Affect of Longitudinal Digital Main Care on Diabetes High quality of Care


This article was originally published here

J Gen Intern Med. 2021 Jan 22. doi: 10.1007 / s11606-020-06547-x. Online before printing.


BACKGROUND: Lack of access to health care due to a shortage of doctors is a major driver of the expansion of telemedicine in rural areas. Telemedicine is effective in treating chronic conditions such as diabetes, but its effectiveness in primary care is unknown.

OBJECTIVE: To assess the differences in diabetes care before and after implementing a longitudinal virtual primary care program.

DESIGN: Propensity Score-Matched Cohort Study using Difference-in-Difference Analysis.

PARTICIPANTS: Patients with diabetes treated between January 2018 and December 2019 in VA primary care clinics that implemented the V-IMPACT (Virtual Integrated Multisite Patient Aligned Care Teams) program.

EXPOSURE: Patient involved in at least one V-IMPACT visit while patients with normal care did not attend V-IMPACT.

MAIN MEASURES: The primary result was a change in hemoglobin A1C (HbA1C), and the secondary results included a change in the proportion of patients who met the diabetes quality indicators: blood pressure control, statin use, angiotensin converting enzyme inhibitors, or angiotensin II receptor blockers ( ACEi / ARB)) use and annual microalbuminuria tests.

IMPORTANT RESULTS: Our propensity-matched cohort included 9010 patients, equally divided between those who participated in V-IMPACT and those who remained in usual personal care. Among those with diabetes who participated in V-IMPACT, the change in mean HbA1C was -0.055% (95% CI -0.088 to -0.022%), while those in usual care were -0.047% (95%) CI – 0.080 to – 0.014) had%) change before and after the program implementation. We observed an absolute increase in the proportion of prescribed statins in the V-IMPACT group of 5.1% (95% CI 2.4 to 7.7%), an increase in the prescribed ACE / ARB of 5.3% (95% CI 2.5 to 8.2%) and an increase of 4.6%. (95% 1.7 to 7.5%) Increase in annual microalbuminuria tests completed. V-IMPACT was not associated with a significant difference in the ratio of controlled blood pressure at thresholds of <140/90 or <130/90 mmHg.

CONCLUSIONS: The quality of diabetes care provided by a virtual longitudinal model of primary care was similar, if not better, than traditional personal care.

PMID: 33483815 | DOI: 10.1007 / s11606-020-06547-x