Date of Graduation

Spring 2026

Document Type

Culminating Project

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

Committee Chairperson

Jacquelyn Owens DNP

Committee Member

Mary Lettieri DNP

Abstract

Veterans experience disproportionately high rates of type 2 diabetes mellitus (20.5% vs 11.6% nationally), driven by military-related factors such as PTSD, deployment-related obesity, and service-connected disabilities. At a large urban primary care clinic, 28% (40/141) of veterans with type 2 diabetes mellitus had persistently elevated HbA1c levels of ≥8%, indicating a high risk for diabetes-related complications. This quality improvement project aimed to reduce the proportion of veterans with HbA1c of ≥8% by implementing tailored telemedicine-based medication education, leveraging underutilized virtual care infrastructure to address access barriers and improve diabetes self-management. Participants received two 30-minute telemedicine medication and disease management education sessions at approximately days 14 ± 7 and 42 ± 7, focusing on medication reconciliation, adherence strategies, motivational interviewing, and social determinants of health, followed by repeat HbA1c testing at around 90 ± 7 days. Among the 13 veterans who completed the intervention and follow-up laboratory testing, mean HbA1c decreased from 8.50% to 7.81%. Over half of participants achieved HbA1c below 8% (61.5%) and a reduction of at least 0.5%, while 46.2% achieved a reduction of at least 1.0%. This DNP quality improvement project demonstrated that a structured telemedicine-based medication education intervention is feasible within a VHA primary care clinic and is associated with clinically meaningful improvements in glycemic control among high-risk veterans.

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