Impact of Longitudinal Virtual Primary Care on Diabetes Quality of Care
Background Lack of healthcare access to due to physician shortages is a significant driver of telemedicine expansion in rural areas. Telemedicine is effective for management of chronic conditions such as diabetes but its effectiveness in primary care settings is unknown. Objective To evaluate differ...
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| Veröffentlicht in: | Journal of general internal medicine : JGIM 2021-09, Vol.36 (9), p.2585-2592 |
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| container_title | Journal of general internal medicine : JGIM |
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| creator | Lu, Amy D. Gunzburger, Elise Glorioso, Thomas J. Smith, William B. Kenney, Rachael R. Whooley, Mary A. Ho, P. Michael |
| description | Background
Lack of healthcare access to due to physician shortages is a significant driver of telemedicine expansion in rural areas. Telemedicine is effective for management of chronic conditions such as diabetes but its effectiveness in primary care settings is unknown.
Objective
To evaluate differences in diabetes care before and after implementation of a longitudinal virtual primary care program.
Design
Propensity score-matched cohort study utilizing difference-in-differences analysis.
Participants
Patients with diabetes who received care at VA primary care clinics between January 2018 and December 2019 where the Virtual Integrated Multisite Patient Aligned Care Teams (V-IMPACT) program was implemented.
Exposure
Patient participation in at least one V-IMPACT visit while usual care patients did not participate in V-IMPACT.
Main Measures
The primary outcome was change in hemoglobin A1C (HbA1C) and secondary outcomes included change in the proportion of patients meeting diabetes quality indicators: blood pressure control, statin use, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ACEi/ARB) use, and annual microalbuminuria testing.
Key Results
Our propensity-matched cohort included 9010 patients split evenly between those who participated in V-IMPACT and those who remained in usual in-person care. Among individuals with diabetes who participated in V-IMPACT, the change in mean HbA1C was − 0.055% (95% CI − 0.088 to − 0.022%) while those in usual care had a − 0.047% (95% CI − 0.080 to − 0.014%) change before and after program implementation. We observed a 5.1% (95% CI 2.4 to 7.7%) absolute increase in the proportion prescribed statins in the V-IMPACT group, a 5.3% (95% CI 2.5 to 8.2%) increase prescribed ACE/ARBs, and a 4.6% (95% 1.7 to 7.5%) increase in completed yearly microalbuminuria testing. V-IMPACT was not associated with a significant difference in the proportion with controlled blood pressure at < 140/90 or < 130/90 mmHg thresholds.
Conclusions
Quality of diabetes care delivered by a longitudinal virtual primary care model was similar if not better than traditional in-person care. |
| doi_str_mv | 10.1007/s11606-020-06547-x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7822396</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2480460355</sourcerecordid><originalsourceid>FETCH-LOGICAL-c474t-8e6616525123c62fd6e531bfd4b9a7e30f79b6dc305d4bf8ad8420b82a0ac1753</originalsourceid><addsrcrecordid>eNp9UclO5DAQtRAIGpgf4IAicZlLmPLuXJBQMyxSSzDSMFfLSZzGKB03doKav8dNWAYOnEryW-qVH0IHGI4xgPwVMRYgciCQg-BM5qsNNMGc8ByzQm6iCSjFciUp20G7Md4DYEqI2kY7lDJFFeYTdHG1WJqqz3yTzXw3d_1Qu8602T8X-iHNm-AWJjxlUxNs5rvszJnS9jZmfxLq-qe1cI3to63GtNH-eJ176Pb899_pZT67vrians7yiknW58oKgUWKiAmtBGlqYTnFZVOzsjDSUmhkUYq6osDTU6NMrRiBUhEDpsKS0z10Mvouh3Jh68p2fTCtXo4xtTdOf0Y6d6fn_lFLRQgtRDL4-WoQ_MNgY68XLla2bU1n_RA1YQqYAMrXu46-UO_9ENLvJBYXTBSKYUgsMrKq4GMMtnkPg0Gve9JjTzr1pF960qskOvz_jHfJWzGJQEdCTFA3t-Fj9ze2zwSqnh0</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2564698410</pqid></control><display><type>article</type><title>Impact of Longitudinal Virtual Primary Care on Diabetes Quality of Care</title><source>SpringerNature Complete Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><source>Alma/SFX Local Collection</source><creator>Lu, Amy D. ; Gunzburger, Elise ; Glorioso, Thomas J. ; Smith, William B. ; Kenney, Rachael R. ; Whooley, Mary A. ; Ho, P. Michael</creator><creatorcontrib>Lu, Amy D. ; Gunzburger, Elise ; Glorioso, Thomas J. ; Smith, William B. ; Kenney, Rachael R. ; Whooley, Mary A. ; Ho, P. Michael</creatorcontrib><description>Background
Lack of healthcare access to due to physician shortages is a significant driver of telemedicine expansion in rural areas. Telemedicine is effective for management of chronic conditions such as diabetes but its effectiveness in primary care settings is unknown.
