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Vinadé Chagas ME, Cristina Jacovas V, de Campos Moreira T, Rodrigues Moleda Constant HM, Fernanda Rohden S, Stiehl Alves S, Santini F, Dall'Agnol S, König Klever E, Cezar Cabral F, da Silva Terres M. Are We Adequately Measuring Patient Satisfaction with Telemedicine? A Systematic Review with a Meta-Analysis. Telemed J E Health 2024. [PMID: 38436274 DOI: 10.1089/tmj.2023.0530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Introduction: Telemedicine has gained significant attention as an effective means of providing health care remotely, particularly during the COVID-19 pandemic. Patient satisfaction is a critical aspect of implementing telemedicine, but we have no comprehensive understanding of satisfaction levels and the associated factors. The aim of this systematic review and meta-analysis was to assess patient satisfaction related to telemedicine consultations and to identify key factors influencing satisfaction levels. Results: The search yielded a total of 147 cross-sectional studies, of which 107 met the criteria for inclusion in the meta-analysis. Overall, patient satisfaction with teleconsultations was found to be high, with satisfaction levels ranging from 38 to 100 on a scale of 0 to 100. Only a small percentage (2.72%) of the studies reported satisfaction levels below 75%. Surprisingly, most studies used nonvalidated satisfaction questionnaires, which highlight the need for the development of standardized measurement instruments. Conclusions: This systematic review and meta-analysis provide evidence that patients generally exhibit high levels of satisfaction with telemedicine consultations. The use of nonvalidated satisfaction questionnaires in many studies, however, suggests a need for more standardized assessment tools. Factors such as the time interval between the consultation and the assessment were found to influence satisfaction levels. Understanding these factors can help health care providers improve telemedicine services and patient-provider relationships and optimize health care delivery in the context of telemedicine. Further research is warranted to develop validated satisfaction measurement instruments and explore any additional factors that influence patient satisfaction with telemedicine.
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Affiliation(s)
- Maria Eulália Vinadé Chagas
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | | | | | | | | | - Suelen Stiehl Alves
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Fernando Santini
- Universidade do Vale do Rio dos Sinos (Unisinos), Business School, Porto Alegre, Rio Grande do Sul, Brazil
| | - Sara Dall'Agnol
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Emanuele König Klever
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Mellina da Silva Terres
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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Vaagan A, Haaland-Øverby M, Eriksen AA, Fredriksen K, Stenov V, Varsi C, Ingadóttir B, Cleal BR, Alvheim AR, Westermann KF, Strømme H, Kristjansdottir OB. Group-based patient education via videoconference: A scoping review. PATIENT EDUCATION AND COUNSELING 2024; 118:108026. [PMID: 37939596 DOI: 10.1016/j.pec.2023.108026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 10/12/2023] [Accepted: 10/15/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES To summarize recent evidence on the feasibility, acceptability, and effectiveness of videoconference (VC) group-based patient and caregiver education. METHODS Systematic searches of the literature were conducted. Data was extracted on the characteristics of the studies and interventions and on the feasibility, acceptability, and effectiveness of the interventions. RESULTS From 12,570 hits, 65 studies were eligible for inclusion. Their results confirmed previously identified tendencies of high feasibility and acceptability of VC group patient education, and improved health outcomes. However, evidence of effectiveness is limited, and the quality of studies is varied. Several patient and caregiver groups also remain under-researched. Only four studies stated that facilitators were trained in using VC-technology. CONCLUSION VC group-based patient and caregiver education is feasible and acceptable and may improve health outcomes for participant patients and caregivers. However future research should increase the number of high-quality randomized controlled trials to establish the effectiveness of VC group-based education for several groups of patients and caregivers. Studies of the training of facilitators is also warranted. PRACTICE IMPLICATIONS The results suggest that interventions should be more accessible. An overview of the recent evidence may also stimulate the development and evaluation of VC group-based patient and caregiver education.
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Affiliation(s)
- André Vaagan
- Norwegian National Advisory Unit on Learning and Mastery in Health, Postbox 4959 Nydalen, 0424 Oslo, Norway.
| | - Mette Haaland-Øverby
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway; Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | | | - Kari Fredriksen
- Learning and Mastery Center, Stavanger University Hospital, Stavanger, Norway
| | - Vibeke Stenov
- Health Promotion Research, Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Cecilie Varsi
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway,; Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Brynja Ingadóttir
- Faculty of Nursing and Midwifery, University of Iceland, Reykjavik, Iceland
| | - Bryan Richard Cleal
- Health Promotion Research, Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Anita Røyneberg Alvheim
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
| | - Karl Fredrik Westermann
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
| | - Hilde Strømme
- Library of Medicine and Science, University of Oslo, Oslo, Norway
| | - Olöf Birna Kristjansdottir
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway; Mental health team West, Primary care of the capital area, Reykjavik, Iceland
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3
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Leksell J, Toft E, Rosman J, Eriksson JW, Fischier J, Lindholm-Olinder A, Rosenblad A, Nerpin E. Virtual clinic for young people with type 1 diabetes: a randomised wait-list controlled study. BMC Endocr Disord 2023; 23:255. [PMID: 37990315 PMCID: PMC10664359 DOI: 10.1186/s12902-023-01516-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 11/17/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND The transition from paediatric to adult care for young adults with type 1 diabetes poses unique challenges. Virtual diabetes clinics using smartphone applications offer a promising approach to support self-management and enhance communication with healthcare providers. The primary objective of this study was to evaluate the effects of a virtual diabetes clinic on glycaemic control, treatment satisfaction, and quality of life among young adults diagnosed with type 1. METHODS 79 participants with type 1 diabetes aged 18-25 years were included in a prospective, single-centre, randomised, wait-list controlled trial. Participants were randomly assigned to either the intervention group or the wait-list control group. The intervention group received instant access to a virtual care platform called Vista Dialog, which facilitated real-time communication between patients and healthcare providers. Glycosylated haemoglobin (HbA1c) levels, time in range (TIR), time below range (TBR), diabetes treatment satisfaction, and quality of life were assessed at baseline and after 6 months. RESULTS Baseline characteristics were similar between the intervention and control groups, except for education level, where there was a skewed distribution between the groups (the intervention group had a lower education level). At the 6-month follow-up, there were no significant differences in HbA1c levels, TIR, TBR, or diabetes treatment satisfaction between the two groups. However, the intervention group demonstrated a significant decrease in the burden on physical health compared with the control group, indicating an improved quality of life. CONCLUSIONS The implementation of a virtual diabetes clinic using the Vista Dialog platform did not result in significant improvements in glycaemic control or treatment satisfaction compared with usual care. However, it did show potential benefits in terms of reducing the burden on physical health and improving quality of life in young adults with type 1 diabetes. Further research is needed to explore the long-term effects and optimal use of virtual clinics in diabetes management. TRIAL REGISTRATION ISRCTN number: 73,435,627 (registration date: 23/10/2019): https://doi.org/10.1186/ISRCTN73435627 . The performance and results of this trial adhere to the guidelines outlined in the CONSORT 2010 (Consolidated Standards of Reporting Trials) recommendations.
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Affiliation(s)
- Janeth Leksell
- Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Akademiska sjukhuset, Uppsala, SE-75185, Sweden.
| | - Eva Toft
- Department of Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden
- Diabetes Unit, Ersta Hospital, Stockholm, Sweden
| | - Jessica Rosman
- Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Akademiska sjukhuset, Uppsala, SE-75185, Sweden
| | - Jan W Eriksson
- Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Akademiska sjukhuset, Uppsala, SE-75185, Sweden
| | - Johan Fischier
- Diabetes Unit, Karolinska University hospital, Stockholm, Sweden
| | - Anna Lindholm-Olinder
- Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Akademiska sjukhuset, Uppsala, SE-75185, Sweden
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Andreas Rosenblad
- Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Akademiska sjukhuset, Uppsala, SE-75185, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden
- Department of Statistics, Uppsala University, Uppsala, Sweden
| | - Elisabet Nerpin
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
- Department of Medical Sciences, Respiratory Medicine, Allergy and Sleep, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden
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4
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Dinh T, Staab EM, Nuñez D, Zhu M, Wan W, Schaefer CT, Campbell A, Quinn M, Baig AA. Evaluating Effects of Virtual Diabetes Group Visits in Community Health Centers During the COVID-19 Pandemic. J Patient Exp 2023; 10:23743735231199822. [PMID: 37693188 PMCID: PMC10492483 DOI: 10.1177/23743735231199822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023] Open
Abstract
Diabetes is the seventh leading cause of death in the US. Diabetes group visits (GVs), which include group education and individual medical visits have been shown to improve clinical outcomes. However, few studies have evaluated virtual GVs. We conducted a single-arm pilot study to test the impact of virtual diabetes GVs in Midwestern community health centers (CHCs). Adult patients with diabetes participated in monthly virtual GVs for 6 months. Surveys and chart abstraction were used to assess patient-reported and clinical outcomes. Five CHCs implemented virtual GVs with 34 patients attending at least one session. Virtual GVs show promise as evidenced by these findings: (1) Patients had a nonsignificant decrease in A1C. (2) In the subgroup of patients with baseline A1C ≥ 9%, there was a significant decrease in A1C. (3) Patients had significant increases in diabetes knowledge and support as well as a decrease in diabetes distress. Future studies with a larger sample size and a control comparison group are needed to assess the impact of virtual GVs on patient outcomes.
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Affiliation(s)
- Tracy Dinh
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Erin M Staab
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Daisy Nuñez
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Mengqi Zhu
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Wen Wan
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | | | | | - Michael Quinn
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Arshiya A Baig
- Department of Medicine, University of Chicago, Chicago, IL, USA
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5
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Bisno DI, Reid MW, Pyatak EA, Flores Garcia J, Salcedo-Rodriguez E, Torres Sanchez A, Fox DS, Hiyari S, Fogel JL, Marshall I, Bachmann G, Raymond JK. Virtual Peer Groups Reduce HbA1c and Increase Continuous Glucose Monitor Use in Adolescents and Young Adults with Type 1 Diabetes. Diabetes Technol Ther 2023; 25:589-601. [PMID: 37335751 DOI: 10.1089/dia.2023.0199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Background: Adolescents and young adults (AYA) from diverse and marginalized backgrounds with type 1 diabetes (T1D) generally have higher hemoglobin A1c (HbA1c) levels and less frequent continuous glucose monitor (CGM) use than AYA from more privileged backgrounds. Further, scant data address the impact of virtual peer groups (VPG) on health-related outcomes for ethnically and racially diverse AYA with T1D. Methods: CoYoT1 to California was a 15-month randomized controlled trial for AYA aged 16-25 years. In this study, AYA were randomized to receive standard care (n = 28), or CoYoT1 care (n = 40), which consisted of person-centered provider visits and bimonthly VPG. VPG were AYA-driven discussions. AYA completed the Diabetes Distress Scale (DDS), Center for Epidemiologic Studies Depression (CES-D), and Diabetes Empowerment Scale-Short Form (DES-SF) scales at baseline and all study visits. Results: Participants were 50% Latinx and 75% publicly insured. Among CoYoT1 care participants, 19 attended at least 1 VPG session (VPG attendees) and 21 did not attend any VPG sessions. VPG attendees participated in 4.1 VPG sessions on average. VPG attendees had a relative reduction in HbA1C (treatment effect -1.08%, effect sizes values [ES] = -0.49, P = 0.04) and increase in CGM use (treatment effect +47%, ES = 1.00, P = 0.02) compared to standard care. VPG participation was not associated with statistically significant changes in DDS, CES-D, and DES-SF scores. Conclusions: In a 15-month randomized controlled trial, AYA with T1D who participated in VPG reported significant improvements in HbA1c and CGM use. Peer interactions may support unmet needs of AYA with T1D from diverse and marginalized backgrounds. ClinicalTrials.gov Identifier: NCT03793673.
