Teleconsultation and Diabetes Care Amid COVID-19 Pandemic in India: Scopes and Challenges

Challenges of using telemedicine for patients with diabetes during the COVID-19 pandemic: A scoping review

Background

Telemedicine has aided patients with diabetes during the COVID-19 pandemic in receiving better healthcare services. However, despite its numerous benefits, the use of this technology has faced several challenges. This study aimed to identify the challenges of using telemedicine for patients with diabetes during the COVID-19 pandemic.

Methods

This scoping review was conducted in 2024. Relevant articles published between 2020 and 2023 were searched in databases including PubMed, Scopus, Web of Science, ProQuest, and the Cochrane Library. Initially, 822 articles were retrieved, and after screening 21 articles were selected.

Results

The challenges of using telemedicine for patients with diabetes during the COVID-19 pandemic were categorized into the clinical, individual, organizational, and technical challenges. The clinical challenges included the lack of physical examinations and unavailability of patients' medical history. The individual challenges contained difficulties in using smart phones by patients and their low level of literacy. The organizational challenges were related to insufficient laws about obtaining patient consent and limited reimbursement for telemedicine services, and the technical challenges included limited access to the high-speed Internet services and inadequate technical infrastructure for telemedicine services. Most studies highlighted the role of individual and organizational challenges in using this technology.

Conclusions

Considering the numerous challenges experienced in using telemedicine for patients with diabetes during the COVID-19 pandemic, it seems that more attention should be paid to address each of these challenges to improve the actual usage, service quality, and user acceptance of telemedicine technology. This, in turn, can lead to saving costs and improving the health status and quality of life of patients with diabetes.

Teleconsultation management in healthcare during the COVID-19 pandemic: The impact of Perceived Justice on satisfaction and Word-Of-Mouth

Following the restrictions on movement imposed during the COVID-19 pandemic, the greater demands placed on physicians and many healthcare infrastructures, a large number of health teleconsultation platforms have emerged around the world. The aim of this paper is to obtain a better understanding of the acceptance of teleconsultation platforms by patients. To this end, a survey of 1273 patients was carried out using a teleconsultation platform during the pandemic period in France (from 9 July to 29 October 2020). The questionnaire mobilized existing scales to measure Satisfaction, Perceived Justice and, finally, the intention to disseminate by Word-Of-Mouth (WOM). Data were analysed using a Partial Least Squares approach. The study confirms the impact of Distributive, Informational and Procedural Justice on Satisfaction and the impact of Distributive and Informational Justice on WOM. The findings emphasize the influence of Satisfaction on WOM. The results detect a mediating effect of Satisfaction on WOM and moderating effects of gender, age and long-standing use. This research contributes to both theoretical and practical COVID-19 research and may be used by healthcare professionals to develop teleconsultation services, one of the means of supporting interaction and satisfying patients’ treatment requirements during the pandemic.

Digital transformation of healthcare during the COVID-19 pandemic: Patients’ teleconsultation acceptance and trusting beliefs

The COVID-19 pandemic boosted the digital transformation of many services, including healthcare, and access to medical care using teleconsultation has increased rapidly. Thus, a growing number of online platforms have been developed to accommodate patients’ needs. This paper examines the factors that predict the intention to use medical teleconsultation by extending the unified theory of acceptance and use of technology (UTAUT2) with the three dimensions of trusting beliefs and self-efficacy. A survey was administered to patients who had used a teleconsultation platform during the pandemic period. As one of the largest studies to date, a sample of 1233 respondents was collected and analyzed using a partial least squares approach, often mobilized in the information systems (IS) domain. Furthermore, a deep analysis using all recommended metrics was performed. The results highlight the significance of trusting beliefs, and self-efficacy in the adoption of digital healthcare services. These findings contribute to both theory and practice in COVID-19 research.

