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TeleTEAM Care for Diabetes Program

Summary 
  • Need: The rate of diabetes and diabetes mortality in North Carolina is higher than in many other states, but is even higher in the eastern part of the state.
  • Intervention: TeleTEAM provides integrated care for patients with diabetes during regular primary care visits, using telehealth to connect them with off-site behavioral therapists, dietitians, clinical pharmacists, and a medical diabetologist.
  • Results: Patients who have received care from TeleTEAM providers have shown decreases in blood sugar, as well as in weight, depression, and diabetes-related distress.
Description

According to the Centers for Disease Control, many counties in eastern North Carolina are part of the Diabetes Belt, where at least 11 percent of the population suffers from the disease. The death rate from diabetes in eastern North Carolina is 30 percent higher than in other parts of the state, and is nearly 2.5 times higher among African Americans there. Diabetes management and prevention of complications in rural primary care are frequently exacerbated by profound lifestyle and behavioral challenges that limit optimal health outcomes.

Diabetes mortality chart - M&I #953
Disparate Outcomes in Diabetes in eastern North Carolina (From the Comparable Outcomes Associated with Telehealth-delivered Team Care for Diabetes in Rural Primary Care Practices presentation. Courtesy of Brody School of Medicine at East Carolina University).

Because rural primary care providers are challenged by little or no access to services that can assist in delivering much needed chronic disease care, East Carolina University (ECU) created TeleTEAM, a telehealth model that connects patients to an off-site diabetes care team during primary care office visits at their local clinics. The approach is designed to treat the myriad aspects of managing diabetes and co-morbid medical and behavioral health conditions.

TeleTEAM provides:

  • A registered dietitian who delivers medical nutrition therapy and education specifically targeted toward achieving greater blood glucose, weight, lipids, and blood pressure control through diet and lifestyle adjustments.
  • A behavioral health specialist who helps patients address co-morbid behavioral health challenges such as depression/anxiety and medication adherence, with the aim of increasing levels of physical activity and improving sleep.
  • A clinical pharmacist who provides recommendations for treatment options for better blood glucose and blood pressure control, and who facilitates patient adherence to the regimen.
  • A medical diabetologist who offers additional comprehensive recommendations for patients with uncontrolled diabetes and related chronic health conditions.

Telemedicine connectivity via TeleTEAM is currently offered at 10 clinical sites in rural eastern North Carolina. Of patients given TeleTEAM referrals, 6 percent have been referred to a diabetologist, 56 percent to a dietitian, 26 percent to a behavioral therapist, and 9 percent to a clinical pharmacist.

View full-sizeTele-TEAM Care Sites
Courtesy of Brody School of Medicine at East Carolina University.

The Federal Office of Rural Health Policy’s Office for the Advancement of Telehealth awarded ECU’s TeleTEAM a three-year grant in 2013 to help establish new delivery sites in eastern North Carolina. The TeleTEAM Program also received funding from the Kate B. Reynolds Charitable Trust.

Services offered
  • Helps identify patients at-risk for diabetes and diabetic patients with multiple behavioral and medical comorbidities.
  • Links patients with off-site behavioral specialists, dietitians, pharmacists, and/or a medical diabetologist during their regular primary care office visits.
  • Works with physicians, nurses, and coaches to implement care plan and follow-up care for patients.
Results

Between 2/25/2014 and 8/24/2016 the TeleTEAM staff completed 1,215 encounters.

Adult diabetic patients enrolled in a study comparing face-to-face encounters with specialists vs. patients receiving access to specialists in rural primary settings via TeleTEAM showed similar drops in HbA1c (blood glucose levels). A study conducted early in the program showed that the mean HbA1c level was down 1.1 percent by the three-month follow-up office visit. A TeleTEAM survey showed that 82 percent of patients enrolled in the program agreed that telemedicine had made it easier for them to access care from specialists.

Presentations

Cummings, D.M. & Rodebaugh, L., Russo, D., Jennings, J., Banks, E., Sisneros, J., Nye, A.M. & Patil, S. Comparable Outcomes Associated with Telehealth-delivered Team Care for Diabetes in Rural Primary Care Practices. Presentation to NCHICA Thought Leader Forum, Greenville, NC, October 6, 2016.

Russo, D.C. & Cummings, D.M. Integrating Behavioral Healthcare with Primary Care Management in Rural North Carolina. Invited Presentation to North Carolina Institute of Medicine, October 16, 2015.

Cummings, D.M. & Jennings, J. Use of Telehealth and Other Innovative Technologies to Improve Diabetes Self-Management Education and Monitoring. American Diabetes Association 30th Annual Clinical Conference on Diabetes, Orlando, FL, May 2015.

Boyd, D. Dealing with Diabetes: Grants Help ECU Extend Care to Rural Areas. ECU News Service, Aug. 27, 2013.

Barriers

Typical challenges include:

  • Clinic buy-in, patient engagement, patients’ missed appointments due to lack of communication between clinic and patients, and turnover of clinic staff.
  • Identifying clinic “champions,” an ongoing challenge.
  • Covering the cost of services to patients. Billing patients for services is logistically challenging because it can be difficult to acquire accurate insurance information from the patient, and limited help is available from office staff at service delivery sites.
Contact Information
Jill Jennings, Project Coordinator
TeleTEAM: East Carolina University, Brody School of Medicine
252.744.2607
jenningsj@ecu.edu
Topics
Behavioral health
Diabetes
Integrated service delivery
Telehealth
States served
North Carolina
Date added
May 2, 2017
Date updated or reviewed
October 16, 2017

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.