1
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Ajjan RA, Battelino T, Cos X, Del Prato S, Philips JC, Meyer L, Seufert J, Seidu S. Continuous glucose monitoring for the routine care of type 2 diabetes mellitus. Nat Rev Endocrinol 2024; 20:426-440. [PMID: 38589493 DOI: 10.1038/s41574-024-00973-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/10/2024]
Abstract
Although continuous glucose monitoring (CGM) devices are now considered the standard of care for people with type 1 diabetes mellitus, the uptake among people with type 2 diabetes mellitus (T2DM) has been slower and is focused on those receiving intensive insulin therapy. However, increasing evidence now supports the inclusion of CGM in the routine care of people with T2DM who are on basal insulin-only regimens or are managed with other medications. Expanding CGM to these groups could minimize hypoglycaemia while allowing efficient adaptation and escalation of therapies. Increasing evidence from randomized controlled trials and observational studies indicates that CGM is of clinical value in people with T2DM on non-intensive treatment regimens. If further studies confirm this finding, CGM could soon become a part of routine care for T2DM. In this Perspective we explore the potential benefits of widening the application of CGM in T2DM, along with the challenges that must be overcome for the evidence-based benefits of this technology to be delivered for all people with T2DM.
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Affiliation(s)
- Ramzi A Ajjan
- The LIGHT Laboratories, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Tadej Battelino
- Faculty of Medicine, University of Ljubljana Medical Centre, Ljubljana, Slovenia
| | - Xavier Cos
- DAP Cat Research Group, Foundation University Institute for Primary Health Care Research Jordi Gol i Gorina, Barcelona, Spain
| | - Stefano Del Prato
- Section of Diabetes and Metabolic Diseases, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Laurent Meyer
- Department of Endocrinology, Diabetes and Nutrition, University Hospital, Strasbourg, France
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Samuel Seidu
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK.
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2
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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; 30:1522-1538. [PMID: 38436274 DOI: 10.1089/tmj.2023.0530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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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3
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Quesada-Caballero M, Carmona-García A, Chami-Peña S, Caballero-Mateos AM, Fernández-Martín O, Cañadas-De la Fuente GA, Romero-Bejar JL. Telemedicine in Elderly Hypertensive and Patients with Chronic Diseases during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:6160. [PMID: 37834803 PMCID: PMC10574013 DOI: 10.3390/jcm12196160] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND One aspect of the distancing measures imposed in response to the COVID-19 pandemic is that telemedicine consultations have increased exponentially. Among these consultations, the assessment and follow-up of patients with chronic diseases in a non-presential setting has been strengthened considerably. Nevertheless, some controversy remains about the most suitable means of patient follow-up. OBJECTIVE To analyze the impact of the telemedicine measures implemented during the COVID-19 period on chronic patients. MATERIAL AND METHODS A systematic review was carried out using the following databases: PubMed, Pro-Quest, and Scopus. The systematic review followed the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search equation utilized descriptors sourced from the Medical Subject Headings (MeSH) thesaurus. The search equation was: "hypertension AND older AND primary care AND (COVID-19 OR coronavirus)" and its Spanish equivalent. RESULTS The following data were obtained: 14 articles provided data on 6,109,628 patients and another 4 articles focused on a study population of 9684 physicians. Telemedicine was less likely to be used by elderly patients (OR 0.85; 95% C.I. 0.83-0.88; p = 0.05), those of Asian race (OR 0.69; 95% C.I. 0.66-0.73; p = 0.05), and those whose native language was not English (OR 0.89; 95% C.I. 0.78-0.9; p = 0.05). In primary care, lower use of telemedicine was associated with residents of rural areas (OR 0.81; p = 0.05), patients of African American race (OR 0.65, p = 0.05), and others (OR 0.64; p = 0.05). A high proportion (40%) of physicians had no prior training in telemedicine techniques. The highest quality in terms of telephone consultation was significantly associated with physicians who did not increase their prescription of antibiotherapy during the pandemic (OR = 0.30, p = 0.05) or prescribe more tests (OR 0.06 p = 0.05), i.e., who maintained their former clinical criteria despite COVID-19. CONCLUSIONS Telemedicine is of proven value and has been especially useful in the COVID-19 pandemic. A mixed remote-presential model is most efficient. Appropriate training in this area for physicians and patients, together with correct provision, is essential to prevent errors in implementation and use.
