Table 2:
Telemedicine interventions
| Study* (subgroup) | Provider | Form of communication | Frequency of feedback | Interactive follow-up | Medication adjustment | Nutrition counselling | Exercise | Blood pressure management | General education | |
|---|---|---|---|---|---|---|---|---|---|---|
| Provider to patient | Patient to provider | |||||||||
| Zhou,156 2014 | Diabetes team | Web portal SMS Telephone |
Web portal | – | Yes | – | Yes | Yes | – | – |
| Kirwan,99 2013 | Diabetes educator | Web portal | SMS Smartphone application |
Weekly | Yes | Yes | Yes | – | – | Yes |
| Moattari,110 2013 | Nurse Physician Nutritionist |
Web portal SMS |
Web portal SMS Telephone |
Weekly | Yes | – | Yes | – | – | Yes |
| Orsama,117 2013 | CDSS | Web portal (CDSS) | Web portal Smartphone application Telephone |
– | Yes | – | – | Yes | Yes | Yes |
| Pacaud,118 2012 (Web static) | Diabetes educator Physician |
Web portal (email) | Web portal (email) | – | Yes | Yes | – | – | – | Yes |
| Pacaud,118 2012 (Web Interactive) | Diabetes educator Physician |
Web portal (email, chat, bulletin board) | Web portal (email, chat, bulletin board) | – | Yes | Yes | – | – | – | Yes |
| Avdal,51 2011 | Nurse | Web portal | Web portal | – | Yes | – | – | – | – | Yes |
| Carter,58 2011 | Nurse Physician |
Web portal Videoconference |
Web portal Smart device |
Every 2 wk | Yes | – | – | – | – | Yes |
| Cho,62 2011 | CDSS Nurse Physician |
Web portal | Web portal | – | – | – | – | – | – | – |
| Quinn,125 2011 (coach only) | CDSS Diabetes educator |
Web portal | Web portal Smartphone application Telephone |
– | Yes | – | – | – | – | Yes |
| Quinn,125 2011 (coach PCP portal) | CDSS Diabetes educator Physician |
Web portal | Web portal Smartphone application Telephone |
– | Yes | – | – | – | – | Yes |
| Quinn,125 2011 (coach PCP portal with decision support) | CDSS Diabetes educator Physician |
Web portal | Web portal (with decision support) Smartphone application Telephone |
– | Yes | – | – | – | – | Yes |
| Tildesley,140 2011 | Physician | Web portal | Web portal Telephone |
– | Yes | Yes | – | – | – | – |
| Lorig,103 2010 (Web program) | Trained peer Moderator/Program administrator | Web portal | Web portal | Weekly | Yes | – | Yes | Yes | – | Yes |
| Lorig,103 2010 (Web program plus email reinforcement) | Trained peer Moderator/Program administrator | Web portal Listserv |
Web portal Listserv |
Weekly | Yes | – | Yes | Yes | – | Yes |
| McCarrier,108 2009 | CDSS Care manager |
Web portal |
Web portal |
Weekly | Yes | Yes | Yes | Yes | – | Yes |
| Ralston,126 2009 | CDSS Care manager |
Web portal | Web portal | Weekly | Yes | Yes | Yes | Yes | – | Yes |
| Shea,133 2009 | Care manager | Web portal Videoconference |
Web portal Smart device |
– | Yes | Yes | – | – | Yes | Yes |
| Yoo,153 2009 | CDSS Physician |
Web portal | SMS Smart device |
Twice daily | Yes | – | Yes | Yes | Yes | Yes |
| Kim,98 2008 | Nurse | Web portal SMS |
Web portal | Weekly | Yes | Yes | Yes | Yes | – | Yes |
| Yoon,154 2008 | Nurse Physician |
Web portal SMS |
Web portal | Weekly | Yes | Yes | Yes | Yes | – | Yes |
| Bond,57 2007 | Nurse Research team |
Web portal | Web portal | – | Yes | Yes | Yes | Yes | – | Yes |
| Kim,96 2007 | Nurse Diabetes educator |
Web portal SMS |
Web portal | Weekly | Yes | Yes | Yes | Yes | – | – |
| Cho,61 2006 | Nurse Physician Dietitian |
Web portal | Web portal | Every 2 wk | Yes | Yes | Yes | Yes | – | Yes |
| McMahon,109 2005 | Nurse | Web portal Telephone |
Web portal Smart devices |
– | Yes | Yes | – | – | Yes | Yes |
| Kwon,100 2004 | Nurse Physician Dietitian |
Web portal |
Web portal | – | Yes | Yes | Yes | Yes | – | – |
| Gomez,78 2002 | CDSS Physician |
Web portal | Web portal (PDA) Telephone |
Every 2 wk | Yes | Yes | Yes | – | – | – |
