A Multidisciplinary Intervention Utilizing Virtual Communication Tools to Reduce Health Disparities: A Pilot Randomized Controlled Trial

Abstract

Advances in technology are likely to provide new approaches to address healthcare disparities for high-risk populations. This study explores the feasibility of a new approach to health disparities research using a multidisciplinary intervention and advanced communication technology to improve patient access to care and chronic disease management. A high-risk cohort of uninsured, poorly-controlled diabetic patients was identified then randomized pre-consent with stratification by geographic region to receive either the intervention or usual care. Prior to enrollment, participants were screened for readiness to make a behavioral change. The primary outcome was the feasibility of protocol implementation, and secondary outcomes included the use of patient-centered medical home (PCMH) services and markers of chronic disease control. The intervention included a standardized needs assessment, individualized care plan, intensive management by a multidisciplinary team, including health coach-facilitated virtual visits, and the use of a cloud-based glucose monitoring system. One-hundred twenty-seven high-risk, potentially eligible participants were randomized. Sixty-one met eligibility criteria after an in-depth review. Due to limited resources and time for the pilot, we only attempted to contact 36 participants. Of these, we successfully reached 20 (32%) by phone and conducted a readiness to change screen. Ten participants screened in as ready to change and were enrolled, while the remaining 10 were not ready to change. Eight enrolled participants completed the final three-month follow-up. Intervention feasibility was demonstrated through successful implementation of 13 out of 14 health coach-facilitated virtual visits, and 100% of participants indicated that they would recommend the intervention to a friend. Protocol feasibility was demonstrated as eight of 10 participants completed the entire study protocol. At the end of the three-month intervention, participants had a median of nine total documented contacts with PCMH providers compared to four in the control group. Three intervention and two control participants had controlled diabetes (hemoglobin A1C <9%). Multidisciplinary care that utilizes health coach-facilitated virtual visits is an intervention that could increase access to intensive primary care services in a vulnerable population. The methods tested are feasible and should be tested in a pragmatic randomized controlled trial to evaluate the impact on patient-relevant outcomes across multiple chronic diseases.

Role of Telemedicine in Multidisciplinary Team Meetings

“…Two mainly used methods include video and telephone conferencing. [141516171819] Key findings from the reviewed articles are summarized in Table 2.…”

“…The methods tested are feasible and should be tested in a pragmatic randomized controlled trial to evaluate the impact on patient-relevant outcomes across multiple chronic diseases. [18]…”

Understanding Physicians’ Preferences for Telemedicine During the COVID-19 Pandemic: Cross-sectional Study

“…Most past research has focused on patient preference and outcomes of care [9,12,[16][17][18][19][20][21] rather than provider inclination. Studies suggest that telemedicine has been accepted more by patients than by providers [22], with providers citing technological barriers to care provision [13,[23][24][25].…”

“…In contrast to the current broad dissemination of telemedicine across medical specialties, prior research focused on the effectiveness of telemedicine mostly in specific populations [5,6] and for behavioral health encounters [7][8][9][10]. Research shows that optimal and efficacious use of telemedicine requires willingness of both the physician and patient to engage on these nontraditional platforms [9]. Physician satisfaction and preference for telemedicine, however, has not been studied as abundantly, especially after the emergence of COVID-19 [10,11].…”

Attitudes of the Public to Receiving Medical Care during Emergencies through Remote Physician–Patient Communications

“…It is a rapidly developing field and an increasing component of all health services globally, where achievements in health status outcomes can be obtained [ 17 , 18 ]. Increased access, reduced travel time, less crowded facilities, and a reduced threshold for vulnerable groups are examples of how providing health services through remote communication can help optimize citizens’ health status [ 17 , 19 ].…”