A nurse practitioner–led telehealth protocol to improve diabetes outcomes in primary care

Abstract

Background: Diabetes-related complications contribute to a costly health burden in the United States. Telehealth (TH) is a tool that can increase access to care and offer ongoing support for chronic disease self-management.Local Problem: A primary care practice in Texas needed a method to manage an influx of patients with uncontrolled diabetes and improve type 2 diabetes outcomes using nurse practitioner (NP) TH appointments.Methods: Thirty patients meeting inclusion criteria participated in monthly TH check-ins and followed monthly for 3 months. Baseline and postintervention diabetes laboratory studies (hemoglobin A1c [HbA1c], estimated glomerular filtration rate, and microalbumin) were collected.Interventions: During each monthly TH visit, an NP-led diabetes TH QI protocol was implemented. The Telehealth Usability Questionnaire was administered to patients after the 3-month intervention. Results:The TH QI protocol resulted in an overall ;1% reduction in HbA1c. Over 73% of participants experienced various reductions of HbA1c, of which 2.3% achieved a postintervention HbA1c <7%, indicating controlled diabetes. Kidney function indicated by eGFR improved by 7 ml/min/1.73 m 2 in 83% of participating patients. At the end of the 3month intervention, 84% of participants expressed overall satisfaction with TH appointments.Conclusions: Interventions using TH to improve chronic disease may be useful in diabetes outcomes and selfmanagement. Monthly TH visits can improve patient outcomes, reduce complications, and enhance the patientprovider relationship. Preventive self-care activities and long-term use of TH visits for self-management are implications for future studies.

Nurse and midwife involvement in task‐sharing and telehealth service delivery models in primary care: A scoping review

“…In 51 studies nurses led face-to-face task-sharing models (Ahmed et al, 2013;Anger et al, 2020;Asgary et al, 2020;Bajis et al, 2020;Barton et al, 2013;Bedelu et al, 2007;Bernhardt, 2023;Brennan et al, 2011;Carroll, 2021;Chin-Quee et al, 2020;Clarke et al, 2020;Gerin et al, 2007;Grisot et al, 2019;Hoffman et al, 2023;Hui et al, 2022;Hunkeler et al, 2000;Iversen et al, 2020;Jackson et al, 2017;Jeong et al, 2018;Jordan et al, 2011;Kwak et al, 2021;Looman et al, 2015;Macduff et al, 2001;Mallow et al, 2018;Mammen et al, 2020;McKissick et al, 2017;Momin et al, 2022;Moriyama et al, 2021;O'Brien, 2022;Pichayapinyo et al, 2019;Ramakrishnan et al, 2020;Roy et al, 2022;Rutledge et al, 2018;Schofield et al, 2005;Shaw et al, 2013;Stone et al, 2010;Teo et al, 2024;Turner et al, 2009;Vierhile, 2017;Wakefield et al, 2011;Williams et al, 2001) and six studies described interventions that included both face-to-face and telehealth task-sharing models of care…”

“…The acceptability of models in which nurses utilised telehealth was explored in 12 studies (Billington et al, 2015;Carlisle & Warren, 2013;Ciemins et al, 2013;Clarke et al, 2020;Delahunty-Pike et al, 2023;Hunkeler et al, 2000;Macduff et al, 2001;Mammen et al, 2020;Momin et al, 2022;Pichayapinyo et al, 2019;Vierhile, 2017;Williams et al, 2001). Nurse-led telehealth was acceptable to patients in 12 studies, (Carlisle & Warren, 2013;Ciemins et al, 2013;Clarke et al, 2020;Delahunty-Pike et al, 2023;Hunkeler et al, 2000;Macduff et al, 2001;Mammen et al, 2020;Momin et al, 2022;O'Brien, 2022;Teo et al, 2024;Vierhile, 2017;Williams et al, 2001).…”

“…The acceptability of models in which nurses utilised telehealth was explored in 12 studies (Billington et al, 2015;Carlisle & Warren, 2013;Ciemins et al, 2013;Clarke et al, 2020;Delahunty-Pike et al, 2023;Hunkeler et al, 2000;Macduff et al, 2001;Mammen et al, 2020;Momin et al, 2022;Pichayapinyo et al, 2019;Vierhile, 2017;Williams et al, 2001). Nurse-led telehealth was acceptable to patients in 12 studies, (Carlisle & Warren, 2013;Ciemins et al, 2013;Clarke et al, 2020;Delahunty-Pike et al, 2023;Hunkeler et al, 2000;Macduff et al, 2001;Mammen et al, 2020;Momin et al, 2022;O'Brien, 2022;Teo et al, 2024;Vierhile, 2017;Williams et al, 2001). Patients were significantly more satisfied with general care and information provided (Hunkeler et al, 2000;Teo et al, 2024), and felt that telehealth increased access to healthcare through convenience (Delahunty-Pike et al, 2023;Macduff et al, 2001;Teo et al, 2024;Vierhile, 2017) and efficiency (Vierhile, 2017), while parents of paediatric patients liked that telehealth avoided school and sport absenteeism (Vierhile, 2017).…”

“…Momin et al, 2022;Ngassa et al, 2022;O'Brien, 2022;Pichayapinyo et al, 2019;Pond et al, 2021;Putnis et al, 2023;Smits et al, 2020;Teo et al, 2024;Vierhile, 2017;Williams et al, 2001;Zewdu et al, 2022). Patients in one study considered nurses to be suitable treatment providers for depression therapy and found the treatment to be both useful and beneficial(Everitt-Penhale et al, 2019).…”

“…Bove, 2010;Carlisle & Warren, 2013;Chang et al, 2007;Chin-Quee et al, 2020;Cook et al, 2007;Datta et al, 2010;Delahunty-Pike et al, 2023;Engel et al, 2015;Everitt-Penhale et al, 2019;Fox & McCorkle, 2018;Gerin et al, 2007;Hoffman et al, 2023;Hunkeler et al, 2000;Husain et al, 2022;Jackson et al, 2017;Jeong et al, 2018;Jindal et al, 2022;Jordan et al, 2011;Kathree et al, 2023;Kwak et al, 2021;McCombe et al, 2022;Momin et al, 2022;Moriyama et al, 2021;Ngassa et al, 2021;Ngassa et al, 2022;Nnorom et al, 2021;O'Brien, 2022;O'Byrne et al, 2021;O'Keefe et al, 2023;Parker et al, 2022;Putnis et al, 2023;Ramakrishnan et al, 2020;Roy et al, 2022;Rutledge et al, 2018;Safren et al, 2021;Sanne et al, 2010;Schofield et al, 2005;Stone et al, 2010;Vierhile, 2017;Zewdu et al, 2022). This included lifestyle counselling(Ajay et al, 2016;…”