TeleTeam Care: Promoting Lifestyle and Behavioral Health for Uncontrolled Diabetic
Patients in Underserved Rural Communiti...
of 1


Published on: Mar 3, 2016

Transcripts - Nasrallah_FNCE2015

  • 1. TeleTeam Care: Promoting Lifestyle and Behavioral Health for Uncontrolled Diabetic Patients in Underserved Rural Communities via Telehealth Background Problems Addressed: • Rural primary care providers are challenged with little or no access to services that can assist in delivering much needed chronic disease care to patients with diabetes and behavioral challenges. • Diabetes management and prevention of complications in rural primary care is frequently exacerbated by profound lifestyle and behavioral challenges that limit health outcomes. • Diabetics with behavioral problems have more diabetes complications. Demographics: • High prevalence of diabetes in eastern NC (11.3% vs. 9.8% in NC) • Higher prevalence in African Americans (16.7% vs. 10.2% in whites). • Nearly 50% of patients with diabetes have co-morbid behavioral challenges and require help with lifestyle changes, medications, and/or counseling for concurrent depression, anxiety, or adjustment disorders. Purpose Evaluate the clinical and pragmatic effectiveness of delivering team-based care for underserved patients with diabetes and behavioral challenges via telehealth into rural primary care practices. Attend to patients who have diabetes and co-morbid behavioral challenges who are either insured through federally subsidized funding, uninsured, or privately insured, but unable to afford the high cost of specialist services and prescriptions. Provide team-based care to patients with little knowledge of diabetes self-management practices and limited exposure to diabetes education. Methodology TeleTeam Team-Based Delivery Care Coordination of Patient Referrals and Subsequent Encounters • Utilize basic screening instrument at rural primary care practice site to identify patients who have one or more self-management challenges. • Diet and lifestyle, blood glucose control, medication, and depression and/or anxiety. • Communicate with project coordinator to initiate “point-of-care” telehealth consultation or schedule future appointments. • Arrange follow-up visits by collaborative discussion among the patient, rural primary care staff, and specialist provider(s) and evaluate progress of patients. • Healthy eating, being active, monitoring, taking medications, problem solving, reducing risk, and health coping. Referrals to TeleTEAM Specialty Services Anticipated Results Conclusion This initiative has been able to demonstrate that team-based care delivered via telehealth can be successful in delivering diabetes care in impoverished rural communities with limited local care options. Next Steps • Enhance outreach efforts and expand patient base. • Improve screening process to expand number of patients receiving specialty care. • Increase overall number of telehealth encounters. • Limit number of canceled or no-show appointments. • Improve growth and sustainability of program. • Study and implement latest technological approaches for improved patient care. Care Outcome Anticipated Outcome and/or Results HbA1c Goal: <7.0 Average drop from 10.0 at baseline to 8.5 at 3 months (paired t-test p<.000) August 2015 Body Weight Goal: Limit further weight gain and achieve a stable weight Overall reduction in weight and body mass index (BMI) and/or maintenance of bodyweight. Depression and/or anxiety Average PHQ-8 scored 10.7 at baseline to 6.8 at 6 months (not statistically significant matched paired t-test p<.09) August 2015 Diabetes related-distress Reduced disease related stress and improvement in distress scores. Food intake patterns Increased intake of fruits and non-starchy vegetables and reduced intake of sugar sweetened beverages, fast and friend foods, and high sodium and/or processed foods. Self-care activities Increased knowledge of ability to apply self-care behaviors. Provides cognitive behavioral therapy techniques as well as health behavior related goal-setting and the delivery of a behavioral prescription to facilitate activation of adaptive health behaviors. Delivers specific dietary behaviors including limiting portion sizes, total calories, and sugar sweetened beverages, and increasing healthy food consumption, physical activity, and goal-setting. Provides recommendations to the local provider for treatment options for better control of blood sugar and blood pressure, as well as facilitating patient adherence to the regimen. Behavioral Therapist Clinical Pharmacist Dietitian Lana Nasrallah MPH, RD, LDN, Jill Jennings RDN, LDN, Doyle M Cummings PharmD, Dennis Russo PhD, Elizabeth Banks PhD, LMFT, Lisa Rodebaugh BSN, RN, Shivajirao Patil MD, Ann Marie Nye PharmD, Jillaine Hardee PharmD, Gloria Jones ACKNOWLEDGEMENT: We appreciate the generous support of the Kate B. Reynolds Charitable Trust and the HRSA Office of Rural HealthPolicy; OAT Office; HRSA Grant # H2ARH26028 VMG– Bertie BSOM ECU Family Medicine VMG – Aurora VMG– Tarboro VMG – Pinetops GMC – Wallace VMC – Wallace GMC – Faison Kinston CHC RCCHC - Murfreesboro RCCHC – Ahoskie RCCHC – Colerain OIC – Rocky Mount RHCC - Robeson Completes medical evaluation and provides comprehensive recommendations to the rural primary care provider for patient management. Diabetologist Nutrition Therapy 56% Diabetology 6% Pharmacotherapy 9% Behavioral Therapy 29%

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