Diabetics to get care through the Internet
Diabetics to get care through the Internet
Is this the house call of the future’?
Traditionally underserved rural and inner-city residents with diabetes will begin receiving care from their homes this fall through a $28 million program in New York state.
The IDEATel demonstration project, funded by a grant from the Health Care Financing Administration, will be used as a model to develop treatments for other diseases such a depression, heart failure, obesity, and asthma.
In the New York study, half of the 1,500 patients will receive the telemedicine intervention and the other half will continue to receive their usual care, says Steven Shea, MD. Shea is a Hamilton Southworth Professor of Medicine in Public Health at Columbia University College of Physicians and Surgeons in New York City and the director of the division of general medicine at Columbia Presbyterian Medical Center of New York-Presbyterian Hospital. Program participants include the college, the medical center, and SUNY Upstate Medical University.
"This house call of the future will allow patients and clinicians to reach out across any distance for care," he says.
Education, frequent monitoring and medication adjustments in the home setting can help patients achieve better glucose and blood pressure control, and has the potential to prevent or slow the progression of complications, Shea says.
Participants in the program will receive a Web-capable personal computer with a camera attached to it, allowing them to have a two-way videophone call with the nurse case manager.
The equipment will include a blood pressure measuring device and a fingerstick glucometer that connect directly to the computer. Information from those measurements will be uploaded through the Internet to the clinical information system at New York Presbyterian Hospital, where it will be managed.
If information recorded on the computer varies from predetermined values, an automated alert will be sent to a physician or nurse. The system will also provide suggestions and reminders to patients about what steps they need to take to maintain good health.
The nurses will be able to display information, including a time trend, so patients and case managers can look at the information at the same time and understand what changes need to be made.
The patients will be able to access Web-based information and educational resources provided by the American Diabetes Association in English and Spanish. "In a doctor’s office, diabetes care takes place for a few minutes every few months. But in a patient’s home, diabetes care occurs every day. Telemedicine will give people the tools they need to take controls of their diabetes," Shea says.
Patients who are enrolled in the program will receive an individual evaluation and a personalized plan for managing their disease. The plan may involve monitoring their condition at home or may include visits to the doctor.
Patients will receive Internet service, training on equipment use, and maintenance support. They will check their own blood sugar, blood pressures, and other factors that affect diabetes.
"One of the goals is to find out how the patients will use the technology once it is made available," Shea says. He anticipates that by next Jan. 1, researchers will know whether the patients will actually utilize the technology and whether the project will be successful.
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