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Delivering care at a distance for people with diabetes

Daniel Flanagan
Daniel Flanagan asks what is needed for diabetes services to successfully transition to a hybrid model of remote and face-to-face care.

COVID-19 has delivered many bad things in the past two years. It has also forced some changes in practice which have the potential for being significant improvements. The usual process of change is a slow evolution but crises often force through much more rapid change. One of the more obvious changes is the way that we communicate with patients and the way that we communicate together with each other.

Overall, most people would accept that the ability to meet with each other without the need to travel has been a positive, but I think many of us are still looking forward to the day when we can sit together in the same room once more. Relationships with patients and colleagues benefit from the personal approach of meeting face to face, but these benefits are more difficult to define and measure than the more obvious advantage of time saving. There are also more obvious benefits for the patient from meeting face to face, such as the ability to measure blood pressure or perform a clinical examination. The time-saving benefits need to be balanced against a sense of isolation for both patients and health professionals and a lack of team spirit. In time this will manifest as a lack of strategic planning and perhaps a slower pace of change. The bottom line may be that not meeting together as a team or with patients may result in a lower standard of care in the future.

It is very important now to consider what has been good about the changes in communication to try and capture those benefits, but also to consider what we think would be the best way of delivering care as we, hopefully, move away from the pandemic. We are starting to see published evidence to support us in this planning. The paper by Hannah Forde and colleagues is timely and helpful. They present the results of a survey of healthcare professionals performed in late 2020. A few months before then, we had seen a sudden change from almost no telemedicine to almost no face-to-face contact. The professionals who responded were those involved in the delivery of insulin pump services and were perhaps more likely to be comfortable with technology change than the wider group delivering diabetes care.

There are some obvious themes in the results. The majority of consultations were by telephone. Access to patient data and laboratory results was often limited. Patient familiarity was regarded as a significant barrier (but not directly measured), although healthcare professional familiarity was also, to a lesser extent, a problem. Note that the survey did not look at the views of people with diabetes.

The paper is useful but, at this point there are a lot more questions to answer. There is a risk of slipping back into old ways of working and, potentially, losing some of these new benefits. Perhaps the key question is how, at a particular point in time, do we decide if meeting by telephone, video or face to face is going to be of most benefit. Even before that, we need to understand why within individual services some health professionals delivered a high proportion of consultations by video while others delivered none.

The likely conclusion is that all three methods have their place. Booking a patient for a clinic or training session often involves a series of administrative steps. In the past, this was one pathway. We now have the potential for three parallel pathways, with a constant interchange between them. This is complex and requires a level of sophistication (and investment) that currently does not exist.

Click here to read the article Digest.

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