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PurposePharmacist‐led telemedicine initiatives have been shown to lower hemoglobin A1c (HbA1c) levels compared with usual care, but few studies have targeted patients with uncontrolled diabetes in the rural setting. The purpose of this study was to evaluate the impact of a pharmacist‐led diabetes telemedicine initiative on HbA1c in patients with uncontrolled diabetes at a family medicine clinic in rural North Carolina.MethodsPharmacists implemented a telemedicine initiative to help manage patients with uncontrolled diabetes at a large, rural family medicine clinic. Adult patients with uncontrolled diabetes were identified through a generated report or by provider referrals. Pharmacy residents called each patient and documented type of interventions, demographic information, and HbA1c results. Patients were followed within a time period of 18 months (September 2018‐March 2020).ResultsA total of 64 patients were successfully contacted by the telemedicine program. The patients were primarily non‐Hispanic, white patients (50% female) with type 2 diabetes on insulin. The most common interventions that patients received included general education (68.8%), scheduling labs (51.6%), insulin titration (51.6%), and facilitating medication access (50.0%). For patients who had been in the telemedicine program long enough to have had an HbA1c lab completed post‐contact (n = 46), there was a significant reduction of 1.15 in mean HbA1c (t = −3.5, P < .01) compared with their initial HbA1c prior to receiving phone calls.ConclusionA pharmacist‐led diabetes telemedicine program was associated with a reduction in HbA1c for patients with uncontrolled diabetes in a rural family practice.

Objectives: Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) are significant public health concerns, especially given the risks for disease interactions. Rates of HCV and HIV are increasing, especially in rural areas. Local health departments (LHDs) play an important role in rural health care, offering screening, testing, and treatment for HCV and HIV. Gaps persist in LHD resources for meeting these demands, especially in Appalachia and the US South.Methods: To explore HCV/HIV screening, testing, and treatment approaches and perspectives in south-central Appalachian North Carolina, structured telephone questionnaires were administered to communicable disease nurses and other health department staff directly involved in screening and testing. Mixed-methods data analyses were conducted and triangulated with stakeholders.Results: Eighteen participants representing 19 counties completed the questionnaire, achieving a saturation sample. Participants reported barriers to screening and testing, including housing insecurity, lack of transportation and insurance, unemployment, and the isolation of living in a rural area. Divergence in perceptions of barriers between public health regions emerged, as did perceptions of who is at risk and use of stigmatizing language about people at risk for HCV/HIV.Conclusions: This study highlights the impact of LHD behaviors and perceptions on screening and testing, and offers recommendations to improve HCV/HIV screening and testing accessibility in south-central Appalachia, a high-risk region.