Issue 172 Item 14 Over the Mountains and Across the Rivers Telemedicine Works fo

Diabetic patients who do not live close to a diabetes specialty clinic benefit from a program that uses video conference by telephone, in place of a standard consultation.

Dr. Ilana Harman-Boehm, with Soroka University Medical Centre in Beersheva, Israel, presented study results of the first 51 patients participating in such a program. All subjects were required to live at least 50 kilometres from the centre’s diabetes unit in order to be eligible, and to have made at least one visit to the diabetes clinic in the prior year.

Patient records were opened at the diabetes centre and at the patient’s regular family practice clinic through an on-line consult. The patient’s blood pressure and electrocardiogram findings were transmitted on-line by the family practice clinic to the diabetes consultant. In addition, the most recent laboratory results were available on-line, directly from the central laboratory, at both ends.

A regular on-line consultation was performed by the diabetologist, with open discussion encouraged between the patient, family physician, clinic nurse, and diabetes clinic staff. A summary of the consultation was immediately faxed to the family clinic.

An assessment of metabolic measures obtained 3 months prior to the program and measures obtained 6 months after enrolment showed that total cholesterol decreased from 183 mg % to 172 mg % (p less than 0.04), low-density lipoprotein-cholesterol decreased from 103mg % to 95 mg % (p less than 0.015), and systolic blood pressure decreased from 146 mm Hg to 139 mm Hg (p less than 0.002). Hemoglobin A1c decreased significantly from 8.5 ±1.7% to 8.0 ±1.8 %. There were no changes in high-density lipoprotein-cholesterol or triglyceride and levels.

Overall, about two-thirds of patients reported that they were satisfied with the consultation. While patients also said it was as useful as their regular consult and stated that they were pleased that they could save time and money by not having to travel a lengthy distance to the diabetes clinic, many commented that they missed the personal contact – with the doctor and diabetes educator.

Dr. Harman-Boehm said she believes the program can provide effective diabetes management for patients who can’t be treated in the conventional manner. "Achieving metabolic goals in diabetes is often extremely difficult and requires multiple visits and consultations between the patient and diabetes care team until the patient becomes independent in self-care," Dr. Harman-Boehm said. "At that point, the patient needs routine but less frequent follow-up visits to make sure he stays on track. This becomes increasingly difficult when long distances separate the patient from the treating diabetes team. Hopefully, this program will effectively address that problem."

IDF: [Study title: Telemedicine: the management of diabetes. Abstract 41]

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