Feasibility of Shared Telemedicine Appointments for Low SES Adolescents and Young Adults with T1D

Abstract

Background: Shared medical appointments (SMA) via home telemedicine may improve clinic attendance and adherence to care recommendations in adolescent and young adult patients (AYA) with type 1 diabetes (T1D). Participation in home telemedicine requires basic health literacy, reliable access to high-speed Internet on a compatible device, and a private location for attending appointments. AYA from households with lower socioeconomic status (SES) may encounter barriers to participation in home telemedicine due to limited resources. Objective: Evaluate the feasibility of conducting SMA via home telemedicine for low SES AYA with T1D. Methods: We conducted baseline patient and family assessments as part of a prospective study on the use of SMA and telemedicine for AYA with T1D who attend a pediatric outpatient endocrinology clinic. We calculated SES for each family using a modified version of the Hollingshead index, and dichotomized patients into low and high SES groups. Results: AYA reported nearly equal interest in attending SMA (Low: 76%; High: 66%), and in completing appointments online (Low: 41%; High: 45%), regardless of SES. Patients reported having access to high-speed Internet (100%), favored home appointments (Low: 35%; High: 42%), and reported having private space (Low: 83%; High: 88%). Low SES patients were younger than high SES patients (15 vs. 17 years, p = 0.01), and reported shorter disease duration (6 vs. 9 years, p < 0.01). Low SES patients reported needing help reading medical information at least sometimes more frequently (76%) than high SES patients (56%, p = 0.05). However, this effect was attenuated in multiple regression analysis, where variations in patients’ health literacy were associated with age (p < 0.05) instead of SES. Conclusions: Low SES AYA with T1D are equally equipped and interested in utilizing shared telemedicine as high SES patients. Home telemedicine may be a feasible format for diabetes care and psychosocial support for all patients, regardless of SES. Disclosure J.J. Flores Garcia: None. M.W. Reid: None. J. Raymond: None.