Experiences and Perceptions of Telehealth Visits in Diabetes Care During and After the COVID-19 Pandemic Among Adults With Type 2 Diabetes and Their Providers: Qualitative Study

Patient and Clinician Perspectives on the Effectiveness of Current Telemedicine Approaches in Endocrinology Care for Type 2 Diabetes: Qualitative Study

BACKGROUND

Since the rapid widespread uptake in 2020, the use of telemedicine to deliver diabetes specialty care has persisted. However, evidence evaluating patient and clinician perspectives on benefits, shortcomings, and approaches to improve telemedicine care for type 2 diabetes is limited.

OBJECTIVE

This study aims to assess clinician and patient perspectives on specific benefits and limitations of current telemedicine care delivery for type 2 diabetes and views on approaches to enhance telemedicine effectiveness for patients who rely on it.

METHODS

We conducted semistructured qualitative interviews with diabetes specialty clinicians and adults with type 2 diabetes. We used a qualitative description approach to characterize participant perspectives on care delivery for type 2 diabetes via telemedicine.

RESULTS

Both clinicians (n=15) and patients (n=13) identify significant benefits of telemedicine in overcoming both physical (geographic and transportation) and scheduling (work commitments and wait times) barriers to specialty care for type 2 diabetes. In addition, telemedicine may enhance communication around diabetes care by improving information sharing between patients and clinicians. However, clinicians identify limited availability of home blood glucose data and vital signs as factors, which impair the optimal management of type 2 diabetes and related comorbid conditions via telemedicine. Previsit preparation, involvement of multidisciplinary providers, and frequent brief check-ins were identified by patients and clinicians as potential strategies to improve the quality of telemedicine care for adults with type 2 diabetes.

CONCLUSIONS

Patients and clinicians identify key strengths of telemedicine in enhancing access to diabetes specialty care for adults with type 2 diabetes and describe approaches to ensure that telemedicine delivers high-quality diabetes care to patients who rely on it.

Patient perceptions of rural telehealth diabetes control program in Department of Veteran's Affairs

PURPOSE

The prevalence of diabetes mellitus in the Department of Veteran's Affairs (VA) is higher than in the general public, with nearly 25% of Veterans enrolled in VA care diagnosed with diabetes. VA cares for over 2.7 million Veterans in rural areas who may face barriers to accessing specialty care for diabetes management. The goal of this study was to understand Veteran patient experiences with a novel telehealth diabetes program designed to improve diabetes care for Veterans in rural areas.

METHODS

We conducted a qualitative evaluation of Veteran's experiences as part of a larger mixed methods evaluation of the VA Telediabetes program. We conducted semistructured interviews with rural Veterans enrolled in the program to understand their experiences and perceptions. We conducted an inductive-deductive content analysis to identify salient themes related to diabetes control, perceptions of telehealth for diabetes care, and previous experiences with diabetes management. Methods are described according to the SRQR checklist for qualitative research.

FINDINGS

We conducted interviews with 26 rural Veterans enrolled in the Telediabetes program between April 2022 and March 2023 and identified three themes related to their experience in the program: (1) Telediabetes care is more frequent and comprehensive than previous diabetes care; (2) Telediabetes care is convenient and thorough, but there are some barriers; and (3) Patients describe that their diabetes control as better in Telediabetes program compared to diabetes management in primary care.

CONCLUSIONS

Veterans perceived that Telediabetes had a positive impact on their diabetes control and described the quality of care as excellent. Programs like Telediabetes bring together a group of interdisciplinary specialists to provide care for rural patients have the potential to alleviate barriers to specialty care in rural areas.

The Impact of Virtual Consultations on Quality of Care for Patients With Type 2 Diabetes: A Systematic Review and Meta-Analysis

BACKGROUND

Virtual consultations (VC) have transformed healthcare delivery, offering a convenient and effective way to manage chronic conditions such as Type 2 Diabetes (T2D). This systematic review and meta-analysis evaluated the impact of VC on the quality of care provided to patients with T2D, mapping it across the six domains of the US National Academy of Medicine (NAM) quality-of-care framework (ie, effectiveness, efficiency, patient-centeredness, timeliness, safety, and equity).

METHODS

A systematic search was conducted in PubMed/MEDLINE, Cochrane, Embase, CINAHL, and Web of Science for the period between January 2010 and December 2024. Eligible studies involved adult T2D patients, evaluated synchronous VCs, and reported outcomes relevant to NAM quality domains. Two independent reviewers performed screening, and studies were assessed using the Mixed Methods Appraisal Tool (MMAT). A narrative synthesis was conducted for each quality domain, and a meta-analysis of HbA1c levels was performed using random-effects models.

