Improving geriatric telehealth support for older, rural veterans at risk of diabetic foot complications

ABSTRACT

Background. Diabetic foot complications are costly and common with a higher prevalence in patients aged 65 years and older.1 Access problems are barriers for rural older adults with history of diabetic foot conditions and contribute to higher risk of hospitalizations, emergency room visits, and complications such as ulcers and amputations.2 To prevent these complications, guidelines recommend diabetes self-management education and support (DSMES) with motivational interviewing to promote enhanced self-management for high risk individuals.3 Provider delivery of DSMES has been challenged due to the novel coronavirus (COVID-19) pandemic.4 Therefore, new interventions are needed for improving rural geriatric DSMES access and providing rural primary care providers with geriatric diabetic foot education support. We developed and implemented a novel geriatric high-risk foot DSMES telehealth program at the Atlanta VA Healthcare System to deliver evidence-based structured intensive high risk foot diabetes education for rural older Veterans along with consultation and education for rural primary care providers. Methods: This telehealth program was developed using evidence-based guidelines and is being implemented currently at the Atlanta VA Healthcare System using a plan-do-study-act cycle. Rural Veterans aged 65 and older with diabetes, at risk for diabetes related foot complications and receiving VA primary care are eligible for this three-month consultation program. Initial program effectiveness outcomes include self-efficacy and self-management behaviors reported at baseline and after the three-month intervention. Results/Conclusion: The implementation of this high-risk foot DSMES program will improve rural older Veteran access to evidenced-based structured diabetic foot focused DSMES consultation to enhance participant self-management behaviors and self-efficacy as well as improve support for primary care provider high risk foot education. Veteran enrollment is currently underway with evaluation outcomes forthcoming. We anticipate initial results will be available in at least 30 Veterans.