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Affiliation(s)
- Miguel Quesada-Caballero
- Centro de Salud Albayda La Cruz, Distrito Sanitario Granada-Metropolitano, Servicio Andaluz de Salud, Calle Virgen de la Consolación 12, 18015 Granada, Spain;
| | - Ana Carmona-García
- Critical Care and Emergency Unit (UCCU), Distrito Sanitario Granada-Metropolitano, Servicio Andaluz de Salud, Calle Virgen de la Consolación 12, 18015 Granada, Spain
| | - Sara Chami-Peña
- Hospital de la Serranía de Ronda, Servicio Andaluz de Salud, Carretera San Pedro Km 2, 29400 Ronda, Spain
| | - Antonio M. Caballero-Mateos
- Gastroenterology and Hepatology Department, San Cecilio University Hospital, Av. del Conocimiento s/n, 18016 Granada, Spain
| | - Oscar Fernández-Martín
- Centro de Salud Guadix, Área de Gestión Sanitaria Nordeste Granada, Servicio Andaluz de Salud, Ctra. de Murcia s/n, 18800 Baza, Spain
| | - Guillermo A. Cañadas-De la Fuente
- Faculty of Health Sciences, University of Granada, Avda. Ilustración 60, 18016 Granada, Spain;
- Brain, Mind and Behaviour Research Center (CIMCYC), University of Granada, 18071 Granada, Spain
| | - José Luis Romero-Bejar
- Statistics and Operational Research Department, University of Granada, Avda. Fuentenueva s/n, 18071 Granada, Spain;
- Institute of Mathematics, University of Granada (IMAG), Ventanilla 11, 18001 Granada, Spain
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18012 Granada, Spain
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4
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Jallal M, Berrada K, Bouaddi O, El Badisy I, Charaka H, Serhier Z, Bennani Othmani M, Nejjari C, Khalis M. How Physicians in a Moroccan Tertiary Care Center Perceive Teleconsultation During COVID-19 Pandemic? Telemed J E Health 2023; 29:284-292. [PMID: 36126680 DOI: 10.1089/tmj.2022.0094] [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: 11/12/2022] Open
Abstract
Background: Recent technological advances have paved the way for a new modality of medical practice known as teleconsultation. Positive perceptions about the benefits of teleconsultation and its acceptance by clinicians are key predictors of its uptake. The aim of this study was to assess knowledge, perceptions, and acceptability of teleconsultation among Moroccan physicians. Methods: This is a descriptive cross-sectional study conducted at the Cheikh Khalifa International University Hospital (HCK) of Casablanca, Morocco. Study participants answered an anonymous self-administered questionnaire designed based on similar studies. The questionnaire contained four sections related to demographic characteristics, knowledge about telemedicine and teleconsultation, perceptions about teleconsultation, and its acceptability by the study participants. Results: Of 486 eligible participants, a total of 212 completed the questionnaire. Approximately 96.7% had prior knowledge of teleconsultation. Most participants identified internet access (95.3%), data security (93.4%), and confidentiality (92.9%) as the main facilitators to the use of teleconsultation. The main barriers to the use of teleconsultation were internet access issues (98.6%), poor audio quality (96.2%), poor video quality (94.3%), and difficulty encountered by patients in expressing themselves and communicating with their physician (79.7%). The majority of participants (91.5%) believed that teleconsultation will be an integral part of future medical practice and about 70.8% thought that they would be able to allot time to teleconsultation in their current schedules. Conclusions: The findings of this study should be used by policy makers to remove barriers and promote enablers of teleconsultation use by physicians to bring health care closer to the Moroccan population.
