Is Telehealth Appropriate For Everyone Who Has Diabetes
Just as different medications are necessary to meet the varied needs of people with diabetes, different approaches to diabetes care are required to best meet everyones management needs. To help you decide whether telehealth is right for you, consider the following questions:
If youre not able to answer yes to all these questions, with some minor adjustments, you may need to reconsider telehealth. If your answer to any is no, be sure to speak with your diabetes care team about instructions they may have for using their telehealth platform or for scheduling a telephone or in-office visit instead to make sure you receive optimal care. It is also important to note that telehealth appointments should not be used for any situations that are critical or require immediate attention.
Telemonitoring And Health Counseling For Self
1Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden
2Faculty of Medicine, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
3Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
4Department of Nursing Sciences, Mid Sweden University, Östersund, Sweden
Diabetes Telehealth: Tips For A Successful Virtual Visit
Early last year, if someone told you that your diabetes health care diabetes provider appointments, diabetes self-management education sessions, follow-up with office staff and more would soon occur as telehealth visits, you might have been more than surprised. Fast forward to 2021, and we are in the midst of the unprecedented times of the novel coronavirus and its impact on health care. The use of telehealth, which is the provision of care outside of the healthcare facility by means of technology, has become widely utilized. In fact, telehealth has grown at such an incredible rate in response to COVID-19 that its estimated that by the end of 2020, there were over 1 billion sessions between patients and their healthcare providers worldwide.
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How Do Cms Updates Affect Our Ability To Provide Dsmt Training
DSMT Can Now be Audio-Only
DSMT services may be billed for audio-only, but only if the video is not available or possible. Make sure to document the mode of instruction and the rationale if using audio-only.
See: COVID-19 Emergency Declaration Waiver for more information.
Can RNs & Pharmacists Now Provide Telehealth and Bill for DSMT?
The ADA and ADCES have been working hard to decipher the language and intent in the updated guidelines. It seems that RN and Pharmacists are now included based on an assessment of the wording in the new documents. CMS continues to expand the definition of providers eligible to furnish telehealth services during the COVID-19 public health emergency.
As DSMT programs bill as an entity, rather than at the individual provider level, the American Diabetes Association is seeking confirmation that DSMT programs that are eligible through Medicare Part B, are considered distant site practitioners approved to furnish telehealth services.
See: Blanket Waivers for HealthCare Providers Fact Sheet for more information.
Hospital-Based Programs Can Bill for Telehealth DSMT on the UB-04 Form
Hospitals may now bill for education and management services as if they were furnished in the hospital and consistent with any specific requirements for billing Medicare in general, including any relevant modifications in effect during the COVID-19 PHE.
See: CMS Hospitals Without Walls Initiative for more information.
Data Extraction And Interpretation
Data were extracted using a piloted data extraction template for included studies , and each study was checked for accuracy . We extracted the description of intervention and component of self-management support inclusion and exclusion criteria population of interest duration and intensity of intervention outcomes measured and results as presented in the review. The synthesis and conclusions of each review were collated: we did not analyze results from individual RCTs.
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Sample Size And Statistical Analysis
The original intended sample size was 200, based on a power of 0.8, an of 0.05, and an effect size of 0.5% change in GHb as the primary outcomes, with detectable clinically relevant changes in secondary outcomes and allowing conservatively for 30% loss to follow-up. However, due to withdrawal of one FQHC early in the participant recruitment process, we re-evaluated our recruitment requirements allowing for only 19% loss to follow-up. This was a practical decision, based on actual experience of our group of 81% retention in a similar study .
Analyses were conducted with SAS version 9.1 . Linear mixed models for repeated measures tested for differences for each outcome. These models used group as the predictor of interest, controlling for potential confounders. Planned contrasts of group differences were used to identify significant changes between groups from baseline to 6 months and baseline to 12 months. Post hoc analyses, with recognized power limitations, were conducted separately on a subsample with data from the 24-month visit. Consistent with the original design criteria, P values < 0.05 were regarded as significant.
Weighting And Quality Assessment
We assessed the quality of the included reviews using the revised A Measurement Tool to Assess Systematic Reviews quality assessment tool. Each included review was assessed independently by 2 reviewers and disagreements were resolved by discussion. We combined the R-AMSTAR score with the size of the review and an assessment of self-management focus to assign a star-based weighting to the evidence from each review. We awarded 1 star for each of the following:
R-AMSTAR score > 30
> 1000 participants
Explicit self-management focus
We then used the weighting of each review to inform the synthesis. Any disagreements in the full-text screening, quality assessment, or data extraction were resolved by discussion, involving a third author when agreement could not be reached.
