Abstract
Objective
We studied a telemedicine intervention for persistent poorly controlled diabetes mellitus (PPDM) that combined telemonitoring, self-management support, and medication management. The intervention was designed for practical delivery using existing Veterans Affairs (VA) telemedicine infrastructure. To refine the intervention and inform the delivery of the intervention in other settings, we examined participants’ experiences.
Methods
We conducted semistructured interviews with 18 Veterans who completed the intervention. We analyzed interview text using directed content analysis and categorized themes by hemoglobin A1c (HbA1c) improvement (<1% or ≥1%).
Results
Participants generally reported greater awareness of their blood glucose levels; however, they described dissatisfaction with the telemonitoring interface and competing demands during the intervention. Participants with <1% HbA1c improvement reported that these challenges interfered with their engagement. Participants with ≥1% HbA1c improvement reported new self-management routines despite challenges.
Conclusion
Despite competing demands and frustration with the telemonitoring interface, many participants demonstrated intervention engagement and substantial improvement in HbA1c ($1%). Differences in engagement may reflect differing capacity to manage treatment burden. Because it relies on existing infrastructure, this intervention is a promising model for addressing PPDM within VA. Future work should focus on optimizing systems’ telemedicine infrastructure; while reliance on existing infrastructure may facilitate practical delivery, and it may also limit intervention engagement by excessively contributing to treatment burden.
Acknowledgments
This work was supported by a grant from the US Department of Veterans Affairs, Veterans Health Administration, Health Services Research & Development (Diabetes QUERI RRP 12-458), and the Center for Health Services Research in Primary Care (COIN CIN 13-410). Portions of these data were presented at the American Diabetes Association Scientific Sessions, held in Boston, Massachusetts, June 8, 2015, and the Veterans Affairs Health Services Research and Development National Meeting, held in Philadelphia, PA, July 10, 2015. The views expressed in this article are those of the authors and do not necessarily reflect the position of the Department of Veterans Affairs or Duke University.
Disclosure
MJC is supported by a Career Development Award from VHA Health Services Research and Development (CDA 13-261). The other authors report no conflicts of interest in this work.