Implementation barriers and facilitators of a virtual telehealth program for patients with persistently poorly controlled type 2 diabetes mellitus: a rapid qualitative analysis approach.

backgroundPersistently poorly controlled type 2 diabetes mellitus (PPDM) affects 10-15% of patients with diabetes and disproportionately contributes to morbidity, mortality, and expenditure. Unresponsive to standard outpatient treatment, PPDM requires intensified and comprehensive approaches that lend themselves to a telehealth delivery modality. Despite the recognized need for these types of comprehensive telehealth care models, little is known about factors that influence their implementation in real-world care settings. The objective of this study was to use a secondary qualitative analysis approach to understand implementation barriers and facilitators of a comprehensive virtual care program that has demonstrated superiority in comparison to standard telehealth for patients with PPDM.

methodsPatients (n = 19) and clinical and administrative staff (n = 8) participated in interviews to discuss their first-hand experience with implementation of comprehensive telehealth as part of a comparative effectiveness randomized controlled trial. Using the Health Equity Implementation Framework, we conducted a secondary analysis using rapid qualitative methods to identify factors that may influence the implementation of this approach into routine care delivery.

resultsThe comprehensive diabetes telehealth intervention complemented primary care goals to support diabetes self-management but required novel, complex patterns of communication with the existing care team. The approach was perceived as effective, but the intensity of the program introduced challenges with maintaining ongoing patient engagement. Adaptations related to standardizing provider training and integrating locally available resources and complementary programs may amplify the benefit of the approach to patients. Staffing the approach may require new clinical roles or substituting existing responsibilities to ensure sufficient capacity to deliver the approach with fidelity.

conclusionComprehensive diabetes telehealth intervention implementation is facilitated by using existing infrastructure and care team organization. Opportunities exist to improve fit of the program as part of routine delivery at scale. Findings have implications for the design of strategies to improve implementation efforts required to offer the program at scale to patients with PPDM. CLINICAL TRIAL NUMBER: Not applicable.