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Quality And Weighting Of Included Reviews
R-AMSTAR scores for the included systematic reviews ranged from 19 to 43 out of a possible 44. gives scores for the individual components of the R-AMSTAR score. Taking into account quality assessment, explicit self-management focus, and total population size, 8 reviews received an evidence weighting of 3 stars , 23 received 2 stars , 21 received 1 star , and 1 received no stars . The first column of the table in displays these criteria.
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When To Schedule An In
Some aspects of diabetes care arent possible to do remotely. If youre experiencing any complications or having difficulty managing your diabetes, you may need to see a specialist in person.
Diabetes can cause problems with the eyes, kidney, and nerves, and can lead to open sores on the feet. These complications may get worse over time. So its important to get these things evaluated in person and treated.
You may also want to consider an in-person appointment if youre having frequent episodes of low blood sugar .
Who Can Provide Dsmes Telehealth Services
For Medicare reimbursement, DSMES telehealth services must be provided by a qualified DSMES provider who is also one of the following provider types:
- Clinical Social Workers
- Registered Dieticians or Nutrition Professionals
Louisiana Medicaid does not limit the providers that can provide services via telehealth. Each licensing board can limit their providers ability to deliver services via telehealth.
During the COVID-19 public health emergency, the Centers for Medicare and Medicaid Services released updated guidance that allowed accredited and recognized DSMES programs to provide and bill for DSMES services delivered via telehealth during the public health emergency.
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Embracing Change For Better Healthcare
The findings from this study are consistent with mounting evidence supporting the case for managing diabetes with telehealth. A 2015 Cochrane Review that examined the efficacy and feasibility of using telehealth with patients with diabetes found that telehealth interventions result in significantly improved blood glucose control compared to usual care interventions. Additionally, a systematic review from2009 concluded that home telehealth results in improved glycemic control compared to standard care among patients with type 2 diabetes.
Telehealth has great potential to change the way diabetes is managed by improving efficiency of care and enhancing quality of treatment for all patients who suffer from this condition. Providers who embrace new health technology will be able to increase access to care in underserved communities and contribute to reduced healthcare costs associated with diabetes management.
Examples Of Rural Diabetes Telehealth Programs
- The Catalina Island Telemedicine Center was established to help residents of Santa Catalina Island, located off the coast of California, to access specialty care electronically. Some telemedicine services offered include diabetic education and eye screenings. To help residents see specialist providers, the telemedicine center partnered with Loma Linda University Medical Center, the Los Angeles County Department of Mental Health, and a private psychiatry company.
- Project ECHO provides evidence-based programs for managing complex conditions, including diabetes. This model extends care to rural patients through videoconferencing and is used in communities across the country.
- The Mississippi Diabetes Telehealth Network, a program of the University of Mississippi Medical Center’s Center for Telehealth, was launched in 2014 to improve care for people with diabetes in Mississippi’s Delta region. The program provides remote patient monitoring, using telehealth to deliver health education, coaching, and interventions to patients in their homes. Evaluation results indicate that providing remote patient monitoring through telehealth is effective for diabetes management in rural areas.
- The University of Virginia Diabetes Tele-Education Program uses video conferencing technology to deliver diabetes education to people who have, or are at high risk for developing, diabetes. The diabetes education courses address diabetes basics, nutrition, self-management, and lifestyle changes.
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Statement Of Main Findings
The individual long-term conditions considered in this metareview differed both in the quantity of evidence for telehealth interventions supporting self-management and in the findings and conclusions of the included systematic reviews. Diabetes and heart failure constituted the greatest evidence base, with available data on cancer being very limited.
Overview Of Presentation Of Results
provides an overview of the focus, quality, findings, and conclusions of each of the included reviews. It also displays how the interventions described map to Pearce et als taxonomy of self-management support . Additional detail is shown in . The text that follows synthesizes the findings against the 2 aims of the metareview.
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Telemedicine For Diabetes Management During The Covid
In perhaps one of the most significant changes to occur in health care as a result of the coronavirus disease 2019 pandemic, telemedicine has suddenly reached the widespread adoption many proponents have championed for years. Recognizing the necessity of telemedicine in light of the current crisis both to address increased treatment needs and to prevent unnecessary in-person contact some payors and state legislators have loosened certain restrictions regarding its use across clinical specialties.
