JMIR Publications

ABSTRACT

Background:

Prevention through Intervention (PTI), is a community paramedicine (CP) program developed by Birmingham Fire and Rescue Services (BFRS) in Alabama. The program aims to reduce dependency on emergency medical services (EMS) for non-emergency related events through education and seeks to lower the frequency of emergency calls in underserved rural populations. For example, fire departments receive a large amount of “emergency preventable” calls relating to chronic conditions, such as diabetes. Specifically, education surrounding hypoglycemia prevention may improve health literacy and disease management and reduce fear of hypoglycemia.

Objective:

The purpose of this project was to 1) standardize intervention protocol for the CP program with an emphasis on hypoglycemia, 2) use telehealth to tailor the intervention to meet educational needs of participants, and 3) facilitate follow-ups and conduct a preliminary pilot evaluation of the program.

Methods:

This single arm pre-test, post-test intervention included a) an initial in-person visit Week 1, b) 3 weekly tele-coaching calls (Week 2-4), c) one biweekly call (Week 6), d) and a final in-person visit (Week 8) for post-data collection for individuals who have called EMS for hypoglycemic events. In-person visits included educational sessions conducted by EMS personnel. Education included tailored media content relating to hypoglycemia. Weekly tele-coaching calls focused on hypoglycemia symptom monitoring and education reinforcement through the use of a telehealth dashboard. Primary outcome measure included Fear of Hypoglycemia (FH) using the Hypoglycemia Scale: FH-15. Secondary outcome measures included self-efficacy via Perceived Diabetes Self-Management Scale (PDSMS), knowledge of diabetes via Spoken Knowledge in Low Literacy Diabetes scale (SKILLD) and reported EMS hypoglycemia calls.

Results:

A total of 40 participants completed the study intervention. The FH survey showed a decreasing trend in all three subdomains from pre-test to post-test: fear (13.78 vs 9.38), avoidance (8.19 vs 6.08), and interference (10.97 vs 7.92). However, analysis showed no significant differences between total FH scores from pre-test to post-test. Results showed a significant increase in self-efficacy of hypoglycemia self-management via PDSMS (6 + 8.59, P<.027). The SKILLD results showed a significant improvement on Complications of Diabetes, with a mean difference between pre- and post-survey data of 0.5 + 65 (P=.013).

Conclusions:

This study shows preliminary and promising results for a community-based intervention, specifically for hypoglycemia. Frequency of hypoglycemic events and emergency calls were reduced, FH domains trended towards a decrease even though not statistically significant, and participants reported increased self-efficacy and knowledge in hypoglycemia management. However, socio-economic and educational status may have led to high dropout rates and low attendance during the intervention, which is a consideration for future telehealth studies. Clinical Trial: ClinicalTrials.gov NCT03665870