Stephanie Crossen, MD, MPH, Associate Professor, at the University of California Davis Department of Pediatrics and Center for Health and Technology, in a recent NIH NIDDK blog https://www.niddk.nih.gov talked about using Telehealth to provide patient-centered diabetes care.
The COVID-19 pandemic has led to a dramatic increase in the use of telehealth to provide diabetes care. A NIH study examined data from multiple U.S. clinics and found that less than 1% of diabetes care visits were conducted via telehealth in January and February 2020. By April 2020, most diabetes visits were being conducted via telehealth
Diabetes management depends on patient-generated data and the health coaching relationships between patients and their healthcare professionals which can be easily incorporated into a telehealth visit. In the last decade or so, with improved cloud connectivity and data sharing for so many diabetes devices, accessing patient-generated data remotely is easier than ever.
Healthcare professionals report some of the benefits and challenges to using telehealth to deliver diabetes care:
- For patients who are willing to let you see and learn about their home environment, telehealth visits can help present their challenges. For example patients at home are able to show problems in the home that report how they are not able to store insulin properly
- Telehealth allows pediatric health professionals to continue diabetes care when patients go to college of move away
- For healthcare professionals, the ability to physically examine patients via telehealth is quite limited. However, it is not always necessary to perform a detailed physical exam unless a specific concern arises
Thoughts and suggestions from healthcare professionals or organizations as to what is needed when starting up or scaling up a telehealth program for diabetes care:
- Invest in telehealth products and processes that promote equity, such as software that requires lower digital health literacy and uses multiple languages
- Allow for both video and telephone encounters as some patients may want to receive remote care but have trouble using video applications
- Provide flexibility by converting in person visits to telehealth visits when needed
- Provide orientation and training for healthcare professionals involved in telehealth
New areas for research on the use of telehealth in diabetes care includes:
- How telehealth can be used for shared medical appointments and virtual peer groups
- Analyzing remote data to figure out which patients need more support when it is needed
- Comparing outcomes from remote monitoring and from more frequent telehealth visits
- How to best deliver behavioral health and mental health support to patients with diabetes via telehealth
- How best to connect diabetes specialists with primary care providers through such programs such as Project ECHO to facilitate remote consultations and enable provider-to-provider education
Today, health systems are working to improve access and equity in telehealth by working to offer telehealth interpretation services, adapt software applications for more languages, and provide telehealth navigators for people with limited digital health literacy.