Date of Graduation

2015

Document Type

Dissertation

Degree Type

DNP

College

School of Nursing

Department

Adult Health

Committee Chair

Jennifer Mallow

Committee Co-Chair

Laurie Theeke

Committee Member

Renee Schwertfeger

Abstract

Background: Type II Diabetes is associated with increased morbidity and mortality. Intense education and positive behavior reinforcement by healthcare professionals has been shown to enhance personal glycemic control for patients with Type II diabetes. However, limitations often prevent patient attendance at diabetes education classes. The purpose of this change project was to assess the efficacy of a telemonitoring intervention on glycemic control. Kotter's change process served as the conceptual underpinning for the project.;Objective: The overall objective was to implement a telemonitoring intervention based on Kotter's change process in a sample of adults with Type II diabetes who obtained care at a rural primary care clinic. The intervention provided education and advanced practice nurse-led management of diabetes. Evaluation outcome measures included glycemic control, enhanced patient knowledge, effectiveness, and feasibility of telemonitoring to improve glycemic control for adult patients with Type II diabetes, living in a rural area.;Methods: A literature search was performed guided by the PICOT question "In adult patients with diabetes, does education by telephone affect blood glucose control?" Seven Randomized Control Trials (RCTs) and one cohort study were reviewed, all of which were quantitative studies, as well as a systematic review on telemonitoring for chronic diseases. Based on the information from these articles, a telemonitoring intervention was developed. The intervention methods included development of a telemonitoring dialogue based on the seven essential components of diabetes education per the AADE7, and introduction of a SMART plan to launch a change project for a rural healthcare clinic to include telemonitoring for diabetes education and management. The change process was guided by Kotter's change theory.;Results: The telemonitoring intervention was performed on a group of ten participants. Eight participants completed the intervention, with an attrition rate of 20%. Mean blood glucose values for the eight participants decreased from 213 mg/dL to 153 mg/dL. However, the findings were not statistically significant (p-value 0.107). Based on post intervention feedback, patient and providers reported satisfaction with the telemonitoring intervention for education and management. Feasibility was hindered by lack of reimbursement for this type of intervention due to reimbursement criteria currently in place for telemonitoring, as well as time and staffing constraints.;Discussion: While findings for blood glucose levels were not statistically significant, likely due to the small sample size, patients experiencing these type of blood glucose reductions may see significant reductions in morbidity and mortality from diabetes. Patients and providers may also experience greater satisfaction implementing this type of intervention. Telemonitoring interventions for diabetes education and management have demonstrated effectiveness in the literature, and could be offered as an alternative to face-to-face interventions. However, due to lack of reimbursement and the large amount of time needed to implement, telemonitoring in this rural clinic may not be routinely implemented in the future.

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