Objective
To evaluate differences in diabetes care before and after implementation of a longitudinal virtual primary care program.
Design
Propensity score-matched cohort study utilizing difference-in-differences analysis.
Participants
Patients with diabetes who received care at VA primary care clinics between January 2018 and December 2019 where the Virtual Integrated Multisite Patient Aligned Care Teams (V-IMPACT) program was implemented.
Exposure
Patient participation in at least one V-IMPACT visit while usual care patients did not participate in V-IMPACT.
Main Measures
The primary outcome was change in hemoglobin A1C (HbA1C) and secondary outcomes included change in the proportion of patients meeting diabetes quality indicators: blood pressure control, statin use, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ACEi/ARB) use, and annual microalbuminuria testing.
Key Results
Our propensity-matched cohort included 9010 patients split evenly between those who participated in V-IMPACT and those who remained in usual in-person care. Among individuals with diabetes who participated in V-IMPACT, the change in mean HbA1C was − 0.055% (95% CI − 0.088 to − 0.022%) while those in usual care had a − 0.047% (95% CI − 0.080 to − 0.014%) change before and after program implementation. We observed a 5.1% (95% CI 2.4 to 7.7%) absolute increase in the proportion prescribed statins in the V-IMPACT group, a 5.3% (95% CI 2.5 to 8.2%) increase prescribed ACE/ARBs, and a 4.6% (95% 1.7 to 7.5%) increase in completed yearly microalbuminuria testing. V-IMPACT was not associated with a significant difference in the proportion with controlled blood pressure at < 140/90 or < 130/90 mmHg thresholds.
Conclusions
Quality of diabetes care delivered by a longitudinal virtual primary care model was similar if not better than traditional in-person care.</description><identifier>ISSN: 0884-8734</identifier><identifier>EISSN: 1525-1497</identifier><identifier>DOI: 10.1007/s11606-020-06547-x</identifier><identifier>PMID: 33483815</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Angiotensin ; Angiotensin II ; Angiotensin-converting enzyme inhibitors ; Blood pressure ; Chronic conditions ; Chronic illnesses ; Diabetes ; Diabetes mellitus ; Enzyme inhibitors ; Health care ; Hemoglobin ; Internal Medicine ; Medicine ; Medicine & Public Health ; Original Research ; Patients ; Peptidyl-dipeptidase A ; Primary care ; Quality of care ; Rural areas ; Statins ; Telemedicine</subject><ispartof>Journal of general internal medicine : JGIM, 2021-09, Vol.36 (9), p.2585-2592</ispartof><rights>Society of General Internal Medicine 2021</rights><rights>Society of General Internal Medicine 2021.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-8e6616525123c62fd6e531bfd4b9a7e30f79b6dc305d4bf8ad8420b82a0ac1753</citedby><cites>FETCH-LOGICAL-c474t-8e6616525123c62fd6e531bfd4b9a7e30f79b6dc305d4bf8ad8420b82a0ac1753</cites><orcidid>0000-0002-6028-299X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7822396/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7822396/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,41488,42557,51319,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33483815$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lu, Amy D.</creatorcontrib><creatorcontrib>Gunzburger, Elise</creatorcontrib><creatorcontrib>Glorioso, Thomas J.</creatorcontrib><creatorcontrib>Smith, William B.</creatorcontrib><creatorcontrib>Kenney, Rachael R.</creatorcontrib><creatorcontrib>Whooley, Mary A.</creatorcontrib><creatorcontrib>Ho, P. Michael</creatorcontrib><title>Impact of Longitudinal Virtual Primary Care on Diabetes Quality of Care</title><title>Journal of general internal medicine : JGIM</title><addtitle>J GEN INTERN MED</addtitle><addtitle>J Gen Intern Med</addtitle><description>Background
Lack of healthcare access to due to physician shortages is a significant driver of telemedicine expansion in rural areas. Telemedicine is effective for management of chronic conditions such as diabetes but its effectiveness in primary care settings is unknown.
