Evaluating eRAMP telecare for diabetes in outpatient clinics: a hybrid effectiveness-implementation study

This study evaluated the effectiveness and implementation of a telecare-enhanced hybrid consultation model for diabetes management in public general outpatient clinics. In a single-blind, non-inferiority randomized controlled trial involving 786 adults with type 2 diabetes across seven clinics, participants were assigned to either a hybrid care group, receiving alternating telecare and in-person consultations, or a control group, receiving in-person care only, over 84 weeks. The intervention group (IG) showed comparable HbA1c levels to the control group (CG). Blood pressure readings were consistently lower in the IG, and medication adherence remained stable, unlike the CG, which experienced a midline decline. All clinics sustained the telecare model post-trial. Implementation was facilitated by strong leadership and a reliable digital infrastructure, though challenges such as digital literacy and staff workload remained. The model proved effective, comparable cost, and feasible within a public healthcare setting.