Research Proposal On The Relationship Between DSME Through Telehealth Services And A1C Levels In Elderly T2DM Patients

Research Proposal On The Relationship Between DSME Through Telehealth Services And A1C Levels In Elderly T2DM Patients

Introduction

According to the Centers for Disease Control, diabetes affects more than 30.3 million Americans in which it can cause visual disturbances or blindness, heart attacks, strokes, amputations of the legs and feet, and end-stage kidney disease. Currently, the problem in the United States is that most healthcare expenditures for diabetes go towards treating complications and hospitalizations, thus a focused paradigm shift needs to be directed towards spending more resources on prevention, research, and collaborative efforts that can reduce costly complications (Powers, 2016). Texas ranks seventh highest in the nation, with approximately 11.2 % of adults who have been diagnosed with diabetes (CDC). Among the Hispanics, type 2 diabetes (T2DM) prevalence rates are higher amongst adults, in particular, women in South Texas are at higher risk than their male counterparts as most of them are obese, overweight, or have sedentary habits.

Traditional Diabetes Self-Management Education and Support (DSME/S) services involve face-to-face attention given to patients. Among the Hispanics in South Texas, face to face care does not relate entirely to positive health outcomes due to limitations, such as misunderstanding of the health status in the community, the reluctance of patients towards the services, an insufficient number of health caregivers (Powers, 2017). However, education and support can be provided by the nurses through information and communication technologies to patients remotely, a process referred to as telehealthcare. The study will be used to show the relationship between DSME/S services provided through telehealth processes and the decreased levels of A1C in elderly patients who will receive attention through the approach. Hispanics aged 65 years and above in South Texas will be the main subjects of the research. The primary research question will be about the association between the DSME/S services, which are offered through telehealth, and the outcome in the patients’ A1C levels. Direct links between the use of telehealth services and health outcomes, specifically in levels of A1C in the body, which result from using such approaches, will be examined. Notably, implementing telehealth facilities during the delivery of DSME/S services will help monitor the needs of many elderlies in South Texas as compared to the traditional approach of providing education and support to free clinic patients.

Also, DSME/S services are used by practitioners to provide education concerning diabetes, whereby a patient sets goals to be achieved at regular intervals towards healthy living. However, in the research, participation criteria will entail subjects between 65-70 years of age, who will have recently been diagnosed with T2DM (less than one year), and are functionally independent, alert, oriented, and able to read English or Spanish (Texas Health and Human Services, 2019). Besides, participants will be excluded if they will have dementia, learning disability, or any other significant comorbidity, such as cancer, heart disease, chronic obstructive pulmonary disease (COPD), strokes, or seizures. Consequently, participants’ needs will be considered by qualified instructors in diabetes management, for instance, nurses, dietitians, or pharmacists. The results of the study will show that patients under telehealth DSME/S services demonstrate reduced A1C levels, besides improved behavioral and psychological outcomes with the help of health caregivers.

Moreover, in South Texas, Type 2 diabetes among Hispanics has become a health challenge, especially in persons over 45 years of age, overweight, or physically inactive. The disproportional T2DM prevalence among the people in Texas is attributed to the socioeconomic status of the community (Powers, 2016). Focusing on the T2DM prevalence among the Latinos brings forth measures, which are applicable within the social and political environment towards the improvement of health outcomes. Past approaches to the DSME/S services have left gaps in effective delivery to trigger patients’ coping behavior towards diabetes. These gaps will be addressed through the use of telehealth in delivery techniques of the services aiming at reducing T2DM prevalence among the elderly Hispanic persons in South Texas. Efforts towards the engaging telehealth channels in DSME/S services include analysis of patient health data using decision support software, communication with diabetics, frequent therapy reminders, and reducing transport costs for nurses or doctors (Threatt & Ward, 2017). Understanding the personal experiences of patients through constant communication on health progress lowers the A1C levels in people with diabetes. Analysis of the patients ‘experiences using decision support software within the DSME/S services, therefore, will provide the best intervention and care plans depending on the individual needs of the elderly Hispanic patients, especially in Texas.

Additionally, the main objective of analyzing the existing DSME/S services will be to establish new approaches through telehealth services in availing knowledge to patients and the general public about diabetes. Assessing the nature of services and the social factors, which influence positive results, will help adopt interactive and remote telehealth means, which show progress in reducing hemoglobin A1C levels in patients. (Threatt & Ward, 2017). As DSME/S services are incorporated in offices, care organizations, and at homes, medical practitioners will develop mutual relationships with patients. This association will be examined after the application of technology-based communication and monitoring channels. For instance, Nurse-Led Tele-coaching will involve sharing diabetes knowledge with the patients using information and communication technologies where data is transmitted over a long distance (Odnoletkova et al., 2016). The situation implies that tele-coaching will ensure effective communication and close progress of health status regarding lower A1C levels in patients.

Also, the objective of incorporating telehealth in DSME/S service approaches will be to facilitate positive health outcomes more so to control blood sugar levels in elderly Hispanic persons who will be newly diagnosed with T2DM. Telehealth programs will train patients to manage their disease, provide educational modules for them to read, and delivering timely information regarding their health status to facilitate individualized treatment. Consequently, closing the gap between the patients and the providers of diabetes self-management services will fasten the psychological and behavioral changes required for optimum health status. The relationship between telehealth programs integrated into DSME/S services and health outcomes will be established through examining various factors related to A1C outcomes.

