JMIR Publications

ABSTRACT

Background:

Despite the increasing prevalence of diabetes in the United States, outcomes continue to fall behind targets and health disparities remain. New approaches to care delivery, including asynchronous telehealth models, should be evaluated as a means of increasing access to care equitably.

Objective:

To evaluate the impact of an asynchronous virtual care model for diabetes and hypertension across a diverse patient population on A1c and blood pressure control.

Methods:

This retrospective cohort study compares the hemoglobin A1c and blood pressure among 95 individuals after 12 months of participation in the 9amHealth virtual care program. The program includes asynchronous care from physicians, including medication prescriptions and lab orders, review of remote patient monitoring data, plus synchronous visits with dietitians and diabetes educators. First and last hemoglobin A1c and blood pressure values were compared among participants, and results were further examined by patient self-reported race and ethnicity.

Results:

The cohort include 45% patients of color. Among all 95 participants, the average HbA1c decreased from 8.2% to 7.2% (-1.0, p<.001), with an average of 314 days between the first and last results. Among participants with a baseline A1c >8%, the average HbA1c decreased from 10.2% to 8.1% (n=46, -2.1, p<.001). Among those with a baseline A1c >9%, the average HbA1c decreased from 11.0% to 8.2% (n=32, -2.8, p<.001). The average A1c among participants who identified as a race/ethnicity other than white decreased from 8.6 to 7.4% (n=39, -1.2, p=.001). The average BP decreased by 17.7mmHg systolic (n=12, p=.006) and 14.3mmHg diastolic (n=12, p=.002). Among participants self-identifying as a race or ethnicity other than white, the results similarly showed a decrease in BP (average reduction in systolic BP of 10mmHg and in diastolic BP of 9mmHg) but with a very small number of individuals meeting the criteria for analysis (n=5).

Conclusions:

Results from this cohort demonstrate effectiveness of an asynchronous virtual care clinic in lowering hemoglobin A1c and blood pressure across a diverse patient population, with similar results across race/ethnicity groups. This flexible model of care may efficiently improve the health outcomes of people living with diabetes and hypertension while decrease health disparities.