| Arora,50 2014 | CDSS | SMS | – | Twice daily | Yes | – | Yes | Yes | – | Yes |
| Nagrebetsky,113 2013 | Nurse | SMS Telephone |
Smart device | Monthly | Yes | Yes | – | – | – | – |
| Rossi,130 2013 | Physician | SMS | SMS | – | Yes | Yes | – | – | – | Yes |
| Tang,138 2013 | CDSS Care manager Dietitian |
SMS | Web portal Smart device |
– | Yes | Yes | Yes | Yes | – | Yes |
| Goodarzi,79 2012 | Research team | SMS | – | NA | Yes | – | – | – | – | Yes |
| Lim,102 2011 | CDSS Nurse Physician Dietitian Exercise trainer |
SMS | Smart device | ~ daily† | Yes | Yes | – | – | – | Yes |
| Shetty,134 2011 | Health care provider | SMS | – | NA | Yes | – | Yes | Yes | – | Yes |
| Kim,95 2010 | CDSS | SMS | Smart device | Daily | Yes | Yes | – | – | – | Yes |
| Rossi,129 2010 | Physician Dietitian |
SMS | SMS | – | Yes | Yes | Yes | – | – | Yes |
| Tildesley,141 2010 | Physician | SMS | SMS Smart device | – | Yes | Yes | – | – | – | – |
| Benhamou,53 2007 | Physician | SMS | PDA | Weekly | Yes | – | – | – | – | – |
| Kim,92 2007 | CDSS | SMS | Web portal Smart device |
– | Yes | – | Yes | Yes | – | Yes |
| Harno,81 2006 | Diabetes team | SMS | Smart device | – | Yes | – | Yes | Yes | – | – |
| Katalenich,88 2015 | CDSS | Automated text and voice reminder (CDSS) | – | Daily | – | Yes | – | – | – | – |
| Nicolucci,115 2015 | CDSS Nurse | Automated text, email and voice reminder (CDSS) Telephone |
Smart devices Call-me button |
Monthly | Yes | – | – | – | – | Yes |
| Khanna,91 2014 | CDSS | Automated interactive voice (CDSS to telephone) | – | – | Yes | – | Yes | – | – | – |
| Glasgow,75 2012 (CASM) | CDSS Research team |
Automated interactive voice (CDSS to telephone) |
Web portal | – | Yes | – | Yes | Yes | – | Yes |
| Glasgow,75 2012 (CASM plus) | CDSS Physician Nutritionist Research team |
Automated interactive voice (CDSS to telephone) Telephone |
Web portal Telephone |
Twice | Yes | – | Yes | Yes | – | Yes |
| Graziano,80 2009 | CDSS Research team | Automated interactive voice (CDSS to telephone) Telephone |
– | – | Yes | – | Yes | Yes | – | Yes |
| Holbrook,84 2009 | CDSS Research team |
Automated voice reminder (Telephone) Letter |
– | – | – | – | – | Yes | Yes | Yes |
| Schillinger,131 2009 | CDSS Care manager |
Automated interactive voice (CDSS to telephone) Telephone |
– | Weekly | Yes | – | Yes | Yes | – | Yes |
| Piette,120 2001 | CDSS Nurse |
Automated interactive voice (CDSS to telephone) Telephone |
– | Weekly | Yes | Yes | – | – | – | Yes |
| Piette,121 2000 | CDSS Nurse |
Automated interactive voice (CDSS to telephone) Telephone |
Telephone | Weekly | Yes | Yes | – | – | – | Yes |
| Pressman,123 2014 | Care manager | Smart device Telephone |
Smart device | Weekly | Yes | – | – | – | – | Yes |
| Wakefield,145 2011 | CDSS Nurse Diabetes educator Physician |
Smart device Telephone |
Smart device | – | Yes | – | Yes | Yes | – | Yes |
| Stone,136 2010 | Nurse | Smart device Telephone |
Smart device | Monthly | Yes | Yes | – | – | Yes | Yes |
| Jansa,86 2006 | Diabetes team | Smart device | Smart device Telephone Fax |
1.5 times per mo | Yes | Yes | Yes | Yes | – | Yes |
| Steventon,135 2014 | CDSS Nurse Support worker |
Computer software | Smart device Telephone |
~ daily† | Yes | Yes | – | – | – | Yes |
| Charpentier,60 2011 | Physician | Computer software Telephone |
Smartphone application | Every 2 wk | Yes | Yes | – | – | – | – |
| Tsang,142 2001 | CDSS | Computer software | PDA | Every 2 d | – | – | Yes | – | – | Yes |
| Rasmussen,127 2015 | Nurse Physician |
Videoconference | – | – | Yes | Yes | Yes | Yes | – | – |
| Davis,65 2010 | Nurse Dietitian |
Videoconference Telephone |
– | Monthly | Yes | – | Yes | Yes | – | Yes |
| Whitlock,149 2000 | Care manager Physician |
Videoconference | – | Weekly | Yes | – | Yes | Yes | – | – |
