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Video Telemedicine Improves Rural Care

93% of patients reported a positive clinic visit and said they would use the video telemedicine technology again in the future. A new study by researchers at the Molokai General Hospital in Kaunakakai, Hawaii, demonstrated that video telemedicine technology was associated with improved diabetes management in medically underserved rural communities by improving the patients’ access to health care. The study also found that patients satisfaction with video telemedicine technology was high.
The study was led by Barbara Satterfield, MPH, telehealth coordinator from Molokai General Hospital. The findings were presented at the 2004 CDC Diabetes Translation Conference in Chicago.

Satterfield and her colleagues studied patients who were treated at the Video Telemedicine Clinic on Molokai. Molokai, located between Oahu and Maui, is one of the more rural islands in Hawaii. Patients here often have a more difficult time gaining access to a doctor – particularly a specialist – because most doctors practice on the more populated islands. The Video Telemedicine Clinic was designed to provide the same services as a conventional office visit for patients with diabetes who lived on Molokai.
Patients who participated in the Video Telemedicine Clinic went to the clinic once a month. At these visits, they met with a nurse or a diabetes educator at the clinic and were linked to an endocrinologist on another island via video technology. The nurse or diabetes educator acted as the endocrinologist’s designee and performed clinical tasks for the patient as directed by the endocrinologist. A video camera that transmitted images back to the doctor was also available at the clinic; this allowed the doctor to examine the lower extremities of the patient.

According to Satterfield, the goal of the Video Telemedicine Clinic is to accurately replicate the conventional office visit; patients should not receive second-rate care simply because they are not having a face-to-face visit with an endocrinologist. If a patient were having difficulties, a face-to-face doctor’s visit would be scheduled.

Satterfield and her colleagues compared patients with diabetes who were treated at the Video Telemedicine Clinic with those who did not participate in the program and continued with conventional medical appointments.

The researchers followed both groups of patients for 18 months, Satterfield said that at the end of 18 months, the two groups were similar in terms of diabetes management and treatment. “The proportions of patients in both groups that were receiving the recommended blood tests and physical exams were fairly equal,” Satterfield said. “As a consequence, we saw the same trends in each patient group develop over time as evidenced by improved lab values such as HbA1c levels, HDL cholesterol and blood pressure.”

But Satterfield noted that the researchers were surprised to find that patients who were treated at the Video Telemedicine Clinic often had a more dramatic improvement in disease management. “The telemedicine patients, as a group, made more of a dramatic shift in terms of improving their glycemic control and ultimately reducing their risk for developing complications,” she said. “Perhaps this is because telemedicine affords another access point to the specialist that would otherwise be unavailable.”
Satterfield and her colleagues also found that patient satisfaction was high with the Video Telemedicine Clinic. A patient satisfaction survey showed that 93% of patients reported a positive clinic visit and said they would use the video telemedicine technology again in the future.

According to Donna Carvalho, RN, from the Molokai General Hospital and the Video Telemedicine Clinic, patients said they felt video telemedicine allowed for a less intimidating office visit. She added that patients also reported an appreciation for the shorter appointment visits with the Video Telemedicine Clinic.

The patient satisfaction survey also showed that patients agreed that the quality of care was not compromised with video telemedicine. Furthermore, they said the clinic was efficient and the technical aspect – including the sound and video – did not diminish the benefits of the program.

The researchers said video telemedicine is a new option that may offer improved care for rural patients. They said that similar programs could be developed in other rural areas.

Mikami J, Mau M, Carvalho D, et al. Reaching medically underserved communities through video telemedicine technology: Experiences from the Molokai Diabetes Program. Presented at the 2004 CDC Diabetes Translation Conference. May 11-14, 2004. Chicago.

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FACT:
People with diabetes had a 65 percent higher risk of developing Alzheimer’s disease. For the measurements of cognitive decline, researchers found a difference between diabetics and nondiabetics only in the speed of making simple perceptual comparisons. Results were controlled for age, sex, and educational level. Archives of Neurology. May 2004, Vol. 61, pp. 661–666.