Comparison between in-person, telehealth, and combination visits among Veterans treated in a pharmacist-led diabetes management clinic

Abstract: Background: The Veterans Affairs San Diego Healthcare System converted its pharmacist-run Diabetes Intense Medical Management (DIMM) Clinic to telehealth during the COVID-19 pandemic. Previous studies suggested that in-person DIMM visits improved glycemic control, medication adherence, and patient satisfaction. To explore if these benefits apply to telehealth, we compared glycemic control in veterans with post-COVID-19 telehealth DIMM visits and pre-pandemic in-person DIMM visits. Objective: The primary study objective was to evaluate the mean hemoglobin (A1c) change from baseline in cohorts who received telehealth visits, traditional visits, or a combination of both after 12 months of intervention. Secondary objectives included evaluation of all-cause mortality and the average time to mortality (days). Methods: A retrospective multi-arm historical cohort control study was conducted to compare 12-month glycemic control among veterans with type 2 diabetes who initiated DIMM care via audio-only telehealth, in-person, or combination between August 2018 and November 2021. Primary endpoint was the 12-month change in A1c from baseline; secondary measures included all-cause mortality and the average time to mortality (days). Results: A total of 44 veterans were included for analysis. At 12 months, the average decrease in A1c from baseline were -0.90% (95% CI: -2.82, 1.01), -1.73% (95% CI: -3.33, -0.14), and -1.42% (95% CI: -2.67, -0.18) for the In-Person, Telehealth, and Combination groups, respectively. No differences in quarterly HbA1c rate of change were reported across the groups. All-cause mortality was highest in the In-person group (15.4%) compared to the Telehealth (4.6%) and the Combination (0.0%) groups; however, these differences were not statistically significant. Lastly, there were no significant differences in average time to death between the groups. Conclusion: Telehealth may be an alternative method of access to pharmacist-led diabetes care that is slowly making its way into our healthcare systems as a permanent fixture.

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