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Affiliation(s)
- Daniel I Bisno
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Mark W Reid
- Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Elizabeth A Pyatak
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
| | | | | | | | - D Steven Fox
- School of Pharmacy, University of Southern California, Los Angeles, California, USA
| | - Sarah Hiyari
- Children's Hospital Los Angeles, Los Angeles, California, USA
| | | | - Ian Marshall
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Gloria Bachmann
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Jennifer K Raymond
- Children's Hospital Los Angeles, Los Angeles, California, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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6
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Bassi M, Dufour F, Strati MF, Franzone D, Scalas M, Lionetti B, Spacco G, Rizza F, Sburlati P, Casalini E, Parodi S, d’Annunzio G, Minuto N. Advanced Hybrid Closed Loop users' satisfaction of telemedicine and telenursing in pediatric and young adult type 1 diabetes. Front Public Health 2023; 11:1249299. [PMID: 37711248 PMCID: PMC10497768 DOI: 10.3389/fpubh.2023.1249299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/14/2023] [Indexed: 09/16/2023] Open
Abstract
Background and aims The aim of the study was to evaluate the satisfaction of the use of telemedicine and telenursing in children and young adults with Type 1 Diabetes (T1D) using Advanced Hybrid Closed Loop systems (AHCL) with a focus on the role of connectivity, data download and the ease of technical steps in the set and sensor change procedures. Methods An online anonymous survey was administered to AHCL users. The questionnaire consisted of five Clusters: Cluster A-B-C included questions related to the general satisfaction in the use of telemedicine, Cluster D was focused on the role of data download and connectivity, Cluster E was related to satisfaction in telenursing and Cluster F to the perception of ease of execution of the technical steps like changing the infusion set and the sensor. Results We collected 136 completed questionnaires. 83.8% of AHCL users were overall satisfied with the quality of the telemedicine service. 88.2% of patients downloaded AHCL data before visits and the overall quality of televisits (data sharing, connectivity, ease of use) was satisfactory for 85.3% of users. Telenursing support during set and sensor change procedures was considered effective by 98% of AHCL users. The sensor and insulin infusion set change procedure is perceived as different for the two systems: set change simpler for Medtronic (p = 0.011) users, while sensor change was simpler for Tandem users (p = 0.009). Conclusion Telemedicine and telenursing have an essential role in diabetology and are highly appreciated in AHCL users. The nurse support in the education of the use of AHCL systems is effective and must be implemented. Unfortunately, not all patients have the technological tools needed for downloading data at home and using telemedicine services; this represents an important challenge for the future of diabetology and for the equity in accessibility to care.
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Affiliation(s)
- Marta Bassi
- Pediatric Clinic, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Francesca Dufour
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Marina Francesca Strati
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Daniele Franzone
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Marta Scalas
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Barbara Lionetti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Giordano Spacco
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Francesca Rizza
- Pediatric Clinic, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Prisca Sburlati
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Emilio Casalini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Stefano Parodi
- Epidemiology and Biostatistics Unit, Scientific Directorate, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Nicola Minuto
- Pediatric Clinic, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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7
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Zurynski Y, Carrigan A, Meulenbroeks I, Sarkies MN, Dammery G, Halim N, Lake R, Davis E, Jones TW, Braithwaite J. Transition models of care for type 1 diabetes: a systematic review. BMC Health Serv Res 2023; 23:779. [PMID: 37474959 PMCID: PMC10360292 DOI: 10.1186/s12913-023-09644-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 06/04/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Managing the care regimen for Type 1 Diabetes is challenging for emerging adults, as they take on greater responsibility for self-management. A diverse range of models of care have been implemented to improve safety and quality of care during transition between paediatric and adult services. However, evidence about acceptability and effectiveness of these is limited. Our aim was to synthesise the evidence for transition models and their components, examine the health related and psychosocial outcomes, and to identify determinants associated with the implementation of person-centred models of transition care. METHOD We searched Medline, CINAHL, EMBASE and Scopus. Peer reviewed empirical studies that focused on T1D models of care published from 2010 to 2021 in English, reporting experimental, qualitative, mixed methods, and observational studies were included. RESULTS Fourteen studies reported on health and psychosocial outcomes, and engagement with healthcare. Three key models of care emerged: structured transition education programs (6 studies), multidisciplinary team transition support (5 studies) and telehealth/virtual care (3 studies). Compared with usual practice, three of the six structured transition education programs led to improvements in maintenance of glycaemic control, psychological well-being, and engagement with health services. Four MDT transition care models reported improved health outcomes, and improved engagement with health services, however, three studies reported no benefit. Reduced diabetes related stress and increased patient satisfaction were reported by two studies, but three reported no benefit. Telehealth and virtual group appointments improved adherence to self-management and reduced diabetes distress but did not change health outcomes. CONCLUSIONS Although some health and psychosocial benefits are reported, the results were mixed. No studies reported on T1D transition model implementation outcomes such as acceptability, adoption, and appropriateness among clinicians or managers implementing these models. This gap needs to be addressed to support future adoption of successful models.
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Affiliation(s)
- Yvonne Zurynski
- NHMRC Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde, Sydney, Australia.
| | - Ann Carrigan
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde, Sydney, Australia
| | - Isabelle Meulenbroeks
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Mitchell N Sarkies
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde, Sydney, Australia
| | - Genevieve Dammery
- NHMRC Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Nicole Halim
- NHMRC Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Rebecca Lake
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde, Sydney, Australia
| | - Elizabeth Davis
- Telethon Kids Institute, University of Western Australia, Perth, Australia
- Perth Children's Hospital, Perth, Australia
| | - Timothy W Jones
- Telethon Kids Institute, University of Western Australia, Perth, Australia
- Perth Children's Hospital, Perth, Australia
| | - Jeffrey Braithwaite
- NHMRC Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, North Ryde, Sydney, Australia
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8
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Crossen SS, Wagner DV. Narrowing the Divide: The Role of Telehealth in Type 1 Diabetes Care for Marginalized Communities. J Diabetes Sci Technol 2023; 17:901-908. [PMID: 36896887 PMCID: PMC10348000 DOI: 10.1177/19322968231157367] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Widespread uptake of telehealth in response to the COVID-19 pandemic has highlighted geographic, demographic, and economic disparities in access to virtual care. However, research studies and clinical programs that predate the pandemic demonstrate the potential for telehealth-based interventions to improve access to and outcomes of type 1 diabetes (T1D) care for individuals in geographically or socially marginalized communities. In this expert commentary, we discuss telehealth-based care models that have been successful in improving care for marginalized T1D populations. We also outline the policy changes needed to expand access to such interventions to reduce established disparities in T1D care and promote better health equity among people living with T1D.
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Affiliation(s)
- Stephanie S. Crossen
- Division of Pediatric Endocrinology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - David V. Wagner
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
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9
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Ballesta S, Chillarón JJ, Inglada Y, Climent E, Llauradó G, Pedro-Botet J, Cots F, Camell H, Flores JA, Benaiges D. Telehealth model versus in-person standard care for persons with type 1 diabetes treated with multiple daily injections: an open-label randomized controlled trial. Front Endocrinol (Lausanne) 2023; 14:1176765. [PMID: 37441496 PMCID: PMC10333924 DOI: 10.3389/fendo.2023.1176765] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/06/2023] [Indexed: 07/15/2023] Open
Abstract
Objective Increasing evidence indicates that the telehealth (TH) model is noninferior to the in-person approach regarding metabolic control in type 1 diabetes (T1D) and offers advantages such as a decrease in travel time and increased accessibility for shorter/frequent visits. The primary aim of this study was to compare the change in glycated hemoglobin (HbA1c) at 6 months in T1D care in a rural area between TH and in-person visits. Research design and methods Randomized controlled, open-label, parallel-arm study among adults with T1D. Participants were submitted to in-person visits at baseline and at months 3 and 6 (conventional group) or teleconsultation in months 1 to 4 plus 2 in-person visits (baseline and 6 months) (TH group). Mixed effects models estimated differences in HbA1c changes. Results Fifty-five participants were included (29 conventional/26 TH). No significant differences in HbA1c between groups were found. Significant improvement in time in range (5.40, 95% confidence interval (CI): 0.43-10.38; p < 0.05) and in time above range (-6.34, 95% CI: -12.13- -0.55;p < 0.05) in the TH group and an improvement in the Diabetes Quality of Life questionnaire (EsDQoL) score (-7.65, 95% CI: -14.67 - -0.63; p < 0.05) were observed. In TH, the costs for the participants were lower. Conclusions The TH model is comparable to in-person visits regarding HbA1c levels at the 6-month follow-up, with significant improvement in some glucose metrics and health-related quality of life. Further studies are necessary to evaluate a more efficient timing of the TH visits.
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Affiliation(s)
- Sílvia Ballesta
- Endocrinology and Nutrition, Consorci Sanitari de l’Alt Penedès Garraf, Vilafranca del Penedès, Spain
- Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Universitari Mar, Barcelona, Spain
| | - Juan J. Chillarón
- Endocrinology and Nutrition, Consorci Sanitari de l’Alt Penedès Garraf, Vilafranca del Penedès, Spain
- Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Barcelona Biomedical Research Park (PRBB), Barcelona, Spain
- Department of Medicine, Universitat Pompeu Fabra, Barcelona, Spain
| | - Yolanda Inglada
- Endocrinology and Nutrition, Consorci Sanitari de l’Alt Penedès Garraf, Vilafranca del Penedès, Spain
| | - Elisenda Climent
- Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Department of Medicine, Universitat Pompeu Fabra, Barcelona, Spain
| | - Gemma Llauradó
- Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Barcelona Biomedical Research Park (PRBB), Barcelona, Spain
- Department of Medicine, Universitat Pompeu Fabra, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Juan Pedro-Botet
- Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Universitari Mar, Barcelona, Spain
| | - Francesc Cots
- Management Control Department, Hospital del Mar, Barcelona, Spain
| | - Helena Camell
- Internal Medicine, Hospital Comarcal de l´Alt Penedès, Vilafranca del Penedès, Spain
| | - Juana A. Flores
- Endocrinology and Nutrition, Consorci Sanitari de l’Alt Penedès Garraf, Vilafranca del Penedès, Spain
- Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Barcelona Biomedical Research Park (PRBB), Barcelona, Spain
- Department of Medicine, Universitat Pompeu Fabra, Barcelona, Spain
| | - David Benaiges
- Endocrinology and Nutrition, Consorci Sanitari de l’Alt Penedès Garraf, Vilafranca del Penedès, Spain
- Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Barcelona Biomedical Research Park (PRBB), Barcelona, Spain
- Department of Medicine, Universitat Pompeu Fabra, Barcelona, Spain
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10
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von Sengbusch S, Schneidewind J, Bokelmann J, Scheffler N, Bertram B, Frielitz FS, Hiort O, Lange K. Monthly video consultation for children and adolescents with type 1 diabetes mellitus during the COVID-19 pandemic. Diabetes Res Clin Pract 2022; 193:110135. [PMID: 36374788 PMCID: PMC9616483 DOI: 10.1016/j.diabres.2022.110135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/06/2022] [Accepted: 10/18/2022] [Indexed: 12/14/2022]
Abstract
AIMS To explore the impact of primarily telemedical care for children and adolescents with type 1 diabetes by monthly video consultations on metabolic control and parents' treatment satisfaction and disease-specific burden during the COVID-19 pandemic. METHODS In this 12-month multicenter observational follow-up VIDIKI 2.0 study, 100 participants (3-18 years) received monthly video consultations, which partially replaced quarterly outpatient clinic appointments during the pandemic. The children's metabolic parameters as well as the parents' treatment satisfaction and diabetes specific burden were assessed at study entry and 12 months later. RESULTS During the study, 912 video consultations took place (mean 0.84 ± 0.23 / patient/month). The children's HbA1c remained stable, while mean sensor glucose level and glucose management indicator decreased. Simultaneously, parents' treatment satisfaction significantly increased, and their diabetes-specific burden and distress decreased. CONCLUSIONS Primarily telemedical care of children and adolescents with type 1 diabetes during the COVID-19 pandemic via monthly video consultations resulted in a significant improvement in parents' treatment satisfaction and their diabetes-specific burden and distress. It was associated with a slight improvement in mean sensor glucose and glucose management indicator, while HbA1c remained stable. Thus, video consultations offer great potential to enhance standard care for children and adolescents with diabetes.
