Centre for Health Services Research, Faculty of Medicine, Brisbane, The University of Queensland, QLD 4102, Australia.
Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD 4102, Australia.
Int J Environ Res Public Health. 2019 Mar 18;16(6):959. doi: 10.3390/ijerph16060959.
Conventional outpatient services are unlikely to meet burgeoning demand for diabetes services given increasing prevalence of diabetes, and resultant impact on the healthcare workforce and healthcare costs. Disruptive technologies (such as smartphone and wireless sensors) create an opportunity to redesign outpatient services. In collaboration, the Department of Diabetes and Endocrinology at Brisbane Princess Alexandra Hospital, the University of Queensland Centre for Health Services Research and the Australian e-Health Research Centre developed a mobile diabetes management system (MDMS) to support the management of complex outpatient type 2 diabetes mellitus (T2DM) adults. The system comprises of a mobile App, an automated text-messaging feedback and a clinician portal. Blood glucose levels (BGL) data are automatically transferred by Bluetooth-enabled glucose meter to the clinician portal via the mobile App. The primary aim of the study described here is to examine improvement in glycaemic control of a new model of care employing MDMS for patients with complex T2DM attending a tertiary level outpatient service. A two-group, 12-month, pilot pragmatic randomised control trial will recruit 44 T2DM patients. The control group will receive routine care. The intervention group will be supported by the MDMS enabling the participants to potentially better self-manage their diabetes, and the endocrinologists to remotely monitor BGL and to interact with patients through a variety of eHealth modalities. Intervention participants will be encouraged to complete relevant pathology tests, and report on current diabetes management through an online questionnaire. Using this information, the endocrinologist may choose to reschedule the appointment or substitute it with a telephone or video-consultation. This pilot study will guide the conduct of a large-scale study regarding the capacity for a new model of care. This model utilises multimodal eHealth strategies via the MDMS to primarily improve glycaemic control with secondary aims to improve patient experience, reduce reliance on physical clinics, and decrease service delivery cost.
传统的门诊服务不太可能满足糖尿病服务不断增长的需求，因为糖尿病的患病率不断上升，这对医疗保健劳动力和医疗保健成本产生了影响。颠覆性技术（如智能手机和无线传感器）为重新设计门诊服务创造了机会。在昆士兰大学卫生服务研究中心和澳大利亚电子健康研究中心的协作下，布里斯班公主亚历山德拉医院的糖尿病和内分泌科开发了一种移动糖尿病管理系统（MDMS），以支持复杂的 2 型糖尿病（T2DM）成人门诊管理。该系统包括一个移动应用程序、一个自动化的短信反馈和一个临床医生门户。血糖仪通过蓝牙将血糖（BGL）数据自动传输到移动应用程序，然后通过移动应用程序传输到临床医生门户。这里描述的研究的主要目的是检查使用 MDMS 为在三级门诊服务就诊的复杂 T2DM 患者提供新的护理模式是否能改善血糖控制。一项两臂、12 个月、试点实用随机对照试验将招募 44 名 T2DM 患者。对照组将接受常规护理。干预组将得到 MDMS 的支持，使参与者能够更好地自我管理糖尿病，内分泌医生可以远程监测 BGL，并通过各种电子健康模式与患者互动。干预参与者将被鼓励完成相关的病理检查，并通过在线问卷报告当前的糖尿病管理情况。根据这些信息，内分泌医生可以选择重新安排预约，或通过电话或视频咨询代替。这项试点研究将为一项关于新护理模式的可行性的大型研究提供指导。这种模式利用 MDMS 中的多种电子健康策略，主要是改善血糖控制，次要目标是改善患者体验，减少对实体诊所的依赖，并降低服务交付成本。
