Challenges and Lessons Learned From a Telehealth Community Paramedicine Program for the Prevention of Hypoglycemia: Pre-Post Pilot Feasibility Study.

Mohanraj Thirumalai,Ayse G Zengul,Eric Evans

doi:10.2196/26941

Mohanraj Thirumalai, Ayse G Zengul + Show 1 more

Open Access

https://doi.org/10.2196/26941

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Journal: JMIR diabetes	Publication Date: Aug 3, 2021
Citations: 2	License type: cc-by

Affiliation: University of Alabama at Birmingham

Abstract

BackgroundPrevention through Intervention is a community paramedicine program developed by Birmingham Fire and Rescue Services in Alabama. This program aims to reduce dependency on emergency medical services (EMS) for nonemergency-related events through education and to lower the frequency of emergency calls in underserved populations. A telehealth intervention with an emphasis on hypoglycemia was implemented to (1) tailor the intervention to meet the educational needs of participants and (2) facilitate follow-ups. A pre-post pilot feasibility evaluation of the telehealth intervention was conducted.ObjectiveThis paper describes the results of the feasibility evaluation, implementation challenges, and the lessons learned about the deployment of a hypoglycemia prevention program in an underserved area and its evaluation.MethodsThis single-arm pretest-posttest intervention included (1) an initial in-person visit (week 1), (2) 3 weekly telecoaching calls (weeks 2-4), (3) 1 biweekly call (week 6), and (4) a final in-person visit (week 8) for collecting posttest data from individuals who called EMS due to hypoglycemic events. In-person visits included educational sessions conducted by EMS personnel. Participants’ education included tailored content related to hypoglycemia. Weekly telecoaching calls focused on hypoglycemia symptom monitoring and education reinforcement via a telehealth dashboard. The primary measures focused on feasibility measures, and exploratory measures focused on the fear of hypoglycemia, self-efficacy, and a knowledge of diabetes.ResultsA total of 40 participants participated in the intervention. However, the study was marred with high attrition. The various factors behind the low retention rate were discussed. There was a decreasing trend in all three subdomains of the fear of hypoglycemia from pretest to posttest. There was also a significant increase in participants’ self-efficacy in hypoglycemia self-management (P=.03).ConclusionsThis study shows preliminary and promising results for a community-based intervention specifically for hypoglycemia. However, the socioeconomic setting in which the intervention was delivered may have resulted in high dropout rates and low attendance during the intervention, which are considerations for future telehealth studies.Trial RegistrationClinicalTrials.gov NCT03665870; https://clinicaltrials.gov/ct2/show/NCT03665870

Highlights

Hypoglycemia is a common but potentially avoidable health problem that can be a barrier to achieving good glycemic control
The unpleasant aspects of hypoglycemia may result in severe anxiety and the fear of hypoglycemia (FH) in people with diabetes
The FH is associated with the frequency of past hypoglycemic episodes and can promote compensatory behaviors, such as reducing insulin dosages to avoid hypoglycemia

Summary

Introduction

Hypoglycemia is a common but potentially avoidable health problem that can be a barrier to achieving good glycemic control. The FH is associated with the frequency of past hypoglycemic episodes and can promote compensatory behaviors, such as reducing insulin dosages to avoid hypoglycemia. This can be a major barrier to achieving glycemic control for people with diabetes [9,10,11]. This program aims to reduce dependency on emergency medical services (EMS) for nonemergency-related events through education and to lower the frequency of emergency calls in underserved populations.

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Conclusion