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) was 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).
At the time of the program creation, the Georgia counties of Candler, Emanuel, Tattnall, and Toombs had approximately 7,500 diabetic patients. Each county was also both a Primary Care Health Professional Shortage Area (HPSA) and a Medically Underserved Area (MUA). Additionally, these counties each had more than 20% of residents in poverty and 20% uninsured.
Risk factors for diabetes were prevalent in the area, largely due to an obesity rate of greater than 30%. Since high obesity rates are also paired with physical inactivity rates, rates above 26% further complicated the landscape. Despite these statistics, over 75% of rural Georgia counties had no certified diabetes educator.
To improve these statistics, 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 (FQHC) operating numerous rural clinic locations.
The program was designed to reduce transportation costs and economic barriers rural residents face in seeking diabetic care. ADEPT employed a centrally-located diabetes educator providing in-person education services at the Emanuel office. For patient education in the remaining counties, a telehealth connection was used, maximizing the availability of diabetes education services without the need for travel to remote sites. Project ADEPT also featured translation services for Spanish-only speaking patients
Partnering organizations for the 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.
In-person/remote teleconnected diabetes education with a curriculum that included:
- chronic disease self-management skills
- skills for monitoring blood glucose
- interventions to lower blood glucose levels
- obesity education
The original project ADEPT had a total of 128 direct patient encounters and an additional 556 indirect encounters. As of May 2015, 36% of participants had A1c levels at less than 8.0. Nearly 60% had blood pressure readings less than 140/90. Preliminary results showed that 75% of participants had decreased A1c from pre- to post-testing and 66.7% of participants showed a decrease in BMI as well.
- Challenges in hiring and training a diabetes educator
- Scheduling patients
- Accessing patient records
- Ensuring providers within all clinic locations are familiar with the program
- Concerns over liability if diabetes educator is not a clinic employee
- Maintain communication with referring providers
- Be flexible in program implementation and restructuring
- Be mindful of long-term impact and sustainability
- Conduct kick-off events with the educator physically present at the teleconnection sites to for initial “meet and greet” with staff and potential participants
- Arrange 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.