RESULTS

In total, 15 studies involving 821 014 participants were included. VCs were comparable with face-to-face care in effectiveness, efficiency, patient-centeredness, and timeliness, with improvements in accessibility and patient satisfaction. Mixed results were found for safety due to limitations in physical assessments, and for equity, with older adults and those with lower digital literacy facing more challenges. The meta-analysis showed no significant difference in HbA1c reduction between VCs and face-to-face (standardized mean difference [SMD] = -0.31, 95% confidence interval [CI]: -0.71 to 0.09, P = 0.12).

CONCLUSION

VCs offer a promising alternative to in-person care, but addressing digital disparities and improving access for older adults are essential for maximizing VC potential.

Telehealth service use and quality of care among US adults with diabetes: A cross-sectional study of the 2022 health information national trends survey

OBJECTIVE

To characterise telehealth use, reasons for using or not using telehealth and the factors associated with telehealth use among US adults with diabetes.

DESIGN

A cross-sectional study.

SETTING

Data were sourced from the 2022 Health Information National Trends Survey.

PARTICIPANTS

US adults aged 18 years or older with self-reported diagnosis of diabetes (both type 1 and type 2).

PRIMARY AND SECONDARY OUTCOMES

Past 12-month utilisation of telehealth services, modality (eg, video, voice only), overall perception of quality of care, perceived trust in healthcare system and patient-centred communication score.

RESULTS

In an analysis of 1116 US adults with diabetes, representing 33.6 million individuals, 48.1% reported telehealth use in the past year. Telehealth users were likely to be younger, women, with higher income, and urban dwellers. Older adults (≥65 years) were less likely to use telehealth compared with those aged 18-49 years (OR 0.43, 95% CI 0.20 to 0.90). Higher income and more frequent healthcare visits were predictors of telehealth usage, with no significant differences across race, education or location. Across respondents with telehealth usage, 39.3% reported having video-only, 35.0% having phone (voice)-only and 25.7% having both modalities. The main motivations included provider recommendation, convenience, COVID-19 avoidance and guidance on in-person care needs. Non-users cited preferences for in-person visits, privacy concerns and technology challenges. Patient-reported quality-of-care outcomes were comparable between telehealth users and non-users, with no significant differences observed by telehealth modality or area of residence (metro status).

CONCLUSIONS

Around half of US adults with diabetes used telehealth services in the past year. Patient-reported care quality was similar for telehealth and in-person visits. However, further efforts are needed to address key barriers to telehealth adoption, including privacy concern, technology difficulties, and care coordination issues.

Challenges of using telemedicine for patients with diabetes during the COVID-19 pandemic: A scoping review

Background

Telemedicine has aided patients with diabetes during the COVID-19 pandemic in receiving better healthcare services. However, despite its numerous benefits, the use of this technology has faced several challenges. This study aimed to identify the challenges of using telemedicine for patients with diabetes during the COVID-19 pandemic.

Methods

This scoping review was conducted in 2024. Relevant articles published between 2020 and 2023 were searched in databases including PubMed, Scopus, Web of Science, ProQuest, and the Cochrane Library. Initially, 822 articles were retrieved, and after screening 21 articles were selected.

Results

The challenges of using telemedicine for patients with diabetes during the COVID-19 pandemic were categorized into the clinical, individual, organizational, and technical challenges. The clinical challenges included the lack of physical examinations and unavailability of patients' medical history. The individual challenges contained difficulties in using smart phones by patients and their low level of literacy. The organizational challenges were related to insufficient laws about obtaining patient consent and limited reimbursement for telemedicine services, and the technical challenges included limited access to the high-speed Internet services and inadequate technical infrastructure for telemedicine services. Most studies highlighted the role of individual and organizational challenges in using this technology.

Conclusions

Considering the numerous challenges experienced in using telemedicine for patients with diabetes during the COVID-19 pandemic, it seems that more attention should be paid to address each of these challenges to improve the actual usage, service quality, and user acceptance of telemedicine technology. This, in turn, can lead to saving costs and improving the health status and quality of life of patients with diabetes.

