Using Telehealth to Provide Diabetes Care to Patients in Rural Montana: Findings from the Promoting Realistic Individual Self-Management Program

Objective: The objectives of this study were to demonstrate the feasibility of telehealth technology to provide a team approach to diabetes care for rural patients and determine its effect on patient outcomes when compared with face-to-face diabetes visits. Materials and Methods: An evaluation of a patient-centered interdisciplinary team approach to diabetes management compared telehealth with face-to-face visits on receipt of recommended preventive guidelines, vascular risk factor control, patient satisfaction, and diabetes self-management at baseline and 1, 2, and 3 years postintervention. Results: One-year postintervention the receipt of recommended dilated eye exams increased 31% and 43% among telehealth and face-to-face patients, respectively (p = 0.28). Control of two or more risk factors increased 37% and 69% (p = 0.21). Patient diabetes care satisfaction rates increased 191% and 131% among telehealth and face-to-face patients, respectively (p = 0.51). A comparison of telehealth with face-to-face patients resulted in increased self-reported blood glucose monitoring as instructed (97% vs. 89%; p = 0.63) and increased dietary adherence (244% vs. 159%; p = 0.86), respectively. Receipt of a monofilament foot test showed a significantly greater improvement among face-to-face patients (17% vs. 35%; p = 0.01) at 1 year postintervention, but this difference disappeared in years 2 and 3. Conclusions: Telehealth proved to be an effective mode for the provision of diabetes care to rural patients. Few differences were detected in the delivery of a team approach to diabetes management via telehealth compared with face-to-face visits on receipt of preventive care services, vascular risk factor control, patient satisfaction, and patient self-management. A team approach using telehealth may be a viable strategy for addressing the unique challenges faced by patients living in rural communities.