The contribution of teleconsultation and videoconferencing to diabetes care: a systematic literature review

Fenne Verhoeven, Lisette van Gemert-Pijnen, Karin Dijkstra, Nicol Nijland, Erwin Seydel, Michaël Steehouder, Fenne Verhoeven, Lisette van Gemert-Pijnen, Karin Dijkstra, Nicol Nijland, Erwin Seydel, Michaël Steehouder

Abstract

Background: A systematic literature review was carried out to study the benefits of teleconsultation and videoconferencing on the multifaceted process of diabetes care. Previous reviews focused primarily on usability of technology and considered mainly one-sided interventions.

Objective: The objective was to determine the benefits and deficiencies of teleconsultation and videoconferencing regarding clinical, behavioral, and care coordination outcomes of diabetes care.

Methods: Electronic databases (Medline, PiCarta, PsycINFO, ScienceDirect, Telemedicine Information Exchange, ISI Web of Science, Google Scholar) were searched for relevant publications. The contribution to diabetes care was examined for clinical outcomes (eg, HbA(1c), blood pressure, quality of life), behavioral outcomes (patient-caregiver interaction, self-care), and care coordination outcomes (usability of technology, cost-effectiveness, transparency of guidelines, equity of care access). Randomized controlled trials (RCTs) with HbA(1c) as an outcome were pooled using standard meta-analytical methods.

Results: Of 852 publications identified, 39 met the inclusion criteria for electronic communication between (groups of) caregivers and patients with type 1, type 2, or gestational diabetes. Studies that evaluated teleconsultation or videoconferencing not particularly aimed at diabetes were excluded, as were those that described interventions aimed solely at clinical improvements (eg, HbA(1c)). There were 22 interventions related to teleconsultation, 13 to videoconferencing, and 4 to combined teleconsultation and videoconferencing. The heterogeneous nature of the identified videoconferencing studies did not permit a formal meta-analysis. Pooled results from the six RCTs of the identified teleconsultation studies did not show a significant reduction in HbA(1c) (0.03%, 95% CI = - 0.31% to 0.24%) compared to usual care. There was no significant statistical heterogeneity among the pooled RCTs (chi(2) (7)= 7.99, P = .33). It can be concluded that in the period under review (1994-2006) 39 studies had a scope broader than clinical outcomes and involved interventions allowing patient-caregiver interaction. Most of the reported improvements concerned satisfaction with technology (26/39 studies), improved metabolic control (21/39), and cost reductions (16/39). Improvements in quality of life (6/39 studies), transparency (5/39), and better access to care (4/39) were hardly observed. Teleconsultation programs involving daily monitoring of clinical data, education, and personal feedback proved to be most successful in realizing behavioral change and reducing costs. The benefits of videoconferencing were mainly related to its effects on socioeconomic factors such as education and cost reduction, but also on monitoring disease. Additionally, videoconferencing seemed to maintain quality of care while producing cost savings.

Conclusions: The selected studies suggest that both teleconsultation and videoconferencing are practical, cost-effective, and reliable ways of delivering a worthwhile health care service to diabetics. However, the diversity in study design and reported findings makes a strong conclusion premature. To further the contribution of technology to diabetes care, interactive systems should be developed that integrate monitoring and personalized feedback functions.

Conflict of interest statement

None declared.

Figures

Figure 1.
Figure 1.
Study selection process
Figure 2.
Figure 2.
Comparison of changes in HbA1c control versus intervention

