Cargando…

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

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 patien...

Descripción completa

Detalles Bibliográficos
Autores principales: Emerson, John F., Welch, Madelyn, Rossman, Whitney E., Carek, Stephen, Ludden, Thomas, Templin, Megan, Moore, Charity G., Tapp, Hazel, Dulin, Michael, McWilliams, Andrew
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4730422/
https://www.ncbi.nlm.nih.gov/pubmed/26703661
http://dx.doi.org/10.3390/ijerph13010031
_version_ 1782412396582666240
author Emerson, John F.
Welch, Madelyn
Rossman, Whitney E.
Carek, Stephen
Ludden, Thomas
Templin, Megan
Moore, Charity G.
Tapp, Hazel
Dulin, Michael
McWilliams, Andrew
author_facet Emerson, John F.
Welch, Madelyn
Rossman, Whitney E.
Carek, Stephen
Ludden, Thomas
Templin, Megan
Moore, Charity G.
Tapp, Hazel
Dulin, Michael
McWilliams, Andrew
author_sort Emerson, John F.
collection PubMed
description 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.
format Online
Article
Text
id pubmed-4730422
institution National Center for Biotechnology Information
language English
publishDate 2015
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-47304222016-02-11 A Multidisciplinary Intervention Utilizing Virtual Communication Tools to Reduce Health Disparities: A Pilot Randomized Controlled Trial Emerson, John F. Welch, Madelyn Rossman, Whitney E. Carek, Stephen Ludden, Thomas Templin, Megan Moore, Charity G. Tapp, Hazel Dulin, Michael McWilliams, Andrew Int J Environ Res Public Health Communication 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. MDPI 2015-12-22 2016-01 /pmc/articles/PMC4730422/ /pubmed/26703661 http://dx.doi.org/10.3390/ijerph13010031 Text en © 2015 by the authors; licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons by Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Communication
Emerson, John F.
Welch, Madelyn
Rossman, Whitney E.
Carek, Stephen
Ludden, Thomas
Templin, Megan
Moore, Charity G.
Tapp, Hazel
Dulin, Michael
McWilliams, Andrew
A Multidisciplinary Intervention Utilizing Virtual Communication Tools to Reduce Health Disparities: A Pilot Randomized Controlled Trial
title A Multidisciplinary Intervention Utilizing Virtual Communication Tools to Reduce Health Disparities: A Pilot Randomized Controlled Trial
title_full A Multidisciplinary Intervention Utilizing Virtual Communication Tools to Reduce Health Disparities: A Pilot Randomized Controlled Trial
title_fullStr A Multidisciplinary Intervention Utilizing Virtual Communication Tools to Reduce Health Disparities: A Pilot Randomized Controlled Trial
title_full_unstemmed A Multidisciplinary Intervention Utilizing Virtual Communication Tools to Reduce Health Disparities: A Pilot Randomized Controlled Trial
title_short A Multidisciplinary Intervention Utilizing Virtual Communication Tools to Reduce Health Disparities: A Pilot Randomized Controlled Trial
title_sort multidisciplinary intervention utilizing virtual communication tools to reduce health disparities: a pilot randomized controlled trial
topic Communication
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4730422/
https://www.ncbi.nlm.nih.gov/pubmed/26703661
http://dx.doi.org/10.3390/ijerph13010031
work_keys_str_mv AT emersonjohnf amultidisciplinaryinterventionutilizingvirtualcommunicationtoolstoreducehealthdisparitiesapilotrandomizedcontrolledtrial
AT welchmadelyn amultidisciplinaryinterventionutilizingvirtualcommunicationtoolstoreducehealthdisparitiesapilotrandomizedcontrolledtrial
AT rossmanwhitneye amultidisciplinaryinterventionutilizingvirtualcommunicationtoolstoreducehealthdisparitiesapilotrandomizedcontrolledtrial
AT carekstephen amultidisciplinaryinterventionutilizingvirtualcommunicationtoolstoreducehealthdisparitiesapilotrandomizedcontrolledtrial
AT luddenthomas amultidisciplinaryinterventionutilizingvirtualcommunicationtoolstoreducehealthdisparitiesapilotrandomizedcontrolledtrial
AT templinmegan amultidisciplinaryinterventionutilizingvirtualcommunicationtoolstoreducehealthdisparitiesapilotrandomizedcontrolledtrial
AT moorecharityg amultidisciplinaryinterventionutilizingvirtualcommunicationtoolstoreducehealthdisparitiesapilotrandomizedcontrolledtrial
AT tapphazel amultidisciplinaryinterventionutilizingvirtualcommunicationtoolstoreducehealthdisparitiesapilotrandomizedcontrolledtrial
AT dulinmichael amultidisciplinaryinterventionutilizingvirtualcommunicationtoolstoreducehealthdisparitiesapilotrandomizedcontrolledtrial
AT mcwilliamsandrew amultidisciplinaryinterventionutilizingvirtualcommunicationtoolstoreducehealthdisparitiesapilotrandomizedcontrolledtrial
AT emersonjohnf multidisciplinaryinterventionutilizingvirtualcommunicationtoolstoreducehealthdisparitiesapilotrandomizedcontrolledtrial
AT welchmadelyn multidisciplinaryinterventionutilizingvirtualcommunicationtoolstoreducehealthdisparitiesapilotrandomizedcontrolledtrial
AT rossmanwhitneye multidisciplinaryinterventionutilizingvirtualcommunicationtoolstoreducehealthdisparitiesapilotrandomizedcontrolledtrial
AT carekstephen multidisciplinaryinterventionutilizingvirtualcommunicationtoolstoreducehealthdisparitiesapilotrandomizedcontrolledtrial
AT luddenthomas multidisciplinaryinterventionutilizingvirtualcommunicationtoolstoreducehealthdisparitiesapilotrandomizedcontrolledtrial
AT templinmegan multidisciplinaryinterventionutilizingvirtualcommunicationtoolstoreducehealthdisparitiesapilotrandomizedcontrolledtrial
AT moorecharityg multidisciplinaryinterventionutilizingvirtualcommunicationtoolstoreducehealthdisparitiesapilotrandomizedcontrolledtrial
AT tapphazel multidisciplinaryinterventionutilizingvirtualcommunicationtoolstoreducehealthdisparitiesapilotrandomizedcontrolledtrial
AT dulinmichael multidisciplinaryinterventionutilizingvirtualcommunicationtoolstoreducehealthdisparitiesapilotrandomizedcontrolledtrial
AT mcwilliamsandrew multidisciplinaryinterventionutilizingvirtualcommunicationtoolstoreducehealthdisparitiesapilotrandomizedcontrolledtrial