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Affiliation(s)
- Manar Jallal
- Medical Informatics Laboratory, Faculty of Medicine and Pharmacy, University Hassan II, Casablanca, Morocco
| | - Kenza Berrada
- Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
| | - Oumnia Bouaddi
- International School of Public Health, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
| | - Imad El Badisy
- International School of Public Health, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
| | - Hafida Charaka
- Department of Research and Development, Ibn Sina University Hospital Center, Rabat, Morocco
| | - Zineb Serhier
- Medical Informatics Laboratory, Faculty of Medicine and Pharmacy, University Hassan II, Casablanca, Morocco
| | - Mohammed Bennani Othmani
- Medical Informatics Laboratory, Faculty of Medicine and Pharmacy, University Hassan II, Casablanca, Morocco
| | - Chakib Nejjari
- International School of Public Health, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
| | - Mohamed Khalis
- International School of Public Health, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
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5
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Gevers-Montoro C, Deldar Z, Furlan A, Lazar EA, Ghalibaf E, Ortega-De Mues A, Khatibi A. From hands-on to remote: Moderators of response to a novel self-management telehealth programme during the COVID-19 pandemic. Eur J Pain 2022; 26:1368-1379. [PMID: 35610958 PMCID: PMC9320893 DOI: 10.1002/ejp.1968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 04/17/2022] [Accepted: 05/04/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND In March 2020, state-wide lockdowns were declared in many countries, including Spain. Citizens were confined to their homes and remotely supported activities were prioritized as an alternative to in-person interactions. Previous data suggest that remote and self-management interventions may be successful at reducing pain and related psychological variables. However, individual factors influencing the effectiveness of these interventions remain to be identified. We aimed to investigate the psychological and motivational factors moderating changes in pain observed in chiropractic patients undertaking a novel telehealth self-management programme. METHODS A cohort of 208 patients from a chiropractic teaching clinic was recruited to participate in the study. Patients received telehealth consultations and individualized self-management strategies tailored for their current complaint. They were encouraged to make use of these strategies daily for 2-4 weeks, whilst rating their pain intensity, motivation and adherence. Validated questionnaires were completed online to assess catastrophizing, kinesiophobia and anxiety. RESULTS A total of 168 patients completed the first 2 weeks of the programme, experiencing significant reductions in all variables. Kinesiophobia emerged as a key factor influencing pain reduction and moderating the association between motivation and pain relief. In turn, adherence to the programme was associated with lower pain intensity, although moderated by the degree of motivation. CONCLUSIONS In the context of COVID-19, when introducing remote and self-management strategies, pain cognitions and motivational factors should be taken into consideration to foster adherence and yield better pain outcomes.
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Affiliation(s)
- Carlos Gevers-Montoro
- Madrid College of Chiropractic - RCU María Cristina, Madrid, Spain.,Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Zoha Deldar
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada.,Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Andrea Furlan
- KITE, Toronto Rehabilitation Institute, University of Toronto, University Health Network, Institute for Work & Health, Toronto, Ontario, Canada
| | - Eric A Lazar
- Madrid College of Chiropractic - RCU María Cristina, Madrid, Spain
| | - Erfan Ghalibaf
- Institute for Cognitive Science Studies (ICSS), Tehran, Iran
| | | | - Ali Khatibi
- Centre of Precision Rehabilitation for Spinal Pain, University of Birmingham, Birmingham, UK.,Centre for Human Brain Health, University of Birmingham, Birmingham, UK
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6
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Idriss S, Aldhuhayyan A, Alanazi AA, Alasaadi W, Alharbi R, Alshahwan G, Baitalmal M, Alonazi W. Physicians’ Perceptions of Telemedicine Use During the COVID-19 Pandemic in Riyadh, Saudi Arabia: Cross-sectional Study (Preprint). JMIR Form Res 2021; 6:e36029. [PMID: 35714293 PMCID: PMC9278404 DOI: 10.2196/36029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/15/2022] [Accepted: 06/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background Objective Methods Results Conclusions
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Affiliation(s)
| | | | | | - Walaa Alasaadi
- Health Administration Department, King Saud University, College of Business, Riyadh, Saudi Arabia
| | - Reem Alharbi
- Home Healthcare Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ghadah Alshahwan
- Home Healthcare Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammad Baitalmal
- Quantitative Analysis Department, King Saud University, College of Business Administration, Riyadh, Saudi Arabia
| | - Wadi Alonazi
