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Lau K, Escudero C, Lee I, Yu C. Experiences of Motivational Interviewing in Virtual Health-care Visits for Adults With Type 2 Diabetes Mellitus: A Qualitative Analysis. Can J Diabetes 2024:S1499-2671(24)00087-X. [PMID: 38641003 DOI: 10.1016/j.jcjd.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 04/01/2024] [Accepted: 04/08/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVES The purpose of this qualitative study is to identify barriers minimizing the effectiveness of motivational interviewing during virtual clinic encounters for individuals with type 2 diabetes based on the capability, opportunity, motivation, and behaviour (COM-B) model. METHODS One-on-one semistructured interviews were conducted from March to June 2023, with 17 adults with type 2 diabetes (64.7% female; median age 69 years, range 47 to 83 years) followed at St. Michael's Hospital (Toronto, Canada). Themes from transcribed interviews were identified through descriptive analysis using a grounded theory approach. RESULTS The following main themes were identified: 1) face-to-face appointments strengthen provider-patient rapport and collaboration; 2) virtual encounters reduce patient accountability and hinder health-seeking behaviour; and 3) individuals with physical disabilities and/or low technological proficiency experience decreased provider accessibility. Protective factors that can mitigate these negative impacts include establishing rapport during in-person appointments before transitioning to virtual appointments and incorporating a video component during virtual encounters. CONCLUSIONS Several barriers of virtual appointments currently limit the effectiveness of motivational interviewing for individuals with type 2 diabetes and make it difficult to provide person-centred care, especially by phone. However, there are protective factors that help to maintain healthy lifestyle behaviours, even after transitioning to virtual settings, and are areas for optimization moving forward.
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Affiliation(s)
- Kimberley Lau
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Carlos Escudero
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Irene Lee
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Catherine Yu
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada.
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Jairoun AA, Al-Hemyari SS, Shahwan M, Al-Qirim T, Shahwan M. Benefit-Risk Assessment of ChatGPT Applications in the Field of Diabetes and Metabolic Illnesses: A Qualitative Study. Clin Med Insights Endocrinol Diabetes 2024; 17:11795514241235514. [PMID: 38495947 PMCID: PMC10943713 DOI: 10.1177/11795514241235514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/06/2024] [Indexed: 03/19/2024] Open
Abstract
Background The use of ChatGPT and artificial intelligence (AI) in the management of metabolic and endocrine disorders presents both significant opportunities and notable risks. Objectives To investigate the benefits and risks associated with the application of ChatGPT in managing diabetes and metabolic illnesses by exploring the perspectives of endocrinologists and diabetologists. Methods and materials The study employed a qualitative research approach. A semi-structured in-depth interview guide was developed. A convenience sample of 25 endocrinologists and diabetologists was enrolled and interviewed. All interviews were audiotaped and verbatim transcribed; then, thematic analysis was used to determine the themes in the data. Results The findings of the thematic analysis resulted in 19 codes and 9 major themes regarding the benefits of implementing AI and ChatGPT in managing diabetes and metabolic illnesses. Moreover, the extracted risks of implementing AI and ChatGPT in managing diabetes and metabolic illnesses were categorized into 7 themes and 14 codes. The benefits of heightened diagnostic precision, tailored treatment, and efficient resource utilization have potential to improve patient results. Concurrently, the identification of potential challenges, such as data security concerns and the need for AI that can be explained, enables stakeholders to proactively tackle these issues. Conclusions Regulatory frameworks must evolve to keep pace with the rapid adoption of AI in healthcare. Sustained attention to ethical considerations, including obtaining patient consent, safeguarding data privacy, ensuring accountability, and promoting fairness, remains critical. Despite its potential impact on the human aspect of healthcare, AI will remain an integral component of patient-centered care. Striking a balance between AI-assisted decision-making and human expertise is essential to uphold trust and provide comprehensive patient care.
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Affiliation(s)
- Ammar Abdulrahman Jairoun
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Pulau Pinang, Malaysia
- Health and Safety Department, Dubai Municipality, Dubai, United Arab Emirates
| | - Sabaa Saleh Al-Hemyari
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Pulau Pinang, Malaysia
- Pharmacy Department, Emirates Health Services, Dubai, United Arab Emirates
| | - Moyad Shahwan
- College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, United Arab Emirates
| | - Tariq Al-Qirim
- Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Monzer Shahwan
- Diabetes Clinic, AL-Swity Center for Dermatology and Chronic Diseases, Ramallah, Palestine
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3
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Senthinathan A, Tu K, Stephenson E, O'Neill B, Lipscombe L, Ji C, Butt DA, Apajee J, Train A, Crampton N. A comparison between different patient groups for diabetes management during phases of the COVID-19 pandemic: a retrospective cohort study in Ontario, Canada. BMC PRIMARY CARE 2024; 25:43. [PMID: 38280984 PMCID: PMC10821561 DOI: 10.1186/s12875-024-02272-0] [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: 11/06/2022] [Accepted: 01/10/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND With the onset of the COVID-19 pandemic and the large uptake in virtual care in primary care in Canada, the care of patients with type 2 diabetes has been greatly affected. This includes decreased in-person visits, laboratory testing and in-person assessments such as blood pressure (BP). No studies have investigated if these changes persisted with pandemic progression, and it is unclear if shifts impacted patient groups uniformly. The purpose of this paper was to examine changes in diabetes care pre, early, and later pandemic across different patient groups. METHODS A repeated cross-sectional design with an open cohort was used to investigate diabetes care in adults with type 2 diabetes for a 6-month interval from March 14 to September 13 over three consecutive years: 2019 (pre-pandemic period), 2020 (early pandemic period), and 2021 (later pandemic period). Data for this study were abstracted from the University of Toronto Practice-Based Research Network (UTOPIAN) Data Safe Haven, a primary care electronic medical records database in Ontario, Canada. Changes in diabetes care, which included primary care total visits, in-person visits, hemoglobin A1c (HbA1c) testing, and BP measurements were evaluated across the phases of the pandemic. Difference in diabetes care across patient groups, including age, sex, income quintile, prior HbA1c levels, and prior BP levels, were assessed. RESULTS A total of 39,401 adults with type 2 diabetes were included in the study. Compared to the 6-month pre-pandemic period, having any in-person visits decreased significantly early pandemic (OR = 0.079 (0.076-0.082)), with a partial recovery later pandemic (OR = 0.162 (95% CI: 0.157-0.169). Compared to the pre-pandemic period, there was a significant decrease early pandemic for total visits (OR = 0.486 (95% CI: 0.470-0.503)), HbA1c testing (OR = 0.401 (95% CI: 0.389-0.413)), and BP measurement (OR = 0.121 (95% CI: 0.116-0.125)), with partial recovery later pandemic. CONCLUSIONS All measures of diabetes care were substantially decreased early pandemic, with a partial recovery later pandemic across all patient groups. With the increase in virtual care due to the COVID-19 pandemic, diabetes care has been negatively impacted over 1-year after pandemic onset.
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Affiliation(s)
- A Senthinathan
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
| | - K Tu
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- North York General Hospital, Toronto, ON, Canada
- Toronto Western Family Health Team, University Health Network, Toronto, ON, Canada
| | - E Stephenson
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - B O'Neill
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada
- MAP Centre for Urban Health Solutions, LiKa Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - L Lipscombe
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - C Ji
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - D A Butt
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Scarborough Health Network, Toronto, ON, Canada
| | - J Apajee
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - A Train
- Department of Family Medicine, Queen's University, Kingston, ON, Canada
| | - N Crampton
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Toronto Western Family Health Team, University Health Network, Toronto, ON, Canada
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Amiri P, Nadri H, Bahaadinbeigy K. Facilitators and barriers of mHealth interventions during the Covid-19 pandemic: systematic review. BMC Health Serv Res 2023; 23:1176. [PMID: 37898755 PMCID: PMC10613392 DOI: 10.1186/s12913-023-10171-w] [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] [Received: 03/03/2023] [Accepted: 10/18/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND With the spread of Covid-19 disease, health interventions related to the control, prevention, and treatment of this disease and other diseases were given real attention. The purpose of this systematic review is to express facilitators and barriers of using mobile health (mHealth) interventions during the Covid-19 pandemic. METHODS In this systematic review, original studies were searched using keywords in the electronic database of PubMed until August 2022. The objectives and outcomes of these studies were extracted. Finally, to identify the facilitators and barriers of mHealth interventions, a qualitative content analysis was conducted based on the strengths, weaknesses, opportunities, and threats (SWOT) analysis method with Atlas.ti 8 software. We evaluated the studies using the Mixed Methods Appraisal Tool (MMAT). RESULTS In total, 1598 articles were identified and 55 articles were included in this study. Most of the studies used mobile applications to provide and receive health services during the Covid-19 pandemic (96.4%). The purpose of the applications was to help prevention (17), follow-up (15), treatment (12), and diagnosis (8). Using SWOT analysis, 13 facilitators and 18 barriers to patients' use of mHealth services were identified. CONCLUSION Mobile applications are very flexible technologies that can be customized for each person, patient, and population. During the Covid-19 pandemic, the applications designed due to lack of interaction, lack of time, lack of attention to privacy, and non-academic nature have not met their expectations of them.
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Affiliation(s)
- Parastoo Amiri
- Department of Health Information Technology, School of Allied Medical Sciences, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Hamed Nadri
- Department of Health Information Technology, , School of Allied Medical Sciences, Urmia University of Medical Sciences, Urmia, Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute of Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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Brunton L, Soiland-Reyes C, Wilson P. A qualitative evaluation of the national rollout of a diabetes prevention programme in England. BMC Health Serv Res 2023; 23:1043. [PMID: 37773125 PMCID: PMC10543852 DOI: 10.1186/s12913-023-10002-y] [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: 06/21/2022] [Accepted: 09/01/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND The National Health Service Diabetes Prevention Programme (NHS DPP) was commissioned by NHS England in 2016 and rolled out in three 'waves' across the whole of England. It aims to help people with raised blood glucose levels reduce their risk of developing type 2 diabetes through behaviour change techniques (e.g., weight loss, dietary changes and exercise). An independent, longitudinal, mixed methods evaluation of the NHS DPP was undertaken. We report the findings from the implementation work package: a qualitative interview study with designated local leads, responsible for the local commissioning and implementation of the programme. The aim of the study was to explore how local implementation processes were enacted and adapted over time. METHODS We conducted a telephone interview study across two time-points. Twenty-four semi-structured interviews with local leads across 19 sampled case sites were undertaken between October 2019 and January 2020 and 13 interviews with local leads across 13 sampled case sites were conducted between July 2020 and August 2020. Interviews aimed to reflect on the experience of implementation and explore how things changed over time. RESULTS We identified four overarching themes to show how implementation was locally enacted and adapted across the sampled case sites: 1. Adapting to provider change; 2. Identification and referral; 3. Enhancing uptake in underserved populations; and 4. Digital and remote service options. CONCLUSION This paper reports how designated local leads, responsible for local implementation of the NHS DPP, adapted implementation efforts over the course of a changing national diabetes prevention programme, including how local leads adapted implementation during the COVID-19 pandemic. This paper highlights three main factors that influence implementation: the importance of facilitation, the ability (or not) to tailor interventions to local needs and the role of context in implementation.
