“I was absolutely fine, doctor,” she said, earnestly. “So I thought I could skip one month.”
How often do your patients with diabetes skip their monthly appointments? Sometimes they feel well and their reports are all good. Sometimes they find the long commute to your clinic too much for the same, predictable routine.
How many no-shows and last-minute cancellations does your practice suffer?
People with diabetes need regular care. Of course.
Most people can manage many aspects on their own:
• Blood sugar monitoring
• Insulin injections
• Fitness and exercise
• Blood pressure monitoring
As an endocrinologist, you feel responsible for overall diabetes control. Regular consultation is necessary for you to review these tests done at home, order others like HbA1c and lipid panels, and advise referrals for eye care and so on.
… is the sameness.
Patients often feel that all visits are identical. So, they’re tempted to skip a few.
America has 29 million people living with diabetes, and not enough endocrinologists (1). Many patients have to travel long distances to see their doctor. Considerable time and money are involved.
Telehealth has improved healthcare access for people with diabetes. During the current health emergency, and perhaps later, patients can consult doctors from their own homes.
Telehealth for endocrinologists can be equally beneficial, as instead of commuting to faraway places for consultations, they can do it from their own office (or home, or while traveling!).
So how do you make the virtual consultation for diabetes similar to the in-person visit? And make sure you get the outcomes?
The patient uploads the record of their blood glucose levels, blood pressure, fitness activities, and other reports. Or even emails it to your office. You can see them on the office computer and add them to the patient’s electronic health record (EHR). If you use telehealth software with integrated ePrescription, prescriptions can be sent electronically to pharmacies, who can even have the meds delivered to the patient.
As usual, this is followed by advice about drugs, diet, exercise and fitness, any further tests, and referrals to specialists.
What are some of the issues you could face?
• Patients are not familiar with the process and the technology being used.
• Since a physical examination is not possible, you fear some conditions may be missed or underestimated.
• When consulting from home, the patient may not have adequate privacy. The quality of the equipment and the internet connection may be inadequate.
These challenges can be met by using the right telehealth technology and learning the new online methods for diagnosis and a few related tricks.
Develop a comforting ‘webside’ manner. When you start a video consult, introduce yourself, look at the camera (rather than the screen), you can open up reports, share your screen and discuss irregularities or fluctuations. Summarize the treatment plan and give the patient time for questions. Try to be friendly and empathetic. Avoid calls and other distractions during a telehealth consult.
Teach your patients how to use glucometers and blood pressure machines at home. Ask them to send you the data.
Electronic Health Records store the data from the patient and can be accessed just as easily in a video consult as in an in-person consult.
Your staff should be able to guide first-time patients. This ensures an anxiety-free and satisfying experience during the call. Have a good quality video and audio set up. A stable internet connection is essential, of course.
Currently, meeting software like Skype or WhatsApp can be used for remote consultations. However, dedicated telehealth platforms provide better features and security.
You may find that outcomes in diabetes care via telehealth are as good as with in-person visits. Blood glucose and Hb1Ac levels show improvement with telehealth (2).
Patients are satisfied with the care and appreciate the improved access and convenience. They kept 88% of appointments (1); reducing no-shows is always good for the patient and the practice.
With the proper approach, a remote diabetes consultation can be as effective as an in-person visit.
An online consultation is different from a regular face-to-face examination and the treating physician/provider may be limited by the written information and imaging provided by the patient or limited by the technology during the encounter. Accordingly, the diagnosis could be limited.
This article does not claim that an online consult is intended to replace a medical face-to-face evaluation fully or partially by a physician.
1. Xu T, Pujara S, Sutton S, Rhee M. Telemedicine in the Management of Type 1 Diabetes. Prev Chronic Dis. 2018 Jan 25;15:E13. doi: 10.5888/pcd15.170168. PMID: 29369757; PMCID: PMC5800428.
2. Zhai YK, Zhu WJ, Cai YL, Sun DX, Zhao J. Clinical- and cost-effectiveness of telemedicine in type 2 diabetes mellitus: a systematic review and meta-analysis. Medicine (Baltimore). 2014 Dec;93(28):e312. doi: 10.1097/MD.0000000000000312. PMID: 25526482; PMCID: PMC4603080.
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