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Diabetes Connected Health: A Pilot Study of a Patient- and Provider-Shared Glucose Monitoring Web Application. Journal of Diabetes Science and Technology 2009 Alice J. Watson,Joseph C. Kvedar,Basmah Rahman,Alexandra C. Pelletier,Gregory Salber,and Richard W. Grant. Outline. Background

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Diabetes Connected Health: A Pilot Study of a Patient- and Provider-Shared Glucose Monitoring Web Application

Journal of Diabetes Science and Technology 2009

Alice J. Watson,Joseph C. Kvedar,Basmah Rahman,Alexandra C. Pelletier,Gregory Salber,and Richard W. Grant

outline
Outline
  • Background
  • Research Design and Methods
  • Results
  • Discussion
  • Lessons Learned
  • Implications for Future Research
background
Background
  • “current standard of care” frequently fails to deliver on evidence-based recommendations for practice.
  • Requirements for more transparent reporting of outcomes and new payment systems that reimburse based on outcomes rather than visit.
  • A remote blood glucose monitoring application [“DiabetesConnected Health“(DCH)]
  • Allows patients to upload glucometer readings from commercially available glucometers.
research design and methods
Research Design and Methods
  • Both patients and providers had access to this Web site, where the data could be viewed, analyzed, and discussed.
  • Subjects were recruited from a primary care practice.
  • 20(8 decline)→12(5 ineligible)→7
  • Prominently featured a graphic representation of blood glucose readings.
  • A “journal” page allows patient to make notes and comments about each reading.
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Provider can access to patient blood glucose readings and notes.
  • One-way messaging allowed provider to send comments to each patient.
  • Each participant was asked to upload their readings using the modem once per day.
results
Results
  • Participant Satisfaction:
    • Five “Excellent” or “Good”
    • Remaining “Average” or “Satisfactory”
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Patients are motivated to improve self-management because they know their provider is watching.
  • The DCH application facilitated greater communication between patient and provider.
  • The use of the product increased patients’ general awareness of their blood sugar and its changes.
  • The application would be most useful for newly diagnosed patients or during times of medication titration.
discussion
Discussion
  • The number of comments per month increased, indicating ongoing engagement.
  • Self-monitoring is likely to be of value when test results are linked to educational or behavioral advice and changes in clinical management.
lessons learned
Lessons Learned
  • Limitations:
    • Small sample size and short follow-up period.
    • Demography Not generalizable.
  • Shortcomings:
    • Messaging was one-way.
    • Difficult to integrate the use of the Web site to provider\'s workflow.
    • User wanted more flexibility in how the readings were displayed.
    • More flexibility in where and when patient could upload readings.
    • More contextual information around high or low readings.
implications for future research
Implications for Future Research
  • Primary outcome measure will be change in HbA1c over the 6-month study.
  • Improvements:
    • Two-way messaging.
    • Integration of the program with other data sources.
    • A summary page detailing all their patients along with key metrics.
    • Customize the appearance of the graph.
    • New method of data upload via a computer.
    • Dates where medication changes were made are highlighted on the graph.
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