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Affiliation(s)
- Simone von Sengbusch
- Division of Pediatric Endocrinology and Diabetology, University Medical Center Schleswig- Holstein, Campus Lübeck, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
| | - Julia Schneidewind
- Division of Pediatric Endocrinology and Diabetology, University Medical Center Schleswig- Holstein, Campus Lübeck, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
| | - Jessica Bokelmann
- Department of Pediatrics, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany.
| | - Nadine Scheffler
- Department of Pediatrics, General Hospital Itzehoe, Robert-Koch-Straße 2, 25524 Itzehoe, Germany.
| | - Bettina Bertram
- Department of Pediatrics, General Hospital Kiel, Chemnitzstraße 33, 24116 Kiel, Germany.
| | - Fabian-Simon Frielitz
- Institute for Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
| | - Olaf Hiort
- Division of Pediatric Endocrinology and Diabetology, University Medical Center Schleswig- Holstein, Campus Lübeck, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
| | - Karin Lange
- Hannover Medical School, Medical Psychology, Carl-Neuberg Straße 1, 30625 Hannover, Germany.
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11
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Toschi E, Leblanc J, Hafida S, Mehta S, Ritholz M, Gabbay R, Laffel L. Caring for Young Adults With Diabetes in the Adult Care Setting: Summary of a Multidisciplinary Roundtable. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:830183. [PMID: 36992759 PMCID: PMC10012109 DOI: 10.3389/fcdhc.2022.830183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/31/2022] [Indexed: 01/09/2023]
Abstract
AimsA multidisciplinary team of clinicians and researchers, patients and family members, and representative from national advocacy groups and research organization met to review the literature, highlight gaps, and identify best practices to improve adult care delivery for young adults (YA) with diabetes.MethodsThe participants prepared presentations in advance, rotated through sessions, and contributed to group discussions in three areas: physical health, mental health, and quality of life (QoL). Session moderators and scribes used thematic analysis to summarize discussions for each topic.ResultsThematic analysis revealed four foci for addressing physical health, mental health and QoL: 1) best practices to facilitate the process of transfer; 2) age-specific curricula and guidelines for prevention and management of comorbidities and complications; 3) collaboration with behavioral health clinicians to address diabetes distress and mental health disorders; and 4) research on the impact of diabetes on QoL in YA.ConclusionThere was substantial interest and need among adult clinicians to work in concert with pediatric and mental health professionals to identify best practices and future directions to improve healthcare process and diabetes-related outcome measures in YA with diabetes.
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Affiliation(s)
- Elena Toschi
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
- Section on Clinical, Behavioral, and Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
- *Correspondence: Elena Toschi,
| | - Jennifer Leblanc
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
| | - Samar Hafida
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
| | - Sanjeev Mehta
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
| | - Marilyn Ritholz
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
| | - Robert Gabbay
- American Diabetes Association, Alexandria, VA, United States
| | - Lori Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
- Section on Clinical, Behavioral, and Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
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12
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Crossen SS, Bruggeman BS, Haller MJ, Raymond JK. Challenges and Opportunities in Using Telehealth for Diabetes Care. Diabetes Spectr 2022; 35:33-42. [PMID: 35308158 PMCID: PMC8914589 DOI: 10.2337/dsi21-0018] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The ongoing coronavirus pandemic led to a rapid and dramatic increase in the use of telehealth for diabetes care. In the wake of this transition, we examine new opportunities and ongoing challenges for using telehealth within diabetes management, based on data and experiences from the pre-pandemic and pandemic time frames.
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Affiliation(s)
- Stephanie S. Crossen
- Division of Pediatric Endocrinology, University of California, Davis, Sacramento, CA
- Corresponding author: Stephanie S. Crossen,
| | | | - Michael J. Haller
- Division of Pediatric Endocrinology, University of Florida, Gainesville, FL
| | - Jennifer K. Raymond
- Division of Pediatric Endocrinology, Children’s Hospital Los Angeles, Los Angeles, CA
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13
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Berkanish P, Pan S, Viola A, Rademaker Q, Devine KA. Technology-Based Peer Support Interventions for Adolescents with Chronic Illness: A Systematic Review. J Clin Psychol Med Settings 2022; 29:911-942. [PMID: 35147830 PMCID: PMC8853345 DOI: 10.1007/s10880-022-09853-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 01/11/2023]
Abstract
Technology may help adolescents with chronic illnesses overcome barriers to accessing peer support, which has been associated with better quality of life and health outcomes. This review aimed to describe technology-based peer support interventions for adolescents with chronic illness following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Of 3781 articles identified, 32 met inclusion criteria. The most common technologies were websites with discussion forums (n = 18), chat messaging (n = 9), and video conferencing (n = 7). Most studies (69%) focused on feasibility and had small sample sizes. Results support the feasibility and acceptability of these interventions. Results suggested positive effects on social support, but were mixed on isolation, quality of life, and disease self-management. There were too few adequately powered randomized controlled trials to determine efficacy of these interventions at this time. Future work should use rigorous methods to evaluate efficacy and account for rapid shifts in technology for adolescent communication.
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Affiliation(s)
| | - Samuel Pan
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Adrienne Viola
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | | | - Katie A Devine
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA. .,Rutgers Cancer Institute of New Jersey and Rutgers, The State University of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08903, USA.
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14
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March CA, Muzumdar R, Libman I. How Do Virtual Visits Compare? Parent Satisfaction With Pediatric Diabetes Telehealth During the COVID-19 Pandemic. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 2:794493. [PMID: 36994343 PMCID: PMC10012131 DOI: 10.3389/fcdhc.2021.794493] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/09/2021] [Indexed: 11/13/2022]
Abstract
BackgroundIn response to the COVID-19 pandemic, many countries relaxed restrictions on telemedicine, allowing for a robust transition to virtual visits for routine care. In response, centers rapidly instituted and scaled telemedicine for pediatric diabetes care. Despite numerous center reports on their experience, little is known about parent perspectives on the widespread increase of telemedicine for pediatric diabetes appointments.ObjectiveTo assess parent satisfaction with virtual care for pediatric diabetes during the COVID-19 pandemic.MethodsWe conducted an online, cross-sectional survey of parents of youth with diabetes who receive care at a large, academic diabetes center regarding their perspectives on newly introduced virtual appointments. Parents were surveyed at two time points during the pandemic using a validated scale which was adapted for diabetes. We explored demographic and clinical factors which may influence parental satisfaction.ResultsOverall, parents expressed high levels of satisfaction (>90%) with functional aspects of the visit, though only approximately half (56%) felt the visit was as good as an in-person encounter. Nearly three-quarters (74%) would consider using telemedicine again in the future. Prior use of telemedicine significantly influenced parent satisfaction, suggesting that parent preferences may play a role in continued use of telemedicine in the future. There was no difference in responses across the two timepoints, suggesting high satisfaction early in the pandemic which persisted.ConclusionsIf permissive policies for telemedicine continue, diabetes centers could adopt hybrid in-person and virtual care models, while considering various stakeholder perspectives (providers and patients) and equity in access to virtual care.
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15
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Marr A, Tsampalieros A, Courtney J, Seid Hamid J, St-Denis-Murphy J, Stevens L, Ahmet A, Goldbloom EB. Patient and family perspectives of a Pre-Transition Visit in a paediatric tertiary care diabetes clinic. BMJ Open Qual 2022; 11:e001563. [PMID: 35101867 PMCID: PMC8804658 DOI: 10.1136/bmjoq-2021-001563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 01/13/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The need to better prepare youth with type 1 diabetes for the transition from paediatric to adult care is evident. As part of a regional quality improvement initiative, a novel Pre-Transition (Pre-T) Visit was developed and piloted at a paediatric tertiary care centre in January 2018 for patients aged 15-18 years to capture the status of their self-management skills, introduce transition tools and identify self-care goals and knowledge gaps to be addressed prior to transition. PURPOSE To evaluate patient and family satisfaction, visit relevance and patient engagement with a novel Pre-T Visit. METHODS From May 2019 to March 2020 a survey was offered to all youth who attended a Pre-T Visit and their parent(s)/caregiver(s). Patient and family satisfaction with, relevance of and engagement with the Pre-T Visit were evaluated using a 5-point Likert scale. Multivariable regression was used to assess patient factors associated with patient level satisfaction. RESULTS Of the 63 youth who participated in a Pre-T Visit, 60 completed the survey. Mean age (SD) of participants was 16.7 (0.8) years; 47% were female. Mean (SD) haemoglobin A1C (A1C) was 8.2% (1.8). Patients reported high levels of satisfaction (95% quite or extremely satisfied) that were consistent across age, A1C, gender and disease duration. Visit relevance and engagement were also rated highly by youth. Parent participants (n=27) also reported high levels of satisfaction (89% quite or extremely satisfied) and relevance. CONCLUSIONS Pre-T Visits were rated highly by patients and their parents. Their impact on glycaemic control and health outcomes following transition requires further study.
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Affiliation(s)
- Alexa Marr
- Division of Endocrinology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Anne Tsampalieros
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Jennilea Courtney
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Jemila Seid Hamid
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Mathematics and Statistics, University of Ottawa, Ottawa, Ontario, Canada
| | - Josee St-Denis-Murphy
- Division of Endocrinology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Liz Stevens
- Division of Endocrinology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Alexandra Ahmet
- Division of Endocrinology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Ellen B Goldbloom
- Division of Endocrinology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
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16
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Nuñez D, Marino-Nuñez D, Staab EM, Dinh T, Zhu M, Wan W, Schaefer CT, Campbell A, Quinn MT, Baig AA. Adapting in-person diabetes group visits to a virtual setting across federally qualified health centers. FRONTIERS IN HEALTH SERVICES 2022; 2:961073. [PMID: 36925842 PMCID: PMC10012803 DOI: 10.3389/frhs.2022.961073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 10/28/2022] [Indexed: 11/13/2022]
Abstract
Diabetes group visits (GVs) have been shown to improve glycemic control, enrich patient self-care, and decrease healthcare utilization among patients with type 2 diabetes mellitus (T2DM). While telehealth has become routine, virtual GVs remain understudied, especially in federally qualified health centers (FQHCs). We conducted a 5-year cluster randomized trial with a waitlist control group to test the impact of diabetes GVs on patients' outcomes in Midwestern FQHCs. Due to COVID-19, the 6 waitlisted FQHCs adapted to virtual GVs. FQHC staff were provided training and support to implement virtual GVs. The GV intervention included 6 monthly 1-1.5-h long education sessions and appointments with a primary care provider. We measured staff perspectives and satisfaction via GV session logs, monthly webinars, and staff surveys and interviews. Adaptations for implementation of virtual GV included: additional staff training, video conferencing platform use, decreased session length and group size, and adjusting study materials, activities, and provider appointments. Sites enrolled a total of 48 adults with T2DM for virtual GVs. Most FQHCs were urban and all FQHCs predominantly had patients on public insurance. Patients attended 2.1 ± 2.2 GVs across sites on average. Thirty-four patients (71%) attended one or more virtual GVs. The average GV lasted 79.4 min. Barriers to virtual GVs included patient technology issues and access, patient recruitment and enrollment, and limited staff availability. Virtual GV facilitators included providing tablets, internet access from the clinic, and technical support. Staff reported spending on average 4.9 h/week planning and implementing GVs (SD = 5.9). On average, 6 staff from each FQHC participated in GV training and 1.2 staff reported past GV experience. All staff had worked at least 1 year at their FQHC and most reported multiple years of experience caring for patients with T2DM. Staff-perceived virtual GV benefits included: empowered patients to manage their diabetes, provided patients with social support and frequent contact with providers, improved relationships with patients, increased team collaboration, and better patient engagement and care-coordination. Future studies and health centers can incorporate these findings to implement virtual diabetes GVs and promote accessible diabetes care.
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Affiliation(s)
- Daisy Nuñez
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Diana Marino-Nuñez
- Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Erin M Staab
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Tracy Dinh
- Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Mengqi Zhu
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Wen Wan
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | | | - Amanda Campbell
- Midwest Clinicians' Network, East Lansing, MI, United States
| | - Michael T Quinn
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Arshiya A Baig
- Department of Medicine, University of Chicago, Chicago, IL, United States
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17
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Garcia JF, Peters AL, Raymond JK, Fogel J, Orrange S. Equity in Medical Care for People Living With Diabetes. Diabetes Spectr 2022; 35:266-275. [PMID: 36082008 PMCID: PMC9396720 DOI: 10.2337/dsi22-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Disparities and inequities exist for individuals with diabetes in marginalized communities of color, especially among people with low socioeconomic status. Although these barriers are apparent, only a few care models have been designed for and examined in racially and ethnically diverse individuals. This article reviews models that have been developed and examined in a variety of different populations and focuses on how to implement elements from these programs in clinical practice. Health equity-promoting ideas and approaches that can be applied throughout the life span (children to seniors) are also included. As diabetes health care providers, researchers, educators, policymakers, and advocates, we must now combine our efforts and focus on historically excluded populations to bridge the gap to essential diabetes care.
