Article

Primary Care Providers’ Perceptions of Home Diabetes Telemedicine Care in the IDEATel Project

Department of Radiology, Columbia University, New York, NY.
The Journal of Rural Health (Impact Factor: 1.77). 12/2006; 23(1):55 - 61. DOI: 10.1111/j.1748-0361.2006.00068.x

ABSTRACT  Context: Few telemedicine projects have systematically examined provider satisfaction and attitudes. Purpose: To determine the acceptability and perceived impact on primary care providers’ (PCP) practices of a randomized clinical trial of the use of telemedicine to electronically deliver health care services to Medicare patients with diabetes in federally designated medically underserved areas of upstate New York, primarily those in rural areas and small towns with limited access to primary care. Methods: A longitudinal phone survey was completed by 116 PCPs with patients with diabetes in the treatment arm of the trial, and conducted 12 and 24 months after a PCP’s first patient was randomized to the home telemedicine arm of the trial. The 36-item survey included measures of acceptability (to PCPs, time required), impact (on patient knowledge, confidence, perceived health outcomes), and communication. Six open-ended questions were analyzed qualitatively. Results: The quantitative data indicated positive responses in terms of acceptability of the telemedicine intervention to the PCPs and of the impact on the PCPs’ patients. This was most evident in issues critical to good control of diabetes: patient knowledge, ability to manage diabetes, confidence, and compliance in managing diabetes. Key qualitative themes, on the positive end, were more patient control and motivation, helpfulness of having extra patient data, and involvement of nurses and dieticians. Negative themes were excessive paperwork and duplication taking more PCP time, and conflicting advice and management decisions from the telemedicine team, some without informing the PCP but none involving medications. Conclusions: Telemedicine was reported to be a positive experience for predominantly rural PCPs and their Medicare-eligible patients from medically underserved areas; several inefficiencies need to be refined.

Download full-text

Full-text

Available from: Fred Tudiver, Aug 10, 2015
1 Follower
 · 
96 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Decision tree classification techniques have been used for a wide range of classification problems and becoming an increasingly important tool for classification of remotely sensed data. These techniques have substantial advantages for land use classification problems because of there flexibility, nonparametric nature, and ability to handle nonlinear relations between features and classes. This paper compares classification results obtained by using a backpropagation neural network and decision tree classifier. It is shown by a number of studies that neural classifiers depends on a range of user defined factors, that ultimately limits their use. This study show that there are fewer number of user defined factor affecting the accuracy of a decision tree classifier. Further, this study highlight that training a decision tree classifier is much faster and these classifiers are easy to read and interpret as compared to a neural classifier which is a "black box". The performance of these two classification system is compared using ETM+ and interferometric SAR data.
    Geoscience and Remote Sensing Symposium, 2002. IGARSS '02. 2002 IEEE International; 02/2002
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Telemedicine is a promising but largely unproven technology for providing case management services to patients with chronic conditions who experience barriers to access to care or a high burden of illness. We conducted a randomized controlled trial comparing telemedicine case management to usual care, with blinding of those obtaining outcome data, in 1,665 Medicare recipients with diabetes, aged 55 years or greater, and living in federally designated medically underserved areas of New York State. In New York City, 98% of participants were black or Hispanic, 69% were Medicaid-eligible, and 93% reported annual household income < or =$20,000. In upstate New York, 91% were white, 14% Medicaid eligible, and 50% reported annual household income < or =$20,000. A baseline survey found that 95% of participants in New York City and 67% in upstate New York reported that they did not know how to use a computer. The primary endpoints were HgbA1c, blood pressure, and low density lipoprotein (LDL) cholesterol levels. In the intervention group (N = 844), mean HgbA1c improved over 1 year from 7.35% to 6.97%, and from 8.35% to 7.42% in the subgroup with baseline HgbA1c > or =7% (N = 353). In the usual care group (N = 821), mean HgbA1c improved over 1 year from 7.42% to 7.17%. Adjusted net reductions (1-year minus baseline mean values in each group, compared between groups) favoring the intervention were as follows: HgbA1c, 0.18% (p = 0.006), systolic and diastolic blood pressure, 3.4 (p = 0.001) and 1.9 mmHg (p < 0.001), and LDL cholesterol, 9.5 mg/dl (p < 0.001). In the subgroup with baseline HgbA1c > or =7%, net adjusted reduction in HgbA1c favoring the intervention group was 0.32% (p = 0.002). Mean LDL cholesterol level in the intervention group at one year was 95.7 mg/dl. The intervention effects were similar in magnitude in the subgroups living in New York City and upstate New York. A satisfaction survey of intervention group participants (N = 346 respondents) showed high levels of satisfaction with major intervention components. A satisfaction survey of participating primary care physicians (N = 116 respondents) showed positive perceptions for acceptability, impact on patients and communication. Telemedicine case management improved glycemic control, blood pressure levels, and total and LDL-cholesterol levels at 1 year of follow-up. Telemedicine is an effective method for translating modern approaches to disease management into effective care for underserved populations.
    Transactions of the American Clinical and Climatological Association 01/2007; 118:289-304.
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this Delphi-based study was to evaluate the intention of Spanish physicians to accept and use telemedicine as a future useful tool in daily practice. An online Delphi questionnaire was answered by 985 physicians (966 in the second round), representatives from rural and urban areas of the entire country (generalists, internists, cardiologists, endocrinologists, and nephrologists). The participants were 65% males, with a mean age of 46.7 years old and 20.3 years in the profession, mostly coming from primary care centers (91.8%) of urban Spanish areas (72.8%). Some responders (56.4%) reported lack of Internet use at work and 80.2% never participated in a telemedicine project, but 80.9% said they would be interested in participating in the future. As for the benefits of telemedicine, the specialties perceived as the most benefited were cardiology, followed by general medicine, pediatrics, and emergency services. The main reported difficulty for telemedicine implementation was the opinion that patients prefer the physical contact with physicians (77.8% of responders). Interviewed participants expressed strong interest in future telemedicine projects related to online training, distance control of chronic diseases, online communication among specialists, and real-time transmission of images and information. Most Spanish physicians have not implemented telemedicine in clinical practice, but they would be interested in future applications such as on-line training or disease control, although they still prefer physical patient contact.
    Telemedicine and e-Health 02/2008; 14(1):42-8. DOI:10.1089/tmj.2007.0018 · 1.54 Impact Factor
Show more