Telenursing versus Traditional Outpatient Care for Older Adults with Type 2 Diabetes: Patient Satisfaction, Medication Adherence, and Lifestyle Modification

Abstract

Background: Comparative evidence on routine telenursing versus traditional outpatient care for older adults with type 2 diabetes in Saudi Arabia remains limited. Objectives: To compare the two modalities on patient satisfaction, medication adherence and lifestyle modification. Methods: A cross-sectional comparative study, reported per STROBE, at Hafar Al-Batin Diabetes Center, Saudi Arabia. Stratified random sampling drew 743 older adults from the telenursing (n = 362) and traditional outpatient (n = 381) clinic populations; allocation followed routine service, not randomization. Outcomes were measured with the Telenursing Interaction and Satisfaction Scale (TISS), Adherence to Refills and Medications Scale (ARMS) and Perceived Adherence Lifestyle Modification Questionnaire (PALM-Q). Groups were compared with independent-samples t, Mann–Whitney U and chi-square tests, and care modality entered into multivariable linear regression adjusted for sociodemographic and clinical covariates. Results: Total satisfaction was marginally higher with telenursing (93.90 ± 3.50 vs. 93.28 ± 3.41; mean difference 0.61, 95% CI 0.12–1.11; d = 0.18), confined to the health information (p < 0.001) and decisional control (p = 0.013) domains. After adjustment it was attenuated and borderline (β = 0.52, 95% CI 0.01–1.04, p = 0.048), and not robust to specification. Medication adherence, lifestyle modification and HbA1c did not differ (HbA1c 8.22 ± 1.03% vs. 8.33 ± 1.10%, p = 0.189). Conclusion: Routine telenursing delivered patient experience and self-management outcomes comparable to traditional care, with no evidence of a clinically meaningful advantage in either direction, supporting it as a non-inferior alternative where in-person attendance is difficult rather than a superior model. The cross-sectional design precludes causal inference