1. Health Care, Education and Research Date: Oct 11, 2016 An Overview of the Efficacy of Delivering DSME and Group- Based DSME via Telehealth Barb Holloway, RN, BSN, CDE

2. Efficacy of DSME provided via telehealth – does it work? Recent study (UC-Davis): those that had telemedicine intervention had greater improvements in A1C compared to those who had usual care U of Pittsburgh: Telemedicine for Reach, Education, Access, and Treatment model –Improvements in empowerment, self-care (adherence to diet and monitoring), and reduction in diabetes distress –Patients reported high levels of satisfaction

6. CTR PRISM Team Members Valerie Caton, MN, FNP-C, Nurse Practitioner, Team Leader Diane Kersten, LCSW, Social Worker Stephanie Selzler, LD, RD, Dietitian Karen Gransbery, RN, CDE, Diabetes Educator Barbara Holloway, RN, CDE, Diabetes Educator Chris Sorli, MD, Endocrinologist Consultant

7. Study Sites

8. Services Provided Individual and Group Education Sessions Patient Care Conferences Support Groups ‘Create Your Weight’ Group

9. Perceived and Actual Challenges Perceived Establishing trust Nonverbal communication Difficulty discussing sensitive issues Managing the technology Actual Scheduling patient or group visits A few rural PCP’s reluctance in allowing the team FNP a role in patient management.

10. n% Female6958 Diagnoses Hypertension Dyslipidemia Depression 84 85 29 71 72 25 Mean + SD Age (years)61.3 + 11.6 Time since diabetes diagnosis (years)6.6 + 8.1 A1C (%)7.7 + 1.5 LDL cholesterol (mg/dl)96.3 + 36.9 Diastolic blood pressure (mmHg)74.3 + 10.7 Systolic blood pressure (mmHg)132.0 + 15.8 BMI (kg/m 2 )35.3 + 7.7 Table 1. Telehealth Patient Baseline Demographics (n = 118)

11. Patient Satisfaction with Technology 111 patients surveyed –100% were satisfied with their telehealth sessions –100% felt comfortable with learning health information using this technology and said they understood as if it were in person –99% felt picture and sound were clear –99% felt equal comfort with in-person encounters and felt comfortable discussing personal information –96% felt their privacy was protected

12. Baseline (%)1 Year After Intervention (%) Difference (%) Satisfaction with diabetes care (agree or strongly agree) “I am very satisfied with the diabetes care I receive.” 2064 200 “The diabetes care I received last few years is just about perfect.” 5287 70 Communication with and among providers (good or excellent) “Keeping me informed about what the next step in care would be” 4468 42 “Communications between the providers caring for me” 4261 45 “Different health care providers being up to date on my current treatments and recent test results” 4267 60 Self-management (good or excellent) “Knowing who to ask when I had questions about my health” 4765 38 Diabetes symptoms (better or much better) “How much have your diabetes symptoms changed in the past 6 months?” 4468 55 Diabetes Care Survey, Baseline Versus 1 Year After PRISM Intervention (n = 118 )

13. Health Care, Education and Research

14. Patient Satisfaction

20. University of Pittsburg TREAT Trial Results

21. DPP - Lifestyle Balance Analysis contains data from on site sessions 2010–2015 (urban), and tele- medicine sessions 2011-2012 (OAT) and 2014-2015 (INBRE). Removal of subjects out of Pryor and those with 0% participation (n=666).

24. SUCCESSES: Patient (a coach) calls PRISM Diabetes team a ‘slam dunk.’ Another patient saw team members at least monthly and joined all the group functions for support and weight loss. He achieved his A1c goals, 10,000 steps a day, a 30# weight loss, and challenged others (even in other sites) to do the same. Another patient had type 2 diabetes for 10 years, using over 300 units of insulin per day, overweight, hypertension, chronic knee pain, and many financial and social problems…

25. SUCCESSES: July 2007 Baseline A1c – 7.5 Cholesterol – 154 Triglycerides – 270 HDL – 38 LDL – 62 BP – 148/78 Weight - 257 November 2007 A1c – 6.7 Cholesterol – 131 Triglycerides – 210 HDL – 44 LDL – 46 BP – 132/74 Weight - 246

26. Barbara Holloway, RN BSN CDE Research Nurse Center for Clinical Translational Research Billings Clinic 406-238-5594 bholloway@billingsclinic.org