The usability testing of the integrated electronic healthcare services for diabetes mellitus patients during the pandemic in Indonesia

Introduction

Diabetes mellitus is a degenerative disease that obliges patients to take continuous healthcare services. During a pandemic situation, all access to healthcare facilities becomes limited. A web-based integrated electronic-healthcare system (IeHS) study was used to overcome this problem. This study aimed to describe patients' ability to access and understand this web-based application.

Method

An observational study using a web-based IeHS took place in Muara Tebo, Indonesia, in 2021. A total of 82 outpatients with diabetes mellitus participated in this study. These patients belonged to local community-based diabetes mellitus. Only adult patients accustomed to using smartphones were invited to participate in this study. All participants were taught to access the web-based application through video recordings. They were asked to fill out the form regarding their understanding of the web-based integrated e-healthcare application. This form was sent online.

Results

From the calculation of the usability scale, the results show that patients have not been able to take advantage of this application in life (the system usability scale (SUS) score 63.38). There is no significant difference between patients' characteristics and the SUS score.

Conclusion

Participants' condition in this study reflects the general state of outpatients. The ability of these participants to access an internet-based application was related to their education level. This condition becomes a challenge for policymakers to improve local human resources to increase their health literacy.

Evaluation of Impact of a Pharmacist-Led Educational Campaign on Disease Knowledge, Practices and Medication Adherence for Type-2 Diabetic Patients: A Prospective Pre- and Post-Analysis

Type 2 Diabetes mellitus is a major public health concern with an alarming global growth rate. According to the World Health Organization (WHO), Saudi Arabia ranks seventh in the world and second in the Middle East for the largest estimated burden of diabetic cases. Evidence shows that pharmacist-led care programs can be beneficial for the effective treatment of diabetes mellitus. Current study was aimed to evaluate the impact of Pharmacist-Based Diabetic Intervention (PDIM) for Type 2 Diabetes patients on knowledge of the disease, adherence to medications and self-care practices during the first wave of COVID-19. A multi-arm pre-post study was conducted among type 2 diabetic patients from April to October 2021 in Sakaka, Saudi Arabia. Patients were randomly divided into an intervention and a control group. The intervention group received the PDIM, whereas the control group only received the usual care. The pharmacist-based diabetes intervention model consisted of a diabetic educational module and medication improvement strategies. Furthermore, the intervention group also received specific telepharmacy services (calls, messages or emails) to address their medication-related problems, inquire about medication adherence and follow-up. At the end of six months, disease knowledge, self-care practices, and medication adherence score were analyzed. Furthermore, HbA1c and lipid profile were also compared. A total of 109 patients were included in the study. A significant difference was observed in the knowledge score between the intervention and control group (16.89 ± 2.01 versus 15.24 ± 2.03, p-value < 0.001). Similarly, self-care practices also improved in the intervention group as compared to the control group (4.39 ± 1.10 versus 3.16 ± 0.97, p-value < 0.001). Furthermore, the medication adherence and HbA1c significantly improved during between the group analysis (p < 0.05). Our study demonstrates that pharmacist-based diabetes intervention model is effective in improving patients’ knowledge of diabetes, self-care practices, medication adherence and glycemic control.

Coronavirus disease-2019: Challenges, opportunities, and benefits in India

BACKGROUND

The human coronavirus was first identified in 1965, belongs to the same family of Viruses as SARS, MERS-Co. The current virus that affected worldwide came into existence in late 2019, recently found in Wuhan, China, and caused a global pandemic called coronavirus disease-2019 (COVID-19). This disease became a quick global pandemic due to the rapid transmission of the virus from one human to another. In the history of humankind, people were inside the four walls for more than a month. The COVID-19 pandemic has posed significant problems in a variety of fields. The current pandemic created many changes that are seen as challenges worldwide. However, it created opportunities and benefits for many, extend a helping hand towards the people in need, in the society, community, and the nation. This paper focuses on challenges, opportunities, and benefits during the (COVID-19) pandemic in India.

