PHILADELPHIA – Patients who lived in rural areas and received tele-endocrinology consultations saw improvements in endocrine disorders such as diabetes, according to a small pilot study.
There was marked improvement in hemoglobin A1c in patients with diabetes, marked improvement in some patients’ lipid profiles, "and we had some patients with thyroid disorders and we saw some euthyroid during the course of the study," said Dr. Rabia Rehman, an endocrinology fellow at the University of Tennessee Health Science Center, Memphis.
The study also highlighted the role of primary care providers in rural areas who referred the patients to the telemedicine consultations and helped with the continuity of their care.
Telemedicine is not a new concept and its potential benefits have been established in certain areas such as stroke care.
Dr. Rehman said tele-endocrinology can be beneficial today, when the rates of diabetes and other endocrine disorders are rising. That’s especially true in rural areas where there’s a lack of specialists and patients have to travel far to get to the nearest specialty provider or medical center, she said.
Sixty-six patients from five rural areas in Tennessee received remote consultations at the telemedicine unit of the University of Tennessee in Memphis over a period of 2½ years. The unit and the remote sites were connected by video cameras, television monitors, and Internet.
Recommendations for management of the conditions were faxed to the patients’ primary care providers, and specialists evaluated laboratory results per primary care providers’ requests.
Among the 66 patients, 35 (53%) had type 2 diabetes, 24 (41%) had hypertension, 30 (45%) had dyslipidemia, 20 (30%) had thyroid disease, and 8 (12%) had osteoporosis or hypercalcemia.
In the 20 of the 35 diabetic patients who had a 6-month follow-up, mean HbA1c decreased by 1.7 percentage points, from 9.1% to 7.5%. The other 15 patients dropped out.
High dropout rate, in fact, was one of the limitations of the study. Dr. Rehman said the attrition could be due to the fact that the patients were comfortable with continuing their care with their primary care providers, and for other unknown reasons.
Follow-up data were available for 4 of the 20 patients with thyroid disease; all 4 became euthyroid, according to the study.
Also, data available on 17 patients with dyslipidemia showed that lipid profiles improved in 12 of them.
Almost all of the patients (97%) said they were comfortable with receiving care through videoconferencing.
Dr. Rehman said that the long-term cost savings due to improved health outcomes far outweighed the upfront cost of setting up the remote sites. She did not provide specific data on the cost of remote sites presented in this study.
These results show that "this is something that should be continued, and bigger, prospective studies should be done on effectiveness of telemedicine and bridging [the health care] gap," said Dr. Rehman, who indicated that she had no disclosures.