OR32-5 Outcomes of Electronic-consultation versus In-Person Clinic Management for Type 2 Diabetes

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: OR32-Health Outcomes & Quality Improvement
Clinical
Monday, June 17, 2013: 11:15 AM-12:45 PM
Presentation Start Time: 12:15 PM
Room 301 (Moscone Center)
Payal Patel*1, Bryan Jiang1, Sabina Hurr2, Morgan Green2, Madhuri Vasudevan3, Marco Marcelli4 and Sanjay Navin Mediwala5
1Baylor College of Medicine, Houston, TX, 2Michael E. DeBakey VA Medical Center, 3Michael E. DeBakey VA Medical Center, Houston, TX, 4Baylor Coll of Med VAMC, Houston, TX, 5Michael E. DeBakey V A Medical Center, Houston, TX
INTRODUCTION: Diabetes (DM) prevalence among US Veterans is higher compared to the general population with 25.7% of Veterans within VISN 16 having DM; 19% of them have a HbA1c >9% or have never had a HbA1c measured. In order to improve specialty care accessibility, the Michael E. DeBakey VAMC (MEDVAMC) implemented the DM Electronic Consultation Service (DMECS) to provide specialty recommendations about diabetes care to primary care physicians (PCPs). The E-consultation is done remotely by an Endocrinologist who reviews the patients’ charts and speaks to patients via telephone. Recommendations are then made via a note in the patient's electronic chart with the PCP responsible for implementing recommendations.

HYPOTHESIS: The purpose of this study is to compare effectiveness of E-consultation to in-person consultation for diabetes management. The primary outcome is change in HbA1c from pre-consultation to 6 months post-consultation in each group. We anticipated E-consultation would be equally or more effective than in-person consultation in lowering HbA1c.

METHODS: A retrospective chart review of patients referred for diabetes consultation at the MEDVAMC from November 1, 2011 to April 20, 2012 was conducted. Patients were divided into two groups: (1) patients seen in-person by an Endocrinologist and (2) patients evaluated via the E-consultation system. Inclusion criteria included type 2 DM and HbA1c >8%. Patients who were pregnant, on insulin pump, had no phone access, type 1 DM, did not receive primary care at the VA, or had seen an endocrinologist in the previous one year were excluded.

RESULTS: Ninety-three patients met inclusion/exclusion criteria for in-person clinic visits compared to 281 patients in the E-consult group. The mean HbA1c for patients seen in-person at baseline and 6 months was 10.3% and 9.3%, respectively [p <0.001]. The mean HbA1c for patients evaluated by E-consultation at baseline and 6 months was 10.1% and 9.1%, respectively [p <0.001]. There was no statistically significant difference in change in HbA1c from baseline to 6 months between the two groups: each group lowered HbA1c by 1 percentage point [p =0.76]. Other results, including change in total insulin dose, blood pressure, lipids, and BMI, will be presented.

CONCLUSION: E-consultation management for DM is as effective as in-person clinic management of DM at the  MEDVAMC.

Nothing to Disclose: PP, BJ, SH, MG, MV, MM, SNM

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm