Meeting the needs of rural veterans through rapid implementation of pharmacist-provided telehealth management of diabetes during the COVID-19 pandemic

BACKGROUND: The rapid implementation of telehealth care owing to the coronavirus disease 2019 (COVID-19) pandemic allowed clinical pharmacist practitioners (CPPs) within the Veterans Health Administration (VA) to continue to provide diabetes management to veterans with health care disparities, including rural veterans. OBJECTIVES: This project aimed to describe the change in hemoglobin A1c (HbA1c) in telehealth-naïve veterans with types 1 or 2 diabetes mellitus (DM) before and after the rapid implementation of CPP-provided telehealth DM management owing to the COVID-19 pandemic. The project also sought to describe potential health care disparities that may be addressed by the increase in telehealth use and the impact of metformin sustained action (SA) recalls. METHODS: Analysis included patients receiving face-to-face DM-focused visits with a CPP before the COVID-19 pandemic (June 1, 2019, to December 1, 2019) who transitioned to telehealth care via telephone or VA Video Connect during the COVID-19 pandemic (June 1, 2020, to December 1, 2020). One or more HbA1c readings within each time frame was required for inclusion. Patients were excluded if previously enrolled in VA telehealth DM management. RESULTS: The rapidly implemented telehealth management of DM provided by VA CPPs was observed to maintain or improve HbA1c control in 84.2% of patients. During the same time frame, 10.9% of patients were taken off metformin SA secondary to national drug recalls. In total, 76% of patients were from rural communities and > 52% of patients traveled greater than 50 miles round trip to receive face-to-face DM care before the pandemic. CONCLUSION: Glycemic control was improved or maintained for most patients who were rapidly converted to pharmacist-provided telehealth DM management during the COVID-19 pandemic. A large majority of rural patients were reached as a result of CPP-provided telehealth care. This provides evidence to support the continued widespread telehealth utilization to effectively manage DM and reach veterans with health care disparities, particularly rural communities.