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Affiliation(s)
- Lisa Brunton
- Division of Population Health, Health Services, Research and Primary Care, School of Health Sciences, The University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK.
| | - Claudia Soiland-Reyes
- Medical Directorate, North West Ambulance Service NHS Trust, Ladybridge Hall, 399 Chorley New Rd, Bolton, BL1 5DD, UK
| | - Paul Wilson
- Division of Population Health, Health Services, Research and Primary Care, School of Health Sciences, The University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK
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Siminerio L, Krall J, Johnson P, Ruppert K, Hammoudeh R, Bandi A, Ng JM. Examining a Diabetes Self-Management Education and Support Telemedicine Model With High-Risk Patients in a Rural Community. J Diabetes Sci Technol 2023; 17:1190-1197. [PMID: 37338130 PMCID: PMC10563533 DOI: 10.1177/19322968231180884] [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] [Indexed: 06/21/2023]
Abstract
BACKGROUND Ongoing support is critical to diabetes self-management education and support (DSMES) effectiveness, but difficult to realize, particularly in areas with limited resources. The objective of this feasibility study was to assess the impact of a virtual support model on diabetes outcomes and acceptability with high-risk patients with type 2 diabetes in a rural community. METHODS In a 12-month nonrandomized trial in federally qualified health centers (FQHCs), patients with hemoglobin A1c (HbA1c) >9% were referred to the Telemedicine for Reach, Education, Access, Treatment, and Ongoing Support (TREAT-ON) program where a Diabetes Care and Education Specialist provided DSMES through videoconferencing. HbA1c change was compared in 30 patients in the intervention group (IG) to a propensity score-matched retrospective control group (CG) of patients who received in-person DSMES delivered by a DCES. Changes in HbA1c, diabetes distress, empowerment, self-care and acceptability were assessed within the intervention group (IG) between those who did and did not meet self-management goals. RESULTS The IG experienced similar significant reductions in HbA1c as the CG. Most (64%) IG participants achieved their self-management goal. Goal attainers had a significant HbA1c decrease of 0.21% every 3 months as well as significant reduction in diabetes distress and improvement in general dietary intake. Regardless of goal attainment, IG participants reported high levels of acceptability with TREAT-ON. CONCLUSIONS This feasibility study suggests that TREAT-ON was well-received and as effective as traditional in-person DSMES. While findings augment ample evidence regarding DSMES benefits, the TREAT-ON model offers additional advantages and provides validation for telehealth to inform future practice in reaching and supporting self-management for high-risk patients in underserved areas. TRIAL REGISTRATION Clinicaltrials.gov, # NCT04107935.
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Affiliation(s)
- Linda Siminerio
- Division of Endocrinology and
Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, PA,
USA
| | - Jodi Krall
- University of Pittsburgh Medical
Center, Pittsburgh, PA, USA
| | | | - Kristine Ruppert
- Department of Epidemiology, University
of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Rawan Hammoudeh
- Division of Endocrinology and
Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, PA,
USA
- University of Pittsburgh Medical
Center, Pittsburgh, PA, USA
| | - Archana Bandi
- Division of Endocrinology and
Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, PA,
USA
- Veterans Affairs Pittsburgh Health
System, Pittsburgh, PA, USA
| | - Jason M. Ng
- Division of Endocrinology and
Metabolism, Department of Medicine, University of Pittsburgh, Pittsburgh, PA,
USA
- University of Pittsburgh Medical
Center, Pittsburgh, PA, USA
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Tong J, Meehan R, Iannicello D, Li R, Joy T, Spaic T, Tung TH, Clemens KK. Improving the efficiency of virtual insulin teaching for patients admitted to hospital through the COVID-19 pandemic: a quality improvement initiative. BMJ Open Qual 2023; 12:e002305. [PMID: 37328282 PMCID: PMC10277138 DOI: 10.1136/bmjoq-2023-002305] [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] [Received: 02/06/2023] [Accepted: 05/25/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Throughout the COVID-19 pandemic, many areas of medicine transitioned to virtual care. For patients with diabetes admitted to hospital, this included diabetes education and insulin teaching. Shifting to a virtual model of insulin teaching created new challenges for inpatient certified diabetes educators (CDE). OBJECTIVE We advanced a quality improvement project to improve the efficiency of safe and effective virtual insulin teaching throughout the COVID-19 pandemic. Our primary aim was to reduce the mean time between CDE referral to successful inpatient insulin teach by 0.5 days. DESIGN, SETTING, PARTICIPANTS We conducted this initiative at two large academic hospitals between April 2020 and September 2021. We included all admitted patients with diabetes who were referred to our CDE for inpatient insulin teaching and education. INTERVENTION Alongside a multidisciplinary team of project stakeholders, we created and studied a CDE-led, virtual (video conference or telephone) insulin teaching programme. As tests of change, we added a streamlined method to deliver insulin pens to the ward for patient teaching, created a new electronic order set and included patient-care facilitators in the scheduling process. MAIN OUTCOME AND MEASURES Our main outcome measure was the mean time between CDE referral and successful insulin teach-back. Our process measure was the percentage of successful insulin pen deliveries to the ward for teaching. As balance measures, we captured the percentage of patients with a successful insulin teach, the time between insulin teach and hospital discharge, and readmissions to hospital for diabetes-related complications. RESULTS Our tests of change improved the efficiency of safe and effective virtual insulin teaching by 0.27 days. The virtual model appeared less efficient than usual in-person care. CONCLUSIONS In our centre, virtual insulin teaching supported patients admitted to hospital through the pandemic. Improving the administrative efficiency of virtual models and leveraging key stakeholders remain important for long-term sustainability.
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Affiliation(s)
- Jeffery Tong
- Medicine, Western University, London, Ontario, Canada
| | - Rebecca Meehan
- Centre for Diabetes, Endocrinology and Metabolism, St.Joseph's Health Care London, London, Ontario, Canada
| | - Dane Iannicello
- Centre for Diabetes, Endocrinology and Metabolism, St.Joseph's Health Care London, London, Ontario, Canada
| | - Raymond Li
- Medicine, Western University, London, Ontario, Canada
| | - Tisha Joy
- Medicine, Western University, London, Ontario, Canada
- Centre for Diabetes, Endocrinology and Metabolism, St.Joseph's Health Care London, London, Ontario, Canada
| | - Tamara Spaic
- Medicine, Western University, London, Ontario, Canada
- Centre for Diabetes, Endocrinology and Metabolism, St.Joseph's Health Care London, London, Ontario, Canada
| | - Tsan-Hua Tung
- Centre for Quality, Innovation and Patient Safety, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Kristin K Clemens
- Medicine, Western University, London, Ontario, Canada
- Centre for Diabetes, Endocrinology and Metabolism, St.Joseph's Health Care London, London, Ontario, Canada
- Centre for Quality, Innovation and Patient Safety, Schulich School of Medicine and Dentistry, London, Ontario, Canada
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Heald AH, Roberts S, Albeda Gimeno L, Gilingham E, James M, White A, Saboo A, Beresford L, Crofts A, Abraham J. A Randomised Control Trial to Explore the Impact and Efficacy of the Healum Collaborative Care Planning Software and App on Condition Management in the Type 2 Diabetes Mellitus Population in NHS Primary Care. Diabetes Ther 2023; 14:977-988. [PMID: 37079268 PMCID: PMC10116475 DOI: 10.1007/s13300-023-01404-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/28/2023] [Indexed: 04/21/2023] Open
Abstract
INTRODUCTION Effective and scalable solutions to support management of Type 2 Diabetes (T2D) at a distance are a priority for health systems worldwide. The use of personalised care planning has been shown to be effective at improving the health outcomes and the experience of care amongst people with T2D and other long-term health conditions. Here we describe a specific example of such an intervention. METHODS The sample comprised 197 participants with T2D randomised to either the active intervention group with digital health planning (App + usual care), with 115 participants, or the control group (usual care), with 82 participants. We analysed data in relation to changes in body mass index (BMI) and glycated haemoglobin (HbA1c) over a 6-month follow-up period. We also analysed responses to questionnaires sent out and held interviews with participants that were in the active treatment group and therefore had a care plan created and access to an app. RESULTS The active treatment group had significant reductions in HbA1c (p < 0.01) and BMI (p < 0.037) vs the control group (no significant change). The average percentage change in HbA1c for the treatment group over 6 months was - 7.4% (± SE 1.4%), compared with 1.8% (± SE 2.1%) for the control group. The average percentage change in BMI for the treatment group was - 0.7% (± SE 0.4%) and it was - 0.2% (± SE 0.5%) for the control group. A higher percentage of the active treatment group reduced their HbA1c and BMI than the control group. For HbA1c, 72.4% of the active treatment group reduced their HbA1c, compared to 41.5% of the control group. For BMI, 52.7% of the active treatment group experienced a reduction, compared to 42.9% for the control group. Self-measured quality of life (QoL) improved for patients in the active treatment group, shown by an increase in their pre-trial to post-trial EQ-5D-5L rating by an average of 0.0464 (± SE 0.0625), compared to a decrease of 0.0086 (± SE 0.0530) for the control group. The average EQ VAS score also increased pre- to post-trial for the active treatment group, on average by 8.2%, whereas it decreased by an average of - 2.8% for the control group. CONCLUSION These findings point to how the provision of personalised plans of care, support and education linked to a mobile app, can result in HbA1c and BMI reduction for many individuals with T2D. The use of a patient management app as well as a personalised care plan also led to an improvement in patient self-rated QoL and engagement.
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Affiliation(s)
- Adrian H Heald
- Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, UK.
- The School of Medicine, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.
