Endocrinology Telehealth Consultation Improved Glycemic Control Similar to Face-to-Face Visits in Veterans

Abstract

Background: Rates of diabetes for veterans who receive health care through the Veterans Health Administration are higher than rates in the general population. Furthermore, many veterans live in rural locations, far from Veterans Affairs (VA) hospitals, thus limiting their ability to readily seek face-to-face endocrinology care for diabetes. Telehealth (TH) technologies present an opportunity to improve access to specialty diabetes care for such patients; however, there is a lack of evidence regarding the ability of TH to improve glycemic control in comparison to traditional face-to-face consultations. Methods: This was a retrospective cohort study of all new endocrinology diabetes consultations at the Denver VA Medical Center over a 1-year period. Results: A total of 189 patients were included in the analysis. In all, 85 patients had received face-to-face (FTF) endocrinology consultation for diabetes and 104 patients had received TH consultation. Subjects were mostly males (94.7%) and the mean age was 62.8 ± 10.1 years old. HbA1c improved from 9.76% (9.40% to 10.11%) to 8.55% (8.20% to 8.91%) ( P < .0001) for the TH group and from 9.56% (9.16% to 9.95%) to 8.62% (8.22% to 9.01%) ( P < .0001) for the FTF group after 1 visit. This change in HbA1c was not significantly different in the TH and FTF groups ( P = .24). TH visits were associated with a hypothetical savings in median distance traveled of 231.2 miles per trip (which equates to $94.79 saved per trip). Conclusions: Endocrinology TH consultations improved short-term glycemic control as effectively as traditional FTF visits in a veteran population with diabetes.

Telemedicine consultation for patients with diabetes mellitus: a cluster randomised controlled trial

“…A recent retrospective cohort analysis of videoconference consultation in a similar VA medical system, when used instead of the endocrine clinic visit also showed no difference in change of haemoglobin A1c between the two groups. 8 Only a few randomised clinical trials to demonstrate the efficacy of telemedicine have been carried out. [5][6][7]12,15 There is great variability in design of these studies, looking at different methods of telemedicine interventions.…”

“…Studies in diabetic patients have shown telemedicine to be an effective strategy in improving glycaemic control [5][6][7] or non-inferior to usual clinic care. [8][9][10][11] However, only a few studies have been randomised controlled trials, [5][6][7]12 and those have randomised individual patients. Most studies used asynchronous teleconsultations or remote monitoring, where the information provided to the health-care provider and the response to patient do not occur simultaneously.…”

Teleconsulta: uma Revisão Integrativa da Interação Médico-Paciente Mediada pela Tecnologia

“…As for the situations in which medical teleconsultation can be indicated, this review identified 11 studies that addressed specific conditions, 7 of which used video teleconsultation and the other three used the electronic consultation system or a combination of video and telephone or even video, phone and email. Studies that compared medical teleconsultation by video with faceto-face consultations identified equivalent results regarding glycemic control of individuals with diabetes 39 , as well as in exacerbations, disease control and quality of life of patients with asthma 34 and in the treatment of childhood obesity 37 . High rates of satisfaction were also identified among patients treated for rheumatological diseases 47 and better experience of care and health outcomes in nephrology care 35 .…”

Approach to the Patient With Thyrotoxicosis Using Telemedicine

“…Multiple groups have shown positive results for diabetes care via telemedicine. Diabetes consults, provided by endocrine specialists, lead to similar hemoglobin A 1c improvement when delivered via telemedicine or traditional office visits ( 5 ). Endocrine consultation via telemedicine improves diabetes care in special populations, such as residents of correctional facilities, while helping to control costs of care related to transport ( 6 ).…”

“…Differences in reimbursement structures between surgical and medical practices and across states can limit generalizability of some financial analyses. At the same time, many patients may save money from reduced travel ( 5 , 30 ) and time away from work when they access specialty care via telemedicine, and health care systems can increase their geographic reach without adding additional costly overhead expenses by using telemedicine. Telemedicine can also create more capacity for in-person visits within a practice ( 30 ).…”