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Affiliation(s)
| | | | | | | | - Sharon Orrange
- University of Southern California, Los Angeles, CA
- Corresponding author: Sharon Orrange,
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18
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Desimone ME, Sherwood J, Soltman SC, Moran A. Telemedicine in cystic fibrosis. J Clin Transl Endocrinol 2021; 26:100270. [PMID: 34765457 PMCID: PMC8571077 DOI: 10.1016/j.jcte.2021.100270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/30/2021] [Accepted: 10/21/2021] [Indexed: 02/08/2023] Open
Abstract
Cystic Fibrosis (CF) requires lifetime multidisciplinary care to manage both pulmonary and extra pulmonary manifestations. The median age of survival for people with CF is rising and the number of adults with CF is expected to increase dramatically over the coming years. People with CF have better outcomes when managed in specialty centers, however access can be limited. Telemedicine and technology-based care solutions may help to overcome barriers to availability and improve access. This review outlines the use of telehealth for CF management. Telehealth has been utilized for CF across a broad variety of indications, even prior to the COVID-19 pandemic, and in general has been well accepted by patients and providers. There are a paucity of data, however, related to health outcomes, and the healthcare utilization specific to CF and its related comorbidities. Future studies are needed to address the questions of health outcomes, cost, burdens of telehealth and barriers to implementation.
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Affiliation(s)
- Marisa E. Desimone
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Upstate Medical University 750 East Adams Street, Syracuse, NY 13210, USA
| | - Jordan Sherwood
- Division of Pediatric Endocrinology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Sarah C. Soltman
- Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health and Science University, 3270 SW Pavilion Loop, Portland, OR 97239, USA
| | - Antoinette Moran
- Division of Pediatric Endocrinology, University of Minnesota, 2512 S 7th Street, Minneapolis, MN 55454, USA
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19
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Garcia JF, Fogel J, Reid M, Bisno DI, Raymond JK. Telehealth for Young Adults With Diabetes: Addressing Social Determinants of Health. Diabetes Spectr 2021; 34:357-362. [PMID: 34866868 PMCID: PMC8603121 DOI: 10.2337/dsi21-0011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Type 1 diabetes is a challenging chronic condition and can lead to diabetes-related distress and disengagement. Historically disadvantaged, racially and ethnically diverse young adults (YAs) with type 1 diabetes experience higher blood glucose levels and encounter more barriers to care than their White counterparts. Current research shows that telehealth may provide a route for improving psychosocial issues and diabetes care among YAs.
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Affiliation(s)
- Jaquelin Flores Garcia
- Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA
- Corresponding author: Jaquelin Flores Garcia,
| | - Jennifer Fogel
- Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA
| | - Mark Reid
- Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA
| | - Daniel I. Bisno
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Jennifer K. Raymond
- Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA
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20
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Crossen SS, Romero CC, Loomba LA, Glaser NS. Patient Perspectives on Use of Video Telemedicine for Type 1 Diabetes Care in the United States during the COVID-19 Pandemic. ENDOCRINES 2021; 2:449-456. [PMID: 35373189 PMCID: PMC8975132 DOI: 10.3390/endocrines2040040] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The COVID-19 pandemic has resulted in widespread adoption of telemedicine for management of chronic conditions such as type 1 diabetes (T1D), but few data have been collected about the patient experience and perceived quality of care during this time. We surveyed members of the T1D Exchange patient registry and online community regarding their experiences with and opinions about telemedicine care during the pandemic. Among 2235 survey respondents, 65% had utilized telemedicine. The most common reasons for adopting telemedicine were providers not offering in-person care (66%), concerns about the health risks of in-person care (59%), providers offering (52%) or insurance covering (19%) telemedicine for the first time, and local or state orders to stay home (33%). Among telemedicine users, 62% felt video care was as effective as or more effective than in-person care, and 82% hoped to use telemedicine in the future. The most-cited reason for non-use of telemedicine was that providers were not offering it (49%). Our findings highlight the role of telemedicine in maintaining access to T1D care during the COVID-19 pandemic. Respondents’ satisfaction with telemedicine and interest in its continued use signifies the need for ongoing access to this care modality and for the development of telemedicine best practices within T1D care.
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Affiliation(s)
- Stephanie S. Crossen
- Department of Pediatrics, University of California, Davis, Sacramento, CA 95817, USA
- Center for Health and Technology, University of California, Davis, Sacramento, CA 95817, USA
- Correspondence: ; Tel.: +1-916-734-7098; Fax: +1-916-734-7070
| | - Crystal C. Romero
- Department of Pediatrics, University of California, Davis, Sacramento, CA 95817, USA
| | - Lindsey A. Loomba
- Department of Pediatrics, University of California, Davis, Sacramento, CA 95817, USA
| | - Nicole S. Glaser
- Department of Pediatrics, University of California, Davis, Sacramento, CA 95817, USA
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21
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Majidi S, Reid MW, Fogel J, Anderson B, Klingensmith GJ, Cain C, Berget C, Raymond JK. Psychosocial outcomes in young adolescents with type 1 diabetes participating in shared medical appointments. Pediatr Diabetes 2021; 22:787-795. [PMID: 33838078 DOI: 10.1111/pedi.13212] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 03/20/2021] [Accepted: 04/06/2021] [Indexed: 12/11/2022] Open
Abstract
For youth with type 1 diabetes (T1D), the early adolescent period is associated with worsening diabetes management and high rates of negative psychosocial issues, including depressive symptoms and family conflict. Alternative clinical models may help improve both diabetes and psychosocial outcomes. Our study aims to investigate whether Team Clinic, a shared medical appointment model developed specifically for adolescents with T1D, will improve psychosocial outcomes for middle school-aged youth. Youth with T1D, 11-13 years of age, and their caregivers, participated in a randomized controlled trial comparing Team Clinic to traditional clinic visits (control group). Diabetes characteristics were obtained at every visit. Participants and caregivers completed depression screening and family conflict questionnaires at baseline and end of study. Changes in mean scores on clinical and psychosocial outcomes from baseline to end of study were compared between groups using linear mixed-effects models. Eighty-six youth (51% female; 74% White; 10% Hispanic) completed at least one visit during the 12-month study period. At the end of the study, control group participants reported increases in Emotional Problems compared to Team Clinic participants, including higher levels of Negative Mood/Physical Symptoms (p = 0.02). Team Clinic participants reported reduced family conflict surrounding diabetes at study end, compared to control group participants (p = 0.03). Caregivers did not report change in depressive symptoms or family conflict during the study. Hemoglobin A1C levels did not change over time in either group. Participation in Team Clinic was associated with improved psychosocial outcomes in middle school-aged participants with T1D.
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Affiliation(s)
- Shideh Majidi
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Mark W Reid
- Center for Endocrinology, Diabetes, and Metabolism, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Jennifer Fogel
- Center for Endocrinology, Diabetes, and Metabolism, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Barbara Anderson
- Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA
| | - Georgeanna J Klingensmith
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Cindy Cain
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Cari Berget
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jennifer K Raymond
- Center for Endocrinology, Diabetes, and Metabolism, Children's Hospital Los Angeles, Los Angeles, California, USA
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22
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Rachmiel M, Lebenthal Y, Mazor-Aronovitch K, Brener A, Levek N, Levran N, Chorna E, Dekel M, Barash G, Landau Z, Pinhas-Hamiel O. Glycaemic control in the paediatric and young adult population with type 1 diabetes following a single telehealth visit - what have we learned from the COVID-19 lockdown? Acta Diabetol 2021; 58:697-705. [PMID: 33511493 PMCID: PMC7842171 DOI: 10.1007/s00592-021-01673-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 01/07/2021] [Indexed: 02/08/2023]
Abstract
AIMS Children with chronic diseases were unable to receive their usual care during COVID-19 lockdown. We assessed the feasibility and impact of telehealth visits on the time-in-range (TIR) of paediatric individuals with type 1 diabetes (T1D). METHODS An observational multicentre real-life study. Patients scheduled for an in-clinic visit during the lockdown were offered to participate in a telehealth visit. Sociodemographic, clinical, continuous glucose monitor and pump data were recorded 2 weeks prior and 2 weeks after telehealth visit. The primary endpoint was change in relative-TIR, i.e. change in TIR divided by the percent of possible change (∆TIR/(100-TIRbefore)*100). RESULTS The study group comprised 195 individuals with T1D (47.7% males), mean±SD age 14.6 ± 5.3 years, and diabetes duration 6.0 ± 4.6 years. Telehealth was accomplished with 121 patients and their parents (62.0%); 74 (38.0%) did not transfer complete data. Mean TIR was significantly higher for the two-week period after the telehealth visit than for the two-week period prior the visit (62.9 ± 16.0, p < 0.001 vs. 59.0 ± 17.2); the improvement in relative-TIR was 5.7±26.1%. Initial higher mean glucose level, lower TIR, less time spent at <54 mg/dl range, longer time spent at 180-250 mg/dl range, higher daily insulin dose, and single-parent household were associated with improved relative-TIR. Multiple regression logistic analysis demonstrated only initial lower TIR and single-parent household were significant, odds ratio: -0.506, (95%CI -0.99,-0.023), p=0.04 and 13.82, (95%CI 0.621, 27.016), p=0.04, respectively. CONCLUSIONS Paediatric and young adult patients with T1D benefited from a telehealth visit during COVID-19. However, this modality is not yet suitable for a considerable proportion of patients.
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Affiliation(s)
- Marianna Rachmiel
- Pediatric Endocrinology Unit, Shamir (Assaf Harofeh) Medical Center, Tzrifin, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yael Lebenthal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Kineret Mazor-Aronovitch
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Juvenile Diabetes Center, Maccabi Health Care Services, Ra'anana, Israel
- Pediatric Endocrine and Diabetes Unit, Chaim Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Ramat-Gan, Israel
| | - Avivit Brener
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Noa Levek
- National Juvenile Diabetes Center, Maccabi Health Care Services, Ra'anana, Israel
- Pediatric Endocrine and Diabetes Unit, Chaim Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Ramat-Gan, Israel
| | - Neria Levran
- National Juvenile Diabetes Center, Maccabi Health Care Services, Ra'anana, Israel
- Pediatric Endocrine and Diabetes Unit, Chaim Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Ramat-Gan, Israel
| | - Efrat Chorna
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Michal Dekel
- Pediatric Endocrinology Unit, Shamir (Assaf Harofeh) Medical Center, Tzrifin, Israel
| | - Galia Barash
- Pediatric Endocrinology Unit, Shamir (Assaf Harofeh) Medical Center, Tzrifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zohar Landau
- National Juvenile Diabetes Center, Maccabi Health Care Services, Ra'anana, Israel
- Pediatrics Department, Barzilai Medical Center, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Orit Pinhas-Hamiel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Juvenile Diabetes Center, Maccabi Health Care Services, Ra'anana, Israel
- Pediatric Endocrine and Diabetes Unit, Chaim Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Ramat-Gan, Israel
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Chan CB, Popeski N, Hassanabad MF, Sigal RJ, O'Connell P, Sargious P. Use of Virtual Care for Glycemic Management in People With Types 1 and 2 Diabetes and Diabetes in Pregnancy: A Rapid Review. Can J Diabetes 2021; 45:677-688.e2. [PMID: 34045146 DOI: 10.1016/j.jcjd.2021.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/18/2021] [Accepted: 02/28/2021] [Indexed: 11/26/2022]
Abstract
Our objective in this study was to answer the main research question: In patients with diabetes, does virtual care vs face-to-face care provide different clinical, patient and practitioner experience or quality outcomes? Articles (2012 to 2020) describing interventions using virtual care with the capability for 2-way, individualized interactions compared with usual care were included. Studies involving any patients with diabetes and outcomes of glycated hemoglobin (A1C), quality of care and/or patient or health-care practitioner experience were included. Systematic reviews, randomized controlled studies, quasi-experimental trials, implementation trials, observational studies and qualitative analyses were reviewed. MEDLINE and McMaster Health Evidence databases searched in June 2020 identified 59 articles. Virtual care, in particular telemonitoring, combined with a means of 2-way communications provided improvement in A1C similar or superior to usual care, with the strongest evidence for type 2 diabetes. Virtual care was generally acceptable to patients, who expressed satisfaction with their care. Health-care providers recognized benefits but raised issues of technical support, workflow and compensation.
