Social impact analysis of the effects of a telemedicine intervention to improve diabetes outcomes in an ethnically diverse, medically underserved population: Findings from the IDEATel study

S. Shea, D. Kothari, J.A. Teresi, J. Kong, J.P. Eimicke, R.A. Lantigua, W. Palmas and R.S. Weinstock

American Journal of Public Health, 2013, vol. 103, issue 10, 1888-1894

Abstract: Objectives. We examined the social impact of the telemedicine intervention effects in lower- and higher-socioeconomic status (SES) participants in the Informatics for Diabetes Education and Telemedicine (IDEATel) study. Methods. We conducted a randomized controlled trial comparing telemedicine case management with usual care, with blinded outcome evaluation, in 1665 Medicare recipients with diabetes, aged 55 years or older, residing in federally designated medically underserved areas of New York State. The primary trial endpoints were hemoglobin A1c (HbA1c), low-density lipoprotein cholesterol, and systolic blood pressure levels. Results. HbA1c was higher in lower-income participants at the baseline examination. However, we found no evidence that the intervention increased disparities. A significant moderator effect was seen for HbA1c (P = .004) and systolic blood pressure (P = .023), with the lowest-income group showing greater intervention effects. Conclusions. Lower-SES participants in the IDEATel study benefited at least as much as higher-SES participants from telemedicine nurse case management for diabetes. Tailoring the intensity of the intervention based on clinical need may have led to greater improvements among those not at goal for diabetes control, a group that also had lower income, thereby avoiding the potential for an innovative intervention to widen socioeconomic disparities.

Keywords: aged; article; bioassay; controlled clinical trial; controlled study; diabetes mellitus; ethnic group; ethnology; female; health care planning; human; male; middle aged; randomized controlled trial; social class; telemedicine; total quality management; treatment outcome; United States, Aged; Diabetes Mellitus; Endpoint Determination; Ethnic Groups; Female; Humans; Male; Medically Underserved Area; Middle Aged; New York; Quality Improvement; Social Class; Telemedicine; Treatment Outcome (search for similar items in EconPapers)
Date: 2013
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Citations: View citations in EconPapers (2)

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Persistent link: https://EconPapers.repec.org/RePEc:aph:ajpbhl:10.2105/ajph.2012.300909_3

DOI: 10.2105/AJPH.2012.300909

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