Virtual Clinics Improve Access for Diabetes Patients

March 23, 2016

GLASGOW, Scotland — With an ever-increasing burden of patients with diabetes, many hospital clinics are struggling to provide an adequate number of appointments for each individual, leading to some institutions experimenting with "virtual clinics" and other forms of remote contact as ways of improving access.

At the recent Diabetes UK 2016 Professional Conference attendees heard feedback about some newer ways of communicating with patients that are already up and running in the United Kingdom, with diabetes patients, as well as nurses and doctors, detailing their experiences so far.

Such programs are becoming vital as people with diabetes in the United Kingdom spend, on average, only 3 hours a year with a healthcare professional, according to the charity organizing the meeting, Diabetes UK: "For the remaining 8757 hours they have to manage this complicated condition themselves."

The London Experience: A Consultation of Equals

At Kings College Hospital in London, there are 2700 patients with type 1 diabetes on the books, so many patients only get "one appointment slot per year" in the diabetes clinic, diabetes specialist nurse Geraldine Gallen told the conference.

And around 60% of the patients travel from outside the London area to the clinic.

At best, patients have a consultation once every 3 months, she noted, and as a result, "on average, I was getting 35 emails a day from patients," asking for advice regarding their diabetes management, she explained.

And clinic staff were suffering from the constant question of "how many patients could we squeeze in."

So the team decided to trial a virtual clinic, targeted at two different groups of patients: those "who are motivated, have completed the structured education program [Dose Adjustment For Normal Eating] DAFNE, have good HbA1c, and just need to touch base occasionally," and another group, "those who have high diabetes distress, psychological issues, and are at risk of hypoglycemia."

Ms Gallen explained that "we are not there to make changes for them but to educate them," adding, "I can't see how modern diabetes patients can survive this on their own."

The virtual clinic allocates appointment slots of 20 minutes for a specialist nurse situated in a quiet room to go through the patient's "downloads" with them, getting them to look at the glucose and insulin pattern themselves — using software such as Carelink or Diasend, she noted.

Initially, the team used Skype to connect with patients, but they found that this was often complicated because the patient needed to use their computer screen to look at their downloads and therefore couldn't be on Skype at the same time. Now they tend to just use the telephone.

Describing the difference it has made to her life, type 1 diabetes patient Imogen Lee, PhD, told attendees that the two-way connection in this virtual encounter is mutually beneficial: "While the diabetes nurse can read the patterns [in the downloads]…without me, she can't understand the reasons why.

"It's about teamwork and enabling patients to flag molehills before they become mountains," she added.

Another type 1 diabetes patient, Mark Norman, a young man who had just graduated from college, detailed his experience in another part of London, in the East End, in Newham, where diabetologist Shanti Vijayaraghavan, of Newham University Hospital, has set up a "virtual" service alongside the traditional clinic.

In Newham, they use a Skype appointment system, and it is "fundamentally changing the patient-healthcare professional dynamic," said Mr Norman.

"You can talk to people when you need to; it's a consultation of equals," he stressed.

With a 70% ethnic minority demographic and 40% of those living in the area aged under 25, Dr Vijayaraghavan noted how useful it is to supplement hospital appointments with this remote approach.

For example, instead of having to take a whole day or at least an afternoon off work to attend the clinic, many patients can factor a remote Skype consult into their working day, she noted.

Similarly, instead of younger relatives having to take time out to accompany elderly relatives to appointments, again, they can be scheduled at the convenience of patients and their families.

The Scottish Story: My Diabetes, My Way

A few hundred miles to the north of London, in Scotland, which has its own devolved government and a separate healthcare system from England, there is a nationwide program administered under the Scottish Care Information Diabetes Collaboration called "My Diabetes, My Way," which is essentially an electronic diabetes healthcare record that patients can access themselves.

Andy McQueen, a type 2 diabetes patient who was diagnosed in 1992, told the Diabetes UK attendees how the system gives him online access to his own medical records, explaining: "I can look back on 24 years of data."

It enables him to see the pattern in his HbA1c measurements rather than just a set number every 3 months, he noted. Often, any peaks and troughs can be traced to specific life events, he explained. And if the overall pattern is relatively stable, he said he doesn't worry too much.

Deborah Wake, MBChB, PhD, MRCPE, from the University of Dundee, noted that "My Diabetes, My Way" is "integrated with Diasend" for patients to download their data and includes "set goals" and a discussion forum for peer support.

So far, the system has 18,000 registrants and gets 40,000 hits per month, but she acknowledged there is "still a long way to go," as there are only "8000 active users" out of a population of 270,000 people with diabetes in Scotland.

Nevertheless, it is proof of concept, and ''My Diabetes, My Way" could be transplanted anywhere, Dr Wake concluded.


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