Psychosocial Outcomes of Telemedicine Case Management for Elderly Patients With Diabetes
The randomized IDEATel trial
- Paula M. Trief, PHD1,
- Jeanne A. Teresi, EDD, PHD2,
- Roberto Izquierdo, MD34,
- Philip C. Morin, MS3,
- Robin Goland, MD5,
- Leslie Field, RN, MSN5,
- Joseph P. Eimicke, MS2,
- Rebecca Brittain, BS1,
- Justin Starren, MD, PHD6,
- Steven Shea, MD7 and
- Ruth S. Weinstock, MD, PHD348
- 1Departments of Psychiatry and Medicine, SUNY Upstate Medical University, Syracuse, New York
- 2Research Division, Hebrew Home for the Aged at Riverdale, Riverdale, New York
- 3Department of Medicine, SUNY Upstate Medical University, Syracuse, New York
- 4Joslin Diabetes Center, Syracuse, New York
- 5Naomi Berrie Diabetes Center, Columbia University, New York, New York
- 6Biomedical Informatics Department, Columbia University, New York, New York
- 7Department of Epidemiology and Biomedical Informatics, Joseph Mailman School of Public Health, Columbia University, New York, New York
- 8Department of Medicine, VA Medical Center, Syracuse, New York
- Address correspondence and reprint requests to Paula M. Trief, PhD, Department of Psychiatry, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY 13210. E-mail:
Diabetes case management (DCM) may improve medical outcomes (1,2). Case managers coordinate care and often provide a mix of interventions, e.g., telephone outreach, education, reminders. However, the efficacy of DCM is unclear. Three systematic reviews lend only limited support for the efficacy of DCM for improving glycemic control but none for lipid, weight, or blood pressure benefits (3–5).
DCM studies typically target biomedical outcomes and ignore potential psychosocial effects. Yet, psychosocial variables (e.g., depression, anxiety, social support) relate to hyperglycemia, complications, adherence, and quality of life (6–11). Thus, a positive impact of DCM on these factors is important. Two studies did assess psychosocial outcomes of DCM and found improved self-efficacy and satisfaction (cluster visit) (12) and quality of life (dietitian-led DCM group) (13).
Because barriers (e.g., distance, weather) limit DCM access, telemedicine can be used. A review of telemedicine versus face-to-face trials concluded that, while feasible and acceptable, there is little evidence that telemedicine has clinical benefits (14). Our team published results of a trial of telemedicine DCM versus usual care for elderly diabetic patients (15). The intervention resulted in significant improvements in glycemic control, blood pressure, and total and LDL cholesterol (16).
The purpose of the Informatics for Diabetes Education and Telemedicine (IDEATel) project, funded by the Centers for Medicare and Medicaid Services, is to evaluate the feasibility and effectiveness of telemedicine with a diverse, medically underserved, elderly diabetic sample. The purpose of this study is to assess the impact of the IDEATel intervention on secondary psychosocial outcomes.
RESEARCH DESIGN AND METHODS—
A detailed description of the IDEATel study design has been previously reported (15,16). Medicare recipients were recruited if they were aged ≥55 years, diagnosed with diabetes, and without moderate/severe impairments or comorbidities. Research nurses blinded to the groups …