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Patient perceptions of a comprehensive telemedicine intervention to address persistent poorly controlled diabetes

机译：病人对全面远程医疗干预以解决持续控制不良的糖尿病的看法

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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.
机译：目的：我们研究了将远程监控，自我管理支持和药物管理相结合的持续性控制不良的糖尿病（PPDM）的远程医疗干预措施。该干预措施旨在使用现有的退伍军人事务（VA）远程医疗基础设施进行实际交付。为了完善干预措施并告知在其他情况下干预措施的交付情况，我们检查了参与者的经验。方法：我们对完成干预的18名退伍军人进行了半结构化访谈。我们使用定向内容分析法对访谈文本进行了分析，并通过血红蛋白A1c（HbA1c）改善（<1％或≥1％）对主题进行了分类。结果：参与者普遍报告他们对血糖水平的认识更高;但是，他们描述了对远程监控界面的不满以及干预期间的竞争需求。 HbA1c改善低于1％的参与者报告说，这些挑战影响了他们的参与。 HbA1c改善≥1％的参与者尽管面临挑战，但仍报告了新的自我管理程序。结论：尽管竞争激烈的需求和对远程监控界面的挫败感，但许多参与者仍表现出干预参与和HbA1c的显着改善（≥1％）。参与的差异可能反映了管理治疗负担的能力不同。因为它依赖于现有基础结构，所以这种干预是解决VA中PPDM的一种有前途的模型。未来的工作应集中在优化系统的远程医疗基础架构上;对现有基础设施的依赖可能有助于实际交付，也可能通过过度增加治疗负担来限制干预措施。

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