Use of three computer training methods in elderly underserved rural patients enrolled in a diabetes telemedicine program.

A telephone survey of Medicare beneficiaries with diabetes living in rural underserved areas and enrolled in the Informatics for Diabetes Education and Telemedicine project identified 109 subjects who requested further training in functions of the home telemedicine unit after initial in-home training by regional nurse installers. The initial training provided the skills needed to videoconferences with nurse case managers and to transmit blood glucose and blood pressure readings, but further instruction was needed for access to Web-based education features and messaging. This study evaluated these elderly patients' perceptions of the helpfulness of three additional telemedicine training methods:in-home visit with an regional nurse installer referencing a user's manual, unassisted patient use of the user's manual, and telephone-based training not using regional nurse installers reinforcing the user's manual. Eligible subjects rated the helpfulness of the three computer training methods on a five-point Likert scale (1 = "not helpful at all," 5 = "very helpful"). Participants rated "in-home" training with an regional nurse installer significantly higher than they did for the user's manual alone (P < .01). In response to this finding and other companion usability studies, Informatics for Diabetes Education and Telemedicine deployed home telemedicine units with enhanced remote training capabilities to better emulate characteristics of in-person training.