Objective
To evaluate differences in diabetes care before and after implementation of a longitudinal virtual primary care program.
Design
Propensity score-matched cohort study utilizing difference-in-differences analysis.
Participants
Patients with diabetes who received care at VA primary care clinics between January 2018 and December 2019 where the Virtual Integrated Multisite Patient Aligned Care Teams (V-IMPACT) program was implemented.
Exposure
Patient participation in at least one V-IMPACT visit while usual care patients did not participate in V-IMPACT.
Main Measures
The primary outcome was change in hemoglobin A1C (HbA1C) and secondary outcomes included change in the proportion of patients meeting diabetes quality indicators: blood pressure control, statin use, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ACEi/ARB) use, and annual microalbuminuria testing.
Key Results
Our propensity-matched cohort included 9010 patients split evenly between those who participated in V-IMPACT and those who remained in usual in-person care. Among individuals with diabetes who participated in V-IMPACT, the change in mean HbA1C was − 0.055% (95% CI − 0.088 to − 0.022%) while those in usual care had a − 0.047% (95% CI − 0.080 to − 0.014%) change before and after program implementation. We observed a 5.1% (95% CI 2.4 to 7.7%) absolute increase in the proportion prescribed statins in the V-IMPACT group, a 5.3% (95% CI 2.5 to 8.2%) increase prescribed ACE/ARBs, and a 4.6% (95% 1.7 to 7.5%) increase in completed yearly microalbuminuria testing. V-IMPACT was not associated with a significant difference in the proportion with controlled blood pressure at < 140/90 or < 130/90 mmHg thresholds.
Conclusions
Quality of diabetes care delivered by a longitudinal virtual primary care model was similar if not better than traditional in-person care.</description><subject>Angiotensin</subject><subject>Angiotensin II</subject><subject>Angiotensin-converting enzyme inhibitors</subject><subject>Blood pressure</subject><subject>Chronic conditions</subject><subject>Chronic illnesses</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Enzyme inhibitors</subject><subject>Health care</subject><subject>Hemoglobin</subject><subject>Internal Medicine</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Research</subject><subject>Patients</subject><subject>Peptidyl-dipeptidase A</subject><subject>Primary care</subject><subject>Quality of care</subject><subject>Rural areas</subject><subject>Statins</subject><subject>Telemedicine</subject><issn>0884-8734</issn><issn>1525-1497</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9UclO5DAQtRAIGpgf4IAicZlLmPLuXJBQMyxSSzDSMFfLSZzGKB03doKav8dNWAYOnEryW-qVH0IHGI4xgPwVMRYgciCQg-BM5qsNNMGc8ByzQm6iCSjFciUp20G7Md4DYEqI2kY7lDJFFeYTdHG1WJqqz3yTzXw3d_1Qu8602T8X-iHNm-AWJjxlUxNs5rvszJnS9jZmfxLq-qe1cI3to63GtNH-eJ176Pb899_pZT67vrians7yiknW58oKgUWKiAmtBGlqYTnFZVOzsjDSUmhkUYq6osDTU6NMrRiBUhEDpsKS0z10Mvouh3Jh68p2fTCtXo4xtTdOf0Y6d6fn_lFLRQgtRDL4-WoQ_MNgY68XLla2bU1n_RA1YQqYAMrXu46-UO_9ENLvJBYXTBSKYUgsMrKq4GMMtnkPg0Gve9JjTzr1pF960qskOvz_jHfJWzGJQEdCTFA3t-Fj9ze2zwSqnh0</recordid><startdate>20210901</startdate><enddate>20210901</enddate><creator>Lu, Amy D.</creator><creator>Gunzburger, Elise</creator><creator>Glorioso, Thomas J.</creator><creator>Smith, William B.</creator><creator>Kenney, Rachael R.</creator><creator>Whooley, Mary A.</creator><creator>Ho, P. Michael</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QL</scope><scope>7RV</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>M7N</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-6028-299X</orcidid></search><sort><creationdate>20210901</creationdate><title>Impact of Longitudinal Virtual Primary Care on Diabetes Quality of Care</title><author>Lu, Amy D. ; Gunzburger, Elise ; Glorioso, Thomas J. ; Smith, William B. ; Kenney, Rachael R. ; Whooley, Mary A. ; Ho, P. Michael</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-8e6616525123c62fd6e531bfd4b9a7e30f79b6dc305d4bf8ad8420b82a0ac1753</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Angiotensin</topic><topic>Angiotensin II</topic><topic>Angiotensin-converting enzyme inhibitors</topic><topic>Blood pressure</topic><topic>Chronic conditions</topic><topic>Chronic illnesses</topic><topic>Diabetes</topic><topic>Diabetes mellitus</topic><topic>Enzyme inhibitors</topic><topic>Health care</topic><topic>Hemoglobin</topic><topic>Internal Medicine</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Research</topic><topic>Patients</topic><topic>Peptidyl-dipeptidase A</topic><topic>Primary care</topic><topic>Quality of care</topic><topic>Rural areas</topic><topic>Statins</topic><topic>Telemedicine</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lu, Amy D.