| | | | | | - Erin Gilingham
- Park Lane Surgery, Waters Green Medical Centre, Macclesfield, UK
| | | | - Alison White
- Middlewood Partnership, Bollington, Cheshire, UK
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Pettersson S, Jaarsma T, Hedgärd K, Klompstra L. Self-care in migrants with type 2 diabetes, during the COVID-19 pandemic. J Nurs Scholarsh 2023; 55:167-177. [PMID: 36353793 PMCID: PMC10098933 DOI: 10.1111/jnu.12842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/12/2022] [Accepted: 10/12/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Type 2 diabetes is increasing globally and particularly affects vulnerable groups in society, such as migrants. Research shows that type 2 diabetes is a risk factor for severe illness when infected with COVID-19. Diabetes-related complications can be prevented with good glycaemic control. In addition, good glycaemic control has been shown to be an important cornerstone for preventing severe illness in individuals infected with COVID-19. In order to maintain good glycaemic control, self-care is needed. The purpose of this article is to describe self-care maintenance and possible changes in self-care maintenance and to explore factors related to unchanged self-care maintenance in migrant patients with type 2 diabetes during the COVID-19 pandemic. The second aim is to describe well-being, social support, and the need for support from healthcare services during the COVID-19 pandemic in migrant patients with type 2 diabetes. DESIGN/METHOD A triangulation design with cross-sectional data collection was used. Both quantitative and qualitative data were collected and interpreted together in a triangulation design. Patients were selected by a diabetes nurse from a computer system at a health center in south-eastern Sweden and invited to participate in the study. A questionnaire was translated into the languages most commonly used at the clinic and sent out to 332 migrant patients who had been diagnosed with type 2 diabetes and treated in primary care. This questionnaire assessed self-care maintenance for diabetes (questions inspired by the Self-Care of Diabetes Inventory), with questions added to every item to assess changes during the pandemic. When changes occurred, we asked the participants to elaborate. Open-ended questions asked the participants how they would like to receive information when there are changes in their healthcare. Descriptive statistical analyses were used for the quantitative data and qualitative data was analyzed using a directed approach to content analysis. RESULTS In total, 79 participants answered the questionnaire (mean age 69 ± 11, 51% male, 47% born in the Middle East). Of these, 76% stated a change in self-care. More than half (58%) stated changes in maintaining an active lifestyle, 40% had changed their physical exercise, and 38% had changed their behavior to avoid getting sick. Participants said that this change was due to staying at home or canceling social activities because they feared meeting people during the pandemic. Others were more physically active than before on a regular basis during the pandemic due to taking walks to get fit, as a precaution related to COVID-19, and having greater awareness about how to avoid getting sick. Approximately one-quarter of the participants experienced a change in contact with healthcare due to poorer access to care, with fewer doctors' appointments and care being postponed during the pandemic. More than half (58%) would like to receive information about healthcare changes by a letter in the regular mail. Social support had changed for 35% of the participants, with less support from family and friends due to the risk of being infected with COVID-19. CONCLUSION The COVID-19 pandemic led to societal restrictions that changed the way of life for many individuals. Migrant patients with type 2 diabetes, who are already a vulnerable group regarding self-care, had difficulties in maintaining good living habits during the pandemic. During crises such as COVID-19, support with self-care, such as closer contact with healthcare providers, is vital. CLINICAL RELEVANCE Knowledge about how the COVID-19 pandemic has affected migrants with type 2 diabetes can be used to support healthcare providers in identifying individuals who are at high risk of suffering from the consequences of their diabetes associated with the pandemic.
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Affiliation(s)
- Sara Pettersson
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Klara Hedgärd
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Leonie Klompstra
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
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Al-Mutairi AM, Alshabeeb MA, Abohelaika S, Alomar FA, Bidasee KR. Impact of telemedicine on glycemic control in type 2 diabetes mellitus during the COVID-19 lockdown period. Front Endocrinol (Lausanne) 2023; 14:1068018. [PMID: 36817609 PMCID: PMC9936328 DOI: 10.3389/fendo.2023.1068018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/18/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The lockdown at the start of coronavirus disease 2019 (COVID-19) pandemic in Saudi Arabia (March 2020 to June 2020) shifted routine in-person care for patients with type 2 diabetes mellitus (T2DM) to telemedicine. The aim of this study was to investigate the impact telemedicine had during this period on glycemic control (HbA1c) in patients with T2DM. METHODS 4,266 patients with T2DM were screened from five Ministry of National Guard Health Affairs hospitals in the Kingdom of Saudi Arabia. Age, gender, body mass index (BMI), HbA1c (before and after the COVID-19 lockdown), duration of T2DM, comorbidities and antidiabetic medications data were obtained. Mean and standard deviation of differences in HbA1c were calculated to assess the impact of telemedicine intervention. Correlations between clinically significant variances (when change in the level is ≥0.5%) in HbA1c with demographics and clinical characteristic data were determined using chi square test. RESULTS Most of the participants were Saudis (97.7%) with 59.7% female and 56.4% ≥60 years of age. Obesity was 63.8%, dyslipidemia 91%, and hypertension 70%. Mean HbA1c of all patients slightly rose from 8.52% ± 1.5% before lockdown to 8.68% ± 1.6% after lockdown. There were n=1,064 patients (24.9%) whose HbA1c decreased by ≥0.5%, n =1,574 patients whose HbA1c increased by ≥0.5% (36.9%), and n =1,628 patients whose HbA1c changed by <0.5% in either direction (38.2%). More males had significant improvements in glycemia compared to females (28.1% vs 22.8%, p<0.0001), as were individuals below the age of 60 years (28.1% vs 22.5%, p<0.0001). Hypertensive individuals were less likely than non-hypertensive to have glycemic improvement (23.7% vs 27.9%, p=0.015). More patients on sulfonylureas had improvements in HbA1c (42.3% vs 37.9%, p=0.032), whereas patients on insulin had higher HbA1c (62.7% vs 56.2%, p=0.001). HbA1c changes were independent of BMI, duration of disease, hyperlipidemia, heart and kidney diseases. CONCLUSION Telemedicine was helpful in delivering care to T2DM patients during COVID-19 lockdown, with 63.1% of patients maintaining HbA1c and improving glycemia. More males than females showed improvements. However, the HbA1c levels in this cohort of patients pre- and post-lockdown were unsatisfactorily high, and may be due to in part lifestyle, age, education, and hypertension.
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Affiliation(s)
- Abrar M. Al-Mutairi
- Research Unit, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
- Ministry of National Guard Health Affairs (MNG-HA), Riyadh, Saudi Arabia
- *Correspondence: Abrar M. Al-Mutairi, ; Keshore R. Bidasee,
| | - Mohammad A. Alshabeeb
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
- Ministry of National Guard Health Affairs (MNG-HA), Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
| | - Salah Abohelaika
- Department of Clinical Pharmacology, Qatif Central Hospital, Qatif, Saudi Arabia
| | - Fadhel A. Alomar
- Department of Pharmacology and Toxicology, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Keshore R. Bidasee
- Departments of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, United States
- Department of Environment and Occupational Health, University of Nebraska Medical Center, Omaha, NE, United States
- Nebraska Redox Biology Center, Lincoln, NE, United States
- *Correspondence: Abrar M. Al-Mutairi, ; Keshore R. Bidasee,
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11
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Bolli GB, Cheng AYY, Owens DR. Insulin: evolution of insulin formulations and their application in clinical practice over 100 years. Acta Diabetol 2022; 59:1129-1144. [PMID: 35854185 PMCID: PMC9296014 DOI: 10.1007/s00592-022-01938-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 07/01/2022] [Indexed: 11/22/2022]
Abstract
The first preparation of insulin extracted from a pancreas and made suitable for use in humans after purification was achieved 100 years ago in Toronto, an epoch-making achievement, which has ultimately provided a life-giving treatment for millions of people worldwide. The earliest animal-derived formulations were short-acting and contained many impurities that caused adverse reactions, thereby limiting their therapeutic potential. However, since then, insulin production and purification improved with enhanced technologies, along with a full understanding of the insulin molecule structure. The availability of radio-immunoassays contributed to the unravelling of the physiology of glucose homeostasis, ultimately leading to the adoption of rational models of insulin replacement. The introduction of recombinant DNA technologies has since resulted in the era of both rapid- and long-acting human insulin analogues administered via the subcutaneous route which better mimic the physiology of insulin secretion, leading to the modern basal-bolus regimen. These advances, in combination with improved education and technologies for glucose monitoring, enable people with diabetes to better meet individual glycaemic goals with a lower risk of hypoglycaemia. While the prevalence of diabetes continues to rise globally, it is important to recognise the scientific endeavour that has led to insulin remaining the cornerstone of diabetes management, on the centenary of its first successful use in humans.
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12
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Booth E, McFetridge K, Ferguson E, Paton C. Teaching undergraduate medical students virtual consultation skills: a mixed-methods interventional before-and-after study. BMJ Open 2022; 12:e055235. [PMID: 35710246 PMCID: PMC9207740 DOI: 10.1136/bmjopen-2021-055235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To evaluate the impact and transferability of a novel teaching method on virtual communication skills for final year medical students. DESIGN Mixed-methods, interventional before-and-after study. SETTING NHS Lanarkshire, Scotland. PARTICIPANTS 21 final year medical students on their obstetrics and gynaecology (O&G) placement from September to December 2020. INTERVENTIONS A two-part teaching session on virtual communication skills. MAIN OUTCOME MEASURES Self-reported confidence in conducting consultations preteaching and post-teaching, exposure to virtual consultations, usefulness of teaching and transferability to primary care. Data were collected using preteaching and post-teaching evaluation tools and an online survey. RESULTS Of 21 participants, 1 student did not attend the second session so was excluded from post-teaching evaluation results and the online survey. Preteaching results were collected from 21 participants and post-teaching results from 20. Mean confidence scores increased across all domains post-teaching. Mean confidence in opening the consultation increased from 2.67 (95% CI 2.21 to 3.13) to 4.70 (95% CI 4.50 to 4.90); history-taking from 3.38 (95% CI 3.07 to 3.69) to 4.45 (95% CI 4.19 to 4.71); decision-making and forming a management plan from 2.62 (95% CI 2.28 to 2.96) to 3.90 (95% CI 3.66 to 4.14) and closing the consultation from 2.81 (95% CI 2.45 to 3.17) to 4.60 (95% CI 4.38 to 4.81). There was no change in exposure to virtual consultations during O&G placement. 16 (80%) participants responded to the online survey; 14 (87.5%) rated the sessions 'very useful' and all 16 considered them worthwhile continuing. 12 (75%) had the opportunity to practise virtual consultations on general practitioner, mostly via telephone. CONCLUSIONS We found that teaching students virtual consultation skills improved short term confidence and were transferable to primary care placements. Future research is suggested to assess this teaching model following adaptation and incorporation into medical education and training across specialties and grades. It would be useful to evaluate the impact on competence post intervention through observed skills.
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Affiliation(s)
- Edie Booth
- Department of Medical Education, NHS Lanarkshire, Bothwell, UK
- Department of Medical Education Glasgow, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
| | - Kate McFetridge
- Department of Medical Education, NHS Lanarkshire, Bothwell, UK
- Department of Medical Education Glasgow, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
| | - Evelyn Ferguson
- Department of Medical Education Glasgow, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
- Department of Obstetrics and Gynaecology, University of Glasgow, Glasgow, UK
| | - Catherine Paton
- Department of Medical Education, NHS Lanarkshire, Bothwell, UK
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13
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Chen YH, Wu HW, Huang CC, Lee JK, Yang LT, Hsu TP, Hung CS, Ho YL. The Logistics of Medication and Patient Flow in Video-Based Virtual Clinics During a Sudden COVID-19 Outbreak in Taiwan: Observational Study. Interact J Med Res 2022; 11:e37880. [PMID: 35687404 PMCID: PMC9191329 DOI: 10.2196/37880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/26/2022] [Accepted: 05/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background The COVID-19 pandemic was well controlled in Taiwan until an outbreak in May 2021. Telemedicine was rapidly implemented to avoid further patient exposure and to unload the already burdened medical system. Objective To understand the effect of COVID-19 on the implementation of video-based virtual clinic visits during this outbreak, we analyzed the logistics of prescribing medications and patient flow for such virtual visits at a tertiary medical center. Methods We retrospectively collected information on video-based virtual clinic visits and face-to-face outpatient visits from May 1 to August 31, 2021, from the administrative database at National Taiwan University Hospital. The number of daily new confirmed COVID-19 cases in Taiwan was obtained from an open resource. Results There were 782 virtual clinic visits during these 3 months, mostly for the departments of internal medicine, neurology, and surgery. The 3 most common categories of medications prescribed were cardiovascular, diabetic, and gastrointestinal, of which cardiovascular medications comprised around one-third of all medications prescribed during virtual clinic visits. The number of virtual clinic visits was significantly correlated with the number of daily new confirmed COVID-19 cases, with approximately a 20-day delay (correlation coefficient 0.735; P<.001). The patient waiting time for video-based virtual clinic visits was significantly shorter compared with face-to-face clinic visits during the same period (median 3, IQR 2-6 min vs median 20, IQR 9-42 min; rank sum P<.001). Although the time saved was appreciated by the patients, online payment with direct delivery of medications without the need to visit a hospital was still their major concern. Conclusions Our data showed that video-based virtual clinics can be implemented rapidly after a COVID-19 outbreak. The virtual clinics were efficient, as demonstrated by the significantly reduced waiting time. However, there are still some barriers to the large-scale implementation of video-based virtual clinics. Better preparation is required to improve performance in possible future large outbreaks.