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Affiliation(s)
- Catherine B Chan
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada; Department of Agricultural, Food and Nutritional Sciences, Li Ka Shing Centre for Health Innovation Research, University of Alberta, Edmonton, Alberta, Canada; Department of Physiology, University of Alberta, Edmonton, Alberta, Canada.
| | - Naomi Popeski
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Mortaza Fatehi Hassanabad
- Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada; Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ronald J Sigal
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Petra O'Connell
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Peter Sargious
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada; Department of Medicine, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
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24
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Smith MB, Albanese-O'Neill A, Yao Y, Wilkie DJ, Haller MJ, Keenan GM. Feasibility of the Web-Based Intervention Designed to Educate and Improve Adherence Through Learning to Use Continuous Glucose Monitor (IDEAL CGM) Training and Follow-Up Support Intervention: Randomized Controlled Pilot Study. JMIR Diabetes 2021; 6:e15410. [PMID: 33560234 PMCID: PMC7902192 DOI: 10.2196/15410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 07/11/2020] [Accepted: 07/23/2020] [Indexed: 01/29/2023] Open
Abstract
Background Proper training and follow-up for patients new to continuous glucose monitor (CGM) use are required to maintain adherence and achieve diabetes-related outcomes. However, CGM training is hampered by the lack of evidence-based standards and poor reimbursement. We hypothesized that web-based CGM training and education would be effective and could be provided with minimal burden to the health care team. Objective The aim of this study was to perform a pilot feasibility study testing a theory-driven, web-based intervention designed to provide extended training and follow-up support to adolescents and young adults newly implementing CGM and to describe CGM adherence, glycemic control, and CGM-specific psychosocial measures before and after the intervention. Methods The “Intervention Designed to Educate and improve Adherence through Learning to use CGM (IDEAL CGM)” web-based training intervention was based on supporting literature and theoretical concepts adapted from the health belief model and social cognitive theory. Patients new to CGM, who were aged 15-24 years with type 1 diabetes for more than 6 months were recruited from within a public university’s endocrinology clinic. Participants were randomized to enhanced standard care or enhanced standard care plus the IDEAL CGM intervention using a 1:3 randomization scheme. Hemoglobin A1c levels and psychosocial measures were assessed at baseline and 3 months after start of the intervention. Results Ten eligible subjects were approached for recruitment and 8 were randomized. Within the IDEAL CGM group, 4 of the 6 participants received exposure to the web-based training. Half of the participants completed at least 5 of the 7 modules; however, dosage of the intervention and level of engagement varied widely among the participants. This study provided proof of concept for use of a web-based intervention to deliver follow-up CGM training and support. However, revisions to the intervention are needed in order to improve engagement and determine feasibility. Conclusions This pilot study underscores the importance of continued research efforts to optimize the use of web-based intervention tools for their potential to improve adherence and glycemic control and the psychosocial impact of the use of diabetes technologies without adding significant burden to the health care team. Enhancements should be made to the intervention to increase engagement, maximize responsiveness, and ensure attainment of the skills necessary to achieve consistent use and improvements in glycemic control prior to the design of a larger well-powered clinical trial to establish feasibility. Trial Registration ClinicalTrials.gov NCT03367351, https://clinicaltrials.gov/ct2/show/NCT03367351.
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Affiliation(s)
- Madison B Smith
- College of Nursing, University of Florida, Gainesville, FL, United States
| | | | - Yingwei Yao
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, United States
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, United States
| | - Michael J Haller
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Gail M Keenan
- Department of Family, Community and Health Systems Science, College of Nursing, University of Florida, Gainesville, FL, United States
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25
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March CA, Flint A, DeArment D, Gilliland A, Kelly K, Rizzitano E, Chrisman A, Muzumdar RH, Libman IM. Paediatric diabetes care during the COVID-19 pandemic: Lessons learned in scaling up telemedicine services. ENDOCRINOLOGY DIABETES & METABOLISM 2020; 4:e00202. [PMID: 33349799 PMCID: PMC7744857 DOI: 10.1002/edm2.202] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 09/14/2020] [Accepted: 10/13/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Christine A March
- Division of Pediatric Endocrinology, Metabolism, and Diabetes UPMC Children's Hospital of Pittsburgh Pittsburgh PA USA
| | - Amanda Flint
- Division of Pediatric Endocrinology, Metabolism, and Diabetes UPMC Children's Hospital of Pittsburgh Pittsburgh PA USA
| | - Diana DeArment
- Division of Pediatric Endocrinology, Metabolism, and Diabetes UPMC Children's Hospital of Pittsburgh Pittsburgh PA USA
| | - Amy Gilliland
- Division of Pediatric Endocrinology, Metabolism, and Diabetes UPMC Children's Hospital of Pittsburgh Pittsburgh PA USA
| | - Karen Kelly
- Division of Pediatric Endocrinology, Metabolism, and Diabetes UPMC Children's Hospital of Pittsburgh Pittsburgh PA USA
| | - Ernesto Rizzitano
- Division of Pediatric Endocrinology, Metabolism, and Diabetes UPMC Children's Hospital of Pittsburgh Pittsburgh PA USA
| | - Aaron Chrisman
- Division of Pediatric Endocrinology, Metabolism, and Diabetes UPMC Children's Hospital of Pittsburgh Pittsburgh PA USA
| | - Radhika H Muzumdar
- Division of Pediatric Endocrinology, Metabolism, and Diabetes UPMC Children's Hospital of Pittsburgh Pittsburgh PA USA
| | - Ingrid M Libman
- Division of Pediatric Endocrinology, Metabolism, and Diabetes UPMC Children's Hospital of Pittsburgh Pittsburgh PA USA
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26
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Population Health Management in Diabetes Care: Combining Clinical Audit, Risk Stratification, and Multidisciplinary Virtual Clinics in a Community Setting to Improve Diabetes Care in a Geographically Defined Population. An Integrated Diabetes Care Pilot in the North East Locality, Oxfordshire, UK. Int J Integr Care 2020; 20:21. [PMID: 33335462 PMCID: PMC7716785 DOI: 10.5334/ijic.5177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background: Disparities in diabetes care are prevalent, with significant inequalities observed in access to, and outcomes of, healthcare. A population health approach offers a solution to improve the quality of care for all with systematic ways of assessing whole population requirements and treating and monitoring sub-groups in need of additional attention. Description of the care practice: Collaborative working between primary, secondary and community care was introduced in seven primary care practices in one locality in England, UK, caring for 3560 patients with diabetes and sharing the same community and secondary specialist diabetes care providers. Three elements of the intervention included 1) clinical audit, 2) risk stratification, and 3) the multi-disciplinary virtual clinics in the community. Methods: This paper evaluates the acceptability, feasibility and short-term impact on primary care of implementing a population approach intervention using direct observations of the clinics and surveys of participating clinicians. Results and discussion: Eighteen virtual clinics across seven teams took place over six months between March and July 2017 with organisation, resources, policies, education and approximately 150 individuals discussed. The feedback from primary care was positive with growing knowledge and confidence managing people with complex diabetes in primary care. Conclusion: Taking a population health approach helped to identify groups of people in need of additional diabetes care and deliver a collaborative health intervention across traditional organisational boundaries.
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27
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Evaluation of telephone and virtual visits for routine pediatric diabetes care during the COVID-19 pandemic. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2020; 22:100238. [PMID: 33072519 PMCID: PMC7548628 DOI: 10.1016/j.jcte.2020.100238] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/28/2020] [Accepted: 10/03/2020] [Indexed: 02/06/2023]
Abstract
Aims To evaluate pediatric type 1 diabetes telehealth visits during the COVID-19 pandemic, with a focus on assessing the usability of these visits and gathering patient perspectives. Methods An online survey, which included a validated telehealth usability questionnaire, was offered via email to families with a telephone or virtual visit since the COVID-19-related cancellation of routine in-person care. Survey data was linked with the British Columbia (BC) Clinical Diabetes Registry. Outcomes between groups were assessed using Welch's t-test. Associations with type of visit as well as with desire to return to in-person care were assessed with logistic regression models. Results The response rate was 47%. Of 141 survey respondents, 87 had clinical data available in the BC Clinical Diabetes Registry, and thus were included in our analysis. Overall, telephone and virtual visits were rated highly for usability. Telephone visits were easier to learn to use, and simpler to understand; however, telephone and virtual visits were similar across multiple areas. No factors associated with choosing one type of visit over the other, or with desire to return to in-person care, could be identified. 72% of participants want future telehealth care; however, some would like all future care to be in-person. Conclusions Telephone and virtual visits had impressive usability. Many families want telehealth to play a significant part in their future care.
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28
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Cuttriss N, Bouchonville MF, Maahs DM, Walker AF. Tele-rounds and Case-Based Training: Project ECHO Telementoring Model Applied to Complex Diabetes Care. Pediatr Clin North Am 2020; 67:759-772. [PMID: 32650871 DOI: 10.1016/j.pcl.2020.04.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Lack of access to subspecialty care and persistent suboptimal outcomes for insulin-requiring patients with diabetes mandates development of innovative health care delivery models. The workforce shortage of endocrinologists in the United States results in primary care providers taking on the role of diabetes specialists despite lack of confidence and knowledge in complex diabetes management. The telementoring model Project ECHO amplifies and democratizes specialty knowledge to reduce disparities in care and improve health outcomes. Project ECHO can be applied to type 1 diabetes and other complex medical conditions to address health disparities and urgent needs of complex patients throughout the lifespan.
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Affiliation(s)
- Nicolas Cuttriss
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
| | - Matthew F Bouchonville
- Division of Endocrinology, Diabetes and Metabolism, University of New Mexico, MSC10 5550 1 University of New Mexico, Albuquerque, NM 87131, USA
| | - David M Maahs
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, 300 Pasteur Drive, Room G-313, Stanford, CA 94305, USA
| | - Ashby F Walker
- Department of Health Services Research, Management and Policy, HPNP, Room 3117, University of Florida, Gainesville, FL 32611, USA
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29
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Abstract
Management of type 1 diabetes mellitus for pediatric and young adult patients is well suited for telehealth. Diabetes management requires frequent communication with health care providers as well as the interpretation of many types of data that can be measured in the home and shared virtually to the provider by the patient. Telehealth technologies allow for a safe alternative and/or addition to in-person care for youth with diabetes. Telehealth increases access to health care, saves time and money, and results in improvements in rates of appointment adherence, patient satisfaction, and quality of life.
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Affiliation(s)
- Jennifer L Fogel
- Division of Endocrinology, Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA
| | - Jennifer K Raymond
- Division of Endocrinology, Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA; Keck School of Medicine of the University of Southern California, 1975 Zonal Avenue, Los Angeles, CA 90089, USA.
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30
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Fuchs J, Hovorka R. COVID-19 and Diabetes: Could Diabetes Technology Research Help Pave the Way for Remote Healthcare? J Diabetes Sci Technol 2020; 14:735-736. [PMID: 32475169 PMCID: PMC7673188 DOI: 10.1177/1932296820929714] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Julia Fuchs
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Roman Hovorka
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- Department of Paediatrics, University of Cambridge, UK
- Roman Hovorka, PhD, University of Cambridge Metabolic Research Laboratories, NIHR Cambridge Biomedical Research Centre, Wellcome Trust-MRC Institute of Metabolic Science, Box 289, Addenbrookes Hospital, Hills Road, Cambridge CB2 0QQ, UK.
