Achieving Chronic Care Equity by Leveraging the Telehealth Ecosystem (ACCTIVATE): A Multilevel Randomized Controlled...

Area of Science:

• Public Health
• Health Equity
• Digital Health

Background:

• Persistent racial/ethnic and socioeconomic disparities in diabetes and hypertension outcomes in the U.S. were exacerbated by the COVID-19 pandemic.
• Suboptimal telehealth implementation and the digital divide limit access to digital tools for marginalized communities, worsening health inequities.
• Integrating digital and health literacy is crucial for equitable chronic disease management in U.S. health systems.

Purpose of the Study:

• To evaluate a multi-level intervention (ACCTiVATE trial) designed to address barriers to equitable telehealth use among low-income patients with uncontrolled diabetes.
• To assess the individual and synergistic impact of patient-level (digital coaching) and clinic-level interventions on clinical and process measures.
• To improve chronic health outcomes and telehealth equity for marginalized racial/ethnic populations facing access barriers.

Main Methods:

• A 2x2 factorial randomized controlled trial involving 600 low-income, racially/ethnically diverse patients with uncontrolled diabetes and 11 public health primary care clinics.
• Patient-level intervention: digital coaching (health coaching and digital navigation) vs. usual care for 3 months.
• Clinic-level intervention: equity dashboards, patient advisory councils, and practice facilitation vs. usual care for 24 months.

Main Results:

• Primary clinical outcome: change in Hemoglobin A1c (A1c). Primary process outcome: patient portal usage.
• Secondary clinical outcomes: changes in systolic blood pressure (SBP) and microalbuminuria (UACR) at patient and clinic levels.
• Secondary process outcomes: patient-level digital literacy, medication adherence, patient activation, visit show rates, and clinic-level telehealth adoption.

Conclusions:

• The ACCTiVATE trial employs a stakeholder-engaged, user-centered design to ensure feasibility and acceptability for impacted communities.
• If effective, the intervention offers a scalable model to enhance chronic disease outcomes and telehealth equity for marginalized populations.
• The study aims to provide evidence for integrating digital health strategies to overcome structural and interpersonal access barriers.