Older adults experience the greatest burden of diabetes. Resources must be available and accessible to empower older adults to perform diabetes self-care. The purpose of this study was to evaluate a videophone motivational interviewing (MI) diabetes self-management education (DSME) intervention to improve glycemic control of rural older adults. Sixty-six participants (mean age = 64.9 years, range 60-81) with uncontrolled diabetes were enrolled in a 6-month videophone intervention. Experimental group participants (n = 34) received weekly, then monthly, videophone MI DSME calls, whereas control participants (n = 32) received monthly videophone healthy-lifestyle education calls. Although both groups experienced a decreased HbA1c, there was a statistically significant difference in experimental group mean values (p = .015), but not the control group (p = .086). The experimental group demonstrated statistically significant increases in diabetes knowledge (p = .023) and diabetes self-efficacy (p = .002). Experimental group participants with high self-efficacy in contrast to low self-efficacy had a statistically significant decrease in HbA1c (p = .043).

Technology holds potential to improve the quality of healthcare delivery. The use of remote patient monitoring, or telehealth (TH), has been widely adopted by many home care agencies to facilitate early identification of disease exacerbation, particularly for patients with chronic diseases such as heart failure. TH has been successfully used to improve symptom detection and potentially reduce rehospitalization rates. Quantifying program effectiveness through data analysis is a critical step for program improvement, resource allocation, and future strategic planning. Using the Outcome and Assessment Information Set-C database, a retrospective analysis was conducted examining 22 months of heart failure patient data from one home care agency in southern California. Seventy patients receiving TH were compared to patients who received usual home care nursing services. No major differences in baseline socio-demographics were found between the 2 groups. While receiving home healthcare services, the non-TH patients had a 21% all-cause hospital readmission rate, compared to the home TH patients with a 10% all-cause readmission rate. Statistical differences were found between groups on the variables of fall risk, vision, smoking, shortness of breath, the ability to bathe and take oral meds, along with having been discharged from a skilled nursing facility in the last 2 weeks. These results indicate that aggregate data analysis is useful in providing insight into program effectiveness. This study suggests TH programs have the potential to reduce the burden associated with rehospitalizations in the heart failure population.

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An increase of heart rate to physical or mental stress reflects the ability of the autonomous nervous system and the heart to respond adequately. Hyperventilation is a user-controlled breathing maneuver that has a significant impact on coronary function and hemodynamics. Thus, we aimed to investigate if the heart rate response to hyperventilation (HRRHV) can provide clinically useful information. A pooled analysis of the HRRHV after 60 s of hyperventilation was conducted in 282 participants including healthy controls; patients with heart failure (HF); coronary artery disease (CAD); a combination of both; or patients suspected of CAD but with a normal angiogram. Hyperventilation significantly increased heart rate in all groups, although healthy controls aged 55 years and older (15 ± 9 bpm) had a larger HRRHV than each of the disease groups (HF: 6 ± 6, CAD: 8 ± 8, CAD+/HF+: 6 ± 4, and CAD−/HF−: 8 ± 6 bpm, p < 0.001). No significant differences were found between disease groups. The HRRHV may serve as an easily measurable additional marker of cardiovascular health. Future studies should test its diagnostic potential as a simple, inexpensive pre-screening test to improve patient selection for other diagnostic exams.