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Affiliation(s)
- Ying-Hsien Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,National Taiwan University Hospital Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Hui-Wen Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,National Taiwan University Hospital Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Chang Huang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,National Taiwan University Hospital Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Jen-Kuang Lee
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,National Taiwan University Hospital Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Tan Yang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,National Taiwan University Hospital Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Tse-Pin Hsu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,National Taiwan University Hospital Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Sheng Hung
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,National Taiwan University Hospital Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Lwun Ho
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,National Taiwan University Hospital Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan
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14
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D’Silva C, Hafleen N, Mansfield E, Martel S, Fierheller D, Banerjee A, Malhotra G, Mutta B, Dhillon P, Hasan Z, Parikh A, Nooraie RY, Chaze F, Zenlea I. Service provider perspectives on exploring social determinants of health impacting type 2 diabetes management for South Asian adults in Peel region, Canada. Can J Diabetes 2022; 46:611-619.e1. [DOI: 10.1016/j.jcjd.2022.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/29/2022] [Accepted: 05/25/2022] [Indexed: 11/28/2022]
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15
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Foppa L, Alessi J, Nemetz B, de Matos R, Telo GH, Schaan BD. Quality of care in patients with type 1 diabetes during the COVID-19 pandemic: a cohort study from Southern Brazil. Diabetol Metab Syndr 2022; 14:75. [PMID: 35598019 PMCID: PMC9123820 DOI: 10.1186/s13098-022-00845-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 05/10/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Optimal glycemic control is the main goal for patients with diabetes. The results of type 1 diabetes patients' neglected demands during the pandemic can determine a long-term negative clinical, social, and economic impact, and result in worse diabetes control and a higher incidence of chronic complications. Therefore, this study aims to evaluate the impact of the COVID-19 outbreak in the quality of care of patients with type 1 diabetes in Southern Brazil. METHODS Cohort study based on electronic medical records of patients with type 1 diabetes, with scheduled appointments between January 1st 2020, and November 6th 2020, at a university public hospital. The quality indicators used were: assessment of albuminuria and/or serum creatinine, lipid profile, thyroid-stimulating hormone, glycated hemoglobin, retinopathy, and neuropathy. McNemar test was used to analyze categorical variables and the Wilcoxon test for continuous variables. RESULTS Out of 289 patients, 49.5% were women aged 40 ± 12 years old. During the pandemic, 252 patients had at least one face-to-face appointment canceled. The quality of care indicators showed a significant worsening during the COVID-19 pandemic compared to the previous year (p < 0.001). In 2019, 23.2% of the participants had all the indicators evaluated, while in 2020, during the pandemic, only 3.5% had all of them evaluated. CONCLUSION The COVID-19 pandemic hindered the offer of comprehensive and quality care to patients with type 1 diabetes.
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Affiliation(s)
- Luciana Foppa
- Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos 2350, Porto Alegre, RS, 90035-003, Brazil.
- Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, 2º andar, Porto Alegre, RS, 90035-003, Brazil.
| | - Janine Alessi
- Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, 2º andar, Porto Alegre, RS, 90035-003, Brazil
| | - Betina Nemetz
- Nurse School, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-002, Brazil
| | - Rosimeri de Matos
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Avenida Ipiranga, 6680, Jardim Botânico, Porto Alegre, RS, 90619-900, Brazil
| | - Gabriela Heiden Telo
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Avenida Ipiranga, 6680, Jardim Botânico, Porto Alegre, RS, 90619-900, Brazil
- Pontifícia Universidade Católica do Rio Grande do Sul, Avenida Ipiranga, Partenon, Porto Alegre, RS, 668190619-900, Brazil
| | - Beatriz D Schaan
- Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos 2350, Porto Alegre, RS, 90035-003, Brazil
- Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, 2º andar, Porto Alegre, RS, 90035-003, Brazil
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16
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de Kreutzenberg SV. Telemedicine for the Clinical Management of Diabetes; Implications and Considerations After COVID-19 Experience. High Blood Press Cardiovasc Prev 2022; 29:319-326. [PMID: 35579849 PMCID: PMC9111950 DOI: 10.1007/s40292-022-00524-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/07/2022] [Indexed: 12/15/2022] Open
Abstract
Telemedicine is a clinical approach that was seldom used in the day-to-day practice, if not only in certain settings, before the COVID-19 pandemic. As stated by the WHO, telemedicine is: the delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies (ICT) for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, …. Telemedicine has actually represented the most useful and employed tool to maintain contacts between patients and physicians during the period of physical distance imposed by the pandemic, especially during the lockdown. Diabetes in particular, a chronic disease that often needs frequent confronting between patient and health professionals has taken advantage of the telehealth approach. Nowadays, technological tools are more and more widely used for the management of diabetes. In this review results obtained by telemendicine application in type 1 and type 2 diabetic individuals during COVID-19 are revised, and future perspectives for telemedicine use to manage diabetes are discussed.
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17
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Baradez C, Liska J, Brulle-Wohlhueter C, Pushkarna D, Baxter M, Piette J. Brief Digital Solutions in Behavior Change Interventions for Type 2 Diabetes Mellitus: A Literature Review. Diabetes Ther 2022; 13:635-649. [PMID: 35279813 PMCID: PMC8917814 DOI: 10.1007/s13300-022-01244-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 02/25/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION With the advent of the COVID-19 pandemic, health systems increasingly look to digital health solutions to provide support for self-management to people with type 2 diabetes (T2D). This review aimed to assess brief digital behavior change solutions (i.e., solutions that require limited engagement or contact) for T2D, including use of behavior change techniques (BCTs) and their impact on self-care and glycemic control. METHODS A review was conducted by searching Embase and gray literature using a predefined search strategy to identify randomized controlled trials (RCT) published between January 1, 2015, and March 21, 2021. BCTs were coded using an internationally established BCT taxonomy v1 (BCTTv1). RESULTS Out of 1426 articles identified, 10 RCTs were included in qualitative synthesis. Of these, six reported significant improvements in primary outcome(s), including improved patient engagement, glycemic control, self-efficacy, and physical activity. Interventions as short as 12 min were found to be effective, and users' ability to control their preferences was noted as conducive to engagement. Almost three quarters of BCTs targeted by interventions were under the hierarchical clusters of "Feedback and monitoring," "Goals and planning," and "Shaping knowledge." Interventions that targeted fewer BCTs were at least as effective as interventions that were more comprehensive in their goals. DISCUSSION Digital behavior change solutions can successfully improve T2D self-care support and outcomes in a variety of populations including patients with low incomes, limited educational attainment, or living in rural areas. Easy-to-use interventions tailored to patient needs may be as effective as lengthy, complex, and more generalized interventions. CONCLUSIONS Brief digital solutions can improve clinical and behavioral outcomes while reducing patient burden, fitting more easily in patients' lives and potentially improving usability. As T2D patients increasingly expect access to self-care assistance between face-to-face encounters, digital support tools will play a greater role in effective diabetes management programs.
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Affiliation(s)
| | | | | | | | - Mike Baxter
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, England, UK
| | - John Piette
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 2705 Ember Way, Ann Arbor, MI, 48104, USA.
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18
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Forde H, Choudhary P, Lumb A, Wilmot E, Hussain S. Current provision and HCP experiences of remote care delivery and diabetes technology training for people with type 1 diabetes in the UK during the COVID-19 pandemic. Diabet Med 2022; 39:e14755. [PMID: 34862815 DOI: 10.1111/dme.14755] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/28/2021] [Accepted: 12/01/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The COVID-19 pandemic has led to the rapid implementation of remote care delivery in type 1 diabetes. We studied current modes of care delivery, healthcare professional experiences and impact on insulin pump training in type 1 diabetes care in the United Kingdom (UK). METHODS The UK Diabetes Technology Network designed a 48-question survey aimed at healthcare professionals providing care in type 1 diabetes. RESULTS One hundred and forty-three healthcare professionals (48% diabetes physicians, 52% diabetes educators and 88% working in adult services) from approximately 75 UK centres (52% university hospitals, 46% general and community hospitals), responded to the survey. Telephone consultations were the main modality of care delivery. There was a higher reported time taken for video consultations versus telephone (p < 0.001). Common barriers to remote consultations were patient familiarity with technology (72%) and access to patient device data (67%). We assessed the impact on insulin pump training. A reduction in total new pump starts (73%) and renewals (61%) was highlighted. Common barriers included patient digital literacy (61%), limited healthcare professional experience (46%) and time required per patient (44%). When grouped according to size of insulin pump service, pump starts and renewals in larger services were less impacted by the pandemic compared to smaller services. CONCLUSION This survey highlights UK healthcare professional experiences of remote care delivery. While supportive of virtual care models, a number of factors highlighted, especially patient digital literacy, need to be addressed to improve virtual care delivery and device training.
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Affiliation(s)
- Hannah Forde
- Leicester Diabetes Research Centre, Leicester General Hospital, Leicester, UK
| | - Pratik Choudhary
- Leicester Diabetes Research Centre, Leicester General Hospital, Leicester, UK
| | - Alistair Lumb
- Oxford Centre for Diabetes Endocrinology and Metabolism, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Emma Wilmot
- Department of Diabetes, University Hospitals of Derby and Burton NHS FT, Derby, UK
- School of Medicine, Nottingham University, Nottingham, UK
| | - Sufyan Hussain
- Department of Diabetes and Endocrinology, Guy's and St Thomas' NHS Trust, Guy's Hospital, London, UK
- Department of Diabetes, School of Life Course Sciences, King's College London, London, UK
- Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK
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19
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Ewart C, Baharani J, Wilkie M, Thomas N. Patient perspectives and experiences of remote consultations in people receiving kidney care: A scoping review. J Ren Care 2022; 48:143-153. [PMID: 35338610 PMCID: PMC9545432 DOI: 10.1111/jorc.12419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/04/2022] [Accepted: 02/27/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic resulted in a rapid and sometimes chaotic change in how clinical care was delivered for people living with kidney disease, with increased reliance on digital technologies and the introduction of remote services. OBJECTIVES To conduct a scoping review of studies about patients' experiences and perspectives in receipt of remote consultations for kidney care. DESIGN Using Arksey and O'Malley's framework, three databases were searched on EBSCO (CINAHL, MEDLINE and Psych INFO). The search included studies published in English from August 2010 to August 2021. RESULTS Eight studies met the scoping review criteria (two cross-sectional, two mixed-method and four qualitative). Five themes were identified: overall satisfaction with remote services, benefits to patients (convenience, involvement in care and patient safety), barriers to remote consultations (technical difficulties, digital literacy and loss of interpersonal communication), patient concerns (need for physical examination, privacy and confidentiality) and prerequisites for successful remote care (existing patient-practitioner relationship, stable illness phase and access to technology). CONCLUSION Remote consultations confer multiple advantages to patients; therefore, remote consultations should be offered as an option to patients living with kidney disease beyond the COVID-19 pandemic. However, there are several barriers to remote consultation that need to be addressed and understood before implementing remote care long-term. Future research should examine the impact of remote consultations on people living with kidney disease from under-served groups to identify barriers and ensure their suitability and accessibility to the wider population for a more patient-centred approach to kidney care.