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31
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Williams S, Newhook LAA, Power H, Shulman R, Smith S, Chafe R. Improving the transitioning of pediatric patients with type 1 diabetes into adult care by initiating a dedicated single session transfer clinic. Clin Diabetes Endocrinol 2020; 6:11. [PMID: 32518677 PMCID: PMC7275548 DOI: 10.1186/s40842-020-00099-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 05/28/2020] [Indexed: 12/20/2022] Open
Abstract
Background Young adults with type 1 diabetes face potential health problems and disruptions in accessing care related to their move from pediatrics into adult care. At a medium-sized pediatric hospital with no formal transition support program, we developed and evaluated the use of a single-session transfer clinic as an initial quality improvement intervention to improve patient satisfaction, clinic attendance, and knowledge of transition related issues. Methods Following a jurisdictional scan of other diabetes programs, the pediatric diabetes program developed a half-day transfer clinic. After the first transfer clinic was held, evaluation surveys were completed by patients, parents, and healthcare providers. Based on the feedback received, we altered the structure and evaluated the revised clinic by surveying patients and parents. Results All patients and parents who attended reported high levels of satisfaction with the clinic. Providers were also mostly positive regarding their participation. Feedback from the first clinic was used to modify the structure of the second clinic to better meet the needs of participants and to allow the clinic to run more efficiently. The use of group sessions and adapting resources developed by other diabetes programs were viewed favourably by participants and lessened the burden on staff who delivered the clinic. Conclusions A half-day transfer clinic is a viable step towards improving patient and parent satisfaction during the transition into adult care without requiring additional staff or significant expenditures of new resources. This type of clinic can also be incorporated into a larger program of transition supports or be adopted by programs serving young adults with other chronic diseases.
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Affiliation(s)
- Sarah Williams
- Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Canada
| | - Leigh Anne Allwood Newhook
- Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Canada.,Janeway Pediatric Research Unit, Memorial University of Newfoundland and Labrador, St. John's, Canada.,Division of Children and Women's Health, Eastern Health, St. John's, Canada
| | - Heather Power
- Janeway Pediatric Research Unit, Memorial University of Newfoundland and Labrador, St. John's, Canada.,Division of Children and Women's Health, Eastern Health, St. John's, Canada
| | - Rayzel Shulman
- Hospital for Sick Children, Toronto, Canada.,SickKids Research Institute, Toronto, Canada.,Institute for Clinical and Evaluative Sciences, Toronto, Canada
| | - Sharon Smith
- Janeway Pediatric Research Unit, Memorial University of Newfoundland and Labrador, St. John's, Canada
| | - Roger Chafe
- Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Canada.,Janeway Pediatric Research Unit, Memorial University of Newfoundland and Labrador, St. John's, Canada
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32
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Raymond JK, Reid MW, Fox S, Garcia JF, Miller D, Bisno D, Fogel JL, Krishnan S, Pyatak EA. Adapting home telehealth group appointment model (CoYoT1 clinic) for a low SES, publicly insured, minority young adult population with type 1 diabetes. Contemp Clin Trials 2020; 88:105896. [DOI: 10.1016/j.cct.2019.105896] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/12/2019] [Accepted: 11/14/2019] [Indexed: 10/25/2022]
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33
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Frielitz FS, Müller-Godeffroy E, Hübner J, Eisemann N, Dördelmann J, Menrath I, Katalinic A, Hiort O, von Sengbusch S. Monthly Video-Consultation for Children With Type 1 Diabetes Using a Continuous Glucose Monitoring System: Design of ViDiKi, a Multimethod Intervention Study to Evaluate the Benefit of Telemedicine. J Diabetes Sci Technol 2020; 14:105-111. [PMID: 31315446 PMCID: PMC7189148 DOI: 10.1177/1932296819861991] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The introduction of continuous glucose monitoring (CGM) implies new challenges for diabetes care. As CGM systems are often directly linked to a web-based software solution, structured telemedicine care using a video-consultation may be a new option for families who care for children with type 1 diabetes mellitus (T1DM). METHODS "ViDiKi" (Virtual Diabetes Outpatient Clinic for Children and Youth) is a multicenter controlled trial carried out in Northern Germany. ViDiKi will examine if monthly telemedical consultations, in addition to regular care, will improve glycemic control and psychosocial outcomes. The primary outcome is glycemic control as measured by a change in glycated hemoglobin (HbA1c). A total of 240 participants aged between one year and 16 years using a CGM with multiple daily injections (MDI) or insulin pump therapy were recruited and assigned to a starter group or a six-month waiting control group. The sample size is designed to detect a between-group difference of 0.5% in HbA1c change at six months. Secondary outcomes are variability of blood glucose, health-related quality of life, self-efficacy, and satisfaction with telemedicine. To gain deeper insight into the experience of using telemedicine, qualitative interviews will be conducted. In a health-economic analysis, the costs of telemedicine and a cost-of-care analysis will be calculated. CONCLUSIONS The results from the ViDiKi study shall give important information on the feasibility and putative benefits of telemedicine in children with T1DM and their caregivers. GERMAN CLINICAL TRAILS REGISTER (DRKS) DRKS00012645.
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Affiliation(s)
- Fabian-Simon Frielitz
- Institute of Social Medicine and
Epidemiology, University of Luebeck, Germany
- Fabian-Simon Frielitz, Institute for Social
Medicine and Epidemiology, University of Luebeck, Ratzeburger Allee 160, Luebeck
23562, Germany.
| | - Esther Müller-Godeffroy
- Department of Pediatric Endocrinology
and Diabetology, University Medical Center, Campus Luebeck, Germany
| | - Joachim Hübner
- Institute of Social Medicine and
Epidemiology, University of Luebeck, Germany
| | - Nora Eisemann
- Institute of Social Medicine and
Epidemiology, University of Luebeck, Germany
| | - Jana Dördelmann
- Institute of Social Medicine and
Epidemiology, University of Luebeck, Germany
| | - Ingo Menrath
- Department of Pediatric Endocrinology
and Diabetology, University Medical Center, Campus Luebeck, Germany
| | - Alexander Katalinic
- Institute of Social Medicine and
Epidemiology, University of Luebeck, Germany
| | - Olaf Hiort
- Department of Pediatric Endocrinology
and Diabetology, University Medical Center, Campus Luebeck, Germany
| | - Simone von Sengbusch
- Department of Pediatric Endocrinology
and Diabetology, University Medical Center, Campus Luebeck, Germany
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34
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Wan W, Nathan AG, Skandari MR, Zarei P, Reid MW, Raymond JK, Huang ES. Cost-effectiveness of Shared Telemedicine Appointments in Young Adults With T1D: CoYoT1 Trial. Diabetes Care 2019; 42:1589-1592. [PMID: 31189564 PMCID: PMC6647044 DOI: 10.2337/dc19-0363] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/02/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Young adults with type 1 diabetes (T1D) often struggle to achieve glycemic control and maintain routine clinic visits. We aimed to evaluate the societal cost-effectiveness of the Colorado young adults with T1D (CoYoT1) Clinic, an innovative care model of shared medical appointments through home telehealth. RESEARCH DESIGN AND METHODS Patients self-selected into the CoYoT1 (N = 42) or usual care (N = 39) groups. RESULTS Within the trial, we found no significant differences in 9-month quality-adjusted life; however, the control group had a larger decline from baseline in utility than the CoYoT1 group, indicating a quality of life (QoL) benefit of the intervention (difference in difference mean ± SD: 0.04 ± 0.09; P = 0.03). There was no significant difference in total costs. The CoYoT1 group had more study-related visits but fewer nonstudy office visits and hospitalizations. CONCLUSIONS: The CoYoT1 care model may help young adults with T1D maintain a higher QoL with no increase in costs.
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Affiliation(s)
- Wen Wan
- Section of General Internal Medicine, The University of Chicago, Chicago, IL
| | - Aviva G Nathan
- Section of General Internal Medicine, The University of Chicago, Chicago, IL
| | - M Reza Skandari
- Section of General Internal Medicine, The University of Chicago, Chicago, IL
| | - Parmida Zarei
- Section of General Internal Medicine, The University of Chicago, Chicago, IL
| | - Mark W Reid
- Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA
| | - Jennifer K Raymond
- Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA
| | - Elbert S Huang
- Section of General Internal Medicine, The University of Chicago, Chicago, IL
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Ramchandani N, Way N, Melkus GD, Sullivan-Bolyai S. Challenges to Diabetes Self-Management in Emerging Adults With Type 1 Diabetes. DIABETES EDUCATOR 2019; 45:484-497. [PMID: 31304878 DOI: 10.1177/0145721719861349] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of this qualitative descriptive study undergirded by Meleis's Transition Framework was to explore developmental, situational, and organizational challenges experienced by a diverse group of emerging adults (18-29 years old) with type 1 diabetes (T1DM). Their perspectives on creating a developmentally informed diabetes self-management (DSM) program that supports transitional care were also explored. METHODS A purposive sample of emerging adults with T1DM was recruited from the pediatric and adult diabetes clinics of an urban academic medical center. Those who consented participated in either a single focus group or a single interview. Self-reported demographic and clinical information was also collected. RESULTS The sample was comprised of 21 emerging adults, with an average age of 23.6 ± 2.6 years, diabetes duration of 14.7 ± 5.0 years, and 71% female. Four main themes emerged: (1) finding a balance between diabetes and life, (2) the desire to be in control of their diabetes, (3) the hidden burden of diabetes, and (4) the desire to have a connection with their diabetes provider. Use of insulin pumps and continuous glucose monitors and attendance at diabetes camp decreased some of the DSM challenges. Different groups of individuals had different perspectives on living with diabetes and different approaches to DSM. CONCLUSIONS The emerging adults in this study had a strong desire to be in good glycemic control. However, all participants described having a hard time balancing DSM with other competing life priorities. They also desired personalized patient-provider interactions with their diabetes care provider in clinical follow-up services. Even though the study sample was small, important themes emerged that warrant further exploration.
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Affiliation(s)
| | - Niobe Way
- Department of Applied Psychology, New York University Steinhardt, New York, New York
| | | | - Susan Sullivan-Bolyai
- University of Massachusetts Medical School-Graduate School of Nursing, Worcester, Massachusetts
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Bakhach M, Reid MW, Pyatak EA, Berget C, Cain C, Thomas JF, Klingensmith GJ, Raymond JK. Home Telemedicine (CoYoT1 Clinic): A Novel Approach to Improve Psychosocial Outcomes in Young Adults With Diabetes. DIABETES EDUCATOR 2019; 45:420-430. [PMID: 31244396 DOI: 10.1177/0145721719858080] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess the impact of a home telemedicine clinic model (CoYoT1 Clinic) on psychosocial and behavioral outcomes designed for young adults (YAs) with type 1 diabetes (T1D). METHODS YAs self-selected to participate in the CoYoT1 Clinic or serve as a usual care control. CoYoT1 Clinic visits consisted of an individual appointment with a provider and a group appointment with other YAs with T1D using home telemedicine. Psychosocial and behavioral functioning was assessed by 4 measures: Diabetes Distress Scale, Self-Efficacy for Diabetes Scale, Self-Management of Type 1 Diabetes in Adolescence Scale, and Center for Epidemiologic Studies Depression Scale. RESULTS Forty-two patients participated in the CoYoT1 Clinic and 39 patients served as controls. CoYoT1 participants reported lower levels of distress (P = .03), increased diabetes self-efficacy (P = .01), and improved ability to communicate with others about diabetes (P = .04) over the study period compared to controls. YA males in the control group reported increases in depressive symptoms (P = .03) during the study period, but CoYoT1 participants showed no changes. CONCLUSION Group home telemedicine for YAs with T1D positively affects diabetes distress, self-efficacy, and diabetes-specific communication. These positive findings have the potential to also affect the YAs' long-term diabetes outcomes. Further investigation of the model is needed.
