Telehealth consumer-provider interaction: a chronic disease intervention in an underserved population
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The purpose of this study was to evaluate the efficacy of home-based telehealth intervention for the management of diabetes mellitus. The research targets an underserved, predominantly Hispanic population in Laredo, Texas and surrounding counties. Telehealth allows diabetic care management to be delivered to individuals who are not receiving home-based follow-up. The daily transfer of clinical information and provision of health behavioral training to diabetics, within the home, serves as a catalyst for health improvement and long-term behavioral change. As a patient-centered sphere of influence develops, positive health behaviors increase, quality of life improves, and utilization of medical resources declines. Test participants (n = 133) received a home device while controls (n = 71) did not. Data from participant records were retrospectively analyzed to assess the initial, 18-month usage impact of the telecommunication-augmented device on individual diabetic health status. Participants’ HbA1c levels and frequency of outpatient, inpatient, and emergency clinic utilization were compared to pre-group activity. The objective was to determine (a) if this new communication device intervention resulted in improved health, as measured by HbA1c diabetic test values, and (b) if it served to cut costs through decreased resource utilization. Findings displayed by the test group included a mean 21% reduction in HbA1c values and a 49% reduction of total charges. The percentage of test subjects seeking care declined by 38% for inpatient services, and by 13% for outpatient care. Total encounters, or episodes of care, were reduced by 31% for the test cohort with inpatient encounters dropping by 46% and outpatient encounters declining by 25%. Conclusion: A contribution of this study is the evaluation of a new healthcare delivery method as applied to an underserved, predominantly Hispanic population (>99%) living with chronic disease. Although this new form of provider-patient relationship might never replace the traditional office visit, telehealth can be found to improve health and decrease outpatient and inpatient utilization. The benefits of this form of intervention are sufficiently promising to support extended implementation. Virtual healthcare as a supplement to traditional, face-to-face medical encounters continues to be a relatively new but potentially groundbreaking area of research.