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Health Services Research & Development

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2023 HSR&D/QUERI National Conference Abstract

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1166 — Implementation of Diabetes Self-Management Education and Support Within the Virtual Medical Center

Lead/Presenter: Tai-Lyn Wilkerson,  VA Northeast Ohio Healthcare System
All Authors: Wilkerson T (VA Northeast Ohio Healthcare System), Subramaniam, S (VA Northeast Ohio Healthcare System) Hearns, R (VA Northeast Ohio Healthcare System) Meyers, K (VA Northeast Ohio Healthcare System) Stevenson, L (VA Northeast Ohio Healthcare System) Ball, S (VA Northeast Ohio Healthcare System)

Objectives:
The Diabetes Self-Management Education and Support (DSMES) program provides education and medical monitoring of diabetes often preventing serious and debilitating complications. Many veterans, especially rural and underserved populations, struggle to self-manage their diabetes. To improve access to this evidence-based program, the DSMES was implemented using a web-based application, the Virtual Medical Center (VMC), allowing veterans to participate from their home computers.

Methods:
This qualitative evaluation of the VMC DSMES program implementation used semi-structured interview guides based on a combined Kirkpatrick and Technology/Task Fit-Unified Theory of Acceptance and Usability of Technology model including constructs from the Consolidated Framework for Implementation Research. Fifteen key stakeholders (4 DSMES VMC trainers, 5 clinical facilitators and 6 veterans) across sites within Veterans Integrated Services Network (VISN) 10 were interviewed (up to 55 minutes) about their experiences using the program and suggestions for improvement. Transcribed interviews were coded in ATLAS.ti 9 qualitative data analysis software using deductive codes (i.e. behavior, resources, and social influence based on initial frameworks) and inductive (new/emergent) codes.

Results:
Most of the trainers and facilitators reported challenges with downloading the desktop application and low recruitment of participants. Broadband and technical issues related to application installation prevented participation for many veterans. Most of the veterans interviewed who were able to access care within the DSMES VMC reported a positive experience using the program, improved diabetes self-management, and easier access to diabetic care. A few veterans reported time efficiency when accessing the DSMES VMC with the program providing more information than what can fit into a single in-person appointment. Some veterans reported the receipt of equipment and assistance with internet connection from U.S. Department of Veterans Affairs (VA) Information Technology technicians. Stakeholders suggested the creation of outreach campaigns for the DSMES VMC to increase awareness for VA staff and veterans of the program to improve recruitment, and to shift to a web-based platform that is more easily accessible by clicking a link to reduce technical issues with downloading the program.

Implications:
Overall, most veterans interviewed found the DSMES VMC platform relatively easy to access and use. Other stakeholders made suggestions to improve DSMES implementation on the VMC by increasing VA providers and veterans awareness of the program and reducing technical difficulties by switching to a web based platform. These findings can inform future implementation efforts using technology to increase access to care allowing better health education for patients.

Impacts:
The COVID-19 pandemic-related safety protocols may require alternative virtual formats to care delivery such as offered within the VMC. Understanding veteran’s and provider’s experiences with this format could inform adaptation of healthcare delivery when a virtual modality is preferred or necessary.