| Waki,146 2014 | CDSS Physician Dietitian |
Email Telephone |
Smart devices Smartphone |
Daily | Yes | Yes | Yes | Yes | Yes | Yes |
| Leichter,101 2013 | Physician | Email Telephone |
Computer software | Twice | Yes | – | – | – | Yes | – |
| Quinn,124 2008 | CDSS Diabetes educator Physician Nutritionist Research team |
Smartphone application | – | Yes | Yes | Yes | – | – | Yes | |
| Kim,93 2006 | Nurse | Patient Web page Telephone |
Patient Web page | Weekly | Yes | – | – | Yes | – | Yes |
| Farmer,69 2005 | CDSS Nurse |
Patient Web page Telephone |
Smartphone application | Every 2 wk | Yes | Yes | – | – | – | – |
| Bell,52 2012 | Nurse | Smartphone video message |
– | NA | – | – | – | – | – | Yes |
| Glasgow,76 1997 | CDSS Research team |
Video message Telephone |
– | 5 times | Yes | – | Yes | – | – | Yes |
| Heisler,82 2014 | CDSS Community health care worker |
Smartphone application Telephone |
– | Every 3 wk | Yes | – | – | – | – | Yes |
| Kaur,89 2015 | Physician | Telephone | Telephone | Weekly | Yes | – | Yes | Yes | – | – |
| Shahid,132 2015 | Research team | Telephone | – | ~ every 2 wk† | Yes | – | Yes | Yes | – | Yes |
| Chan,59 2014 | Trained peer | Telephone | Telephone | Every 2 wk then monthly then every 2 mo | Yes | – | Yes | Yes | – | Yes |
| Esmatjes,68 2014 | Diabetes team | Telephone | Smart device | Monthly | Yes | Yes | Yes | Yes | – | – |
| Lynch,105 2014 | Trained peer | Telephone | – | Weekly | Yes | – | Yes | Yes | – | Yes |
| O’Conner,116 2014 | Care manager Diabetes educator Pharmacist |
Telephone | – | Once | Yes | – | – | – | – | – |
| Suh,137 2014 | CDSS Trained peer |
Telephone | Smart device | Twice monthly | Yes | Yes | Yes | Yes | – | Yes |
| Varney,144 2014 | Dietitian | Telephone | – | Monthly | Yes | – | Yes | Yes | – | Yes |
| Aliha,48 2013 | Nurse | Telephone | – | Twice weekly then weekly | Yes | – | – | – | – | Yes |
| Blackberry,55 2013 | Nurse | Telephone | – | ~ monthly† | Yes | Yes | – | – | Yes | Yes |
| then 3 sessions | ||||||||||
| Crowley,63 2013 | Nurse | Telephone | – | Monthly | Yes | Yes | Yes | Yes | Yes | Yes |
| Eakin,67 2013 | Counsellor | Telephone | – | ~ every 2 wk† | Yes | – | Yes | Yes | – | Yes |
| Gagliardino,74 2013 | Trained peer | Telephone | – | Weekly then every 2 wk then monthly | Yes | – | – | – | – | Yes |
| Mons,111 2013 | Nurse | Telephone | – | Monthly | Yes | – | – | – | – | – |
| Munshi,112 2013 | Care manager Diabetes educator |
Telephone | – | ~ every 2 wk† | Yes | Yes | Yes | Yes | – | Yes |
| Plotnikoff,122 2013 | Telephone counsellor | Telephone | – | – | Yes | – | – | Yes | – | Yes |
| Van Dyck,143 2013 | Psychologist | Telephone | – | Every 2 wk then monthly | Yes | – | – | Yes | – | Yes |
| Bogner,56 2012 | Research team | Telephone | – | Twice | Yes | – | – | – | – | Yes |
| Del Prato,66 2012 | Physician | Telephone | Smart device | – | Yes | Yes | – | – | – | – |
| Jarab,87 2012 | Pharmacist | Telephone | – | Weekly | Yes | Yes | Yes | Yes | Yes | Yes |
| Marois,107 2012 | Exercise physiologist | Telephone | – | Weekly | Yes | – | – | Yes | – | – |
| Patja,119 2012 | Nurse | Telephone | – | Monthly | Yes | – | – | – | – | Yes |
| Williams,150 2012 | Nurse | Telephone | – | Every 2 wk | Yes | – | – | – | – | Yes |
| Williams,151 2012 | CDSS Research team |
Telephone | Automated interactive voice (Telephone to CDSS) | Weekly | Yes | – | Yes | Yes | – | Yes |
| Farsaei,71 2011 | Pharmacist | Telephone | – | – | Yes | – | – | – | – | Yes |
| Franciosi,72 2011 | Nurse Physician |
Telephone | – | Monthly | Yes | Yes | Yes | Yes | – | Yes |
| Frosch,73 2011 | Nurse | Telephone | – | ~ monthly† | Yes | – | – | – | – | Yes |
| Keogh,90 2011 | Psychologist | Telephone | – | Once | Yes | – | Yes | Yes | – | Yes |
