Telehealth in Rural Montana: Promoting Realistic Independent Self-Management of Diabetes

Abstract

Fondly known as “the last best place,” Montana ranks 44th nationally in state population, fourth in land mass, and third for lowest population density in the United States.1 The state has only three counties with a population > 50,000; 53 of its 56 counties are defined as rural.2 Primary care providers (PCPs) who provide the bulk of diabetes care in rural areas experience multiple challenges, including limited health care resources, geographic isolation, and limited access to diabetes education centers.3 Diabetes is a prevalent and costly disease with significant morbidity and mortality.4 New health care delivery strategies to increase rural patients' access to care are needed. Billings Clinic (BC) is a 272-bed hospital and 225-physician regional multi-specialty group practice. Through its Eastern Montana Telemedicine Network (EMTN), BC provides telehealth care to patients living in rural areas in eastern Montana and parts of Wyoming and the Dakotas. The BC Center for Clinical Translational Research (CTR) was established in 1999 to help promote healthier living and improve management of chronic disease. In 2002, CTR, in collaboration with EMTN, initiated a diabetes management project called Promoting Realistic Individual Self Management (PRISM) to enhance diabetes care in rural communities. The 4-year project study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases. The objective of the PRISM project was to implement and evaluate the effectiveness of a nurse practitioner–led multidisciplinary team approach to enhance diabetes care through patient empowerment and improved self-management in close conjunction with patients' PCPs in both urban and rural settings. The goals were to achieve American Diabetes Association (ADA) standards5 for vascular risk factor control and to improve patient self-management skills and patient satisfaction. This article describes the design and implementation process of the telehealth component of the PRISM program and selected …