Although considerable variation and lack of clarity regarding such changes have been reported, the changes include alterations to rules requiring that patients reside in rural areas with limited access to health care, now allowing for the remote care of patients in all areas.1,2
This unexpected development represents a major boon to diabetes care, which has long been viewed as optimally suited to delivery via telemedicine. A sizable body of research supports its value in the management of adult and pediatric diabetes, with several types of technology used by various providers including endocrinologists and registered dietitians.3-6
The results demonstrated a significantly greater mean reduction in hemoglobin A1c in the telemedicine groups compared with usual care , especially in trials lasting > 6 months and in patients with type 2 diabetes compared with type 1 diabetes . In addition, greater benefits were observed in older patients compared with younger patients.5
How The Program Works
DSMES is an evidence-based service that helps persons with type 2 diabetes effectively self-manage their diabetes and cope with the chronic disease. DSMES interventions focus on:
DSMES sessions are held in an interactive real-time online format with a Certified Diabetes Care and Education Specialist and other licensed health professionals. DSMES services are recognized by the American Diabetes Association or accredited by the Association of Diabetes Care and Education Specialists .
- Diagnosed with type 2 diabetes
- Other test result findings such as HbA1c, oral glucose tolerance test, fasting plasma glucose .
- Documentation of diagnosis of type 2 diabetes
- Diagnosis must be made using one of the following criteria
- Fasting blood glucose 126mg/dL, fasting is defined as no caloric intake for at least 8 hours
- 2-hour plasma glucose 200mg/dL during a 75g oral glucose tolerance test
- HbA1c 6.5%. Test should be performed in a laboratory
- Random plasma glucose 200mg/dL with symptoms of hyperglycemia
- If no symptoms of hyperglycemia, diagnosis requires two abnormal test results from the same sample or in two separate test samples
PreventionLink programs are available to health care providers and residents of:
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Telehealth May Be A Convenient Addition To Your Routine
While a face-to-face visit still might be the best choice for some people and for some health issues, telehealth is certainly a convenient, affordable alternative to an inperson visit for diabetes care. By ensuring you have acceptable technology to access your appointment and you are fully prepared with questions and information, you can increase the chances for a successful telehealth session for both you and your diabetes care team.
Want to learn more about telehealth? Read 2020 Health Trends: Try or Pass?
Screening Of Titles Abstracts And Full Texts
Inclusion criteria were piloted by 2 authors and disagreements were resolved by discussion with all authors. PH then assessed all titles and abstracts against the inclusion criteria. Where no abstract was available, articles were retained for full-text assessment. A random sample of 250 abstracts was screened by 2 reviewers . A kappa statistic of agreement was calculated using IBM SPSS version 22 and was high . Full texts of all potentially eligible articles were assessed independently by 2 reviewers .
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Telehealth For Diabetes Self
|The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.|
|First Posted : September 19, 2005Last Update Posted : November 14, 2007|
This study will examine the feasibility and short and-long-term efficacy of a web-based telehealth intervention with community-dwelling older adults who have been diagnosed with type 2 diabetes. Effectiveness will be evaluated using multiple measures within three different domains: 1) physical 2) behavioral , and 3) psychosocial .
|Behavioral: Telehealth for Diabetes Self ManagementOther: Telehealth for Diabetes Self Management||Not Applicable|
This one year study plans to enroll 62 individuals into two groups. One group will receive the standard diabetic care provided and the second group will receive the standard diabetic care and training on how to use a computer to access the Internet. Participant assignment into either group is random . Study procedures will include the completion of questionnaires a blood pressure reading, weight and a finger prick to obtain a blood sample.
Offering Dsmes Services Through Telehealth
Diabetes is a lifelong condition that requires daily self-management and complex care regimens that may be difficult for people to navigate without support.1Diabetes Self-Management and Support is an evidence-based intervention that provides people with diabetes with the knowledge, skills, and support needed to better manage and navigate daily life with a chronic condition.
Though typically in person, DSMES delivered via telehealth allow participants to access services without having to travel long distances and may even be able to attend sessions from the comfort of their homes.
DSMES delivered via telehealth is expected to uphold the same quality standards as in-person DSMES. Telehealth services follow the same curriculum as in-person DSMES, and participants are required to complete session items, such as participant assessments, just as they would during an in-person program. Participants also have access to the same DSMES resources and tools that they would have access to during an in-person program.
Starting DSMES Services at Your Facility
Learn how to implement DSMES services at your facility and get accredited!
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The Promise Of Technology
Proper management of diabetes is critical to both patient health and efficient healthcare spending. Emerging technological advances have the potential to improve quality of care and increase access to healthcare services for patients with type 2 diabetes. Self-management of diabetes is heavily tied to lifestyle modifications, which can be continuously monitored on telehealth platforms. Additionally, telehealth allows providers to reach patients in rural or underserved communities and provide them with quality care.