References

    1. Wagner EH, Bennett SM, Austin BT, Greene SM, Schaefer JK, Vonkorff M. common ground: health care consumer-centeredness and evidence-based chronic illness care. J Altern Complement Med. 2005;11(1):57–515. doi: 10.1089/acm.2005.11.s-7.
    1. Ouwens Marielle, Wollersheim Hub, Hermens Rosella, Hulscher Marlies, Grol Richard. Integrated care programmes for chronically ill patients: a review of systematic reviews. Int J Qual Health Care. 2005 Apr;17(2):141–6. doi: 10.1093/intqhc/mzi016. mzi016
    1. Farmer A, Gibson O J, Tarassenko L, Neil A. A systematic review of telemedicine interventions to support blood glucose self-monitoring in diabetes. Diabet Med. 2005 Oct;22(10):1372–8. doi: 10.1111/j.1464-5491.2005.01627.x.DME1627
    1. Jennett P A, Affleck Hall L, Hailey D, Ohinmaa A, Anderson C, Thomas R, Young B, Lorenzetti D, Scott R E. The socio-economic impact of telehealth: a systematic review. J Telemed Telecare. 2003;9(6):311–20. doi: 10.1258/135763303771005207.
    1. Balas E A, Jaffrey F, Kuperman G J, Boren S A, Brown G D, Pinciroli F, Mitchell J A. Electronic communication with patients. Evaluation of distance medicine technology. JAMA. 1997 Jul 9;278(2):152–9. doi: 10.1001/jama.278.2.152.
    1. Eysenbach G. A framework for evaluating e-health: systematic review of studies assessing the quality of health information and services for health care consumers on the Internet. J Med Internet Res. 2000;2(12) doi: 10.2196/jmir.2.supl2.e9.
    1. Kern Josipa. Evaluation of teleconsultation systems. Int J Med Inform. 2006 Mar;75(3-4):330–4. doi: 10.1016/j.ijmedinf.2005.08.001.S1386-5056(05)00158-9
    1. National Health Services Wales, authors. Guidance on the use of videoconferencing in health care. National Health Services Wales. [2007 Apr 11].
    1. Taylor Paul. Evaluating telemedicine systems and services. J Telemed Telecare. 2005;11(4):167–77. doi: 10.1258/1357633054068955.
    1. Centre for Reviews and Dissemination, authors. Undertaking systematic reviews of research on effectiveness. Centre for Reviews and Dissemination. [2007 Apr 11].
    1. Jadad A R, Moore R A, Carroll D, Jenkinson C, Reynolds D J, Gavaghan D J, McQuay H J. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996 Feb;17(1):1–12.0197-2456(95)00134-4
    1. Follman D, Elliott P, Suh I, Cutler J. Variance imputation for overviews of clinical trails with continuous response. J Clin Epidemiol. 1992;45(7) doi: 10.1016/0895-4356(92)90054-Q.
    1. Bellazzi R, Larizza C, Montani S, Riva A, Stefanelli M, D'Annunzio G, Lorini R, Gomez E J, Hernando E, Brugues E, Cermeno J, Corcoy R, De Leiva A, Cobelli C, Nucci G, Del Prato S, Maran A, Kilkki E, Tuominen J. A telemedicine support for diabetes management: the T-IDDM project. Comput Methods Programs Biomed. 2002 Aug;69(2):147–61. doi: 10.1016/S0169-2607(02)00038-X.S016926070200038X
    1. Bellazzi R, Arcelloni M, Bensa G, Brugues E, Carson E, et al. Blankenfeld. Design, methods, and evaluation directions of a multi-access service for the management of diabetes mellitus patients. Diabetes Technol Ther. 2003;5(4) doi: 10.1089/152091503322250640.
    1. Biermann Eberhard, Dietrich Wolfgang, Rihl Julian, Standl Eberhard. Are there time and cost savings by using telemanagement for patients on intensified insulin therapy? A randomised, controlled trial. Comput Methods Programs Biomed. 2002 Aug;69(2):137–46. doi: 10.1016/S0169-2607(02)00037-8.S0169260702000378
