1:

This innovation seems incredibly useful in the primary care setting for patients in the population you describe. I am curious about what challenges presented themselves after adopting the program as well as challenges that have come up in terms of sustaining the program over the long-term and how they have been solved

Julia S., Saturday, December 08, 2012 5:38 pm| University; Other clinician

2:

Some of the challenges for maintaining this program are: (1) providing health coaching, tailored to languge, within a healthcare system where telephone counselling is not reimbursed. Some changes have been made to take the intervention to the health plan level, not clinic level, where health coaches can conduct the coaching call backs as part of on-going population health programs. However, the level of coaching skill is difficult to maintain, without on-going training, especially since there can be high turnover in healthcare settings (2) setting up a telemedicine version that is not based on a company owning the programs, which need to be paid, for each clinic that is interested in the program. This we have done by working to centralize the intervention content via a University-based telemedicine project, funded by UCSF-CTSI. The enables adaptations and new versions to be created and tested at lower cost ;(3) a third challenge is to keep the content interesting for patients, so that they can stay in the intervention for long enough to develop skills to change self-care for diabetes, without growing tired of the content. We have shortened our original intervention to 24 weeks (from 39) to reduce redundencies.

Margaret Handley, Monday, December 17, 2012 7:01 pm| University; Researcher

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