- Health Administration Department, King Saud University, College of Business Administration, Riyadh, Saudi Arabia
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7
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Rego N, Pereira HS, Crispim J. Perceptions of Patients and Physicians on Teleconsultation at Home for Diabetes Mellitus: Survey Study. JMIR Hum Factors 2021; 8:e27873. [PMID: 34817394 PMCID: PMC8663635 DOI: 10.2196/27873] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 12/11/2022] Open
Abstract
Background Diabetes mellitus (DM) is one of the most challenging diseases in the 21st century and is the sixth leading cause of death. Telemedicine has increasingly been implemented in the care of patients with DM. Although teleconsultations at home have shown to be more effective for inducing HbA1c reduction than other telemedicine options, before the 2019 coronavirus disease crisis, their use had been lagging behind. Studies on physicians’ or patients’ perceptions about telemedicine have been performed independently of each other, and very few have focused on teleconsultations. In a time of great pressure for health systems and when an important portion of health care has to be assured at a distance, obtaining insights about teleconsultations at home from the stakeholders directly involved in the health care interaction is particularly important. Objective The perceptions of patients and physicians about their intentions to use home synchronous teleconsultations for DM care are examined to identify drivers and barriers inherent to programs that involve home teleconsultations. Methods Two identical questionnaires integrating the technology acceptance model and the unified theory of acceptance and use of technology and assessing the confidence in information and communication technology use of patients and physicians were developed. Responses by patients (n=75) and physicians (n=68) were analyzed using canonical correlation analysis. Results Associations between predictor constructs (performance, effort, social influence, facilitating conditions, and attitude) and intention to use yielded significant functions, with a canonical R2 of 0.95 (for physicians) and 0.98 (patients). The main identified barriers to patient intention to use were the expected effort to explain the medical problem, and privacy and confidentiality issues. The major drivers were the facilitation of contact with the physician, which is beneficial to patient disease management and treatment, time savings, and reciprocity concerning physicians’ willingness to perform teleconsultations. Responses from physicians revealed an association between intention to use and the expected performance of home teleconsultations. The major barrier to intention to use expressed in physicians’ answers was doubts concerning the quality of patient examination. The major drivers were time savings, productivity increases, improvements in patient’s health and patient management, National Health System costs reduction, and reciprocity relative to patients’ willingness to engage in teleconsultations. Conclusions To promote the use of home teleconsultations for DM, decision makers should improve patients’ health literacy so the physician–patient communication is more effective; explore information and communication technology developments to reduce current limitations of non–face-to-face examinations; ensure patient privacy and data confidentiality; and demonstrate the capabilities of home teleconsultations to physicians.
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Affiliation(s)
- Nazaré Rego
- Escola de Economia e Gestão, Universidade do Minho, Braga, Portugal.,Institute for Systems and Computer Engineering, Technology, and Science (INESC TEC), Porto, Portugal
| | | | - José Crispim
- Núcleo de Investigação em Políticas Económicas e Empresariais (NIPE), Escola de Economia e Gestão, Universidade do Minho, Braga, Portugal
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8
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Abstract
Uncontrolled diabetes and/or hyperglycemia is associated with severe COVID-19 disease and increased mortality. It is now known that poor glucose control before hospital admission can be associated with a high risk of in-hospital death. By achieving and maintaining glycemic control, primary care physicians (PCPs) play a critical role in limiting this potentially devastating outcome. Further, despite the hope that mass vaccination will help control the pandemic, genetic variants of the virus are causing surges in some countries. As such, PCPs will treat an increasing number of patients with diabetes who have symptoms of post-COVID-19 infection, or even have new-onset type 2 diabetes as a result of COVID-19 infection. However, much of the literature published focuses on the effects of COVID-19 in hospitalized patients, with few publications providing information and advice to those caring for people with diabetes in the primary care setting. This manuscript reviews the current knowledge of the risk and outcomes of individuals with diabetes who are infected with COVID-19 and provides information for PCPs on the importance of glucose control, appropriate treatment, and use of telemedicine and online prescription delivery systems to limit the potentially devastating effects of COVID-19 in people with hyperglycemia.
