Augmenting Telemonitoring Interventions by Targeting Patient Needs in a Primarily Hispanic Underserved Population

Underserved Hispanic patients are particularly vulnerable to problems associated with controlling diabetes. Hispanics not only are more susceptible to developing diabetes, but also have higher A1C values (1) and more severe diabetesrelated complications. Hispanic Americans are 2.6 times more likely to start treatment for diabetesrelated end-stage renal disease and have a 50% higher mortality rate than non-Hispanic whites (2). According to the Hispanic Community Health Study/Study of Latinos, the prevalence of diabetes in the United States is 10.2% in South Americans, 13.4% in Cubans, 17.7% in Central Americans, 18% in Puerto Ricans and Dominicans, and 18.3% in Mexicans (3). Total yearly costs in 2010 for Hispanics with diabetes totaled $49.8 billion and are estimated to reach $109.9 billion in 2025 because of an expected 111% increase in diabetes cases (4). Many diabetes patients, including Hispanics, are overwhelmed by the high treatment burden of self-care demands (5). A retail pharmacy survey of individuals in five states found that many individuals with diabetes lack a focused management plan and may also be confused about specific health care issues (6). One particular obstacle is nonadherence to diabetes treatments. Hispanic patients have exhibited nonadherence behaviors related to their diabetes treatment, including medication nonadherence (7,8). Nonadherence is very costly (9), and savings of $5 billion annually are possible with improved medication adherence on the part of non-Hispanic and Hispanic patients alike. This could result in 341,000 fewer hospitalizations and 700,000 fewer emergency room visits (10). One tactic to mitigate nonadherence has been to involve pharmacists in diabetes management, particularly in primary care settings, where diabetes is a common diagnosis (11). Studies demonstrating the benefit of pharmacists in diabetes care and of their expertise in medication management highlight their importance as interdisciplinary team members (12–17). Including pharmacists in team-based health care delivery models and increasing their role in primary care service delivery have been strongly suggested (11). Although pharmacists use various strategies to provide diabetes management, one unique tool is telemonitoring, a technology through which patients receive specific recommendations after transmitting health data electronically to providers in another location (18). Studies detailing pharmacists’ roles in telemonitoring patients with diabetes and hypertension demonstrate favorable outcomes (12,19–23).