How Does the Psychological Impact of COVID-19 Affect the Management Strategies of Individuals with Type 1 and Type 2 Diabetes? A Mixed-Method Study

(1) Background: During and after the pandemic, individuals with type 1 and type 2 diabetes struggled to maintain a healthy lifestyle due to psychological distress and the struggle to accommodate contextual challenges and changes in their family and work obligations and expectations. This study aims to explore the long-term impacts of the pandemic on proactive self-management behaviors and outcomes that consider contextual and environmental factors, such as family and work dynamics. (2) Methods: In this mixed-method study, data were collected from 418 participants using the Hospital Anxiety and Depression Scale (HADS) and the Insomnia Severity Index (ISI), followed by 16 individual interviews. (3) Results: The prevalence of depression was 37.1%, that of anxiety was 59.1%, and that of insomnia was 66.3%. Significant differences were observed in anxiety by age (p = 0.02), while individuals with other comorbidities were more likely to report insomnia (p = 0.3). Overall, various challenges during the pandemic have exacerbated emotional distress and complicated self-care routines and adherence to healthy lifestyles. (5) Conclusions: The COVID-19 pandemic has prompted individuals with type 1 and 2 diabetes to adopt alternative health-management methods, such as self-care, proactive initiatives, and daily challenges. Enhancing proactiveness, awareness, and an understanding of individuals' needs is crucial for alleviating stress, controlling disease, and preparing for potential future health crises in the wake of the pandemic's long-term effects.

Capillary blood self-collection for high-throughput proteomics

In this study, we sought to compare protein concentrations obtained from a high-throughput proteomics platform (Olink) on samples collected using capillary blood self-collection (with the Tasso+ device) versus standard venipuncture (control). Blood collection was performed on 20 volunteers, including one sample obtained via venipuncture and two via capillary blood using the Tasso+ device. Tasso+ samples were stored at 2°C-8°C for 24-hs (Tasso-24) or 48-h (Tasso-48) prior to processing to simulate shipping times from a study participant's home. Proteomics were analyzed using Olink (384 Inflammatory Panel). Tasso+ blood collection was successful in 37/40 attempts. Of 230 proteins included in our analysis, Pearson correlations (r) and mean coefficient of variation (CV) between Tasso-24 or Tasso-48 versus venipuncture were variable. In the Tasso-24 analysis, 34 proteins (14.8%) had both a correlation r > 0.5 and CV < 0.20. In the Tasso-48 analysis, 68 proteins (29.6%) had a correlation r > 0.5 and CV < 0.20. Combining the Tasso-24 and Tasso-48 analyses, 26 (11.3%) proteins met these thresholds. We concluded that protein concentrations from Tasso+ samples processed 24-48 h after collection demonstrated wide technical variability and variable correlation with a venipuncture gold-standard. Use of home capillary blood self-collection for large-scale proteomics should be limited to select proteins with good agreement with venipuncture.

Experiences of people with diabetes mellitus of telehealth for diabetes management during the COVID-19 pandemic: a qualitative systematic review protocol

OBJECTIVE

The objective of this review is to explore the experiences of people with diabetes who used telehealth for diabetes management due to COVID-19 pandemic protocols rather than traditional in-person consultations.

INTRODUCTION

COVID-19 intensified globally from January 2020, eliciting a multinational response to infection control for health preservation, including social distancing in public areas and health care settings. The outcome had a significant impact on the health care system, where people with chronic diseases, such as those with diabetes, were required to transition most of their care to telehealth to align with social restrictions.

INCLUSION CRITERIA

This review will include qualitative and mixed methods studies and theses of any research design and in any language that examine the experiences of adults with diabetes who transitioned from in-person consultations to telehealth during the COVID-19 pandemic. Exclusions will include pre-COVID-19 data; quantitative studies; and secondary, tertiary, and all other gray literature.

METHODS

A search of CINAHL (EBSCOhost), Scopus, Emcare (Ovid), Embase, PubMed (NCBI), and several ProQuest databases will be conducted. Studies from January 2020 onwards in any language will be assessed for inclusion. Two independent reviewers will retrieve and screen titles and abstracts and full-text studies, and assess the methodological quality of the included studies utilizing the JBI qualitative critical appraisal tool. The included studies will be synthesized utilizing JBI meta-aggregation, and the certainty of the findings will be assessed with ConQual.

REVIEW REGISTRATION

PROSPERO CRD42023424667.

