Improving telehealth access for low-income patients with diabetes

Achieving Chronic Care equiTy by leVeraging the Telehealth Ecosystem

This study is testing a new way to help low-income patients with diabetes use telehealth services better by providing coaching and support to both patients and clinics.

Quick facts

• Phase: NA
• Study type: Interventional
• Enrollment: 600 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: University of California, San Francisco (other)
• Locations: 1 site (San Francisco, California)
• Trial ID: NCT06598436 on ClinicalTrials.gov

What this trial studies

This study examines a multi-level intervention designed to enhance telehealth access for low-income patients managing chronic conditions like diabetes and hypertension. It combines patient-level digital health coaching with clinic-level practice facilitation to address barriers to telehealth use. The intervention aims to improve digital literacy and patient engagement with virtual care, while also empowering primary care clinics to address disparities in telehealth access. The effectiveness of this approach will be assessed over 24 months through clinical outcomes such as glycosylated hemoglobin levels.

Who should consider this trial

Good fit: Ideal candidates are adults aged 18 and older who speak English or Spanish, have diabetes with an A1C level of 8.0% or higher, and have visited a participating primary care site recently.

Not a fit: Patients with high digital literacy or severe co-morbid conditions that hinder telehealth management may not benefit from this intervention.

Why it matters

Potential benefit: If successful, this intervention could significantly improve chronic disease management and health outcomes for low-income patients.

How similar studies have performed: Other studies have shown promise in using digital health interventions to improve chronic disease management, suggesting this approach may be effective.

Eligibility criteria

Inclusion Criteria:

* ≥ 18 years of age
* English or Spanish-Speaking
* Have uncontrolled diabetes defined as a listed diagnosis of diabetes with a recorded A1C ≥ 8.0% in the past two years or have uncontrolled HTN defined as a listed diagnosis of HTN and last recorded documented SBP \>140 mmHg
* At least 2 visits at a participating SFHN primary care site in the last 24 months

Exclusion Criteria:

* Higher than average digital literacy, defined as an Digital Healthcare Literacy Scale (DHLS) score greater than 10, as determined prior to the baseline study visit; these patients may not benefit from a digital coaching intervention.
* Presence of co-morbid conditions that would make it inappropriate to focus on telehealth chronic disease management. Conditions may include: end-stage or terminal condition with limited life expectancy and severe mental illness.
* Lack of any working phone number
* Visual or hearing impairment that precludes use of telehealth for chronic disease management
* Cognitive impairment defined by the inability to restate study goals during the consent process
* Pregnant

Where this trial is running

San Francisco, California

• Zuckerberg San Francisco General Hospital (ZSFG) & SF Department of Public Health (DPH) — San Francisco, California, United States (RECRUITING)

Study contacts

• Principal investigator: Delphine Tuot, MD MAS — University of California, San Francisco
• Study coordinator: Andy Ramirez, BS

Conditions: Diabetes, Adverse Event, Blood Pressure, Community Advisory Board, Chronic Kidney Disease, Clinic-level Intervention, Clinical Research Coordinator, Cardiovascular Disease