MATERIALS AND METHODS

Online search engines like PubMed and Google Scholar were used to conduct the research. The review article's dates were not restricted in any way. A total of 48 articles were chosen. The data was tabulated based on the kind of study and the outcomes. There are just a few papers available that demonstrate the necessity for more study.

RESULTS

COVID-19 caused unforeseen changes in the health care industry, unequal distribution of health care, and consequences on mental health, according to the review studies. Teleconsultation, Internet use, and E-learning have all become more accessible. A period of transitory economic collapse and an increase in the number of migrants left many despondent. Improvement in family bonding, use of a face mask, and hygiene measures to adapt to the current scenario. There was also an impact on water sources, waste management systems, and environmental resource conservation.

CONCLUSION

Difficult conditions can provide both problems and opportunities and advantages to the people during a pandemic outbreak.

Doctor-Patient Relationship in Synchronous/Real-time Video-Consultations and In-Person Visits: An Investigation of the Perceptions of Young People with Type 1 Diabetes and Their Parents During the COVID-19 Pandemic

Background

Given that the widely acknowledged influence of the doctor-patient relationship on objective health parameters and treatment adherence in chronic illnesses, this study sought to explore how patients perceived the patient-doctor relationship across virtual and in-person contexts.

Methods

Parents’ and patients’ perceptions of doctor-patient relationship were evaluated in 610 children and adolescents (12.17 ± 4.19 years, 50.9% girls) with type 1 diabetes who visited via video-conferencing or in person during the COVID-19 pandemic.

Results

No differences were found between video consultations and in-person visits in terms of care satisfaction (p > .05), doctor-patient relationship—for the dimensions agreement on tasks (p = .506) and bond (p = .828)—as perceived by parents and physician empathy as perceived by patients (p = .096). Parents rated patient-doctor agreement on explicit goals of treatment higher in video consultation than in person (p = .009, d = .211). Agreement on goals (β =  − .180, p = .016) and bond with doctor (β =  − .160, p = .034) were negatively and significantly associated with HbA1c values, but only in participants who visited in person.

Conclusions

Parents’ care satisfaction and perceptions of doctor-patient relationship, along with patients’ perceptions of physician empathy, did not substantially differ between visits carried out in person or via video consultations. Given the high risk of psychological problems described in young people with diabetes, video consultation can be considered a useful opportunity to maintain access to a healthcare provider in a challenging time, such as the COVID-19 pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12529-021-10047-5.

Telepharmacy: A Potential Alternative Approach for Diabetic Patients During the COVID-19 Pandemic

The use of telepharmacy technology allows pharmacists to provide clinical pharmaceutical services to patients with diabetes mellitus (DM) who need regular services during the COVID-19 pandemic while maintaining distance and minimizing face-to-face meetings. The purpose of this review article was to identify the impact of telepharmacy intervention by pharmacists in diabetic patients by reviewing clinical outcomes and patient therapy adherences. A literature search was conducted through the PubMed database using the terms "telemedicine", "telepharmacy", "telehealth" and "telephone" in combination with "pharmacist", 'diabetes' and 'COVID-19' or "Pandemic". From a total of 67 articles identified, 14 research articles conform to the inclusion criteria. Telephone is the most widely used communication model (n = 11). All studies had a positive impact on clinical outcomes and three studies did not provide significant result on therapy adherence. The use of telepharmacy can be maximized and used on a vast scale, with the design of devices and technologies making it easier for pharmacists and diabetic patients to provide and receive clinical pharmaceutical services during the COVID-19 pandemic.

Awareness regarding COVID-19 and problems being faced by young adults with type 1 diabetes mellitus amid nationwide lockdown in India: A qualitative interview study

AIMS

To assess the awareness about COVID-19 and the problems being faced by young adults with T1DM amid nationwide lockdown in India.

