receiving SMS intervention through mobile VT. Adults with stroke and two or more uncontrolled stroke risk factors were eligible. The SMS program, Video-teleconference-Self-management TO Prevent stroke (V-STOP) was delivered over 6 weeks by trained health coaches through VT. We applied Generalized Estimating Equations with site and time in intervention as covariates to evaluate psychological, social, physiological outcomes, self-management behaviors, and quality of life. RESULTS Mean age of 106 participants was 59.3 (±10.9); most were White, Hispanic men, living with someone, with low income. Approximately 69% completed all measures at 6 weeks. Median number of sessions attended was 5 (interquartile range 3) potentially avoiding 210 km of travel per person. Satisfaction with V-STOP and VT delivery was high, at (4.8 [±0.5]) and (4.7 [±0.5]), respectively. Stroke knowledge was improved from 8.8 (±1.0) at baseline to 9.6 (±0.7) at 12 weeks, (p < 0.0001). Improvements were observed in self-efficacy, exercise behaviors, depression and anxiety, disability, and quality of life. CONCLUSION Implementation of SMS is feasible and shows good utility and preliminary effectiveness of using mobile VT to provide stroke follow-up care to stroke survivors. Participants improved self-management behaviors and stroke risk factors.
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Affiliation(s)
- Jane A. Anderson
- Department of Medicine, Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
- Department of Neurology, and Baylor College of Medicine, Houston, Texas, USA
| | - Barbara Kimmel
- Department of Medicine, Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
- Department of Neurology, and Baylor College of Medicine, Houston, Texas, USA
| | - Shubhada Sansgiry
- Department of Medicine, Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Department of Medicine, South Central Mental Illness Research, Education and Clinical Center, Houston, Texas, USA
| | - Chethan P. Venkatasubba Rao
- Department of Neurology, and Baylor College of Medicine, Houston, Texas, USA
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
- Center for Space Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Anette P. Ovalle
- Department of Neurology, and Baylor College of Medicine, Houston, Texas, USA
| | | | - Thomas A. Kent
- Center for Genomic and Precision Medicine, Institute of Bioscience and Technology Texas A&M Health Science Center, Texas, USA
- Houston Methodist Hospital, Neurological Institute, Houston, Texas, USA
- Department of Chemistry, Rice University, Houston, Texas, USA
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