Zupa Margaret F, Alexopoulos Anastasia-Stefania, Esteve Lucy, Rosland Ann-Marie
University of Pittsburgh School of Medicine, Division of Endocrinology and Metabolism, Pittsburgh, PA, USA.
Duke University School of Medicine, Division of Endocrinology, Metabolism, and Nutrition, Durham, NC, USA.
J Endocr Soc. 2023 Mar 20;7(5):bvad039. doi: 10.1210/jendso/bvad039. eCollection 2023 Mar 6.
Recent recommendations guiding appropriate use of telemedicine for endocrinology care have largely relied on expert opinion due to limited evidence on factors that increase quality of telemedicine care. In this study, we assessed the perspectives of front-line specialists on factors and strategies perceived to increase quality of diabetes care delivered via telemedicine after more than 2 years of widespread use.
Adult diabetes specialists in 2 academic health systems who recently used video-based telemedicine to provide diabetes care were invited to participate in an online survey study between March and April 2022. Likert-style questions, followed by related open-ended questions, assessed perspectives on availability of key resources, factors affecting quality, and anticipated benefits from telemedicine for diabetes.
Response rate was 52% (56/111). More than half (54%) of participants reported better overall quality of diabetes care with face-to-face care vs telemedicine. Participants reported clinical data supporting high-quality care, such as home blood glucose readings and vital signs, were often not available with telemedicine. Patient factors, including comorbidities and communication barriers, reduced anticipated benefit from telemedicine, while geographic and mobility barriers increased expected benefit. Providers described multiple health care setting resources that could promote high-quality telemedicine diabetes care, including greater support for sharing patient-generated health data and coordinating multidisciplinary care.
After 2 years of sustained use, diabetes specialists identified telemedicine as an important way to enhance access to care. However, specialists identified additional supports needed to increase appropriate use and delivery of high-quality telemedicine care for patients with complex clinical needs.
由于关于提高远程医疗护理质量因素的证据有限，近期指导内分泌科合理使用远程医疗的建议很大程度上依赖专家意见。在本研究中，我们评估了一线专家对在广泛使用两年多后，通过远程医疗提供糖尿病护理时，被认为能提高护理质量的因素和策略的看法。
2022年3月至4月，邀请了两个学术医疗系统中近期使用基于视频的远程医疗提供糖尿病护理的成年糖尿病专家参与一项在线调查研究。采用李克特式问题，随后是相关的开放式问题，评估对关键资源可用性、影响质量的因素以及远程医疗对糖尿病的预期益处的看法。
回复率为52%（56/111）。超过一半（54%）的参与者报告称，面对面护理的糖尿病护理总体质量优于远程医疗。参与者报告说，远程医疗往往无法获得支持高质量护理的临床数据，如家庭血糖读数和生命体征。患者因素，包括合并症和沟通障碍，降低了远程医疗的预期益处，而地理和行动障碍则增加了预期益处。提供者描述了多种可促进高质量远程医疗糖尿病护理的医疗环境资源，包括对共享患者生成的健康数据和协调多学科护理的更多支持。
经过两年的持续使用，糖尿病专家将远程医疗视为增加医疗服务可及性的重要方式。然而，专家们指出，对于有复杂临床需求的患者，还需要额外的支持来增加高质量远程医疗护理的合理使用和提供。
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