University of Lynchburg DMSc Doctoral Project Assignment Repository

University of Lynchburg DMSc Doctoral Project Assignment Repository


Internal Medicine


Dr. Elyse Watkins, DHSc, PA-C



Purpose: To evaluate current information on the effectiveness of telemedicine in the reduction of hemoglobin (A1c) for rural patients.

Method: Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) protocol was used for eligibility criteria, study selection, data selection, and analysis.16 The CINAHL Full-Text, Cochrane, Medline, and NCBI, databases were searched for English-language articles published between 2015 and 2019. Keywords were: diabetes management, rural, telehealth, or telemedicine. All services under the umbrella of telemedicine were included. Efficacy was based on the reduction of hemoglobin (A1c). Secondary searches used studies in full-text articles while in the review process. Inclusion criteria included: systematic reviews, original research, retrospective studies, descriptive studies, randomized clinical trials, pilot, cohort, and observational studies. Opinion and narrative reviews were excluded.

Results: Two systematic reviews with meta-analysis were examined as well as seven studies including retrospective studies, randomized clinical trials, cohort studies, and observational studies. Evidence suggested telemedicine was successful tool in lowering hemoglobin (A1c) in rural diabetics or those with similar characteristics.

Conclusion: Telemedicine can be effective in delivering patient-centered care in an evidence-based practice model for better management of rural diabetics. Rural medical communities need to overcome barriers in order to benefit from telemedicine with cost savings, improved patient outcomes, improved provider job satisfaction, and increased reimbursements.


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