The purpose of this study is to adapt and pilot-test a successful telemedicine and shared medical appointment clinical care model for young adults with type 1 diabetes. Previously implemented among a privately-insured population at a diabetes specialty center, we will adapt the care model to meet the needs of a low-SES, racially and ethnically diverse population receiving care at a hospital-based endocrine clinic, and evaluate its effectiveness in improving access to care, follow-up frequency, and patient and provider satisfaction.
Journal Articles
Raymond, J. K., Reid, M. W., Fox, S., Garcia, J. F., Miller, D., Bisno, D., Fogel, J. L., Krishnan, S., & Pyatak, E. A. (2020). Adapting home telehealth group appointment model (CoYoT1 clinic) for a low SES, publicly insured, minority young adult population with type 1 diabetes. Contemporary Clinical Trials, 88, 105896. https://doi.org/10.1016/j.cct.2019.105896 Show abstract
As more individuals from diverse backgrounds are diagnosed with Type 1 Diabetes (T1D), the need to address resulting disparities in diabetes outcomes among these populations also escalates. Although young adulthood proves challenging for all patients with diabetes, young adults (YA) from racial/ethnic minorities and low socioeconomic backgrounds face even greater T1D management obstacles. The poorer outcomes in these populations drive an urgent need for alternative care models to improve YA's engagement in their T1D clinical care and address barriers to improved health outcomes. Previous telemedicine initiatives for T1D have yielded positive diabetes care results, especially in YA, offering one promising way to reach this high-risk population. To serve these patients better, an established and successful home telehealth group appointment model, “CoYoT1 Clinic” (Colorado Young Adults with T1D), was adapted to provide care to YA with T1D at a large urban children's hospital in Southern California. At this location, ~70% of patients have public/no insurance, and 85% are racial/ethnic minorities. In this paper, we report the process of adapting the CoYoT1 Clinic model and designing a randomized controlled trial (RCT) to evaluate its efficacy. The adapted model uses meticulous study-design methods that incorporate patient advisors, quantitative and qualitative data collection, collaboration with local stakeholders, intervention development, and patient randomization into a factorial design analyzing telemedicine versus in-person and patient-centered versus standard care. The new model addresses the needs of high-risk YA in Southern California, with the goal of increasing access to care, improving follow-up frequency, and strengthening patient and provider satisfaction.
Keywords. Young adults; Telehealth; Group appointments; Type 1 diabetes; Shared medical appointments; Telemedicine
Bakhach, M., Reid, M. W., Pyatak, E. A., Berget, C., Cain, C., Thomas, J., Klingensmith, G. J., & Raymond, J. K. (2019). Home telemedicine (CoYoT1 clinic): A novel approach to improve psychosocial outcomes in young adults with diabetes. The Diabetes Educator, 45(4), 420-430. https://doi.org/10.1177/0145721719858080 Show abstract
Purpose. To assess the impact of a home telemedicine clinic model (CoYoT1 Clinic) on psychosocial and behavioral outcomes designed for young adults (YAs) with type 1 diabetes (T1D).
Methods. YAs self-selected to participate in the CoYoT1 Clinic or serve as a usual care control. CoYoT1 Clinic visits consisted of an individual appointment with a provider and a group appointment with other YAs with T1D using home telemedicine. Psychosocial and behavioral functioning was assessed by 4 measures: Diabetes Distress Scale, Self-Efficacy for Diabetes Scale, Self-Management of Type 1 Diabetes in Adolescence Scale, and Center for Epidemiologic Studies Depression Scale.
Results. Forty-two patients participated in the CoYoT1 Clinic and 39 patients served as controls. CoYoT1 participants reported lower levels of distress (P = .03), increased diabetes self-efficacy (P = .01), and improved ability to communicate with others about diabetes (P = .04) over the study period compared to controls. YA males in the control group reported increases in depressive symptoms (P = .03) during the study period, but CoYoT1 participants showed no changes.
Conclusion. Group home telemedicine for YAs with T1D positively affects diabetes distress, self-efficacy, and diabetes-specific communication. These positive findings have the potential to also affect the YAs’ long-term diabetes outcomes. Further investigation of the model is needed.
