Effectiveness of Home Telehealth in Comorbid Diabetes and Hypertension: A Randomized, Controlled Trial

TELEMEDICINE and e-HEALTH MAY 2011 Bonnie J. Wakefield, Ph.D., R.N.,1 John E. Holman, M.A.,1 Annette Ray, R.N.,1 Melody Scherubel, R.N.,1 Margaret R. Adams, ARNP, BC-ADM, C.D.E.,2 Stephen L. Hillis, Ph.D.,1,3 and Gary E. Rosenthal, M.D.1,4 1Department of Veterans Affairs (VA) Health Services Research and Development Center for Comprehensive Access & Delivery Research and Evaluation (CADRE), Iowa City VA Medical Center, Iowa City, Iowa. 2Iowa City Veterans Affairs Medical Center, Iowa City, Iowa. 3Department of Biostatistics, College of Public Health and 4Division of General Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa.

Background: Increased emphasis is being placed on the critical need to control hypertension (HTN) in patients with diabetes.

Objective: The objective of this study was to evaluate the efficacy of a nursemanaged home telehealth intervention to improve outcomes in veterans with comorbid diabetes and HTN.

Design: A single-center, randomized, controlled clinical trial design comparing two remote monitoring intensity levels and usual care in patients with type 2 diabetes and HTN being treated in primary care was used.

Measurements: Primary outcomes were hemoglobin A1c and systolic blood pressure (SBP); secondary outcome was adherence.

Results: Intervention subjects experienced decreased A1c during the 6-month intervention period compared with the control group, but 6 months after the intervention was withdrawn, the intervention groups were comparable with the control group. For SBP, the high-intensity subjects had a significant decrease in SBP compared with the other groups at 6 months and this pattern was maintained at 12 months. Adherence improved over time for all groups, but there were no differences among the three groups.

Limitations: Subjects had relatively good baseline control for A1c and SBP; minorities and women were underrepresented.

Conclusions: Home telehealth provides an innovative and pragmatic approach to enhance earlier detection of key clinical symptoms requiring intervention. Transmission of education and advice to the patient on an ongoing basis with close surveillance by nurses can improve clinical outcomes in patients with comorbid chronic illness.

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