Telemedicine improves treatment outcomes for diabetics

Telemedicine could prove a valuable tool if you're struggling to improve care for low-income, uninsured or otherwise underserved diabetic patients.

For instance, a study recently published in the Journal of Health Care for the Poor and Underserved shows how Middletown, Conn.-based Community Health Center Inc., used telemedicine to double the number of patients receiving retinopathy evaluations while reducing the cost per patient by $25. The study focused on underserved populations: 60 percent of participants came from racial or ethnic minorities, 91 percent were at 200 percent or more below the federal poverty level, and 25 percent were uninsured, according to the study's authors.

One of the most interesting aspects of the study: It used a free, web-based system called EyePACS to perform the retinopathy evaluations, meaning the primary-care physicians involved didn't need specialized training to perform the initial testing. Instead, they recorded images with Canon CR-1 digital retinal cameras--purchased specifically for the study--and sent them to Yale ophthalmologists, whose physicians performed the retinopathy evaluations and returned their results through the EyePACS website, the authors explain.

In the end, the telemedicine screenings identified 25 percent of the 611 patients in the study as having diabetic retinopathy. And over the year of the program, overall evaluation rates for diabetics rose to 20 percent, nearly double the previous rate of 10 to 12 percent, the study shows. The telemedicine method also was $25 cheaper per patient than the traditional examination method. Researchers didn't have an explanation for the difference, but are working on a detailed cost analysis.

One unexpected bonus: The free retinopathy evaluation brought patients into their primary-care physicians, who took advantage of the opportunity to evaluate their foot health, insulin levels and other diabetic maintenance issues--something that's often difficult to achieve with this population of patients, according to the authors.

To learn more:
- read the Journal abstract
- download a poster describing the study's primary elements from the Weitzman Center for Innovation

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