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  1. Session #B5b Saturday, October 12, 2013 Virtually Possible: The Use of Technology in the Treatment Of Diabetes Cheryl B. Masters, PhD, Jerry Nymberg, MD, Mark Robinson, MD, Andrea Cochran, PhD, Wes Teeter, MA, LPC Cabarrus Family Medicine Carolinas Healthcare System Collaborative Family Healthcare Association 15th Annual Conference October 10-12, 2013 Broomfield, Colorado U.S.A.

  2. Faculty Disclosure We have not had any relevant financial relationships during the past 12 months.

  3. Study Summary • Study question: Will video-enhanced home monitoring devices increase patient access (and improve outcomes) to a diabetes care team embedded in a patient centered medical home? • Study population: Total enrollment of 119 poorly-controlled diabetic patients (HbA1c > 9%) • Study sites: CFM-Kannapolis, CFM-Concord • Study duration: 3 month intervention and 3 month follow-up • Diabetes Care Team: care manager, nutritionist, clinical psychologist, and clinical pharmacist

  4. Baseline Data Concord Kannapolis

  5. Frequently Cited Barriers To Glycemic Control • Transportation • Financial resources • Mood disorders • Limited knowledge about diabetes Gatchel & Dordt (2003) Clinical Health Psychology and Primary Care

  6. Objectives • Participants will identify the relationship between mood, stress and diabetes. • Participants will describe the prominent psychosocial obstacles to diabetes management. • Participants will identify the advantages of virtual services as a platform for diabetes management.

  7. Patients Randomized to Three Groups

  8. Baseline Demographics

  9. Baseline Glycemic Control Mean by Group

  10. DID Virtual Technology Improve Access?

  11. Changes in Access to the Team

  12. Number of Visits with all DCT Disciplines by 3 Months • * Main study outcome • Note: 100% saw their PCP at study entry

  13. Visits by Discipline After 3 Months(FT is the number of FaceTime Visits) (52 FT) (41 FT) (46 FT) (12 FT)

  14. Did Technology Improve Glycemic Control?

  15. Improvements in Glycemic Control

  16. Was Depression or Stress Related to Diabetes?

  17. What Percentage of Patients Screened Positive for Depression? 32% 35%

  18. Did PHQ-9 Scores Improve with Treatment?

  19. Top 10 Stressors (Holmes & Rahe) • Christmas • Personal injury/illness • Change in financial state • Change in eating habits • Change in health of family member • Death of close family member • Sexual difficulties • Change in social activities • Change in sleeping habits • Death of close friend

  20. Holmes & Raye by Group

  21. Stress, Depression and HbA1c

  22. Coping Style and HbA1c

  23. iPadSatisfaction: Group 3 (n=33)

  24. Satisfaction with Technology

  25. Honeywell Satisfaction: Group 3 (n=38)

  26. Diabetes Care Team Satisfaction with iPad 2

  27. Diabetes Care Team Satisfaction with Honeywell Home Monitor

  28. successful Outcomes • All three groups had increased access to care provided by the Diabetes Care Team (DCT). • If you make visits to DCT free, provide free test strips, and free labs, patients will come! • Test strips cost $310/patient, Labs cost $563/patient • All three groups improved mean A1c at 3 months. The team process works! • The relationship between Diabetes and Depression is bidirectional. Uncontrolled diabetics should be screened with the PHQ-9.

  29. Advantages and Disadvantagesof Virtual Services • All patients eventually were able to operate the technology • Ideal for medication reconciliation, seeing how people really people really eat on a daily basis and what their real life stressors are. • Ideal for patients with transportation issues and limited mobility. • Only lost 1 iPad to a car crash, one was stolen but returned. • There were some technical issues: • Ringer is too low • Lose visit preparation and “specialness” of a visit • Patients don’t know iPAD visit etiquette • Calls get dropped; often had to pre-call anyway • Need to set limits/controls on MiFi’s. • Limits on FaceTimeas an immediate “on call” device to practice

  30. The End

  31. Any Questions??

  32. Session Evaluation Please complete and return theevaluation form to the classroom monitor before leaving this session. Thank you!