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Affiliation(s)
- Catriona Ewart
- Institute of Health and Social Care, London South Bank University, London, UK
| | | | - Martin Wilkie
- Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Nicola Thomas
- Institute of Health and Social Care, London South Bank University, London, UK
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20
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Sathyanarayanan A, Crabtree T, Choudhary P, Elliott J, Evans ML, Lumb A, Wilmot EG. Delivering evidence-based interventions for type 1 diabetes in the virtual world - A review of UK practice during the SARS-CoV-2 pandemic. Diabetes Res Clin Pract 2022; 185:109777. [PMID: 35157943 PMCID: PMC8831709 DOI: 10.1016/j.diabres.2022.109777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 02/02/2022] [Accepted: 02/07/2022] [Indexed: 12/05/2022]
Abstract
AIMS This review considers the impact of the SARS-CoV-2 pandemic on access to interventions for those living with type 1 diabetes and discusses the solutions which have been considered and actioned to ensure ongoing access care. METHODS We performed a focussed review of the published literature, and the guidelines for changes that have been effected during the pandemic. We also drew from expert recommendations and information about local practice changes for areas where formal data have not been published. RESULTS Evidence based interventions which support the achievement of improved glucose levels and/or reduction in hypoglycaemia include group structured education to support self-management, insulin pump therapy and continuous glucose monitoring. The SARS-CoV-2 pandemic had impacted the ability of diabetes services to deliver these intervention. Multiple adaptations have been put in place - transition to online delivery of education and care, and usage of diabetes technology. CONCLUSIONS Although various adaptations have been made during the pandemic that have positively influenced uptake of services, there are many areas of delivery that need immediate improvement in the UK. We recommend a proactive approach in recognising the digital divide and inequity in distribution of these changes and we recommend introducing measures to reduce them.
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Affiliation(s)
| | - T Crabtree
- University Hospitals of Derby and Burton NHS FT, DE22 3NE, UK; Division of Medical Sciences & Graduate Entry Medicine, School of Medicine, University of Nottingham, NG7 2RD, UK.
| | - P Choudhary
- Diabetes Research Centre, Leicester Diabetes Centre - Bloom, University of Leicester, LE1 7RH, UK.
| | - J Elliott
- Department of Oncology and Metabolism, University of Sheffield, S10 2TN, UK.
| | - M L Evans
- Wellcome Trust/ MRC Institute of Metabolic Science and Department of Medicine, University of Cambridge, CB2 1TN, UK.
| | - A Lumb
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford OX3 7LE, UK; NIHR Oxford Biomedical Research Centre, Oxford OX4 2PG, UK.
| | - E G Wilmot
- University Hospitals of Derby and Burton NHS FT, DE22 3NE, UK; Division of Medical Sciences & Graduate Entry Medicine, School of Medicine, University of Nottingham, NG7 2RD, UK
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Ploeg J, Markle-Reid M, Valaitis R, Fisher K, Ganann R, Blais J, Chambers T, Connors R, Gruneir A, Légaré F, MacIntyre J, Montelpare W, Paquette JS, Poitras ME, Riveroll A, Yous ML. The Aging, Community and Health Research Unit Community Partnership Program (ACHRU-CPP) for older adults with diabetes and multiple chronic conditions: study protocol for a randomized controlled trial. BMC Geriatr 2022; 22:99. [PMID: 35120457 PMCID: PMC8814798 DOI: 10.1186/s12877-021-02651-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Older adults (≥65 years) with diabetes and multiple chronic conditions (MCC) (> 2 chronic conditions) experience reduced function and quality of life, increased health service use, and high mortality. Many community-based self-management interventions have been developed for this group, however the evidence for their effectiveness is limited. This paper presents the protocol for a randomized controlled trial (RCT) comparing the effectiveness and implementation of the Aging, Community and Health Research Unit-Community Partnership Program (ACHRU-CPP) to usual care in older adults with diabetes and MCC and their caregivers. METHODS We will conduct a cross-jurisdictional, multi-site implementation-effectiveness type II hybrid RCT. Eligibility criteria are: ≥65 years, diabetes diagnosis (Type 1 or 2) and at least one other chronic condition, and enrolled in a primary care or diabetes education program. Participants will be randomly assigned to the intervention (ACHRU-CPP) or control arm (1:1 ratio). The intervention arm consists of home/telephone visits, monthly group wellness sessions, multidisciplinary case conferences, and system navigation support. It will be delivered by registered nurses and registered dietitians/nutritionists from participating primary care or diabetes education programs and program coordinators from community-based organizations. The control arm consists of usual care provided by the primary care setting or diabetes education program. The primary outcome is the change from baseline to 6 months in mental functioning. Secondary outcomes will include, for example, the change from baseline to 6 months in physical functioning, diabetes self-management, depressive symptoms, and cost of use of healthcare services. Analysis of covariance (ANCOVA) models will be used to analyze all outcomes, with intention-to-treat analysis using multiple imputation to address missing data. Descriptive and qualitative data from older adults, caregivers and intervention teams will be used to examine intervention implementation, site-specific adaptations, and scalability potential. DISCUSSION An interprofessional intervention supporting self-management may be effective in improving health outcomes and client/caregiver experience and reducing service use and costs in this complex population. This pragmatic trial includes a scalability assessment which considers a range of effectiveness and implementation criteria to inform the future scale-up of the ACHRU-CPP. TRIAL REGISTRATION Clinical Trials.gov Identifier NCT03664583 . Registration date: September 10, 2018.
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Affiliation(s)
- Jenny Ploeg
- School of Nursing, Aging, Community and Health Research Unit, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, Ontario, L8S 4K1, Canada.
| | - Maureen Markle-Reid
- School of Nursing, Aging, Community and Health Research Unit, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, Ontario, L8S 4K1, Canada
| | - Ruta Valaitis
- School of Nursing, Aging, Community and Health Research Unit, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, Ontario, L8S 4K1, Canada
| | - Kathryn Fisher
- School of Nursing, Aging, Community and Health Research Unit, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, Ontario, L8S 4K1, Canada
| | - Rebecca Ganann
- School of Nursing, Aging, Community and Health Research Unit, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, Ontario, L8S 4K1, Canada
| | - Johanne Blais
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, 1050, avenue de la Médecine, Local 4617, Québec, G1V 0A6, Canada
| | - Tracey Chambers
- School of Nursing, Aging, Community and Health Research Unit, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, Ontario, L8S 4K1, Canada
| | - Robyn Connors
- Department of Applied Human Sciences, Faculty of Science, University of Prince Edward Island, Room 111, Steel Building, 550 University Avenue, Charlottetown, Prince Edward Island, C1A 4P3, Canada
| | - Andrea Gruneir
- Department of Family Medicine Research Program, University of Alberta, 6-40 University Terrace, Edmonton, Alberta, T6G 2T4, Canada
| | - France Légaré
- VITAM-Centre de recherche en santé durable, Université Laval, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec City, QC, G1J 0A4, Canada and Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, G1K 7P4, Canada
| | - Janet MacIntyre
- Faculty of Nursing, Room 116, Health Sciences Building, University of Prince Edward Island, 550 University Avenue, Charlottetown, Prince Edward Island, C1A 4P3, Canada
| | - William Montelpare
- Margaret and Wallace McCain Chair in Human Development and Health, Department of Applied Human Sciences, Faculty of Science, Room 122, Health Sciences Building, University of Prince Edward Island, 550 University Avenue, Charlottetown, Prince Edward Island, C1A 4P3, Canada
| | - Jean-Sébastien Paquette
- Groupe de Médecine de Famile Universitaire (GMF-U) du Nord de Lanaudière and Department of Family Medicine and Emergency Medicine, Faculty of Medicine Université Laval, Pavillon Ferdinand-Vandry, 1050, Avenue de la Médecine, Local 4617, Québec, G1V 0A6, Canada
| | - Marie-Eve Poitras
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke - Campus Saguenay, 305 Rue Saint Vallier, Chicoutimi, QC, G7H 5H6, Canada
| | - Angela Riveroll
- Department of Applied Human Sciences, Faculty of Science, University of Prince Edward Island, Room 115, Steel Building, 550 University Avenue, Charlottetown, Prince Edward Island, C1A 4P3, Canada
| | - Marie-Lee Yous
- School of Nursing, Aging, Community and Health Research Unit, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, Ontario, L8S 4K1, Canada
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22
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Evans M, Morgan AR, Bain SC, Davies S, Hicks D, Brown P, Yousef Z, Dashora U, Viljoen A, Beba H, Strain WD. Meeting the Challenge of Virtual Diabetes Care: A Consensus Viewpoint on the Positioning and Value of Oral Semaglutide in Routine Clinical Practice. Diabetes Ther 2022; 13:225-240. [PMID: 35044569 PMCID: PMC8767360 DOI: 10.1007/s13300-021-01201-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/24/2021] [Indexed: 02/06/2023] Open
Abstract
While glucagon-like peptide-1 receptor agonists (GLP-1 RAs), such as semaglutide, are among the most effective drugs for treating people with type 2 diabetes (T2D), they are clinically under-utilised. Until recently, the only route for semaglutide administration was via subcutaneous injection. However, an oral formulation of semaglutide was recently licensed, with the potential to address therapy inertia and increase patient adherence to treatment, which is essential in controlling blood glucose and reducing complications. The availability of oral semaglutide provides a new option for both clinicians and patients who are reluctant to use an injectable agent. This has been of particular importance in addressing the challenge of virtual diabetes care during the COVID-19 pandemic, circumventing the logistical problems that are often associated with subcutaneous medication administration. However, there remains limited awareness of the clinical and economic value of oral semaglutide in routine clinical practice. In this article, we present our consensus opinion on the role of oral semaglutide in routine clinical practice and discuss its value in reducing the burden of delivering diabetes care in the post-COVID-19 pandemic period of chronic disease management.
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Affiliation(s)
- Marc Evans
- Diabetes Resource Centre, University Hospital Llandough, Penlan Road, Llandough, Cardiff, CF64 2XX, UK.
| | | | - Stephen C Bain
- Diabetes Research Unit, Swansea University Medical School, Swansea, UK
| | | | | | | | - Zaheer Yousef
- Wales Heart Research Institute, Cardiff University, Cardiff, UK
| | | | - Adie Viljoen
- East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Hannah Beba
- County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - W David Strain
- Diabetes and Vascular Research Centre, University of Exeter Medical School, Exeter, UK
- The Academic Department of Healthcare for Older Adults, Royal Devon and Exeter Hospital, Exeter, UK
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23
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Scoccimarro D, Giove G, Silverii A, Dicembrini I, Mannucci E. Effects of home confinement during COVID-19 outbreak on glycemic control in patients with type 2 diabetes receiving telemedicine support. Acta Diabetol 2022; 59:281-284. [PMID: 34773181 PMCID: PMC8589090 DOI: 10.1007/s00592-021-01817-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/18/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Daniele Scoccimarro
- University of Florence, Florence, Italy.
