Project ADEPT (Applied Diabetes Education Program using Telehealth)
- Need: To provide diabetes education services to the people of rural southeast Georgia.
- Intervention: A telehealth diabetes education program was implemented in the Georgia counties of Candler, Emanuel, Tattnall, and Toombs.
- Results: Participants showed improved control of diabetes and BMI.
Promising (About evidence-level criteria)
Project ADEPT (Applied Diabetes Education Program using Telehealth) is a program dedicated to providing diabetes education services to rural residents through the evidence-based AADE7 Self-Care Behavior model for diabetes self-management education (DSME).
Together, the Georgia counties of Candler, Emanuel, Tattnall, and Toombs have approximately 7,500 diabetic patients. Each county is also both a Primary Care Health Professional Shortage Area (HPSA) and a Medically Underserved Area (MUA). Additionally, these counties each have more than 20% of residents in poverty and 20% are uninsured. Risk factors for diabetes are prevalent in the area, as there is above a 30% obesity rate for each county and physical inactivity rates are at or above 26%. Overall, 11.2% of adult Georgia residents have diabetes, yet over 75% of rural counties have no certified diabetes educator within the county.
In order to remedy this situation, Project ADEPT was created and evaluated by Georgia Southern University’s Rural Health Research Institute, Mercer University’s Center for Rural Health and Health Disparities, and East Georgia Healthcare Center (EGHC), a Federally Qualified Health Center operating numerous rural clinic locations. ADEPT employs a centrally-located diabetes educator who provides in-person education services at the Emanuel office, using telehealth to connect to the counties of Candler, Tattnall, and Toombs to maximize the availability of diabetes education services without the need for travel to remote sites. Project ADEPT also features translation services to facilitate sessions with Spanish-only speaking patients, as this service area is highly diverse. This program is designed to reduce the transportation costs and economic barriers that rural residents face in seeking diabetic care.
Partnering organizations for this program included Georgia Southern University’s Rural Health Research Institute, Mercer University’s Center for Rural Health and Health Disparities, East Georgia Healthcare Center, and Georgia Partnership for Telehealth.
This program received support from a 2012-2015 Federal Office of Rural Health Policy Rural Health Care Services Outreach grant.
Project ADEPT uses a diabetes educator to teach participants via a telehealth network how to monitor and lower blood glucose levels and BMI levels. The instructor also teaches participants how to self-manage their condition and improve their health outcomes.
Project ADEPT has had a total of 128 direct patient encounters and an additional 556 indirect encounters since it was first created. As of May 2015, 36% of participants have their most recent A1c levels (a hemoglobin test to monitor diabetes) at less than 8.0 and nearly 60% have their most recent blood pressure at less than 140/90. Preliminary results showed that 75% of participants had a decrease in A1c from pre- to post-testing and 66.7% of participants showed a decrease in BMI as well.
Some challenges Project ADEPT has encountered include:
- Difficulty in hiring and training a diabetes educator
- Accessing patient records
- Scheduling patients
- Ensuring providers within all clinic locations are familiar with the program
- Concerns over liability if diabetes educator is not a clinic employee
In order to create a similar program, it is important to:
- Maintain good relationships with referring providers
- Be flexible in program implementation and be willing to restructure if need be
- Be mindful of long-term impact and sustainability
- Conduct kick-off events at each of the locations where the educator physically travels to the remote locations to meet staff and potential participants
- Have access to translation services
K. Bryant Smalley, Executive Director
Rural Health Research Institute-Georgia Southern University
Wellness, health promotion, and disease prevention
September 22, 2015
Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.