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Affiliation(s)
- Marwan Bakhach
- Children's Hospital Los Angeles, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Mark W Reid
- Children's Hospital Los Angeles, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Elizabeth A Pyatak
- Chan Division of Occupational Science and Occupational Therapy, Ostrow School of Dentistry, University of Southern California, Los Angeles, California
| | - Cari Berget
- Barbara Davis Center for Diabetes, University of Colorado, Department of Pediatrics, Anschutz Medical Campus, Aurora, Colorado
| | - Cindy Cain
- Barbara Davis Center for Diabetes, University of Colorado, Department of Pediatrics, Anschutz Medical Campus, Aurora, Colorado
| | - John Fred Thomas
- Department of Telehealth, School of Medicine, University of Colorado, Aurora, Colorado.,Department of Psychiatry, School of Medicine, University of Colorado, Aurora, Colorado.,Department of Epidemiology, School of Public Health, University of Colorado, Aurora, Colorado
| | - Georgeanna J Klingensmith
- Barbara Davis Center for Diabetes, University of Colorado, Department of Pediatrics, Anschutz Medical Campus, Aurora, Colorado
| | - Jennifer K Raymond
- Children's Hospital Los Angeles, University of Southern California, Keck School of Medicine, Los Angeles, California
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Abstract
Rates of diabetes are increasing worldwide and there is not a sufficient clinical workforce to care for these patients. Diabetes-related apps are a feasible way to provide diabetes education to large numbers of people with diabetes but attrition rates are high. Apps enhanced by virtual coaching may be a way to circumnavigate these problems. Virtual coaches are able to address common treatment barriers and other health disparities by providing data-driven individualized support in real time, at any time of day, and from anywhere. Enhanced glycemic benefits have been seen in those who use an app plus virtual coaching versus those who use an app alone, along with clinically meaningful behavior change, psychosocial effects, prolonged engagement, and high levels of satisfaction with the system. More research needs to be done to determine the longitudinal and widespread effects of virtual coaching in different populations.
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Kelly SL, Steinberg EA, Suplee A, Upshaw NC, Campbell KR, Thomas JF, Buchanan CL. Implementing a Home-Based Telehealth Group Adherence Intervention with Adolescent Transplant Recipients. Telemed J E Health 2019; 25:1040-1048. [PMID: 30681398 DOI: 10.1089/tmj.2018.0164] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Introduction: To improve access to care and engage adolescent transplant recipients for adherence-promoting interventions, innovative solutions utilizing technology are needed. Materials and Methods: This study describes the implementation of a five-session group intervention targeting medication adherence in adolescent transplant recipients through home-based telemedicine. Results: Seven videoconferencing groups were conducted with a total of 33 participants living a median of 57 miles away from their transplant medical center. The median coefficient of variation (CV) of tacrolimus (immunosuppression medication) decreased from 32.2% to 23.5% from the pregroup to postgroup phase. Analyses indicated that the group was acceptable and engaging for participants, as highlighted by one participant reporting, "I liked how me and the group members came together… it felt like a little family." Overall satisfaction with the group and with the technology was endorsed by 86%. The group intervention was generally feasible; however, there were technological difficulties reported by participants and the facilitator, particularly given the diversity of the home-based connections and equipment. Other adaptations helped improve recruitment, attendance, and participation. Discussion: Implementing a telehealth group can pose unique challenges, especially with a group of adolescent participants. Although nonsignificant, we observed a decrease in the median CV of tacrolimus, indicating that medication adherence generally improved after group intervention. Our experience facilitating these groups provides insights into strategies to optimize feasibility and the participant experience. Distance of participants from the hospital is an important consideration and provides a strong rationale for the need for telemedicine-enabled approaches. We explore and discuss the challenges to implementing a home-based group, suggest practical strategies and developmentally sensitive adjustments when working with adolescents, and propose strategies to prepare clinicians for obstacles that may present when implementing a telehealth group with youth.
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Affiliation(s)
- Sarah L Kelly
- Department of Pediatrics and University of Colorado School of Medicine, Aurora, Colorado.,Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado
| | - Elizabeth A Steinberg
- Department of Pediatrics and University of Colorado School of Medicine, Aurora, Colorado.,Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado
| | - Amanda Suplee
- Pediatric Mental Health Institute, Children's Hospital Colorado, Aurora, Colorado
| | - Naadira C Upshaw
- Pediatric Mental Health Institute, Children's Hospital Colorado, Aurora, Colorado
| | - Kristen R Campbell
- Department of Pediatrics and University of Colorado School of Medicine, Aurora, Colorado
| | - John F Thomas
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado.,Department of Epidemiology, University of Colorado School of Public Health, Aurora, Colorado
| | - Cindy L Buchanan
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado.,Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
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Albanese-O'Neill A, Beauchamp G, Thomas N, Westen SC, Johnson N, Schatz D, Haller MJ. Transition Education for Young Adults With Type 1 Diabetes: Pilot Feasibility Study for a Group Telehealth Intervention. JMIR Diabetes 2018; 3:e10909. [PMID: 30401674 PMCID: PMC6246967 DOI: 10.2196/10909] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/01/2018] [Accepted: 08/01/2018] [Indexed: 11/17/2022] Open
Abstract
Background Young adults with type 1 diabetes (T1D) experience a decline in glycemic outcomes and gaps in clinical care. A diabetes education and support program designed for young adults was delivered through group videoconference and mobile Web. Objective The objective of our study was to assess the feasibility, acceptability, and preliminary efficacy of the program as measured by attendance and webpage views, satisfaction, and pre- and postintervention psychosocial outcomes, respectively. Methods Young adults aged 18-25 years were recruited to attend five 30-minute group diabetes education videoconferences during an 8-week period. Videoconferences included an expert presentation followed by a moderated group discussion. Within 48 hours of each videoconference, participants were sent a link to more information on the study website. Feasibility was assessed using data on videoconference attendance and webpage views. Acceptability was assessed via a Satisfaction Survey completed at the conclusion of the study. Descriptive statistics were generated. Preliminary efficacy was assessed via a survey to measure changes in diabetes-specific self-efficacy and diabetes distress. Pre- and postintervention data were compared using paired samples t tests. Results In this study, 20 young adults (mean age 19.2 [SD 1.1] years) attended an average of 5.1 (SD 1.0) videoconferences equivalent to 153 (SD 30.6) minutes of diabetes education per participant during an 8-week period. Average participant satisfaction scores were 62.2 (SD 2.6) out of a possible 65 points. A total of 102 links sent via text message (short message service) or email resulted in 504 webpage views. There was no statistically significant difference between pre- and postintervention diabetes-specific self-efficacy or diabetes-related distress. Conclusions Delivery of diabetes education via group videoconference using mobile Web follow-up is feasible and acceptable to young adults with T1D. This model of care delivery has the potential to improve attendance, social support, and patient-reported satisfaction. Nevertheless, further research is required to establish the effect on long-term psychosocial and glycemic outcomes.
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Affiliation(s)
- Anastasia Albanese-O'Neill
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Florida, Gainesville, FL, United States
| | - Giovanna Beauchamp
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Nicole Thomas
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Florida, Gainesville, FL, United States
| | - Sarah C Westen
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | | | - Desmond Schatz
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Florida, Gainesville, FL, United States
| | - Michael J Haller
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Florida, Gainesville, FL, United States
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40
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Abstract
PURPOSE OF REVIEW This review summarizes the literature on care and outcome disparities in young adults (YA) with type 1 and type 2 diabetes, and outlines remaining needs and suggestions to reduce disparities and improve care. RECENT FINDINGS Despite well-documented disparities and data from large national and international diabetes populations, the role that social determinants of health play in disease management is largely unstudied. Further, mechanisms of how these risk factors interact with the unique developmental needs of racial-ethnic minority and economically vulnerable young adults with diabetes remain unknown. Little intervention research has focused on improving outcomes in this vulnerable population. More research needs to focus on identifying and addressing risk factors in racial-ethnic minority and economically vulnerable young adults with diabetes. Interventions need to be adapted and developed to meet the unique needs of this high-risk population. Clinicians and healthcare systems must recognize the inequity in care and outcomes for this group and structure clinical programs and policies to promote their optimal care.
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Affiliation(s)
- Shivani Agarwal
- Endocrinology, Diabetes, and Metabolism, University of Pennsylvania, Smilow Translational Research Center Room 12-142 3400 Civic Center Blvd., Philadelphia, PA, USA.
| | - Marisa Hilliard
- Baylor College of Medicine and Texas Children's Hospital, Feigin Tower 1102 Bates Ave., Suite 940, Houston, TX, 77030, USA
| | - Ashley Butler
- Baylor College of Medicine and Texas Children's Hospital, Feigin Tower 1102 Bates Ave., Suite 940, Houston, TX, 77030, USA
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41
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Reid MW, Krishnan S, Berget C, Cain C, Thomas JF, Klingensmith GJ, Raymond JK. CoYoT1 Clinic: Home Telemedicine Increases Young Adult Engagement in Diabetes Care. Diabetes Technol Ther 2018; 20:370-379. [PMID: 29672162 DOI: 10.1089/dia.2017.0450] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Young adults with type 1 diabetes (T1D) experience poor glycemic control, disengagement in care, and are often lost to the medical system well into their adult years. Diabetes providers need a new approach to working with the population. The goal of this study was to determine whether an innovative shared telemedicine appointment care model (CoYoT1 Clinic [pronounced as "coyote"; Colorado Young Adults with T1D]) for young adults with T1D improves care engagement, satisfaction, and adherence to American Diabetes Association (ADA) guidelines regarding appointment frequency. SUBJECTS AND METHODS CoYoT1 Clinic was designed to meet the diabetes care needs of young adults (18-25 years of age) with T1D through home telemedicine. Visits occurred every 3 months over the 1-year study (three times by home telemedicine and one time in-person). Outcomes were compared to patients receiving treatment as usual (control). RESULTS Compared with controls, CoYoT1 patients attended significantly more clinic visits (P < 0.0001) and increased their number of clinic visits from the year before the intervention. Seventy-four percent of CoYoT1 patients were seen four times over the 12-month study period, meeting ADA guidelines, but none in the control group met the ADA recommendation. CoYoT1 patients used diabetes technologies more frequently and reported greater satisfaction with care compared with controls. CONCLUSIONS Delivering diabetes care by home telemedicine increases young adults' adherence to ADA guidelines and usage of diabetes technologies, and improves retention in care when compared to controls. Home telemedicine may keep young adults engaged in their diabetes care during this challenging transition period.
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Affiliation(s)
- Mark W Reid
- 1 Department of Surgery, Division of Ophthalmology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California , Los Angeles, California
| | - Subramanian Krishnan
- 1 Department of Surgery, Division of Ophthalmology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California , Los Angeles, California
| | - Cari Berget
- 2 Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado , Aurora, Colorado
| | - Cindy Cain
- 2 Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado , Aurora, Colorado
| | - John Fred Thomas
- 3 Department of Telehealth, School of Medicine, University of Colorado , Aurora, Colorado
- 4 Department of Psychiatry, School of Medicine, University of Colorado , Aurora, Colorado
- 5 Department of Epidemiology, School of Public Health, University of Colorado , Aurora, Colorado
| | - Georgeanna J Klingensmith
- 2 Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado , Aurora, Colorado
| | - Jennifer K Raymond
- 6 Department of Pediatrics, Division of Endocrinology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California , Los Angeles, California
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42
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Pyatak EA, Carandang K, Vigen CLP, Blanchard J, Diaz J, Concha-Chavez A, Sequeira PA, Wood JR, Whittemore R, Spruijt-Metz D, Peters AL. Occupational Therapy Intervention Improves Glycemic Control and Quality of Life Among Young Adults With Diabetes: the Resilient, Empowered, Active Living with Diabetes (REAL Diabetes) Randomized Controlled Trial. Diabetes Care 2018; 41:696-704. [PMID: 29351961 PMCID: PMC5860833 DOI: 10.2337/dc17-1634] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 12/17/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the efficacy of a manualized occupational therapy (OT) intervention (Resilient, Empowered, Active Living with Diabetes [REAL Diabetes]) to improve glycemic control and psychosocial well-being among ethnically diverse young adults with low socioeconomic status (SES) who have type 1 or type 2 diabetes. RESEARCH DESIGN AND METHODS Eighty-one young adults (age 22.6 ± 3.5 years; hemoglobin A1c [HbA1c] = 10.8%/95 mmol/mol ± 1.9%/20.8 mmol/mol) were randomly assigned to the REAL Diabetes intervention group (IG) or an attention control group (CG) over 6 months. IG participants received biweekly sessions guided by a manual composed of seven content modules; CG participants received standardized educational materials and biweekly phone calls. Blinded assessors collected data at baseline and 6 months. The primary outcome was HbA1c; secondary outcomes included diabetes self-care, diabetes-related quality of life (QOL), diabetes distress, depressive symptoms, and life satisfaction. Change scores were analyzed using Wilcoxon rank sum tests. RESULTS Intent-to-treat analyses showed that IG participants showed significant improvement in HbA1c (-0.57%/6.2 mmol/mol vs. +0.36%/3.9 mmol/mol, P = 0.01), diabetes-related QOL (+0.7 vs. +0.15, P = 0.04), and habit strength for checking blood glucose (+3.9 vs. +1.7, P = 0.05) as compared with CG participants. There was no statistically significant effect modification by sex, ethnicity, diabetes type, recruitment site, or SES. No study-related serious adverse events were reported. CONCLUSIONS The REAL Diabetes intervention improved blood glucose control and diabetes-related QOL among a typically hard-to-reach population, thus providing evidence that a structured OT intervention may be beneficial in improving both clinical and psychosocial outcomes among individuals with diabetes.