Understanding the causes of missingness in primary care: a realist review

BACKGROUND

Although missed appointments in healthcare have been an area of concern for policy, practice and research, the primary focus has been on reducing single 'situational' missed appointments to the benefit of services. Little attention has been paid to the causes and consequences of more 'enduring' multiple missed appointments in primary care and the role this has in producing health inequalities.

METHODS

We conducted a realist review of the literature on multiple missed appointments to identify the causes of 'missingness.' We searched multiple databases, carried out iterative citation-tracking on key papers on the topic of missed appointments and identified papers through searches of grey literature. We synthesised evidence from 197 papers, drawing on the theoretical frameworks of candidacy and fundamental causation.

RESULTS

Missingness is caused by an overlapping set of complex factors, including patients not identifying a need for an appointment or feeling it is 'for them'; appointments as sites of poor communication, power imbalance and relational threat; patients being exposed to competing demands, priorities and urgencies; issues of travel and mobility; and an absence of choice or flexibility in when, where and with whom appointments take place.

CONCLUSIONS

Interventions to address missingness at policy and practice levels should be theoretically informed, tailored to patients experiencing missingness and their identified needs and barriers; be cognisant of causal domains at multiple levels and address as many as practical; and be designed to increase safety for those seeking care.

Determinants of implementation for group medical visits for patients with chronic pain: a systematic review

BACKGROUND

Despite the critical need for comprehensive and effective chronic pain care, delivery of such care remains challenging. Group medical visits (GMVs) offer an innovative and efficient model for providing comprehensive care for patients with chronic pain. The purpose of this systematic review was to identify barriers and facilitators (determinants) to implementing GMVs for adult patients with chronic pain.

METHODS

The review included peer-reviewed studies reporting findings on implementation of GMVs for chronic pain, inclusive of all study designs. Pubmed, EMBASE, Web of Science, and Cochrane Library were searched. Studies of individual appointments or group therapy were excluded. The Mixed Methods Appraisal Tool was used to determine risk of bias. Data related to implementation determinants were extracted independently by two reviewers. Data synthesis was guided by the updated Consolidated Framework for Implementation Research.

RESULTS

Thirty-three articles reporting on 25 studies met criteria for inclusion and included qualitative observational (n = 8), randomized controlled trial (n = 6), quantitative non-randomized (n = 9), quantitative descriptive (n = 3), and mixed methods designs (n = 7). The studies included in this review included a total of 2364 participants. Quality ratings were mixed, with qualitative articles receiving the highest quality ratings. Common multi-level determinants included the relative advantage of GMVs for chronic pain over other available models, the capability and motivation of clinicians, the cost of GMVs to patients and the health system, the need and opportunity of patients, the availability of resources and relational connections supporting recruitment and referral to GMVs within the clinic setting, and financing and policies within the outer setting.

CONCLUSIONS

Multi-level factors determine the implementation of GMVs for chronic pain. Future research is needed to investigate these determinants more thoroughly and to develop and test implementation strategies addressing these determinants to promote the scale-up of GMVs for patients with chronic pain.

TRIAL REGISTRATION

This systematic review was registered with PROSPERO 2021 CRD42021231310 .

Experiences of Motivational Interviewing in Virtual Health-care Visits for Adults With Type 2 Diabetes Mellitus: A Qualitative Analysis

OBJECTIVES

The purpose of this qualitative study is to identify barriers minimizing the effectiveness of motivational interviewing during virtual clinic encounters for individuals with type 2 diabetes based on the capability, opportunity, motivation, and behaviour (COM-B) model.

METHODS

One-on-one semistructured interviews were conducted from March to June 2023, with 17 adults with type 2 diabetes (64.7% female; median age 69 years, range 47 to 83 years) followed at St. Michael's Hospital (Toronto, Canada). Themes from transcribed interviews were identified through descriptive analysis using a grounded theory approach.

RESULTS

The following main themes were identified: 1) face-to-face appointments strengthen provider-patient rapport and collaboration; 2) virtual encounters reduce patient accountability and hinder health-seeking behaviour; and 3) individuals with physical disabilities and/or low technological proficiency experience decreased provider accessibility. Protective factors that can mitigate these negative impacts include establishing rapport during in-person appointments before transitioning to virtual appointments and incorporating a video component during virtual encounters.

CONCLUSIONS

Several barriers of virtual appointments currently limit the effectiveness of motivational interviewing for individuals with type 2 diabetes and make it difficult to provide person-centred care, especially by phone. However, there are protective factors that help to maintain healthy lifestyle behaviours, even after transitioning to virtual settings, and are areas for optimization moving forward.