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Affiliation(s)
- Jeremy Pettus
- University of California, School of Medicine, San Diego, CA, USA
| | - Neil Skolnik
- Family Medicine Residency Program, Abington-Jefferson Health, Abington, PA, USA
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9
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Maietti E, Sanmarchi F, Palestini L, Golinelli D, Esposito F, Boccaforno N, Pia Fantini M, Di Bartolo P. The experience of patients with diabetes with the use of telemedicine and teleassistance services during the COVID-19 pandemic in Italy: Factors associated with perceived quality and willingness to continue. Diabetes Res Clin Pract 2021; 180:109047. [PMID: 34530061 DOI: 10.1016/j.diabres.2021.109047] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 01/21/2023]
Abstract
AIM The purpose of this study is to investigate the individual and contextual determinants of the perceived quality (PQ) of the telemedicine and teleassistance (TMTA) services and the willingness to continue (WC) with them among patients with diabetes using TMTA services during the COVID-19 pandemic in one large region of Italy. METHODS A structured survey was administered to patients with type 1 and 2 diabetes who used TMTA during the first wave of the COVID-19 pandemic. The questionnaire contained questions on TMTA service experience and participants' socio-demographic characteristics. Multiple regression models investigated the independent factors associated with PQ and WC. RESULTS The final analysis included 569 patients with diabetes (54.7% female), with an average age of 58.1 years. TMTA services' PQ and WC were high. A higher education and being unemployed were factors associated with an increased WC. Older age was negatively related to PQ. Perceived support from TMTA service was positively associated with PQ and WC. Perceived increase in disease self-management was positively associated with PQ and WC. CONCLUSIONS Our study identified several determinants of PQ and WC. These socio-demographic and TMTA-related factors should be considered in the implementation of care pathways integrating in-person visits with TMTA.
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Affiliation(s)
- Elisa Maietti
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Italy
| | - Francesco Sanmarchi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Italy.
| | - Luigi Palestini
- Regione Emilia-Romagna - Regional Agency for Health and Social Services, Italy
| | - Davide Golinelli
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Italy
| | - Francesco Esposito
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Italy
| | | | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Italy
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10
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Choudhary P, Bellido V, Graner M, Altpeter B, Cicchetti A, Durand-Zaleski I, Kristensen FB. The Challenge of Sustainable Access to Telemonitoring Tools for People with Diabetes in Europe: Lessons from COVID-19 and Beyond. Diabetes Ther 2021; 12:2311-2327. [PMID: 34390477 PMCID: PMC8363869 DOI: 10.1007/s13300-021-01132-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/26/2021] [Indexed: 01/08/2023] Open
Abstract
Telemedicine in diabetes care has been evolving over several years, particularly since the advent of cloud-connected technologies for diabetes management, such as glucose monitoring devices, including continuous glucose monitoring (CGM) systems, that facilitate sharing of glucose data between people with diabetes and their healthcare professionals in near-real time. Extreme social distancing and shielding in place for vulnerable patients during the COVID-19 pandemic has created both the challenge and the opportunity to provide care at a distance on a large scale. Available evidence suggests that glucose control has in fact improved during this period for people with diabetes who are able to use CGM devices for remote glucose monitoring. The development of telemedicine as part of the standard of care in diabetes faces significant challenges in the European context, particularly in terms of providing consistent and effective care at a distance to large populations of patients while using robust systems that can be supported by large regional and national healthcare services. These challenges include a fragmented approach to healthcare technology assessment and reimbursement, lack of eHealth education and literacy, particularly amongst healthcare professionals, lack of data integration, as well as concerns about electronic health records, patient consent and privacy. Here we review the benefits of and challenges to wider application of telemedicine and telemonitoring in the post-pandemic future, with the aim to ensure that the value of these eHealth services is provided to patients, healthcare providers and health systems.