METHODS

A cross-sectional telephone-based qualitative interview study was conducted in young adults (aged 18-30 years) with T1DM amid lockdown. Following verbal consent, participants were asked 8 open-ended questions, 5 on awareness about COVID-19 and 3 catering to problems being faced concerning diet, physical activity and treatment amid lockdown. On average, 3 interviews were conducted per day with each lasting for 15-20 min. Interviews were recorded, transcribed and analyzed by qualitative content analysis.

RESULTS

Thirty-two participants were interviewed; after exclusion of two poorly recorded interviews, 30 were finally analyzed. Mean age of participants was 22.4 ± 4.0 years (M:F = 8:7). Only 30%, 40% and 53% of participants were aware of modes of transmission (respiratory droplets and fomites), cardinal symptoms (fever, cough and breathing difficulty) and means of prevention (staying indoors, social distancing and regular hand washing), respectively. Majority of participants were unaware of additional risks associated with COVID-19 in diabetes mellitus. Most participants could continue with their routine diet and prescribed treatment regime, however, 90% reported a reduction in physical activity and 72% experienced worsening of glycemic control amid lockdown.

CONCLUSIONS

Young adults with T1DM lack adequate awareness about COVID-19. Increasing awareness and imparting diabetes self-management education via digital/print media is needed.

The impact of telemedicine on patients with uncontrolled type 2 diabetes mellitus during the COVID-19 pandemic in Saudi Arabia: Findings and implications

INTRODUCTION

Routine diabetes care changed during the COVID-19 pandemic due to precautionary measures such as lockdowns, cancellation of in-person visits, and patients' fear of being infected when attending clinics. Because of the pandemic, virtual clinics were implemented to provide diabetes care. Therefore, we conducted this study to assess the impact of these virtual clinics on glycaemic control among high-risk patients with type 2 diabetes mellitus (DM).

METHODS

A prospective single-cohort pre-/post telemedicine care intervention study was conducted on 130 patients with type 2 DM attending a virtual integrated care clinic at a chronic Illness center in a family and community medicine department in Riyadh, Saudi Arabia during the COVID-19 pandemic.

RESULTS

The mean age of the participants was 57 years (standard deviation (SD) = 12) and the mean (SD) duration of diabetes was 14 (7) years. Over a period of 4 months, the HbA1c decreased significantly from 9.98 ± 1.33 pre-intervention to 8.32 ± 1.31 post-intervention (mean difference 1.66 ± 1.29; CI = 1.43-1.88; P <0.001). In addition, most in-person care visits were successfully replaced, as most patients (64%) needed only one or two in-person visits during the 4-month period, compared with typically one visit every 1-2 weeks in the integrated care programme before the pandemic for this group of high-risk patients.

DISCUSSION

The current study found a significant positive impact of telemedicine care on glycaemic control among high-risk patients with DM during the COVID-19 pandemic. Moreover, it showed that telemedicine could be integrated into diabetic care to successfully replace many of the usual in-person care visits. Consequently, health policy makers need to consider developing comprehensive guidelines in Saudi Arabia for telemedicine care to, ensure the quality of care and address issues such as financial reimbursement and patient information privacy.

Teleconsultation for paraphimosis reduction in the geriatric population: Lessons from the COVID-19 pandemic

The health-care sector has been drastically overwhelmed in the wake of prevailing COVID-19 pandemic, hampering elective and emergency medical services alike. The geriatric population is especially affected in this regard as they are the ones who need access to health care services the most, and unfortunately, they are the ones with the highest risk of cross infection and mortality with SARS-COV-2. Lockdown and public restrictions have made the accessibility even harder. Telemedicine has emerged as a useful tool that avoids the risk of cross infection during the face-to-face consultation. Numerous guidelines have been made regarding the implementation of teleconsultations during this pandemic. Through this report, we describe the "beyond guidelines" emergency management of paraphimosis in an aged, bedridden male with comorbidities, through teleconsultation amid the COVID-19 pandemic.