As compared to the traditional method of providing support to people with diabetes, telehealth programs will focus on practical analysis of patient information and health progress. The study will expound on the integration of hospital electronic medical record systems and telehealth technological interfaces, which will both help to organize patient’s information for close supervision and treatment of diabetes. Similarly, decision support software within the telehealth programs will form the basic procedure of giving medical care and prescription to individual patients, which will result in decreased levels in A1C of the diabetic patients in South Texas (Threatt & Ward, 2017). Also, telehealth systems offer effective monitoring and prediction of individual progress on sugar levels, which is done through electronic medical systems that offer a solution to the challenges nurses may encounter as they educate patients. The study will build on the recommendations from the Telehealth for Diabetes Self-management education and support study, which will compare the services offered to the patients and the achieved mean of the A1C level. Consequently, the expansion of telehealth programs in South Texas will ensure that diabetes self-management education reaches more patients in the area at personal levels. The direct relationship of the health practitioners offering DSME/S services through telehealth facilities establishes reliability and consistent contact with patients as compared to the traditional approach where not all elderly with T2DM were given attention.

Finally, the comparison will be made on the change in A1C level in patients with T2DM before the introduction of the telehealth facilities within the DSME/S services, and the average of blood sugar points after integration of such amenities. Going through the health records present before telehealth services were introduced, data on blood sugar levels will be noted. Health implications due to telehealth services as an approach in DSME/S services will be assessed through analyzing statistics from records maintained by medical practitioners. As Hispanics record high diabetes cases, the telehealth daily self-management and care will be examined to establish the factors, which contribute to reduced A1C levels.

Methodology

First, approval by the Institutional Review Board (IRB) will be done before conducting a study in the Hispanic Community in South Texas. Once the credibility of the research is established, the determination of the setting will be done. The report will be compiled after investigating the relationship between telehealth services present in the Hispanics community, including the DSME/S services and the health outcomes of patients, particularly on the blood sugar levels.

The measurement tools, which will be used in the research will, include questionnaires and interviewing techniques. Respondents will fill the questionnaires, and qualitative evaluation of the data will follow in which relevant responses will render the method fruitful. Interviewing will involve face to face conversations where respondents will be expected to answer questions without bias, however, room for prejudice will be left as not all interviewees will be honest.  Also, the independent variable will be the integration of telehealth facilities within the DSME/S services. The access of telehealth service to the T2DM patients since its introduction in South Texas will be purposely varied to elicit changes in the levels of A1C in patients who are beneficiaries of the facilities. The dependent variable will be the level of blood sugar levels in elderly patients in the area before telehealth services were introduced, and after, where the data used will be collected from health practitioners.

Secondly, the study will examine the links between telehealth facilities introduced to newly diagnosed T2DM patients, and the average level of blood sugar in them. The ease of access to telehealth facilities will be established by counting the number of telehealth beneficiaries and the proportion of the patients who still visit hospitals for face to face DSME/S services. Consequently, investigation of the opinions on the contribution of telehealth facilities within DSME/S services towards A1C levels among patients will be noted. The study will utilize purposeful sampling methods to equally select 10 Latinos between the age of 65-70 years from both genders. Fundamentally, the participants will already be diagnosed with T2DM and will have benefited from the telehealth services for a minimum period of 6 months. Besides, the primary methods of collecting data from the research subjects will entail observation of how telehealth services are conducted, administering questionnaires, and conducting individual interviews. A set of guidelines will be written to prompt historical information about the diagnosis and treatment of diabetes through traditional and telehealth facilities in DSME/S services, through questioning. Also, the levels of individual A1C in the six months will be obtained from local health facilities through content analysis.

Additionally, information on the levels of A1C in all the patients will be collected from hospital progress documents. Information to be collected will relate to the existing health telehealth facilities in DSME/S services, which will result from declining in the blood sugar levels of patients. The expected data will include the efforts of telehealth programs towards training patients to manage diseases, providing educational modules for them to read, delivering timely information regarding their health status. Similarly, open-ended questionnaires will be supplied to the 10 respondents to fill without limit of the scope of answers required. These questionnaires will have three sections; initial A1C level, attitude towards telehealth services, and diabetes in the patient (Al-Jassasi & Al-Subhi, 2018). Notably, the validity of the information will be checked by the supervising team, while reliability will be recognized using the test-retest method.

Respondents will be expected to provide information on their daily experiences with telehealth facilities and the coping strategies they will use from the information they will learn. Consequently, they will have to give details on how the traditional DSME/S services were offered by the medical officers, including the Medical Nutrition Therapy (MNT) and the impact on their blood sugar levels as the digital implementation of the initiative began. Information on the interrelationship between traditional DSME/S services delivery will help formulate the relationship between the current telehealth facilities in DSME/S services and the sugar levels in the patients. Checklists will be used to confirm the telehealth Diabetes Self-Management Education and Support services within South Texas. Also, case studies will provide the relationship between telehealth services offered to T2DM patients aged 65 years and above, and the outcomes of their sugar blood levels as compared to the traditional approach of the DSME/S services.

References

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Odnoletkova, I., Ramaekers, D., Nobels, F., Goderis, G., Aertgeerts, B., & Annemans, L. (2016).

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