- Department of Diabetology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy.
| | - Gianluca Giove
- University of Florence, Florence, Italy
- Department of Diabetology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Antonio Silverii
- University of Florence, Florence, Italy
- Department of Diabetology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Ilaria Dicembrini
- University of Florence, Florence, Italy
- Department of Diabetology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Edoardo Mannucci
- University of Florence, Florence, Italy
- Department of Diabetology, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
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24
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Saiyed S, Joshi R, Khattab S, Dhillon S. The Rapid Implementation of an Innovative Virtual Diabetes Boot Camp Program: Case Study. JMIR Diabetes 2022; 7:e32369. [PMID: 35029529 PMCID: PMC8800084 DOI: 10.2196/32369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 10/19/2021] [Accepted: 10/25/2021] [Indexed: 12/28/2022] Open
Abstract
Background COVID-19 disrupted health care, causing a decline in the health of patients with chronic diseases and a need to reimagine diabetes care. With the advances in telehealth programs, there is a need to effectively implement programs that meet the needs of patients quickly. Objective The aim of this paper was to create a virtual boot camp program for patients with diabetes, in 3 months, from project conception to the enrollment of our first patients. Our goal is to provide practical strategies for rapidly launching an effective virtual program to improve diabetes care. Methods A multidisciplinary team of physicians, dieticians, and educators, with support from the telehealth team, created a virtual program for patients with diabetes. The program combined online diabetes data tracking with weekly telehealth visits over a 12-week period. Results Over 100 patients have been enrolled in the virtual diabetes boot camp. Preliminary data show an improvement of diabetes in 75% (n=75) of the patients who completed the program. Four principles were identified and developed to reflect the quick design and launch. Conclusions The rapid launch of a virtual diabetes program is feasible. A coordinated, team-based, systematic approach will facilitate implementation and sustained adoption across a large multispecialty ambulatory health care organization.
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Affiliation(s)
- Salim Saiyed
- University of Pittsburgh Medical Center, Harrisburg, PA, United States
| | - Renu Joshi
- University of Pittsburgh Medical Center, Harrisburg, PA, United States
| | - Safi Khattab
- University of Pittsburgh Medical Center, Harrisburg, PA, United States
| | - Shabnam Dhillon
- University of Pittsburgh Medical Center, Harrisburg, PA, United States
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25
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Vas V, North S, Rua T, Chilton D, Cashman M, Malhotra B, Garrood T. Delivering outpatient virtual clinics during the COVID-19 pandemic: early evaluation of clinicians' experiences. BMJ Open Qual 2022; 11:bmjoq-2020-001313. [PMID: 34996810 PMCID: PMC8743837 DOI: 10.1136/bmjoq-2020-001313] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 12/14/2021] [Indexed: 12/21/2022] Open
Abstract
Background The COVID-19 pandemic has put health systems across the world under significant pressure. In March 2020, a national directive was issued by the National Health Service (NHS) England instructing trusts to scale back face-to-face outpatient appointments, and rapidly implement virtual clinics. Methods A multidisciplinary team of change managers, analysts and clinicians were assembled to evaluate initial implementation of virtual clinics at Guy’s and St Thomas’ NHS Foundation Trust. In-depth interviews were conducted with clinicians who have delivered virtual clinics during the pandemic. An inductive thematic approach was used to analyse clinicians’ early experiences and identify enablers for longer term sustainability. Results Ninety-five clinicians from specialist services across the trust were interviewed between April and May 2020 to reflect on their experiences of delivering virtual clinics during Wave I COVID-19. Key reflections include the perceived benefits of virtual consultations to patients and clinicians; the limitations of virtual consultations compared with face-to-face consultations; and the key enablers that would optimise and sustain the delivery of virtual pathways longer term. Conclusions In response to the pandemic, outpatient services across the trust were rapidly redesigned and virtual clinics implemented. As a result, services have been able to sustain some level of service delivery. However, clinicians have identified challenges in delivering this model of care and highlighted enablers needed to sustaining the delivery of virtual clinics longer term, such as patient access to diagnostic tests and investigations closer to home.
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Affiliation(s)
- Venessa Vas
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Shirley North
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Tiago Rua
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | | | | | - Toby Garrood
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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26
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Waizinger O, Shpigelman M, Shental R, Yunis B, Shimoni P, Od Cohen Y, Kagan I. Diabetes nurse practitioners in the shadow of the COVID-19 pandemic: Challenges, insights, and suggestions for improvement. J Nurs Scholarsh 2021; 54:453-461. [PMID: 34854227 DOI: 10.1111/jnu.12754] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/15/2021] [Accepted: 11/22/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE The study examined the role of diabetes nurse practitioners (DiNPs) and their contribution to the quality of care of individuals with diabetes during the COVID-19 pandemic. Specifically, we examined the benefits and barriers of using telemedicine for managing diabetes. DESIGN A descriptive qualitative research using content analysis of interviews. METHODS Participants were invited through the National DiNPs' Forum. Semi-structured interviews were conducted with 24 licensed DiNPs (age range, 37-58 years) who were involved in the clinical care of individuals with diabetes during the COVID-19 pandemic. The interviews were recorded and transcribed, and content analysis was then used for extracting themes and their related categories. FINDINGS Content analysis revealed five themes: (a) Benefits and barriers of remote diabetes treatment; (b) Teamwork and its implications to DiNPs; (c) Technological challenges, resourcefulness, and creativity; (d) Changed perception of DiNP roles; and (e) Cultural diversity and improving communication skills. The benefits of telemedicine included improved control, efficiency, convenience and satisfaction, while the disadvantages of this method included the inability to provide optimal practical guidance on technical aspects of physical assessments and care. Sectors with limited digital literacy and language barriers had difficulties using telemedicine. Teamwork was reported as a facilitator to managing treatment. Telemedicine provided an opportunity for DiNPs to become more efficient and focused and to clearly define their role in the organization. CONCLUSIONS The COVID-19 pandemic has posed new challenges. Along with the need to adapt the therapeutic approach to remote care, DiNPs improved their professional status, acquired new skills, and were satisfied with their personal and professional growth. CLINICAL RELEVANCE Telemedicine should become an integral part of diabetes management to enable access to populations who cannot come to the clinic. Patients should be guided on using telemedicine platforms.
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Affiliation(s)
- Orit Waizinger
- Nursing Care Coordinator in Diabetes, Haifa and Western Galil District, Clalit Health Services, Tel Aviv, Israel
| | - Miriam Shpigelman
- Nursing Care Coordinator in Diabetes, Sharon-Shomron District, Clalit Health Services, Tel Aviv, Israel
| | - Rachel Shental
- Coordinator of Diabetes Care for Adults, Rambam Health Care Campus, Haifa, Israel
| | - Bushra Yunis
- Coordinator of Diabetes Care, Central District, Meuhedet Health Services, Tel Aviv, Israel
| | - Pnina Shimoni
- Nursing Care Coordinator in Diabetes, Sharon-Shomron District, Clalit Health Services, Tel Aviv, Israel
| | | | - Ilya Kagan
- Nursing Department, Ashkelon Academic College, Ashkelon, Israel
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27
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Negreiros FDDS, Araújo ALD, Mattos SM, Moreira TR, Cestari VRF, Silva LMSD, Moreira TMM. Digital technologies in the care of people with diabetes during the COVID-19 pandemic: a scoping review. Rev Esc Enferm USP 2021; 55:e20210295. [PMID: 34825697 DOI: 10.1590/1980-220x-reeusp-2021-0295] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/18/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To map evidence on the use of digital technologies in the care of people with diabetes during the COVID-19 pandemic. METHOD This is a scoping review, based on the JBI manual, which included scientific articles and gray literature from nine primary and seven secondary databases. Articles were independently assessed by two reviewers. Rayyan® was used to select the studies. The description of study characterization is presented in a table and tables, ending in a narrative synthesis. RESULTS A total of 1,964 studies were identified and, after selection, 23 publications remained for analysis. It turned out that telemedicine was used in all studies and remote consultation support technologies included continuous glucose monitoring devices, glucose data analysis software, insulin delivery systems, applications, audio and/or voice communication devices, which facilitated remote diabetes mellitus monitoring and management. CONCLUSION Telehealth, monitoring technologies, insulin delivery systems and communication devices were tools used to monitor patients with diabetes during the pandemic.
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Affiliation(s)
| | - Açucena Leal de Araújo
- Universidade Estadual do Ceará, Programa de Pós-Graduação em Cuidados Clínicos em Enfermagem e Saúde, Fortaleza, CE, Brazil
| | - Samuel Miranda Mattos
- Universidade Estadual do Ceará, Programa de Pós-Graduação em Saúde Coletiva, Fortaleza, CE, Brazil
| | | | - Virna Ribeiro Feitosa Cestari
- Universidade Estadual do Ceará, Programa de Pós-Graduação em Cuidados Clínicos em Enfermagem e Saúde, Fortaleza, CE, Brazil
| | - Lucilane Maria Sales da Silva
- Universidade Estadual do Ceará, Programa de Pós-Graduação em Cuidados Clínicos em Enfermagem e Saúde, Fortaleza, CE, Brazil
| | - Thereza Maria Magalhães Moreira
- Universidade Estadual do Ceará, Programa de Pós-Graduação em Cuidados Clínicos em Enfermagem e Saúde, Fortaleza, CE, Brazil.,Universidade Estadual do Ceará, Programa de Pós-Graduação em Saúde Coletiva, Fortaleza, CE, Brazil
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28
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Carinci F, Štotl I, Cunningham SG, Poljicanin T, Pristas I, Traynor V, Olympios G, Scoutellas V, Azzopardi J, Doggen K, Sandor J, Adany R, Løvaas KF, Jarosz-Chobot P, Polanska J, Pruna S, de Lusignan S, Monesi M, Di Bartolo P, Scheidt-Nave C, Heidemann C, Zucker I, Maurina A, Lepiksone J, Rossing P, Arffman M, Keskimäki I, Gudbjornsdottir S, Di Iorio CT, Dupont E, de Sabata S, Klazinga N, Benedetti MM. Making Use of Comparable Health Data to Improve Quality of Care and Outcomes in Diabetes: The EUBIROD Review of Diabetes Registries and Data Sources in Europe. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2021; 2:744516. [PMID: 36994337 PMCID: PMC10012140 DOI: 10.3389/fcdhc.2021.744516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/08/2021] [Indexed: 12/16/2022]
Abstract
BackgroundRegistries and data sources contain information that can be used on an ongoing basis to improve quality of care and outcomes of people with diabetes. As a specific task of the EU Bridge Health project, we carried out a survey of diabetes-related data sources in Europe.ObjectivesWe aimed to report on the organization of different sources of diabetes information, including their governance, information infrastructure and dissemination strategies for quality control, service planning, public health, policy and research.MethodsSurvey using a structured questionnaire to collect targeted data from a network of collaborating institutions managing registries and data sources in 17 countries in the year 2017.ResultsThe 18 data sources participating in the study were most frequently academic centres (44.4%), national (72.2%), targeting all types of diabetes (61.1%) covering no more than 10% of the target population (44.4%). Although population-based in over a quarter of cases (27.8%), sources relied predominantly on provider-based datasets (38.5%), fewer using administrative data (16.6%). Data collection was continuous in the majority of cases (61.1%), but 50% could not perform data linkage. Public reports were more frequent (72.2%) as well as quality reports (77.8%), but one third did not provide feedback to policy and only half published ten or more peer reviewed papers during the last 5 years.ConclusionsThe heterogeneous implementation of diabetes registries and data sources hampers the comparability of quality and outcomes across Europe. Best practices exist but need to be shared more effectively to accelerate progress and deliver equitable results for people with diabetes.
