Telemedicine for Diabetes Care
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COMMENTARY
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Telemedicine for Diabetes Care Toree H. Malasanos Division of Pediatric Endocrinology, University of Florida, Gainesville, Florida, USA
1. Growing Need for Telemedicine Diabetes mellitus is ideally suited for studies of healthcare delivery. Inadequate maintenance can result in high-cost care for both acute illness and long-term complications, whereas prevention of even a small percentage of these costs can ‘pay’ for the cost of a telemedicine program. With rapidly increasing numbers of children and adults with diabetes, a growing population, shortages of specialists, and complex management of diabetes, the workload for endocrinologists is increasing as their accessibility to patients is decreasing. Travel to remote regions – one widely accepted means for reaching underserved areas – is limited by increasing clinical demands of home clinics. Time demands have also limited opportunities for teaching, though health literacy has been shown to improve self management and outcomes.[1] Telemedicine increases the efficiency of the provider, allowing patients at remote sites to receive specialist care and more frequent visits while the physician remains at the hub clinic, and web-based education addresses diabetes education needs. Telemedicine allows the most complex patients to remain in their homes while accessing care ‘as needed.’ This allows families to determine if the patient needs to seek urgent care or if measures can be taken at home, including frequent dose adjustments as conditions change. Together, these enhance the family’s ‘self-efficacy’ and improve decision making and healthcare status, ultimately reducing costs. The utility and efficacy of telemedicine is discussed in this commentary, with the intent of urging more providers to consider this mode of patient care delivery. 2. Telemedicine Clinic Telemedicine is the provision of patient care by telecommunication devices, including transfer of data for the formulation of a medical plan. Real-time encounters involve live discussions, visual examination, or auditory data such as auscultation. Videoconference or telephone consultations are classic examples. Asynchronous, or ‘store-and-forward’, exchanges are well suited to
strictly visual information or short text messages that do not depend on live discussion. They are conducted by capturing the information and transferring the stored data at the convenience of the participants. Examples include e-mail, text messages, and stored video. Data collected during routine diabetes visits are primarily numerical (e.g. weight, blood pressure, and blood glucose levels). These data are collected by staff at the remote site and easily transmitted by teleconference to the hub. Conversations with the specialist can then center on management and goal setting. Visits may be offered more frequently, thus providing a more accessible medical ‘home’ for the patient and a place to call during acute illnesses and routine dose adjustments. This, in turn, would result
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