    1. Branger P J, Van't Hooft A, Van Der Wouden J C, Moorman P W, Van Bemmel J H. Shared care for diabetes: supporting communication between primary and secondary care. Int J Med Inform. 1999 Feb;53(2-3):133–42.
    1. Cheitlin Cherry J, Moffatt TP, Rodriguez C, Dryden K. Diabetes Disease Management Program for an Indigent Population-Based Approach in a Primary Care Setting. Diabetes Technol Ther. 2002;4(6)
    1. Dinesen Birthe, Andersen Povl Erik Rostgaard. Qualitative evaluation of a diabetes advisory system, DiasNet. J Telemed Telecare. 2006;12(2):71–4. doi: 10.1258/135763306776084329.
    1. Farmer Andrew J, Gibson Oliver J, Dudley Christina, Bryden Kathryn, Hayton Paul M, Tarassenko Lionel, Neil Andrew. A randomized controlled trial of the effect of real-time telemedicine support on glycemic control in young adults with type 1 diabetes (ISRCTN 46889446) Diabetes Care. 2005 Nov;28(11):2697–702. doi: 10.2337/diacare.28.11.2697. 28/11/2697
    1. Ferrer-Roca O, Franco Burbano K, Cárdenas A, Pulido P, Diaz-Cardama A. Web-based diabetes control. J Telemed Telecare. 2004;10(5):277–81.
    1. Ferrer-Roca O, Cárdenas A, Diaz-Cardama A, Pulido P. Mobile phone text messaging in the management of diabetes. J Telemed Telecare. 2004;10(5):282–5.
    1. Gay C L, Chapuis F, Bendelac N, Tixier F, Treppoz S, Nicolino M. Reinforced follow-up for children and adolescents with type 1 diabetes and inadequate glycaemic control: a randomized controlled trial intervention via the local pharmacist and telecare. Diabetes Metab. 2006 Apr;32(2):159–65. doi: 10.1016/S1262-3636(07)70263-X. MDOI-DM-04-2006-32-2-1262-3636-101019-200517730
    1. Gómez E J, Hernando M E, García A, Del Pozo F, Cermeño J, Corcoy R, Brugués E, De Leiva A. Telemedicine as a tool for intensive management of diabetes: the DIABTel experience. Comput Methods Programs Biomed. 2002 Aug;69(2):163–77. doi: 10.1016/S0169-2607(02)00039-1.S0169260702000391
    1. Henault Robert G, Eugenio Kenneth R, Kelliher Andrew F, Alexis George, Conlin Paul R. Transmitting clinical recommendations for diabetes care via e-mail. Am J Health Syst Pharm. 2002 Nov 15;59(22):2166–9.
    1. Jansà M, Vidal M, Viaplana J, Levy I, Conget I, Gomis R, Esmatjes E. Telecare in a structured therapeutic education programme addressed to patients with type 1 diabetes and poor metabolic control. Diabetes Res Clin Pract. 2006 Oct;74(1):26–32. doi: 10.1016/j.diabres.2006.03.005.S0168-8227(06)00079-9
    1. Kim Hee-Seung, Yoo Yang-Suk, Shim Hye-Sum. Effects of an Internet-based intervention on plasma glucose levels in patients with type 2 diabetes. J Nurs Care Qual. 2005 Oct;20(4):335–40.00001786-200510000-00009
    1. Larizza C, Bellazzi R, Stefanelli M, Ferrari P, De Cata P, Gazzaruso C, Fratino P, D'annunzio G, Hernando E, Gomez E J. The M2DM Project--the experience of two Italian clinical sites with clinical evaluation of a multi-access service for the management of diabetes mellitus patients. Methods Inf Med. 2006;45(1):79–84.06010079
    1. Malasanos Toree H, Patel Bhavin D, Klein Jay, Burlingame Julie B. School nurse, family and provider connectivity in the FITE diabetes project. J Telemed Telecare. 2005;11 Suppl 1:76–8. doi: 10.1258/1357633054461741.
    1. Mazzi Christian P, Kidd Michael. A framework for the evaluation of Internet-based diabetes management. J Med Internet Res. 2002 Jan 10;4(1):e1. doi: 10.2196/jmir.4.1.e1.
