BACKGROUND/RATIONALE:
The VA population is disproportionately affected by diabetes and while most studies report a strong role for patient self-management in promoting optimal diabetes control. Current evidence suggests sub-optimal self-management practices among diabetic patients. Internet and electronic diabetes interventions including decision provider support mechanisms and patient accessible patient health record systems have been demonstrated to improve chronic care in primary care settings. Additionally group medical appointments (GMA) for diabetes management are being recognized as an effective clinical encounter method for diabetes care. Few studies have explored the integration of interactive patient health record systems (PHR) and group diabetes visits. The Veterans Administration (VA) is uniquely suited for exploring the feasibility of such a system because of its robust PHR (MyHealtheVet), over 10 year experience implementing GMA's and unique VA wide implementation of Patient-Centered Medical Home (PCMH) model called Patient Aligned Care Teams (PACT) since 2010.

OBJECTIVE(S):
This study aims to develop a Diabetes Virtual Group Medical Access (D-VGMA) intervention for primary care PACT diabetes patients who opted-in for secure messaging (SM). We will secondarily evaluate the effectiveness of D-VGMA in improving self-management practices and diabetes outcomes among selected participants.

METHODS:
This study was conducted in distinct phases that focus on: a) The development of a reference toolkit and guide for implementation of the D-VGMA intervention using existing evidence based educational materials, individualized PACT team with patient SM communications and formative patient and provider centered review processes, b) Preliminary and full implementation of the D-VGMA intervention among a cohort of patient from a Loma Linda VA (LL-VA) academic primary care team (Academic PACT or APACT), c) Evaluation of the impact of the D-VGMA intervention on Diabetes self-management practices (main outcome), diabetes knowledge and self-efficacy (secondary outcomes). We will also explore the impact of the intervention on standardized clinical diabetes outcome including A1c, LDL-C and BP. The evaluation design will utilize a prospective cohort design using a repeated test approach. Participants in the evaluation study were selected using specific eligibility criteria and recruited through appropriate selection, consent and recruitment procedures. Data collection will be conducted using standardized data collection tools and data analysis will explore the primary hypothesis that the intervention will result in a statistically significant improvement in self-management practices in addition to other secondary outcomes. A program evaluation survey was also conducted.

FINDINGS/RESULTS:
The main interventional portion of the study has been completed. 14 patients were enrolled for the pilot phase of the study and an additional 78 patients were enrolled for the expanded rollout phase which has been completed. Overall there were 2 drop-outs from the pilot phase and 25 drop-outs from the expanded phase. A post-study evaluation questionnaire conducted via phone on 34 of the remaining 65 patients being tracked revealed that 14 of the participants did not complete any modules, 11 completed all modules, and 9 completed some but not all 17 had a very positive impression of the program, 11 had a somewhat positive impression, 4 were neutral, and 2 did not complete the entire questionnaire.
25 very much would recommend the program, 3 somewhat would recommend, 4 were neutral, and 2 did not complete. 21 very much would participate in another, 6 somewhat would participate in another, 2 were neutral, 2 would not participate, 1 somewhat would not participate, and 2 did not complete. Remaining data analysis portion of study on key outcome measures is still in progress.

IMPACT:
It is anticipated that findings from this study will result in the overall improvement in the quality of diabetes care among affected individuals. If the D-VGMA intervention is demonstrated to be effective in improving self-management, self-efficacy, diabetes knowledge and clinical outcomes we anticipate system wide dissemination of D-VGMA. Procedures from this study may also inform similar future virtual interventions aimed at other chronic medical conditions. No updates on impact are fully available as of the final report as data analysis is currently ongoing. Post-study program evaluation showed a favorable results for general impressions, acceptance, and usability of program.

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External Links for this Project

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PUBLICATIONS:

None at this time.

DRA: Diabetes and Other Endocrine Disorders
DRE: Treatment - Observational
Keywords: none
MeSH Terms: none