Effect of COVID19 pandemic and national lockdown on persons with diabetes from rural areas availing care in a tertiary care center, southern India

BACKGROUND AND AIMS

COVID-19 pandemic and lockdown measures to contain it have affected health care services globally. This study aims to assess the effect and urban-rural differences of COVID19 pandemic on diabetes care.

METHODS

This cross-sectional study was conducted among persons with diabetes (PWDs) registered for care at a diabetes clinic of a tertiary care center in Southern India. We collected following information by telephonic interviews: physician consultations, access to diabetes medications and blood sugar tests, use of telemedicine services, out of pocket expenditure and psychological morbidity.

RESULTS

A total of 350 PWDs were interviewed. Majority were male (78%) and from rural areas (79%). One fourth (24%) met any physician for diabetes care at least once during lockdown. PWDs from rural areas mainly consulted a physician in a private clinic (55%) compared to urban areas (26%). Two third (65%) availed medications from private medical shops. Almost half (46%) got their blood sugar tested during and majority of them (81%) reported unsatisfactory glycemic control. Only few (5%) was aware and three utilized telemedicine services. Almost all (99%) spent money (US $ 8.3) for diabetes care. One third (33%) had moderate or high psychological distress.

CONCLUSIONS

Majority of PWDs did not consult a physician during lockdown. Cost of care was high. Measures to improve utilisation of telemedicine services and peripheral health facilities are needed.

Pitfalls in telemedicine consultations in the era of COVID 19 and how to avoid them

BACKGROUND AND AIMS

With restrictions on face to face clinical consultations in the COVID-19 pandemic, Telemedicine has become an essential tool in providing continuity of care to patients. We explore the common pitfalls in remote consultations and strategies that can be adopted to avoid them.

METHODS

We have done a comprehensive review of the literature using suitable keywords on the search engines of PubMed, SCOPUS, Google Scholar and Research Gate in the first week of May 2020 including 'COVID-19', 'telemedicine' and 'remote consultations'.

RESULTS

Telemedicine has become an integral part to support patient's clinical care in the current COVID-19 pandemic now and will be in the future for both primary and secondary care. Common pitfalls can be identified and steps can be taken to prevent them.

CONCLUSION

Telemedicine it is going to play a key role in future of health medicine, however, telemedicine technology should be applied in appropriate settings and situations. Suitable training, enhanced documentations, communication and observing information governance guidelines will go a long way in avoiding pitfalls associated with remote consultations.

Managing common endocrine disorders amid COVID-19 pandemic

BACKGROUND AND AIMS

The novel coronavirus disease (COVID-19) pandemic and the resulting nationwide lockdowns have posed a major challenge to the management of pre-existing and newly diagnosed endocrine disorders. Herein, we have summarized the management approaches of common endocrine disorders amid the ongoing pandemic.

METHODS

We have performed an extensive literature search for articles in PubMed, EMBASE and Google Scholar databases till 25 May 2020, with the following keywords: "COVID-19", "diabetes mellitus", "thyroid disorders", "primary adrenal insufficiency", "Cushing's syndrome", "pituitary tumors", "vitamin D″", "osteoporosis", "primary hyperparathyroidism", "hypoparathyroidism", "management", "treatment" and "guidelines" with interposition of the Boolean operator "AND".

RESULTS

We have summarized the most feasible strategies for the management of diabetes mellitus, thyroid disorders, primary adrenal insufficiency (including congenital adrenal hyperplasia), Cushing's syndrome, pituitary tumors, osteoporosis, primary hyperparathyroidism and hypoparathyroidism amid the constraints laid down by the raging pandemic. In general, medical management should be encouraged and surgical interventions should be deferred whenever possible. Ongoing medications should be continued. Sick-day rules should be sincerely adhered to. Regular contact with physicians can be maintained through teleconsultations and virtual clinics.

CONCLUSIONS

Considering the burden of endocrine disorders in the general population, their management needs to be prioritized amid the ongoing COVID-19 pandemic.