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Affiliation(s)
- Elizabeth A Pyatak
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA
| | - Kristine Carandang
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA
| | - Cheryl L P Vigen
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA
| | - Jeanine Blanchard
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA
| | - Jesus Diaz
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA
| | - Alyssa Concha-Chavez
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA
| | - Paola A Sequeira
- Department of Pediatrics, University of Southern California, Los Angeles, CA
| | - Jamie R Wood
- Children's Hospital Los Angeles, Los Angeles, CA
| | | | - Donna Spruijt-Metz
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA
| | - Anne L Peters
- Division of Endocrinology, University of Southern California, Beverly Hills, CA
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Prahalad P, Tanenbaum M, Hood K, Maahs DM. Diabetes technology: improving care, improving patient-reported outcomes and preventing complications in young people with Type 1 diabetes. Diabet Med 2018; 35:419-429. [PMID: 29356074 DOI: 10.1111/dme.13588] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2018] [Indexed: 01/09/2023]
Abstract
With the evolution of diabetes technology, those living with Type 1 diabetes are given a wider arsenal of tools with which to achieve glycaemic control and improve patient-reported outcomes. Furthermore, the use of these technologies may help reduce the risk of acute complications, such as severe hypoglycaemia and diabetic ketoacidosis, as well as long-term macro- and microvascular complications. In addition, diabetes technology can have a beneficial impact on psychosocial health by reducing the burden of diabetes. Unfortunately, diabetes goals are often unmet and people with Type 1 diabetes too frequently experience acute and long-term complications of this condition, in addition to often having less than ideal psychosocial outcomes. Increasing realization of the importance of patient-reported outcomes is leading to diabetes care delivery becoming more patient-centred. Diabetes technology in the form of medical devices, digital health and big data analytics have the potential to improve clinical care and psychosocial support, resulting in lower rates of acute and chronic complications, decreased burden of diabetes care, and improved quality of life.
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Affiliation(s)
- P Prahalad
- Division of Pediatric Endocrinology, Stanford University, Stanford, CA, USA
| | - M Tanenbaum
- Division of Pediatric Endocrinology, Stanford University, Stanford, CA, USA
| | - K Hood
- Division of Pediatric Endocrinology, Stanford University, Stanford, CA, USA
| | - D M Maahs
- Division of Pediatric Endocrinology, Stanford University, Stanford, CA, USA
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44
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Duke DC, Barry S, Wagner DV, Speight J, Choudhary P, Harris MA. Distal technologies and type 1 diabetes management. Lancet Diabetes Endocrinol 2018; 6:143-156. [PMID: 28867311 DOI: 10.1016/s2213-8587(17)30260-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 06/21/2017] [Accepted: 07/03/2017] [Indexed: 02/09/2023]
Abstract
Type 1 diabetes requires intensive self-management to avoid acute and long-term health complications. In the past two decades, substantial advances in technology have enabled more effective and convenient self-management of type 1 diabetes. Although proximal technologies (eg, insulin pumps, continuous glucose monitors, closed-loop and artificial pancreas systems) have been the subject of frequent systematic and narrative reviews, distal technologies have received scant attention. Distal technologies refer to electronic systems designed to provide a service remotely and include heterogeneous systems such as telehealth, mobile health applications, game-based support, social platforms, and patient portals. In this Review, we summarise the empirical literature to provide current information about the effectiveness of available distal technologies to improve type 1 diabetes management. We also discuss privacy, ethics, and regulatory considerations, issues of global adoption, knowledge gaps in distal technology, and recommendations for future directions.
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Affiliation(s)
- Danny C Duke
- Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA.
| | - Samantha Barry
- Department of Medicine, UMass Memorial Medical Center, Worcester, MA, USA
| | - David V Wagner
- Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
| | - Jane Speight
- The Australian Centre for Behavioural Research in Diabetes, Deakin University, and Diabetes Victoria, Melbourne, VIC, Australia
| | | | - Michael A Harris
- Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
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45
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Bertuzzi F, Stefani I, Rivolta B, Pintaudi B, Meneghini E, Luzi L, Mazzone A. Teleconsultation in type 1 diabetes mellitus (TELEDIABE). Acta Diabetol 2018; 55:185-192. [PMID: 29209814 DOI: 10.1007/s00592-017-1084-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 11/22/2017] [Indexed: 01/24/2023]
Abstract
AIMS The growing incidence of diabetes and the need to contain healthcare costs empower the necessity to identify new models of care. Telemedicine offers an acknowledged instrument to provide clinical health care at a distance, increasing patient compliance and the achievement of therapeutical goals. The objective was to test the feasibility and the efficacy in the improvement of the glycemic control of the teleconsultation for patients with type 1 diabetes mellitus. METHODS A randomized open-label, parallel arms, controlled trial was conducted in two diabetes centers in Italy. Participants affected by type 1 diabetes mellitus have been randomly (1:1) assigned to receive their visits as standard or a web-based care. Patients in the teleconsultation group can arrange their appointments on a Web site and can also have access to web educational courses or to nutritional and psychological counseling. The primary outcome was the assessment of glycemic control by HbA1c measurement after a 12-month follow-up. RESULTS Overall 74 participants were followed for 1 year. HbA1c changes were not statistically different within (p = 0.56 for standard care group; p = 0.45 for telemedicine group) and between (p = 0.60) groups when considering differences from baseline to the end of the study. Patients randomized to teleconsultation reported reduced severe hypoglycemic episodes (p = 0.03). In addition, they were largely satisfied with the activities, perceived a good improvement in the self-management of the diabetes, and reported to have a time saving and a cost reduction. CONCLUSIONS In conclusion, TELEDIABE proposes a new system for the management of patients with type 1 diabetes mellitus.
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Affiliation(s)
- Federico Bertuzzi
- Diabetology Unit, ASST Grande Ospedale Metropolitano Niguarda, P.zza Ospedale Maggiore 3, 20162, Milan, Italy.
| | - Ilario Stefani
- Medicine Department, Legnano ASST Ovest Milanese, Legnano, Italy
| | | | - Basilio Pintaudi
- Diabetology Unit, ASST Grande Ospedale Metropolitano Niguarda, P.zza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Elena Meneghini
- SS Diabetologia, Bassini Hospital, Cinisello Balsamo, Milan, Italy
| | - Livio Luzi
- Metabolism Research Center and Endocrinology and Metabolism, IRCCS Policlinico San Donato Milanese, Milan, Italy
- Department of Biomedical and Health Sciences, University of Milan, Milan, Italy
| | - Antonino Mazzone
- Medicine Department, Legnano ASST Ovest Milanese, Legnano, Italy
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46
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Raymond JK. Models of Care for Adolescents and Young Adults with Type 1 Diabetes in Transition: Shared Medical Appointments and Telemedicine. Pediatr Ann 2017; 46:e193-e197. [PMID: 28489225 DOI: 10.3928/19382359-20170425-01] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Transitioning through adolescence and young adulthood is challenging, and even more so for patients living with a chronic disease such as type 1 diabetes. Patients in this age group encounter multiple obstacles to effectively managing their diabetes, experience suboptimal glycemic control, face higher rates of acute complications, and are often lost to medical follow-up. Comprehensive strategies and innovative clinical models are needed to engage this population in diabetes medical care, address barriers to ideal management, and improve outcomes. Telemedicine, shared medical appointments (SMA), or a combination of telemedicine and SMA are potential models to more successfully, efficiently, and satisfactorily address the urgent need for improved care in this high-risk population. This article reviews various clinical care models within these categories of telemedicine and SMA. [Pediatr Ann. 2017;46(5):e193-e197.].
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47
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Bouchonville MF, Paul MM, Billings J, Kirk JB, Arora S. Taking Telemedicine to the Next Level in Diabetes Population Management: a Review of the Endo ECHO Model. Curr Diab Rep 2016; 16:96. [PMID: 27549110 DOI: 10.1007/s11892-016-0784-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Worldwide increases in diabetes prevalence in the face of limited medical resources have prompted international interest in innovative healthcare delivery models. Project ECHO (Extension for Community Healthcare Outcomes) is a "telementoring" program which has been shown to increase capacity for complex disease management in medically underserved regions. In contrast to a traditional telemedicine model which might connect a specialist with one patient, the ECHO model allows for multiple patients to benefit simultaneously by building new expertise. We recently applied the ECHO model to improve health outcomes of patients with complex diabetes (Endo ECHO) living in rural New Mexico. We describe the design of the Endo ECHO intervention and a 4-year, prospective program evaluation assessing health outcomes, utilization patterns, and cost-effectiveness. The Endo ECHO evaluation will demonstrate whether and to what extent this intervention improves outcomes for patients with complex diabetes living in rural New Mexico, and will serve as proof-of-concept for academic medical centers wishing to replicate the model in underserved regions around the world.
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Affiliation(s)
- Matthew F Bouchonville
- Division of Endocrinology, Diabetes, and Metabolism, University of New Mexico School of Medicine, Albuquerque, NM, USA.
| | - Margaret M Paul
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - John Billings
- Wagner School of Public Service, New York University, New York, NY, USA
| | - Jessica B Kirk
- University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Sanjeev Arora
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
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Koblauch H, Reinhardt SM, Lissau W, Jensen PL. The effect of telepsychiatric modalities on reduction of readmissions in psychiatric settings: A systematic review. J Telemed Telecare 2016; 24:31-36. [PMID: 27663681 PMCID: PMC5768249 DOI: 10.1177/1357633x16670285] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Introduction Telepsychiatric modalities are used widely in the treatment of many mental illnesses. It has also been proposed that telepsychiatric modalities could be a way to reduce readmissions. The purpose of the study was to conduct a systematic review of the literature on the effects of telepsychiatric modalities on readmissions in psychiatric settings. Methods We conducted a systematic literature search in MEDLINE, CINAHL, Embase, Cochrane, PsycINFO and Joanna Briggs databases in October 2015. Inclusion criteria were (a) patients with a psychiatric diagnosis, (b) telepsychiatric interventions and (c) an outcome related to readmission. Results The database search identified 218 potential studies, of which eight were eligible for the review. Studies were of varying quality and there was a tendency towards low-quality studies (five studies) which found positive outcomes regarding readmission, whereas the more methodological sound studies (three studies) found no effect of telepsychiatric modalities on readmission rates. Discussion Previous studies have proven the effectiveness of telepsychiatric modalities in the treatment of various mental illnesses. However, in the present systematic review we were unable to find an effect of telepsychiatric modalities on the rate of readmission. Some studies found a reduced rate of readmissions, but the poor methodological quality make the findings questionable. At the present time there is no evidence to support the use of telepsychiatry due to heterogeneous interventions, heterogeneous patient groups and lack of high-quality studies.
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Affiliation(s)
- Henrik Koblauch
- 1 Research and Development, University College Capital, Denmark.,2 Physiotherapy Programme, University College Capital, Denmark
| | - Sasha M Reinhardt
- 1 Research and Development, University College Capital, Denmark.,3 Nursing Programme, University College Capital, Denmark
| | - Waltraut Lissau
- 1 Research and Development, University College Capital, Denmark.,3 Nursing Programme, University College Capital, Denmark
| | - Pia-Lis Jensen
- 1 Research and Development, University College Capital, Denmark.,3 Nursing Programme, University College Capital, Denmark
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