| Kim,94 2011 | Research team | Telephone | Telephone | Weekly | Yes | – | Yes | Yes | – | Yes |
| Walker,147 2011 | Diabetes educator | Telephone | – | ~ monthly† | Yes | – | Yes | Yes | – | Yes |
| Anderson,49 2010 | Nurse | Telephone | – | Weekly | Yes | – | Yes | Yes | – | Yes |
| Farsaei,70 2010 | Pharmacist | Telephone | – | Weekly | Yes | Yes | Yes | Yes | – | Yes |
| Heisler,83 2010 | Care manager Trained peer Research team |
Telephone | – | – | Yes | Yes | – | – | – | Yes |
| Nesari,114 2010 | Nurse | Telephone | – | Twice weekly then weekly | Yes | Yes | Yes | Yes | – | Yes |
| Dale,64 2009 | Trained peer | Telephone | – | 6 times (frequency decreased over follow-up) | Yes | Yes | – | – | – | – |
| Istepanian,85 2009 | Physician | Telephone | Smart device | – | Yes | – | – | – | – | Yes |
| Rodriguez-Idigoras,128 2009 | CDSS Nurse Physician |
Telephone | Smart device Telephone |
– | Yes | – | – | – | – | – |
| Glasgow,77 2005 | Care manager | Telephone | Telephone | Twice yearly | Yes | – | Yes | Yes | – | Yes |
| Maljanian,106 2005 | Nurse Nutritionist |
Telephone | – | Weekly | Yes | – | Yes | – | – | Yes |
| Young,155 2005 | Nurse Telecarer |
Telephone | – | 3 groups: Every 3 mo Every 2 mo Monthly |
Yes | Yes | – | – | – | Yes |
| Montori,21 2004 | Nurse | Telephone | Smart device | Every 2 wk | Yes | Yes | – | – | – | – |
| Wolf,152 2004 | Care manager | Telephone | – | Monthly | Yes | – | Yes | Yes | – | Yes |
| Kim,97 2003 | Nurse Dietitian |
Telephone | – | Twice weekly then weekly | Yes | Yes | Yes | Yes | – | Yes |
| Biermann,54 2002 | Physician | Telephone | Smart device | – | Yes | Yes | – | – | – | – |
| Thompson,139 1999 | Nurse | Telephone | Telephone | 3 times weekly | Yes | Yes | – | – | – | – |
| Weinberger,148 1995 | Nurse | Telephone | – | Monthly | Yes | Yes | Yes | Yes | – | Yes |
| Ahring,47 1992 | Research team | Telephone | Smart device | Weekly | Yes | Yes | Yes | – | – | Yes |
| Luley,104 2014 | CDSS Research team |
Letter | Smart device | Weekly | – | – | Yes | Yes | – | Yes |
Note: CDSS = clinical decision support system, NA = not applicable, PCP = primary care provider, PDA = personal digital assistant, SMS = short message service (text messaging), “–” = not reported.
*
Studies are ordered by provider-to-patient communication; they are ordered by any use of Web portals, SMS text messaging, automated communication, smart device, computer software, videoconference, email, customized patient Web pages, video messaging, smartphone application, telephone and letter. A smart device is any computerized device specifically developed to collect and transmit patient data to health care providers. Web portals are websites where patients upload blood glucose or other clinical data and share these with their health care providers; many times providers also use Web portals to provide feedback to patients. CDSS systems receive data from patients and automatically respond using computer algorithms in a variety of ways, such as precomposed messages sent as SMS text messages to patients (Kim 201095), alarms sent to the providers when abnormal data are received (Gomez78), analyzed data reports sent to providers (Quinn125) and voice feedback over the telephone to patients (Schillinger131). Other components not mentioned in this table include psychological support, such as support for depression, smoking cessation and behavioural therapy.
†
Indicates an approximate frequency of feedback. For example, we used “~ daily” rather than 3 times per week for Lim102; “~ every 2 wk” replaced 14 times per 6 months for Eakin,67 and 11 times per 6 months for Munshi;112 “~ monthly” replaced 5 times per 6 months for Blackberry55 and Frosch,73 and 10 times per year for Walker;147 and “~ every 2 mo” replaced every 7 weeks for Young.155