Diabetes Self-Management Education via Telemedicine in the United States Air Force

Abstract

Diabetes Self-Management Education (DSME) is recommended for patients with a new diagnosis or without prior diabetes education. However, not all Military Treatment Facilities (MTFs) have capacity to provide this resource to patients, which creates a disparity in healthcare. The Diabetes Center of Excellence (DCOE) has an ADA-recognized DSME program and potential to fill this gap through DSME via telemedicine. The Military Interagency Satellite Training (MIST) system, which utilizes satellite technology to broadcast one-way video and two-way audio to distance learners, is available at all MTFs. To test the concept, DSME was broadcast to Randolph Air Force Base (RAFB) from October 2016-October 2017. During this time, 181 patients enrolled in DSME classes; 127 were DCOE patients and 54 were from RAFB. Among data collected were pre/post patient knowledge tests and the validated 17-item Diabetes-related Distress Scale (DDS-17). Knowledge significantly increased from baseline to Class 4. Few patients completed all 4 classes and 6 month follow-up (n=16). Patients had an increase in all DDS-17 domains at the completion of Class 4; however, by 6 months, distress returned to baseline levels. Patient satisfaction surveys were completed at DCOE (n=429) and RAFB (n=227) at each encounter and provider satisfaction surveys were collected from RAFB facilitators. Patients at RAFB reported higher satisfaction (99.1%) than DCOE patients (97.2%). In fact, most measures of satisfaction were higher in RAFB patients than DCOE patients. Moreover, facilitators expressed high satisfaction with DSME via MIST and all facilitators were willing to conduct more classes in this format. Initiation of the DSME Telehealth program presented challenges, especially in technology-related issues and documentation at 6 months. The pilot program allowed the DCOE to gain valuable feedback from our remote site. Technology issues have largely been resolved enabling us to provide an even better experience to our new sites in 2018. Disclosure N. Watson: None. D.G. Acuna: None. J.L. Wardian: None. E.C. Cobb: None. D. Beavers: None. T.J. Sauerwein: Speaker's Bureau; Self; Merck & Co., Inc., AstraZeneca.