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Affiliation(s)
- Fabrizio Carinci
- Department of Statistical Sciences, University of Bologna, Bologna, Italy
- *Correspondence: Fabrizio Carinci,
| | - Iztok Štotl
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Scott G. Cunningham
- Department of Population Health and Genomics, University of Dundee, Dundee, United Kingdom
| | - Tamara Poljicanin
- Division for Health Informatics and Biostatistics, Croatian Institute of Public Health, Zagreb, Croatia
| | - Ivan Pristas
- Division for Health Informatics and Biostatistics, Croatian Institute of Public Health, Zagreb, Croatia
| | - Vivie Traynor
- Diabetes Department, Larnaca Hospital Cyprus, Larnaca, Cyprus
| | - George Olympios
- Diabetes Department, Larnaca Hospital Cyprus, Larnaca, Cyprus
| | - Vasos Scoutellas
- Diabetes Department, Larnaca Hospital Cyprus, Larnaca, Cyprus
- Health Monitoring Unit, Ministry of Health, Nicosia, Cyprus
| | | | - Kris Doggen
- Health Services Research, Sciensano, Brussels, Belgium
| | - János Sandor
- Department of Public Health and Epidemiology, School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Roza Adany
- Department of Public Health and Epidemiology, School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Karianne F. Løvaas
- Norwegian Diabetes Register for Adults, Norwegian Organisation for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Przemka Jarosz-Chobot
- Department of Children’s Diabetology, Medical University of Silesia, Katowice, Poland
| | - Joanna Polanska
- Department of Data Science and Engineering, The Silesian University of Technology, Gliwice, Poland
| | | | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Marcello Monesi
- Diabetes Unit “Sant’Anna” Hospital Ferrara, Ferrara, Italy
- Associazione Medici Diabetologi (AMD), Rome, Italy
| | - Paolo Di Bartolo
- Associazione Medici Diabetologi (AMD), Rome, Italy
- Azienda Unità Sanitaria Locale (AUSL) Diabetes Unit Romagna, Ravenna, Italy
| | - Christa Scheidt-Nave
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Christin Heidemann
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Inbar Zucker
- Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anita Maurina
- Research and Health Statistics Department, Centre for Disease Prevention and Control of Latvia, Riga, Latvia
| | - Jana Lepiksone
- Research and Health Statistics Department, Centre for Disease Prevention and Control of Latvia, Riga, Latvia
| | | | - Martti Arffman
- Welfare State Research and Reform Unit, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Ilmo Keskimäki
- Welfare State Research and Reform Unit, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Soffia Gudbjornsdottir
- Department of Molecular and Clinical Medicine, University of Gothenburg and Sahlgrenska Hospital, Gothenburg, Sweden
| | | | - Elisabeth Dupont
- International Diabetes Federation European Region, Brussels, Belgium
| | - Stella de Sabata
- International Diabetes Federation European Region, Brussels, Belgium
| | - Niek Klazinga
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Massimo Massi Benedetti
- International Diabetes Federation European Region, Brussels, Belgium
- Hub for International Health Research, Perugia, Italy
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Dauletbaev N, Kuhn S, Holtz S, Waldmann S, Niekrenz L, Müller BS, Bellinghausen C, Dreher M, Rohde GGU, Vogelmeier C. Implementation and use of mHealth home telemonitoring in adults with acute COVID-19 infection: a scoping review protocol. BMJ Open 2021; 11:e053819. [PMID: 34580103 PMCID: PMC8478582 DOI: 10.1136/bmjopen-2021-053819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION mHealth refers to digital technologies that, via smartphones, mobile apps and specialised digital sensors, yield real-time assessments of patient's health status. In the context of the COVID-19 pandemic, these technologies enable remote patient monitoring, with the benefit of timely recognition of disease progression to convalescence, deterioration or postacute sequelae. This should enable appropriate medical interventions and facilitate recovery. Various barriers, both at patient and technology levels, have been reported, hindering implementation and use of mHealth telemonitoring. As systematised and synthesised evidence in this area is lacking, we developed this protocol for a scoping review on mHealth home telemonitoring of acute COVID-19. METHODS AND ANALYSIS We compiled a search strategy following the PICO (Population, Intervention, Comparator, Outcome) and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendation for Scoping Reviews) guidelines. MEDLINE, Embase and Web of Science will be searched from 1 March 2020 to 31 August 2021. Following the title and abstract screening, we will identify, systematise and synthesise the available knowledge. Based on pilot searches, we preview three themes for descriptive evidence synthesis. The first theme relates to implementation and use of mHealth telemonitoring, including reported barriers. The second theme covers the interactions of the telemonitoring team within and between different levels of the healthcare system. The third theme addresses how this telemonitoring warrants the continuity of care, also during disease transition into deterioration or postacute sequelae. ETHICS AND DISSEMINATION The studied evidence is in the public domain, therefore, no specific ethics approval is required. Evidence dissemination will be via peer-reviewed publications, conference presentations and reports to the policy makers.
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Affiliation(s)
- Nurlan Dauletbaev
- Department of Internal, Respiratory and Critical Care Medicine, Philipps-Universitat Marburg, Marburg, Hessen, Germany
- Department of Pediatrics, McGill University Faculty of Medicine and Health Sciences, Montreal, Québec, Canada
| | - Sebastian Kuhn
- Department of Digital Medicine, Bielefeld University Faculty of Medicine, Bielefeld, Germany
| | - Svea Holtz
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Susanne Waldmann
- Central Medical Library, Philipps-Universitat Marburg, Marburg, Hessen, Germany
| | - Lukas Niekrenz
- Department of Pneumology and Intensive Care Medicine, University Hospital Aachen, Aachen, Nordrhein-Westfalen, Germany
| | - Beate S Müller
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Carla Bellinghausen
- Department of Respiratory Medicine, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, University Hospital Aachen, Aachen, Nordrhein-Westfalen, Germany
| | - Gernot G U Rohde
- Department of Respiratory Medicine, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Claus Vogelmeier
- Department of Internal, Respiratory and Critical Care Medicine, Philipps-Universitat Marburg, Marburg, Hessen, Germany
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30
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Quinn LM, Olajide O, Green M, Sayed H, Ansar H. Patient and Professional Experiences With Virtual Antenatal Clinics During the COVID-19 Pandemic in a UK Tertiary Obstetric Hospital: Questionnaire Study. J Med Internet Res 2021; 23:e25549. [PMID: 34254940 PMCID: PMC8409501 DOI: 10.2196/25549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/31/2021] [Accepted: 04/14/2021] [Indexed: 01/25/2023] Open
Abstract
Background The COVID-19 pandemic required rapid implementation of virtual antenatal care to keep pregnant women safe. This transition from face-to-face usual care had to be embraced by patients and professionals alike. Objective We evaluated patients’ and professionals’ experiences with virtual antenatal clinic appointments during the COVID-19 pandemic to determine satisfaction and inquire into the safety and quality of care received. Methods A total of 148 women who attended a virtual antenatal clinic appointment at our UK tertiary obstetric care center over a 2-week period provided feedback (n=92, 62% response rate). A further 37 health care professionals (HCPs) delivering care in the virtual antenatal clinics participated in another questionnaire study (37/45, 82% response rate). Results We showed that women were highly satisfied with the virtual clinics, with 86% (127/148) rating their experience as good or very good, and this was not associated with any statistically significant differences in age (P=.23), ethnicity (P=.95), number of previous births (P=.65), or pregnancy losses (P=.94). Even though 56% (83/148) preferred face-to-face appointments, 44% (65/148) either expressed no preference or preferred virtual, and these preferences were not associated with significant differences in patient demographics. For HCPs, 67% (18/27) rated their experience of virtual clinics as good or very good, 78% (21/27) described their experience as the same or better than face-to-face clinics, 15% (4/27) preferred virtual clinics, and 44% (12/27) had no preference. Importantly, 67% (18/27) found it easy or very easy to adapt to virtual clinics. Over 90% of HCPs agreed virtual clinics should be implemented long-term. Conclusions Our study demonstrates high satisfaction with telephone antenatal clinics during the pandemic, which supports the transition toward widespread digitalization of antenatal care suited to 21st-century patients and professionals.
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Affiliation(s)
| | - Oluwafumbi Olajide
- Department of Obstetrics, University Hospitals of Leicester, Leicester, United Kingdom
| | - Marsha Green
- Department of Obstetrics, University Hospitals of Leicester, Leicester, United Kingdom
| | - Hazem Sayed
- Department of Obstetrics, University Hospitals of Leicester, Leicester, United Kingdom
| | - Humera Ansar
- Department of Obstetrics, University Hospitals of Leicester, Leicester, United Kingdom
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Progression to unscheduled hospital admissions in people with diabetes: a qualitative interview study. BJGP Open 2021; 5:BJGPO.2021.0044. [PMID: 33910915 PMCID: PMC8450884 DOI: 10.3399/bjgpo.2021.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/15/2021] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND People with diabetes often have difficulty maintaining optimal blood glucose levels, risking progressive complications that can lead to unscheduled care. Unscheduled care can include attending emergency departments, ambulance callouts, out-of-hours care, and non-elective hospital admissions. A large proportion of non-elective hospital admissions involve people with diabetes, with significant health and economic burden. AIM To identify precipitating factors influencing diabetes-related unscheduled hospital admissions, exploring potential preventive strategies to reduce admissions. DESIGN & SETTING Thirty-six people with type 1 (n = 11) or type 2 (n = 25) diabetes were interviewed. They were admitted to hospital for unscheduled diabetes-related care across three hospitals in Scotland, Northern Ireland, and the Republic of Ireland. Participants were admitted for peripheral limb complications (n = 17), hypoglycaemia (n = 5), hyperglycaemia (n = 6), or for comorbidities presenting with erratic blood glucose levels (n = 8). METHOD Factors precipitating admissions were examined using framework analysis. RESULTS Three aspects of care influenced unscheduled admissions: perceived inadequate knowledge of diabetes complications; restricted provision of care; and complexities in engagement with self-care and help-seeking. Limited specialist professional knowledge of diabetes by staff in primary and community care, alongside inadequate patient self-management knowledge, led to inappropriate treatment and significant delays. This was compounded by restricted provision of care, characterised by poor access to services - in time and proximity - and poor continuity of care. Complexities in patient engagement, help-seeking, and illness beliefs further complicated the progression to unscheduled admissions. CONCLUSION Dedicated investment in primary care is needed to enhance provision of and access to services. There should be increased promotion and earlier diabetes specialist team involvement, alongside training and use of technology and telemedicine, to enhance existing care.