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Affiliation(s)
- Pratik Choudhary
- Leicester Diabetes Centre (Bloom), Leicester General Hospital, University of Leicester, Leicester, UK.
| | - Virginia Bellido
- Department of Endocrinology and Nutrition, Virgen del Rocío University Hospital, Seville, Spain
| | | | - Bernd Altpeter
- Digital Health Groupe and German Institute of Telemedicine, Frankfurt, Germany
| | - Americo Cicchetti
- School of Healthcare Systems, Economics and Management, Universita Cattolica del Sacro Cuore, Rome, Italy
| | | | - Finn Børlum Kristensen
- Danish Centre for Health Economics (DaCHE), Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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11
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[Telemedicine satisfaction of primary care patients during COVID-19 pandemics]. Semergen 2021; 47:248-255. [PMID: 33781673 PMCID: PMC7951945 DOI: 10.1016/j.semerg.2021.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/09/2021] [Accepted: 01/12/2021] [Indexed: 11/26/2022]
Abstract
Objetivo Evaluar el grado de satisfacción de los pacientes con la telemedicina durante la pandemia de la COVID-19 en la Unidad de Salud Familiar Vitrius. Este trabajo podría obtener información sobre la aceptación de la teleconsulta (TC). Material y métodos Estudio transversal con 253 individuos. Se realizó un cuestionario mediante escala Likert (entre 1-nada satisfecho a 5-totalmente satisfecho) en pacientes con diabetes, hipertensión y en sujetos con otras patologías, entre el primero de abril del 2020 y el primero de mayo de ese mismo año. Se recopilaron datos sociodemográficos, citas previas de telemedicina, niveles de satisfacción con la TC y de aclaración de dudas e interés en un mayor seguimiento de telemedicina. Además, se realizó un análisis comparativo entre los períodos de enero-febrero y abril-mayo de 2020 en relación con la edad, el sexo, la hipertensión arterial (HTA), la diabetes mellitus (DM) y el tipo de contacto (presencial o telemático). Las estadísticas se realizaron con el SPSS® y Excel®. Resultados y discusión Las consultas de seguimiento de diabetes representaron el 34,4% del total. Mayoritariamente hubo un alto nivel de satisfacción e interés en el seguimiento futuro con telemedicina. Sin embargo, los individuos diabéticos y mayores estaban menos interesados en este tipo de seguimiento. Se encontraron diferencias estadísticamente significativas en satisfacción para la edad, sexo y presencia/ausencia de diabetes. El 70,6% de los pacientes sanos prefirió el contacto por correo electrónico al teléfono. Ha sido analizado el número de consultas entre enero-febrero y abril-mayo de 2020 donde se destaca: una reducción significativa del número de consultas presenciales por diabetes (-50,1%) y por hipertensión (-94,1%). Las consultas presenciales por cualquier razón disminuyeron un 72,6% y las no presenciales aumentaron un 61,9%. Existe un sesgo de selección porque la muestra no fue aleatoria. La mayor prevalencia de consultas de diabetes y la falta de ajuste por factores de confusión también pueden afectar los resultados. Conclusiones Este estudio permitió confirmar la importancia de la telemedicina en atención primaria, sobre todo durante la pandemia. En general, los participantes se quedaron satisfechos con la telemedicina y reconocieron su utilidad en el acceso a los cuidados de salud.
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Garattini L, Badinella Martini M, Mannucci PM. Improving primary care in Europe beyond COVID-19: from telemedicine to organizational reforms. Intern Emerg Med 2021; 16:255-258. [PMID: 33196973 PMCID: PMC7668282 DOI: 10.1007/s11739-020-02559-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 10/30/2020] [Indexed: 12/04/2022]
Abstract
The COVID-19 pandemic has put under pressure all the health national systems in Europe and telemedicine (TM) has been an almost unavoidable answer for primary care (PC) services to constrain the contagion. PC includes all the healthcare services that are the first level of contact for individuals. General practitioners (GPs) are the pivotal providers of PC throughout Europe. Although GP costs are mainly covered by public services or social insurances in Europe, they are still self-employed physicians everywhere, differently from their colleagues in hospitals who are traditionally employees. TM is a very general term open to various interpretations and definitions. TM can now be practiced by means of modern audio-visual devices and is an alternative to the traditional face-to-face consultation in general practice. Although the adoption of TM seems to be compelling in our era, its practical dissemination in PC has been quite slow so far, and many different concerns have been raised on it. On the whole, TM widespread adoption in PC seems to be more a matter of labor organization and health care funding than of technology and ethics. Larger-scale organizations comprising a wide range of health professionals have become a pressing priority for a modern PC, because working together is crucial to provide high-quality care to patients, and co-location should boost teamwork and facilitate the management of information technology. A national network of large organizations in PC could be rationally managed through local budgets and should increase efficiency by adopting tools such as TM.