    1. McKay HG, Glasgow R, Feil EG, Boles SM, Barrera M. Internet-based diabetes self-management and support: initial outcomes from the Diabetes Network Project. [2007 Apr 11];Rehabil Psychol. 2002 47 .
    1. McMahon Graham T, Gomes Helen E, Hickson Hohne Sara, Hu Tang Ming-Jye, Levine Betty A, Conlin Paul R. Web-based care management in patients with poorly controlled diabetes. Diabetes Care. 2005 Jul;28(7):1624–9. doi: 10.2337/diacare.28.7.1624. 28/7/1624
    1. Ralston James D, Revere Debra, Robins Lynne S, Goldberg Harold I. Patients' experience with a diabetes support programme based on an interactive electronic medical record: qualitative study. BMJ. 2004 May 15;328(7449):1159. doi: 10.1136/bmj.328.7449.1159. 328/7449/1159
    1. Rutten G E, Maaijen J, Valkenburg A C, Blankestijn J G, De Valk H W. The Utrecht Diabetes Project: telemedicine support improves GP care in Type 2 diabetes. Diabet Med. 2001 Jun;18(6):459–63.dme491
    1. Tsang M W, Mok M, Kam G, Jung M, Tang A, Chan U, Chu C M, Li I, Chan J. Improvement in diabetes control with a monitoring system based on a hand-held, touch-screen electronic diary. J Telemed Telecare. 2001;7(1):47–50. doi: 10.1258/1357633011936138.
    1. Abrahamian Heidemarie, Schueller Andrea, Mauler Harald, Prager Rudolf, Irsigler Karl. Transfer of knowledge from the specialist to the generalist by videoconferencing: effect on diabetes care. J Telemed Telecare. 2002;8(6):350–5. doi: 10.1258/135763302320939248.
    1. Chan Wai Man, Woo Jean, Hui Elsie, Lau Winny W Y, Lai Jerry C K, Lee Diana. A community model for care of elderly people with diabetes via telemedicine. Appl Nurs Res. 2005 May;18(2):77–81. doi: 10.1016/j.apnr.2004.11.002.S0897189705000145
    1. Clemensen Jane, Larsen Simon B, Ejskjaer Niels. Telemedical treatment at home of diabetic foot ulcers. J Telemed Telecare. 2005;11 Suppl 2:S14–6. doi: 10.1258/135763305775124830.
    1. Dansky K H, Palmer L, Shea D, Bowles K H. Cost analysis of telehomecare. Telemed J E Health. 2001 Dec;7(3):225–32. doi: 10.1089/153056201316970920.
    1. Gelfand Kenneth, Geffken Gary, Halsey-Lyda Martha, Muir Andrew, Malasanos Toree. Intensive telehealth management of five at-risk adolescents with diabetes. J Telemed Telecare. 2003;9(2):117–21. doi: 10.1258/135763303321328000.
    1. Hebert M A, Paquin M J, Iversen S. Predicting success: stakeholder readiness for home telecare diabetic support. J Telemed Telecare. 2002;8 Suppl 3:S3:33–6.
    1. Izquierdo Roberto E, Knudson Paul E, Meyer Suzanne, Kearns Joann, Ploutz-Snyder Robert, Weinstock Ruth S. A comparison of diabetes education administered through telemedicine versus in person. Diabetes Care. 2003 Apr;26(4):1002–7. doi: 10.2337/diacare.26.4.1002.
    1. Malasanos TH, Burlingame JB, Youngblade L, Patel BD, Muir AB. Improved access to subspecialist diabetes care by telemedicine: cost savings and care measures in the first two years of the FITE diabetes project. J Telemed Telecare. 2005;11 Suppl 1
    1. Smith Anthony C, Batch Jennifer, Lang Eunice, Wootton Richard. The use of online health techniques to assist with the delivery of specialist paediatric diabetes services in Queensland. J Telemed Telecare. 2003;9 Suppl 2:S54–7. doi: 10.1258/135763303322596273.
    1. Whitlock W L, Brown A, Moore K, Pavliscsak H, Dingbaum A, Lacefield D, Buker K, Xenakis S. Telemedicine improved diabetic management. Mil Med. 2000 Aug;165(8):579–84.
    1. Whittaker Sheila L, Adkins Sherry, Phillips Richard, Jones Jean, Horsley Mary A, Kelley George. Success factors in the long-term sustainability of a telediabetes programme. J Telemed Telecare. 2004;10(2):84–8. doi: 10.1258/135763304773391512.
