Media contact: Micah Hardge
A multisite study will compare the effectiveness of telehealth options in patients with a physical disability, Type 2 diabetes and one other chronic health condition.The University of Alabama at Birmingham Department of Family and Community Medicine was awarded over $11.4 million from the Patient-Centered Outcomes Research Institute to lead a study into how primary care can help patients with physical disabilities, who also deal with Type 2 diabetes and other chronic disease, best manage their health.
The multisite study — “Optimizing Effectiveness of Primary Care Delivered Telehealth Interventions to Manage Type 2 Diabetes in People with Physical Disabilities and Multiple Chronic Conditions” — will compare the effectiveness of digital health coaching, remote patient monitoring and a combination of these options for improving blood sugar levels in people living with physical disabilities, Type 2 diabetes, and at least one other cardiometabolic or cardiorenal comorbidity, such as hypertension, congestive heart failure, coronary artery disease, cancer or chronic kidney disease.
Department of Family and Community Medicine Vice Chair of Research and the study’s principal investigator, Tapan Mehta, Ph.D., says research shows that those living with both chronic diseases and physical disabilities are at a substantially increased risk for poor health status and life satisfaction, making it even harder to effectively manage their chronic conditions.
“There is a well-documented relationship among physical disabilities, diabetes and chronic conditions,” Mehta said. “Interventions based in primary care to help manage chronic conditions in people with physical disabilities need to address suboptimal social determinants of health. This is especially true in the Deep South, where the intersectionality of race and rurality also needs to be accounted for.”
While the COVID-19 pandemic led to a rapid expansion in the use of telehealth, questions remain about the most effective, evidence-based ways to incorporate telehealth modalities as part of routine clinical workflow to facilitate chronic disease management and mitigate health disparities.
Telehealth programs, including digital health coaching and remote patient monitoring, are increasingly being used, especially for those who otherwise have limited access to in-person health care. However, more information is needed to demonstrate which option — or a combination of these interventions — is the most effective and how they affect long-term outcomes among those with physical disabilities and multiple chronic conditions.
The study reflects the department’s research strategy, which focuses on high-impact primary care research that is patient- and community-centered, including work that enhances health promotion, improves care for chronic diseases and advances health care delivery.
“This study was selected for PCORI funding for its potential to answer the need for real-world evidence about how best to incorporate telehealth into the primary care of people with multiple chronic conditions, and how this may differ among populations at risk for health disparities,” said PCORI Executive Director Nakela L. Cook, M.D. “We look forward to following the study’s progress and working with UAB to share the results.”
“We’ve been very strategic in looking for funding opportunities that align to the quintuple aim to improve patient experience and provider experience, improve population health outcomes, reduce cost, and promote health equity,” Mehta said. “Our goal in research is to serve patients and communities while looking at how we can learn, innovate and advance delivery to improve primary care for people with disabilities in managing chronic disease.”
This trial will randomly divide qualified participants into three groups to test different interventions for six months.
Those receiving remote patient monitoring will have a health care team checking and managing their blood sugar remotely. To make this easier for participants, they will be provided the necessary devices and a mobile Wi-Fi data plan to transmit the data, eliminating the need for internet connectivity. If a patient’s blood sugar remains elevated for a long period of time, a registered nurse and health care provider will offer guidance and support.
A second group will receive digital health coaching, which involves one-on-one weekly phone calls with a health coach. This approach offers personalized support and guidance for participants on managing Type 2 diabetes, including advice on nutrition, exercise and taking medications.
Finally, a third group will receive a combination of both the remote patient monitoring and digital health coaching programs.
“Our motivation to respond to PCORI’s call about Telehealth to Optimize Management of Multiple Chronic Conditions among vulnerable populations in primary care was very intentional, and we are excited to have this opportunity to generate rigorous evidence in pragmatic primary care settings,” Mehta said.
This multisite trial will partner with health systems across the Deep South — UAB, the University of Mississippi Medical Center and LSU Health. Alabama, Mississippi and Louisiana currently rank near the bottom of all states for health outcomes (45, 46 and 48, respectively) and have some of the country’s highest rates of diabetes and multiple chronic illnesses, according to America’s Health Rankings.
This award has been approved pending completion of a business and programmatic review by PCORI staff and issuance of a formal award contract.
PCORI is an independent, nonprofit organization authorized by Congress in 2010. Its mission is to fund research that will provide patients, their caregivers and clinicians with the evidence-based information needed to make better-informed health care decisions.