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Affiliation(s)
- Livio Garattini
- Institute for Pharmacological Research Mario Negri IRCCS, Ranica, BG, Italy.
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Garattini L, Badinella Martini M, Zanetti M. More room for telemedicine after COVID-19: lessons for primary care? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:183-186. [PMID: 33231825 PMCID: PMC7683583 DOI: 10.1007/s10198-020-01248-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 05/05/2023]
Affiliation(s)
- Livio Garattini
- Institute for Pharmacological Research Mario Negri IRCCS, Ranica, Italy.
| | | | - Michele Zanetti
- Institute for Pharmacological Research Mario Negri IRCCS, Ranica, Italy
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Sim R, Lee SWH. Patient Preference and Satisfaction with the Use of Telemedicine for Glycemic Control in Patients with Type 2 Diabetes: A Review. Patient Prefer Adherence 2021; 15:283-298. [PMID: 33603347 PMCID: PMC7882448 DOI: 10.2147/ppa.s271449] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/21/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Telemedicine has the potential to improve patient care and management for various chronic diseases such as type 2 diabetes. To ensure the success of any telemedicine program, there is a need to understand the patients' satisfaction and their preferences. This review aims to collate and provide evidence related to practices that may influence the performance of telemedicine for patients with type 2 diabetes. METHODS We searched three electronic databases for studies examining patients' satisfaction and preferences for using telemedicine in type 2 diabetes. An evaluation matrix was developed to collect the data from the included articles. A total of 20 articles were identified and data on the key outcomes identified were narratively synthesized. RESULTS Patients were generally satisfied with the use of telemedicine for management of type 2 diabetes. Users reported that telemedicine was beneficial as it provided constant monitoring, improved access to healthcare providers, and reduced waiting time. When adopting a telemedicine platform, most patients expressed preference for mobile health (mHealth) as the telemedicine modality, especially if it has been endorsed by their physician. To improve usability and sustainability, patients suggested that modules related to diabetes education be enhanced, together with sufficient technical and physician support when adopting telemedicine. Patients also expressed the importance of having a sufficiently flexible platform that could be adapted to their needs. CONCLUSION Personalized telemedicine strategies coupled with appropriate physician endorsement greatly influences a patient's decision to undertake telemedicine. Future work should focus on improving telemedicine infrastructure and increasing physician's involvement, especially during the implementation phase.
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Affiliation(s)
- Ruth Sim
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
| | - Shaun Wen Huey Lee
- School of Pharmacy, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya, Selangor, Malaysia
- Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-Being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
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Savo M, Cipolla M, Cipolla I, Gentile L, Gaddi A. Telemedicine and multichronic comorbidities in the days of COVID.19: Preliminary results from Calabria Project. VASCULAR INVESTIGATION AND THERAPY 2021. [DOI: 10.4103/vit-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Cipolla M, Capello F, Gaddi AV. Telemedicine and ehealth to empower patients with diabetes mellitus, fostering and enhancing the results of a functional diet. MEDITERRANEAN JOURNAL OF NUTRITION AND METABOLISM 2020. [DOI: 10.3233/mnm-200408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Maurizio Cipolla
- President of SIT Calabria, Medical Director of UCCP Catanzaro, Italy
| | - Fabio Capello
- Community Paediatrics, Department of Primary Care, AUSL Bologna, Italy
| | - Antonio V. Gaddi
- President of Digital SIT-EMR (Italian Society of Digital Health and Telemedicine, Emilia Romagna Region), Bologna, Italy
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