</creatorcontrib><creatorcontrib>Gunzburger, Elise</creatorcontrib><creatorcontrib>Glorioso, Thomas J.</creatorcontrib><creatorcontrib>Smith, William B.</creatorcontrib><creatorcontrib>Kenney, Rachael R.</creatorcontrib><creatorcontrib>Whooley, Mary A.</creatorcontrib><creatorcontrib>Ho, P. Michael</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of general internal medicine : JGIM</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lu, Amy D.</au><au>Gunzburger, Elise</au><au>Glorioso, Thomas J.</au><au>Smith, William B.</au><au>Kenney, Rachael R.</au><au>Whooley, Mary A.</au><au>Ho, P. Michael</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of Longitudinal Virtual Primary Care on Diabetes Quality of Care</atitle><jtitle>Journal of general internal medicine : JGIM</jtitle><stitle>J GEN INTERN MED</stitle><addtitle>J Gen Intern Med</addtitle><date>2021-09-01</date><risdate>2021</risdate><volume>36</volume><issue>9</issue><spage>2585</spage><epage>2592</epage><pages>2585-2592</pages><issn>0884-8734</issn><eissn>1525-1497</eissn><abstract>Background
Lack of healthcare access to due to physician shortages is a significant driver of telemedicine expansion in rural areas. Telemedicine is effective for management of chronic conditions such as diabetes but its effectiveness in primary care settings is unknown.
Objective
To evaluate differences in diabetes care before and after implementation of a longitudinal virtual primary care program.
Design
Propensity score-matched cohort study utilizing difference-in-differences analysis.
Participants
Patients with diabetes who received care at VA primary care clinics between January 2018 and December 2019 where the Virtual Integrated Multisite Patient Aligned Care Teams (V-IMPACT) program was implemented.
Exposure
Patient participation in at least one V-IMPACT visit while usual care patients did not participate in V-IMPACT.
Main Measures
The primary outcome was change in hemoglobin A1C (HbA1C) and secondary outcomes included change in the proportion of patients meeting diabetes quality indicators: blood pressure control, statin use, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ACEi/ARB) use, and annual microalbuminuria testing.
Key Results
Our propensity-matched cohort included 9010 patients split evenly between those who participated in V-IMPACT and those who remained in usual in-person care. Among individuals with diabetes who participated in V-IMPACT, the change in mean HbA1C was − 0.055% (95% CI − 0.088 to − 0.022%) while those in usual care had a − 0.047% (95% CI − 0.080 to − 0.014%) change before and after program implementation. We observed a 5.1% (95% CI 2.4 to 7.7%) absolute increase in the proportion prescribed statins in the V-IMPACT group, a 5.3% (95% CI 2.5 to 8.2%) increase prescribed ACE/ARBs, and a 4.6% (95% 1.7 to 7.5%) increase in completed yearly microalbuminuria testing. V-IMPACT was not associated with a significant difference in the proportion with controlled blood pressure at < 140/90 or < 130/90 mmHg thresholds.
Conclusions
Quality of diabetes care delivered by a longitudinal virtual primary care model was similar if not better than traditional in-person care.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>33483815</pmid><doi>10.1007/s11606-020-06547-x</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-6028-299X</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0884-8734 |
| ispartof | Journal of general internal medicine : JGIM, 2021-09, Vol.36 (9), p.2585-2592 |
| issn | 0884-8734 1525-1497 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7822396 |
| source | SpringerNature Complete Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; Alma/SFX Local Collection |
| subjects | Angiotensin Angiotensin II Angiotensin-converting enzyme inhibitors Blood pressure Chronic conditions Chronic illnesses Diabetes Diabetes mellitus Enzyme inhibitors Health care Hemoglobin Internal Medicine Medicine Medicine & Public Health Original Research Patients Peptidyl-dipeptidase A Primary care Quality of care Rural areas Statins Telemedicine |
| title | Impact of Longitudinal Virtual Primary Care on Diabetes Quality of Care |
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