Traditional models of routine follow-up out-patient care are widely recognised to be inefficient and often ineffective as they fail to reliably provide responsive care when patients need intervention. This project aimed to provide more accessible and cost-effective diabetes care by replacing routine follow-up out-patient appointments for patients who don’t require physical examination with web-based consultations. It used everyday technology available in people’s homes and included patients of all ages from ethnically diverse communities conducted in an urban inner-city environment. From January 2011 to the time of entry, 234 online appointments had been conducted. Trends support the qualitative data showing patients who have had several webcam appointments have a reduction in HbA1c levels with fewer A&E attends. A two-year study is now ongoing exploring the role of web-based consultations in improving self-management.
The prevalence of diabetes in Newham is 6.9%-9.9%, around 5-6 times the national average, and due largely due to the local BME population. Rates are projected to increase to 13.5% by 2030.
There are currently 14,000 patients on the local diabetes database (DIAMOND) and the prevalence of Type 2 diabetes in young people is about 4-5 times the national average. The antenatal clinic managed 420 diabetes related pregnancies in 2009/10.
The Borough has high levels of socioeconomic deprivation and this, coupled with cultural factors, leads to poor self management with high non-attendance rates and poor health outcomes.
The Department of Health You’re Welcome (2009) initiative highlighted inflexible services as the leading cause of missed appointments, especially for people in education or employment, or those with carer responsibilities or language problems. Local broadband usage is 70% (63 % national), probably reflecting the needs of this multi-ethnic population. Following a small technology audit with NHS Choices, questionnaire-based surveys were conducted to determine general broadband use and the acceptability of remote consultations. Funding was then obtained to explore web-based consultations in routine diabetes care.
It was anticipated that web-based consultations would improve the efficiency of the outpatient process, enhance patient self-management skills and be cost effective. This would be achieved by: Lowering the cost per outpatient contact; reducing the number of missed appointments (DNAs) and demonstrating improved health outcomes because of a more proactive approach to self-management with a concomitant reduction in attendance at emergency services or use of out-of-hours facilities. It would also reduce costs for patients having to travel or take time away from work or other commitments, reduce the amount of time they needed to allocate for consultations and offer greater convenience.
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