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Telehealth Model

Rural communities can use telehealth and telemedicine to support diabetes care and management. Telehealth is defined as:

“The use of electronic information and telecommunication technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include video conferencing, internet-based services and communication, store-and-forward imaging, streaming media, and terrestrial and wireless communications.”

Telemedicine refers specifically to the delivery of clinical services via technology.

Telehealth and telemedicine use a range of technologies — such as live video, mobile devices and applications (apps), and computers — to overcome rural barriers to healthcare access and improve care. RHIhub's Telehealth Use in Rural Healthcare topic guide provides information on how telehealth can help healthcare providers in rural communities.

Telehealth and telemedicine can be used to deliver diabetes education, management, and monitoring services. This includes:

  • Diabetes self-management – Telehealth can support diabetes self-management activities such as blood sugar (glucose) monitoring and tracking. For example, the Community Preventive Services Task Force (CPSTF) recommends the use of mobile phone apps in healthcare settings for the self-management of type 2 diabetes. These interventions can improve communication. Patients can enter data into mobile apps and receive automated or tailored feedback from healthcare providers.
  • Medication adherence – Taking medications as prescribed is important for diabetes management. Telehealth can help people with diabetes to take their medications correctly — at the correct dose and frequency — and remember to fill prescriptions. Text messages are one way to improve medication adherence among patients with chronic disease, as recommended by the CPSTF.
  • Specialty care consultations – Telehealth can help rural patients to connect with specialty care providers remotely. This helps rural patients because they are no longer required to travel long distances. Video conferencing can be used to provide endocrinology consultations, for example. An endocrinologist may perform clinical assessments, review or order laboratory tests, adjust medications, or make other recommendations regarding clinical treatment plans using telehealth.

For more information about identifying and implementing telehealth programs in rural communities, see the Rural Telehealth Toolkit.

Examples of Rural Diabetes Telehealth Programs

  • The Catalina Island Telemedicine Center was established to help residents of Santa Catalina Island, located off the coast of California, to access specialty care electronically. Some telemedicine services offered include diabetic education and eye screenings. To help residents see specialist providers, the telemedicine center partnered with Loma Linda University Medical Center, the Los Angeles County Department of Mental Health, and a private psychiatry company.
  • Project ECHO provides evidence-based programs for managing complex conditions, including diabetes. This model extends care to rural patients through videoconferencing and is used in communities across the country.
  • The Mississippi Diabetes Telehealth Network, a program of the University of Mississippi Medical Center's Center for Telehealth, was launched in 2014 to improve care for people with diabetes in Mississippi's Delta region. The program provides remote patient monitoring, using telehealth to deliver health education, coaching, and interventions to patients in their homes. Evaluation results indicate that providing remote patient monitoring through telehealth is effective for diabetes management in rural areas.
  • The University of Virginia Diabetes Tele-Education Program uses video conferencing technology to deliver diabetes education to people who have, or are at high risk for developing, diabetes. The diabetes education courses address diabetes basics, nutrition, self-management, and lifestyle changes.

Implementation Considerations

Many rural communities rely on clinical partnerships to deliver telehealth services. Identifying partnership opportunities can help address the cost barriers of implementing telehealth programs. It can also help broaden the range of services available to patients. When using telehealth, it is also important to ensure patient comfort with using technology. Strategies for supporting patients who are less comfortable with using telehealth technology include enlisting support from family, friends, or caregivers. Additionally, programs should communicate the benefit of telehealth to patients and ensure that telehealth programs meet patient needs related to diabetes care.

Program Clearinghouse Examples

Resources to Learn More

Telehealth in Rural Communities
Website
Describes how telehealth programs can provide better access to chronic disease prevention and management programs, and to specialty care including heart disease and stroke, diabetes, and diabetic retinopathy.
Organization(s): National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention