Multidisciplinary Team in Ambulatory Management of Diabetes Mellitus Using Telehealth Among a Sample of Medicaid Patients

Objectives:  Effective treatment of patients with type 2 diabetes mellitus requires a multidisciplinary approach. Our study provided telemedicine healthcare delivery, using a model of collaborative drug therapy management (CDTM) protocol incorporating medical nutrition therapy (MNT) interventions by Dietitians and Pharmacists.  Methods:  We conducted a retrospective chart review of patient data collected between December 2014 and December 2015. We compared five intervention groups of patients (n=12,370) receiving different levels of treatment from Pharmacists, Registered Dietitian/Nutritionist, and/or the Call Center, using Telemedicine consultation techniques over a one-year period. The control group received their supplies through the mail without any contacts with the Call Center, Pharmacists, or Dietitians.  The cross-sectional data collected for A1c were analyzed using ANOVA to assess for within-group differences in A1c reduction among groups with different risk factors. Results:  Roughly, 18 percent of study participants were identified as high-risk, with a serum A1c level greater than 10%.  Lower A1c and low density lipoprotein (LDL) cholesterol levels were reported for patients who received at least four prescription refills over the study period, (-0.113 and -4.931, respectively).  Results reveal that average A1c levels for the intervention groups were lower compared to the control group. Overall, interventions led by Dietitians and Pharmacists resulted in a higher reduction in A1c levels in the high-risk group of patients with type 2 diabetes. Conclusions:  This study showed that using Telemedicine consultation, led by Dietitians and Pharmacists, resulted in a more effective intervention for patients with diabetes and resulted in a positive change of lowering plasma A1c levels and LDL cholesterol as a secondary outcome.  For future study, using the same multidisciplinary intervention and telehealth format, a longitudinal data collected over a minimum of 6-months would allow for tracking of changes in A1c and LDL cholesterol in the individuals with type 2 diabetes.  Keywords: Diabetes, Telemedicine, Telehealth, Pharmacist and Dietitian led intervention, A1c, LDL cholesterol