TABLE 1.
Interactive Video Telehealth Models
| Source | Design | Sample | Intervention | Results | Implications |
|---|---|---|---|---|---|
| Holloway et al., 2011 (7) | Intervention project; nurse practitioner–led multidisciplinary team to enhance diabetes care through DSME using pre-/postintervention evaluation | Nonrandom purposive sample (n = 118) from five rural Montana clinics | Telehealth video conferencing for diabetes care and DSME | Most (97%) of program staff felt that telehealth was a useful tool for patient management and education; patients adapted quickly to technology and shared sensitive issues openly; after 1 year, patients reported improvement in diabetes care of 30–200% post-intervention compared to baseline | Model had a positive impact on diabetes self-management and patient satisfaction by bringing a multidisciplinary team into a rural setting to work in partnership with local PCPs |
| Levin et al., 2013 (12) | Retrospective study | Convenience sample (n = 73) of patients treated in telemedicine program on Aeroe Island, Denmark; mainland treatment center location Svendborg, Denmark | Synchronous and asynchronous telehealth interaction with patients and providers for diabetes clinical care and management, including: | Intervention group compared with data from the Danish National Diabetes Registry: | Major cost savings for patients using telemedicine; estimated savings was $60–70 per patient per visit; overall program cost savings were $9,430–11,170 compared with usual care |
| Post-intervention: | |||||
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| Six-month telemedicine intervention; two visits and two A1C values | Patient satisfaction was related to major reduction in transportation costs | ||||
| Siminerio et al., 2014 (17) | Baseline and post-program behavioral and psychosocial survey; satisfaction survey post-program | Convenience sample (n = 35); patients referred by a PCP if A1C >7% and needed improved glycemic management | Video telehealth for DSME, diabetes self-care empowerment; diabetes team consisting of endocrinologist in urban setting and diabetes nurse educator in rural setting; DES-SF tool used for empowerment assessment | Significant improvement in patient empowerment and self-care when patients received telehealth DSME (DES-SF score 3.8 vs. 4.5, P <0.01); patients’ adherence to diet and glucose monitoring recommendations improved (3.8 ± 2.3 vs. 5.2 ± 1.8; P = 0.01) | Alternative care model for diabetes education and specialty care management in rural community |
| Toledo et al., 2014 (18) | Clinical trial | Convenience sample (n = 31); patients referred by rural PCP and patient volunteers with A1C >7%; location in rural setting with linkage to endocrinologist in urban academic hospital setting | Videoconferencing-based telemedicine with endocrinologists for 1-year follow-up study | Statistically improved glycemic control in the intervention group; baseline A1C 8.6 ± 0.3 in the telemedicine group vs. 8.9 ± 0.4% in usual care; completion A1C 6.6 ± 0.2 in the telemedicine group vs. 8.1 ± 0.2% in usual care, P = 0.02; 93% of intervention group adhered to SMBG recommendation, and 84% of intervention patients received intensified treatment | Videoconferencing-based telemedicine consultants offer potential to overcome geographical barriers to care in rural communities; this model had a significant impact in improving A1C outcomes |
| Davis et al., 2010 (19) | Clinical trial | Random sample (n = 165); patients attended one of three rural community health centers in northeastern South Carolina | Interactive video conferencing for DSME and eye exams | Significant improvement in A1C in the intervention group (baseline 9.2 ± 0.4, 6-month 8.3 ± 0.5; and 12-month 7.4 ± 0.5%) compared with usual care (baseline 8.7 ± 0.4, 6-month 8.6 ± 0.4, and 12-month 8.1 ± 0.4%); P = 0.05 for baseline to 6 months and 0.004 for 12 months; clinical improvement in eye exams (51.2% having exams in the intervention group vs. 46.3% usual care; P = 0.29) | The model used retinal imaging to provide eye exams; digital retinal imaging was electronically transferred to a network ophthalmologist, and abnormal findings were linked to care |
| Fatehi et al., 2013 (21) | Descriptive study with post-program questionnaire | Convenience sample (n = 56); two participating endocrinologists | Medical interventions; reviewed endocrinologists’ opinions on the use of telehealth for specialty care | Fifty-six consultations were provided from a tertiary teaching hospital; after consultations, the physicians interviewed indicated that 34% of the cases seen could have made a better decision if there had been an in-person physical exam; 12 patients required an in-person exam | Endocrinology specialty care can be performed through telehealth; most needed exams can be performed by local provider or, if necessary, in-person follow-up after a telehealth consultation |
| Fatehi et al., 2015 (20) | Cross-sectional observational survey | Questionnaires mailed to 62 participants enrolled in telemedicine program in Australia | Questionnaire with 15 multiple-choice questions and 1 open-ended question was developed for assessing patient satisfaction with video conferencing for specialty care | Questionnaire items showed strong internal consistency (Cronbach’s χ = 0.90); 34% response rate; four dimension assessment:
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Patients with diabetes who were seen remotely by endocrinologists via video conferencing were satisfied with remote consultation |
| Toledo et al., 2012 (22) | Descriptive pilot study | Convenience sample (n = 25); PCPs (n = 7) | Telemedicine endocrinology consultants; PCPs in rural, medically underserved community in Pennsylvania referred patients with poorly controlled diabetes for consultation through telehealth | Mean A1C improved from 9.6 ± 0.4 to 8.5 ± 0.4% (P <0.001, paired t test); 75% of patients experienced absolute decrease in A1C of ≥0.5% from baseline | High levels of satisfaction reported by patients and providers; telehealth model offers improved access to specialty care in rural setting |
| Young et al., 2012 (23) | Randomized experimental study (control group vs. intervention group) | Random sample (n = 121); rural participants living with diabetes | 2-hour orientation at a rural clinic followed by a series of five phone or video contacts ∼2 weeks apart; English- and Spanish-speaking nurses provided coaching; Diabetes Empowerment Scale-Short Form and Diabetes History Form from the Michigan Diabetes Research and Training Center were used as participant assessment tools | From baseline to 9 months post-enrollment, intervention was associated with gains in five of eight indicators of self-efficacy (P <0.05) relative to the control group; intervention group had increased levels of satisfaction with their diabetes care from baseline to 16 weeks and from baseline to 9 months (P <0.05) relative to the control group | Significant improvement in participant self-efficacy in nurse coaching intervention group indicates that this telehealth technology may be an innovative way to empower individuals to work on goals for diabetes self-management, especially in rural areas |
| Watts et al., 2015 (24) | Retrospective study | Purposive sample (n = 35) | Telehealth video conference with diabetes specialists at an urban VHA hospital trained two PCPs at a rural VHA community clinic | After training, PCPs implemented two diabetes mini-clinics over 15 months; patients’ mean A1C improved from 10.2 ± 1.4 to 8.4 ± 1.8% (P <0.001) over average follow-up of 5 months | Telehealth models can be used for rural PCP professional training and have potential for future quality improvement projects for diabetes care/management |