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Huuskes BM, Scholes‐Robertson N, Guha C, Baumgart A, Wong G, Kanellis J, Chadban S, Barraclough KA, Viecelli AK, Hawley CM, Kerr PG, Toby Coates P, Amir N, Tong A. Kidney transplant recipient perspectives on telehealth during the COVID-19 pandemic. Transpl Int 2021; 34:1517-1529. [PMID: 34115918 PMCID: PMC8420311 DOI: 10.1111/tri.13934] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/09/2021] [Accepted: 06/06/2021] [Indexed: 11/30/2022]
Abstract
The COVID-19 pandemic has challenged the delivery of health services. Telehealth allows delivery of care without in-person contacts and minimizes the risk of vial transmission. We aimed to describe the perspectives of kidney transplant recipients on the benefits, challenges, and risks of telehealth. We conducted five online focus groups with 34 kidney transplant recipients who had experienced a telehealth appointment. Transcripts were thematically analyzed. We identified five themes: minimizing burden (convenient and easy, efficiency of appointments, reducing exposure to risk, limiting work disruptions, and alleviating financial burden); attuning to individual context (depending on stability of health, respect patient choice of care, and ensuring a conducive environment); protecting personal connection and trust (requires established rapport with clinicians, hampering honest conversations, diminished attentiveness without incidental interactions, reassurance of follow-up, and missed opportunity to share lived experience); empowerment and readiness (increased responsibility for self-management, confidence in physical assessment, mental preparedness, and forced independence); navigating technical challenges (interrupted communication, new and daunting technologies, and cognizant of patient digital literacy). Telehealth is convenient and minimizes time, financial, and overall treatment burden. Telehealth should ideally be available after the pandemic, be provided by a trusted nephrologist and supported with resources to help patients prepare for appointments.
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Affiliation(s)
- Brooke M Huuskes
- Department of Physiology, Anatomy and MicrobiologyLa Trobe UniversityMelbourneVictoriaAustralia
| | - Nicole Scholes‐Robertson
- Sydney School of Public HealthThe University of SydneySydneyNew South WalesAustralia
- Centre for Kidney ResearchThe Children’s Hospital at WestmeadWestmeadNew South WalesAustralia
| | - Chandana Guha
- Sydney School of Public HealthThe University of SydneySydneyNew South WalesAustralia
- Centre for Kidney ResearchThe Children’s Hospital at WestmeadWestmeadNew South WalesAustralia
| | - Amanda Baumgart
- Sydney School of Public HealthThe University of SydneySydneyNew South WalesAustralia
- Centre for Kidney ResearchThe Children’s Hospital at WestmeadWestmeadNew South WalesAustralia
| | - Germaine Wong
- Sydney School of Public HealthThe University of SydneySydneyNew South WalesAustralia
- Centre for Kidney ResearchThe Children’s Hospital at WestmeadWestmeadNew South WalesAustralia
- Centre for Transplant and Renal ResearchWestmead HospitalSydneyNew South WalesAustralia
| | - John Kanellis
- Department of MedicineMonash UniversityClaytonVictoriaAustralia
- Department of NephrologyMonash Medical CentreClaytonVictoriaAustralia
| | - Steve Chadban
- Department of Renal MedicineRoyal Prince Alfred HospitalCentral Clinical SchoolThe University of SydneySydneyNew South WalesAustralia
| | | | - Andrea K Viecelli
- Department of NephrologyPrincess Alexandra HospitalBrisbaneQueenslandAustralia
| | - Carmel M. Hawley
- Department of NephrologyPrincess Alexandra HospitalBrisbaneQueenslandAustralia
- Australiasian Kidney Trials NetworkUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Peter G. Kerr
- Department of MedicineMonash UniversityClaytonVictoriaAustralia
- Department of NephrologyMonash Medical CentreClaytonVictoriaAustralia
| | - Patrick Toby Coates
- School of MedicineUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Centre Northern Adelaide Renal Transplantation ServiceRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Noa Amir
- Sydney School of Public HealthThe University of SydneySydneyNew South WalesAustralia
- Centre for Kidney ResearchThe Children’s Hospital at WestmeadWestmeadNew South WalesAustralia
| | - Allison Tong
- Sydney School of Public HealthThe University of SydneySydneyNew South WalesAustralia
- Centre for Kidney ResearchThe Children’s Hospital at WestmeadWestmeadNew South WalesAustralia
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Fonseca D, Cavalcanti J, Peña E, Valls V, Sanchez-Sepúlveda M, Moreira F, Navarro I, Redondo E. Mixed Assessment of Virtual Serious Games Applied in Architectural and Urban Design Education. SENSORS (BASEL, SWITZERLAND) 2021; 21:3102. [PMID: 33946868 PMCID: PMC8125721 DOI: 10.3390/s21093102] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 02/06/2023]
Abstract
The creation and usage of serious games on virtual reality (VR) and/or interactive platforms for the teaching of architecture, construction, urban planning, and other derived areas, such as security and risk prevention, require design processes, studies, and research that lead to further consolidation expansion. In that sense, this paper presents two main aims developed: the improvement of a virtual navigation system through the results of previous user studies and mixed research (quantitative and qualitative) improved based on the user perception for educational and professional uses. The VR system used is based on Unreal Engine programming of the HTC Vive sensor. This study is related to the GAME4City 3.0 and a broader project focused on gamified visualization and its educational uses in architectural and urban projects. The results reflect great interest, good usability, and high motivation for further usage for all types of users. However, an apparent resistance to deepen its use continues to be perceived in academia. Based on the research results, weak points of educational gamified systems have been identified, and the main differences and needs in user profiles' function. With these data, progress regarding implementing this kind of system at the teaching and professional levels must be pursued.
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Affiliation(s)
- David Fonseca
- Architecture La Salle, Universitat Ramon Llull, 08022 Barcelona, Spain; (E.P.); (V.V.); (M.S.-S.)
| | - Janaina Cavalcanti
- Instituto de Investigación e Innovación en Bioingeniería (I3B), Universitat Politècnica de Valencia, 46022 Valencia, Spain;
| | - Enric Peña
- Architecture La Salle, Universitat Ramon Llull, 08022 Barcelona, Spain; (E.P.); (V.V.); (M.S.-S.)
| | - Victor Valls
- Architecture La Salle, Universitat Ramon Llull, 08022 Barcelona, Spain; (E.P.); (V.V.); (M.S.-S.)
| | - Mónica Sanchez-Sepúlveda
- Architecture La Salle, Universitat Ramon Llull, 08022 Barcelona, Spain; (E.P.); (V.V.); (M.S.-S.)
| | - Fernando Moreira
- REMIT, IJP, Universidade Portucalense, 4200-072 Porto, Portugal;
- IEETA, Universidade de Aveiro, 3810-193 Aveiro, Portugal
| | - Isidro Navarro
- Escola Tècnica Superior d’Arquitectura de Barcelona, Universitat Politècnica de Catalunya, 08028 Barcelona, Spain; (I.N.); (E.R.)
| | - Ernesto Redondo
- Escola Tècnica Superior d’Arquitectura de Barcelona, Universitat Politècnica de Catalunya, 08028 Barcelona, Spain; (I.N.); (E.R.)
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Byravan S, Sunmboye K. The Impact of the Coronavirus (COVID-19) Pandemic on Outpatient Services-An Analysis of Patient Feedback of Virtual Outpatient Clinics in a Tertiary Teaching Center With a Focus on Musculoskeletal and Rheumatology Services. J Patient Exp 2021; 8:23743735211008284. [PMID: 34179426 PMCID: PMC8205348 DOI: 10.1177/23743735211008284] [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] [Indexed: 11/17/2022] Open
Abstract
The pandemic has resulted in many changes to health services, one of these is the shift from face-to-face consultations to virtual ones across all specialities. As the pandemic continues with no end in sight it seems that virtual consultations will continue for the foreseeable future. In this article, we analyze the patient feedback so far to virtual consultations in a large tertiary center and use this opportunity to reflect on this new service. We have a particular interest in musculoskeletal services as this is largely an outpatient-based speciality and the pandemic has consequently resulted in significant changes in practice. We also consider whether virtual clinics is a sustainable service post-COVID-19 and the benefits and disadvantages of this.
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Affiliation(s)
- Swetha Byravan
- Rheumatology, University Hospitals of Leicester, Infirmary Square, Leicester, United Kingdom
| | - Kehinde Sunmboye
- Rheumatology, University Hospitals of Leicester, Infirmary Square, Leicester, United Kingdom
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Stewart M. Diabetes care in secondary care. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2021; 30:270-271. [PMID: 33733833 DOI: 10.12968/bjon.2021.30.5.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Martha Stewart
- Diabetes Clinical Nurse Specialist, University Hospitals Birmingham and Senior Lecturer in Diabetes Care, Birmingham City University
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Mold F, Cooke D, Ip A, Roy P, Denton S, Armes J. COVID-19 and beyond: virtual consultations in primary care-reflecting on the evidence base for implementation and ensuring reach: commentary article. BMJ Health Care Inform 2021; 28:bmjhci-2020-100256. [PMID: 33436372 PMCID: PMC7804830 DOI: 10.1136/bmjhci-2020-100256] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/15/2020] [Accepted: 12/21/2020] [Indexed: 12/20/2022] Open
Affiliation(s)
- Freda Mold
- Faculty of Health and Medical Sciences, School of Health Sciences, University of Surrey, Guildford, Surrey, UK
| | - Debbie Cooke
- Faculty of Health and Medical Sciences, School of Health Sciences, University of Surrey, Guildford, Surrey, UK
| | - Athena Ip
- Faculty of Health and Medical Sciences, School of Health Sciences, University of Surrey, Guildford, Surrey, UK
| | | | | | - Jo Armes
- Faculty of Health and Medical Sciences, School of Health Sciences, University of Surrey, Guildford, Surrey, UK
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Changing media depictions of remote consulting in COVID-19: analysis of UK newspapers. Br J Gen Pract 2020; 71:e1-e9. [PMID: 33318086 DOI: 10.3399/bjgp.2020.0967] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 11/25/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Remote consulting was introduced quickly into UK general practice in March 2020 as an emergency response to COVID-19. In July 2020, 'remote-first' became long-term government policy. AIM To explore how this change was portrayed in national newspapers and how depictions changed over time. DESIGN AND SETTING Thematic analysis of newspaper articles referring to remote GP consultations from two time periods: 2 March-31 May 2020 (period 1) and 30 July-12 August 2020 (period 2). METHOD Articles were identified through, and extracted from, LexisNexis Academic UK. A coding system of themes and narrative devices was developed and applied to the data. The analysis was developed iteratively, amending the coding structure as new data were added. RESULTS Remote consulting was widely covered in newspapers. Articles in period 1 depicted it positively, equating digital change with progress and linking novel technological solutions with improved efficiency and safety (for example, infection control) in a service that was overdue for modernisation. Articles in period 2 questioned the persistence of a remote-first service now that the pandemic was waning, emphasising, for example, missed diagnoses, challenges to the therapeutic relationship, and digital inequalities. CONCLUSION As the first wave of the pandemic came and went, media depictions of remote consulting evolved from an 'efficiency and safety' narrative to a 'risks, inequalities, and lack of choice' narrative. To restore public trust in general practice, public communication should emphasise the wide menu of consulting options now available to patients and measures being taken to assure safety and avoid inequity.
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