Videoconferencing for Clinical Management of Diabetes

Successful management of diabetes requires frequent appointments with healthcare professionals, many of which take place in hospital outpatient departments. Trips to hospital can be both burdensome and expensive for patients. Several studies have investigated the feasibility and effectiveness of videoconferencing for remote provision of diabetes care, but most have focused on behavioural therapy interventions such as diabetes education, selfmanagement training, and nutrition consultations which are commonly provided by nonphysician health professionals. A few clinical trials have reported the clinical outcome of videoconferencing for diabetes care, but no study has been reported on the reliability of video consultation for diabetes specialised care. The aim of this research was to evaluate the reliability of videoconferencing for clinical management of diabetes. Three preliminary studies were conducted to inform the design of a randomised controlled trial. In the first study, the process of care, delivered by endocrinologists during conventional consultations in a diabetes outpatient clinic was analysed. This study showed that physical examination was not performed in 34% of inperson consultations. The endocrinologists reported that in 86% of the cases, it would be possible to safely provide the same consultation remotely via videoconferencing if the patient was accompanied by a general practitioner at the remote site. This could save the patients cost and inconvenience of long trips. In the second study, the process of consultations provided remotely by endocrinologists via videoconference was analysed. This study was conducted in the tele-endocrinology clinic of a tertiary teaching hospital in Brisbane, which provides specialty consultations remotely to the patients living up to 1800 km away. Fifty six video consultations during a 5-month period were analysed. A nurse accompanied the patients at the remote site in 66% of the consultations, and in 18% of these cases, the endocrinologists requested the nurse to perform a physical examination. The most frequent recommendations were requesting lab tests (75%), adjustment of insulin dose (39%) and referring to an allied health professional (13%). Of these 56 consultations, the endocrinologists requested an in-person visit for three patients. In the third study in the same tele-endocrinology clinic, a questionnaire for assessing the level of patient satisfaction with video consultation was developed. It comprised 15 multiple choice items exploring four dimensions: equipment/technical issues, communication and rapport, clinical assessment, and program evaluation. This questionnaire was then used to assess the satisfaction of the patients living in rural areas of Queensland who had been