    1. Wilbright Wayne A, Birke James A, Patout Charles A, Varnado Myra, Horswell Ron. The use of telemedicine in the management of diabetes-related foot ulceration: a pilot study. Adv Skin Wound Care. 2004 Jun;17(5 Pt 1):232–8.00129334-200406000-00012
    1. Yip Mei Po, Mackenzie Ann, Chan Juliana. Patient satisfaction with telediabetes education in Hong Kong. J Telemed Telecare. 2002;8(1):48–51. doi: 10.1258/1357633021937460.
    1. Chumbler Neale R, Neugaard Britta, Kobb Rita, Ryan Patricia, Qin Haijing, Joo Yongsung. Evaluation of a care coordination/home-telehealth program for veterans with diabetes: health services utilization and health-related quality of life. Eval Health Prof. 2005 Dec;28(4):464–78. doi: 10.1177/0163278705281079.28/4/464
    1. Chumbler Neale R, Vogel W Bruce, Garel Mischka, Qin Haijing, Kobb Rita, Ryan Patricia. Health services utilization of a care coordination/home-telehealth program for veterans with diabetes: a matched-cohort study. J Ambul Care Manage. 2005 Jul;28(3):230–40.00004479-200507000-00006
    1. Chumbler Neale R, Neugaard Britta, Ryan Patricia, Qin Haijing, Joo Yongsung. An observational study of veterans with diabetes receiving weekly or daily home telehealth monitoring. J Telemed Telecare. 2005;11(3):150–6. doi: 10.1258/1357633053688723.
    1. Starren Justin, Tsai Christopher, Bakken Suzanne, Aidala Angela, Morin Philip C, Hilliman Charlyn, Weinstock Ruth S, Goland Robin, Teresi Jeanne, Shea Steven. The role of nurses in installing telehealth technology in the home. Comput Inform Nurs. 2005 Jul;23(4):181–9. doi: 10.1097/00024665-200507000-00004.00024665-200507000-00004
    1. Mair F, Whitten P. Systematic review of studies of patient satisfaction with telemedicine. BMJ. 2000 Jun 3;320(7248):1517–20. doi: 10.1136/bmj.320.7248.1517.
    1. Epping-Jordan J E, Pruitt S D, Bengoa R, Wagner E H. Improving the quality of health care for chronic conditions. Qual Saf Health Care. 2004 Aug;13(4):299–305. doi: 10.1136/qhc.13.4.299. 13/4/299
    1. Norman CD, Skinner HA. eHealth Literacy: Essential Skills for Consumer Health in a Networked World. J Med Internet Res. 2006;8(2)
    1. Pearson Alan, Wiechula Rick, Court Anthea, Lockwood Craig. A re-consideration of what constitutes "evidence" in the healthcare professions. Nurs Sci Q. 2007 Jan;20(1):85–8. doi: 10.1177/0894318406296306.20/1/85
    1. Egger M, Smith GD, Altman DG. Systematic Reviews in Health Care: Meta-Analysis in Context. 2nd edition. London, UK: BMJ Publishing Group; 2001.
    1. Roine R, Ohinmaa A, Hailey D. Assessing telemedicine: a systematic review of the literature. CMAJ. 2001 Sep 18;165(6):765–71.
    1. Bodenheimer Thomas, Wagner Edward H, Grumbach Kevin. Improving primary care for patients with chronic illness. JAMA. 2002 Oct 9;288(14):1775–9. doi: 10.1001/jama.288.14.1775.jip21004
    1. Ericsson KA, Herbert A. Protocol Analysis: Verbal Reports as Data. Cambridge, MA: MIT Press; 1993.
    1. Kempainen R R, Benditt J O. Evaluation and management of patients with pulmonary disease before thoracic and cardiovascular surgery. Semin Thorac Cardiovasc Surg. 2001 Apr;13(2):105–15.S104306790100020X
    1. Bandura Albert. Health promotion by social cognitive means. Health Educ Behav. 2004 Apr;31(2):143–64. doi: 10.1177/1090198104263660.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren