Changes to care delivery at nine international pediatric diabetes clinics in response to the COVID ‐19 global pandemic

Abstract

Background Pediatric diabetes clinics around the world rapidly adapted care in response to COVID‐19. We explored provider perceptions of care delivery adaptations and challenges for providers and patients across nine international pediatric diabetes clinics. Methods Providers in a quality improvement collaborative completed a questionnaire about clinic adaptations, including roles, care delivery methods, and provider and patient concerns and challenges. We employed a rapid analysis to identify main themes. Results Providers described adaptations within multiple domains of care delivery, including provider roles and workload, clinical encounter and team meeting format, care delivery platforms, self‐management technology education, and patient‐provider data sharing. Providers reported concerns about potential negative impacts on patients from COVID‐19 and the clinical adaptations it required, including fears related to telemedicine efficacy, blood glucose and insulin pump/pen data sharing, and delayed care‐seeking. Particular concern was expressed about already vulnerable patients. Simultaneously, providers reported 'silver linings' of adaptations that they perceived as having potential to inform care and self‐management recommendations going forward, including time‐saving clinic processes, telemedicine, lifestyle changes compelled by COVID‐19, and improvements to family and clinic staff literacy around data sharing. Conclusions Providers across diverse clinical settings reported care delivery adaptations in response to COVID‐19—particularly telemedicine processes—created challenges and opportunities to improve care quality and patient health. To develop quality care during COVID‐19, providers emphasized the importance of generating evidence about which in‐person or telemedicine processes were most beneficial for specific care scenarios, and incorporating the unique care needs of the most vulnerable patients.

Adoption of Telemedicine for Type 1 Diabetes Care During the COVID-19 Pandemic

“…A recent study of diabetes centers described adaptations of care delivery in international diabetes clinics in response to COVID-19, but consisted of just nine centers and did not provide quantitative information about the uptake of telemedicine or site-specific practices. 10 Another publication described quality improvement activities used to employ telemedicine services at a National Health Service Hospital in the United Kingdom during the pandemic. 17 However, this reports the data and experience of just one hospital in a government-supported health system where most visits were conducted by phone rather than video visits, the observation period was relatively brief (6 weeks), early in the pandemic, and the study did not focus on a diabetes population.…”

“…Published case studies recently described the novel use and adoption of telemedicine during the COVID-19 pandemic for managing patients with new onset type 1 diabetes (T1D) in the United States 9 and internationally. 10 …”

Telemedicine and COVID ‐19 pandemic: The perfect storm to mark a change in diabetes care. Results from a world‐wide cross‐sectional web‐based survey

“…12 Similar data were published internationally. 7,13 Appropriate devices and platforms to facilitate teleconsultations were also quickly made available in majority of the settings. Most HCPs felt confident using the digital tools and the general satisfaction with telemedicine in everyday practice resulted high, especially considering the short timeframe in which this change happened, and the ongoing pandemic.…”

“…However, our results align with other studies including different target populations. [11][12][13]18,19 We acknowledge a broad data collection time frame, which allowed to reduce the differences in the time of COVID-19 recrudescence/relapse in different countries. Despite this it may represent only the initial stage of a process still ongoing in some areas.…”

Can Innovative Technologies Overcome HbA1c Disparity for African-American Youth with Type 1 Diabetes?

“…75,77-79 Video conferencing use was infrequent in pediatric diabetology but quickly burgeoned during the COVID-19 emergency in the spring of 2020 and has become more widely used and accepted by patients and practitioners. 80,81 Challenges of billing and reimbursement previously limiting telehealth use were quickly addressed. 82 Video conferencing and messaging would facilitate members of the diabetes team to communicate frequently about diabetes management issues with patients and families.…”