Video teleconferencing extends scarce paediatric diabetes specialist care

Orlando 05 June 2004An innovative programme that uses videoconferencing to bring paediatric diabetes specialists to families in underserved areas of Florida was introduced at the American Diabetes Association's 64th Annual Scientific Sessions.

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"Our telemedicine programme saves health care dollars, extends the outreach of scarce paediatric diabetes specialists and has improved the health of our children and teenagers with diabetes", reported Toree Malasanos, MD, assistant professor of pediatric endocrinology at the University of Florida College of Medicine in Gainesville. "Parents and kids see and hear us, and we simultaneously see and hear them."

Most university medical school paediatric endocrinology programmes have remote clinics, especially to reach rural areas, as did the University of Florida prior to videoconferencing. Gainesville doctors and nurses spent hours travelling, and children had only one chance every three months to see them, or else the kids had to travel to them.

"Replication of our video teleconferencing programme around the country would be an excellent way to avoid the enormous waste of travel time and expense that remote programmes incur while improving patient outcomes", stated Dr. Malasanos. "It's a more efficient use of paediatric endocrinologists."

Only some 700 Board-certified paediatric endocrinologists, many of whom do not practise full time because they do research, are available to care for the over 200.000 United States children and teens with diabetes, and many clinics have long waiting times for appointments, according to Dr. Malasanos. "This shortage will only worsen, especially in view of the growing number of overweight children and teens now developing type 2 diabetes", she commented.

More than 18 million Americans have diabetes, a group of serious diseases characterized by high blood glucose levels that result from defects in the body's ability to produce and/or use insulin. Diabetes can lead to severely debilitating or fatal complications, such as heart disease, blindness, kidney disease, and amputations. It is the fifth leading cause of death by disease in the United States.

The video teleconferencing programme established in 2002 to improve access to paediatric diabetes care is called the Florida Initiative in Telehealth and Education (FITE). All children and teens in the programme were enrolled in Medicaid and/or Children's Medical Services of Florida, a programme for families with overwhelming health costs and inadequate financial resources.

Previously, clinics were held every three months, requiring 2 1/2 hours of travel time in each direction to and from the university. Two doctors, a nurse, and a nutritionist travelled to a small local clinic in Daytona and tried to see about 40 children in one day. Any children who missed their appointments either had to travel to Gainesville or wait until the next clinic session and, therefore were not seen by a paediatric diabetes specialist for six months.

"Such a long delay can be an extremely serious problem in many paediatric diabetes situations because growing children may need more frequent changes in their insulin regimen", stated Dr. Malasanos. Now FITE holds a videoconference clinic every two weeks. Although each child in the programme still has appointments scheduled every 3 months, a missed appointment can be rescheduled for two weeks later and a child with special needs can be scheduled for more frequent, even monthly, appointments.

"The local nurse takes vital signs, downloads the child's blood glucose levels from his or her meter, and sends them to us by fax", explained Dr. Malasanos. "So we are ready for a real doctor-patient visit. There's even a zoom camera next to the patient if we need to see a rash or cut."

After two years, the outcomes for youngsters in the programme have been dramatic. Before FITE, the group averaged 13 hospitalizations per year and 47 hospital days per year. This has decreased to 3 hospitalizations per year and 9 days per year. The average number of emergency room visits per year for the group has decreased from 8 to 1,5 per year.

Further, the total financial savings over two years amounted to more than $38.000. This savings is based on the reduction in hospital days and emergency room visits and takes into account equipment and communication costs, but does not even account for the savings on travel costs. "This financial savings does not take into account the time of the paediatric endcrinologists and nurse specialists that has now been made available to care for additional patients in Gainesville", stated Dr. Malasanos.

More than 90 percent of youngsters and their parents were satisfied with the telehealth services and felt that their privacy was respected, and 95 percent felt no or only slight self-consciousness with the video teleconferencing.

The American Diabetes Association is a voluntary health organisation supporting diabetes research, information and advocacy. Founded in 1940, the Association has offices in every region of the country, providing services to hundreds of communities.


Leslie Versweyveld

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