Using telehealth to optimize patient care in pediatric type 1 diabetes mellitus

Using telehealth to optimize patient care in pediatric type 1 diabetes mellitus | Image Credit: © NIKCOA - © NIKCOA - stock.adobe.com.

The COVID-19 pandemic served as a catalyst for the use of telemedicine and telehealth systems and brought the many advantages of telemedicine into focus, further opening the door for physicians and their patients to better acquaint themselves with this very practical approach to patient care. For some patients with pediatric type 1 diabetes mellitus, telehealth has become a preferred option for patient care, as highlighted in a study that recently appeared in the Canadian Journal of Diabetes.¹

“Telemedicine offers clinicians the opportunity to better manage routine and complex chronic patients. It can provide a more comfortable and convenient alternative that can allow for physicians to see them in their chosen setting rather than the clinic or office. It can also help support more effective care coordination and connect patients with other ancillary services that can be difficult to access and/or schedule,” noted Russell C. Libby, MD, pediatrician at the Virginia Pediatric Group, Fairfax, Virginia.

The recent study looked at the changes in telehealth usability and changes in future preferences for telehealth care in pediatric patients with type 1 diabetes mellitus during the COVID-19 pandemic. To conduct telehealth visits, the investigators and their administrative staff contacted the patients and their families, offering them the option to select either a telephone (audio only) or a virtual visit (video and audio) of approximately 30 minutes in duration. Prior to each telehealth visit, a diabetes nurse educator contacted the family and encouraged them to forward blood glucose and insulin dose information via email and to upload any diabetes technology data including pump and/or continuous glucose monitor (CGM) data.

Investigators provided a telehealth questionnaire to study participants at 2 time periods, once early in the pandemic and then again over a year later. Early and later pandemic groups were similar in age, time since diagnosis, HbA1c levels, gender, type of diabetes, and CGM use. The provided questionnaire consisted of the Telehealth Usability Questionnaire (TUQ), modified to the current context of telephone and virtual visits. The validated tool is designed to assess the delivery of telehealth care and focuses on 6 areas including usefulness, ease of use, interface quality, interaction quality, reliability, and satisfaction and future use. Surveys were completed by the pediatric patient, a parent/caregiver, or both, and families who had visits at both time periods were invited to both surveys.

Overall questionnaire survey response rate was 40%. Twenty-seven patient families participated in both the early and late pandemic questionnaires. A dramatic shift was seen towards using virtual visits compared to telephone visits between the early and late pandemic periods, with virtual visits increasing from 46% to 92% of all telehealth visits. Along with the transition to virtual visits, data revealed that there was more participation of the child or adolescent in the later pandemic period telehealth visits, increasing from 81% to 92%. While early pandemic visits mainly included a single provider with only 36% of participants having more than one provider, the later pandemic period transitioned to more multidisciplinary team visits where 80% of participants had more than one provider. Results also showed improvement in “ease of use” and “satisfaction,” while no improvements were seen in telephone visits.

The researchers also found that the odds of indicating a higher preference for more future telehealth visits was 5.1 times higher in the later pandemic group. Moreover, 80% of participants indicated that they would prefer their future care to include telehealth visits in place of some or all in-person visits after the pandemic. According to the study authors, this finding has a direct impact on clinical planning, as it is a strong signal from families that not only do they wish for a future including telehealth care, but their desire for telehealth care is increasing over time.

The researchers concluded, “At our tertiary diabetes centre [sic], families’ desire for future telehealth care has now become the preferred option. This study provides important family perspectives that can help guide development of future diabetes clinical care.”

Reference:

1 Niyyati S, Fung A, Zhang Q, et al. Patient perceptions of telehealth for pediatric type 1 diabetes during the COVID-19 pandemic: a follow-up study. Can J Diabetes. 2023 May 13;S1499-2671(23)00126-0. doi: 10.1016/j.jcjd.2023.05.005 Online ahead of print