Virtual models of chronic disease management: lessons from the experiences of virtual care during the COVID-19 response
Rachael Smithson A B , Elisha Roche A and Christina Wicker AA Transformation and Digital, Gold Coast Health, Gold Coast University Hospital, Block D, Level 6, 1 Hospital Boulevard, Southport, Qld 4215, Australia. Email: elisha.roche@health.qld.gov.au; christina.wicker@health.qld.gov.au
B Corresponding author. Email: rachael.smithson@health.qld.gov.au
Australian Health Review 45(3) 311-316 https://doi.org/10.1071/AH20190
Submitted: 23 July 2020 Accepted: 30 November 2020 Published: 15 February 2021
Journal Compilation © AHHA 2021 Open Access CC BY
Abstract
Objective This study examined Gold Coast staff and patient experiences with the rapid expansion of a virtual model of chronic disease management during the COVID-19 pandemic.
Methods The study undertook a survey of enrolled patients (n = 24) and focus groups with clinical and administrative staff (n = 44) delivering chronic disease programs at Gold Coast Health in Queensland. The study also examined routinely collected activity data for the chronic disease programs before COVID (January–February 2020) and for the first 3 months of the COVID-19 response (March–May 2020).
Results Chronic disease programs continued to provide similar numbers of appointments over the COVID-19 response period, but there was a marked increase in the proportion of appointments that were delivered virtually, either by telephone or video conference. Most patients were satisfied with their virtual care experiences and felt that their health care needs were met.
Conclusions The COVID-19 response provided an opportunity to learn and further develop models of virtual care. Staff and patients were generally supportive of continuing to include virtual appointments in the future. Ongoing concerns were predominantly around the support available to patients and staff to ensure they are trained and equipped to manage the technology and new mode of communicating.
What is known about the topic? Emerging evidence suggests that virtual models of health care delivery, such as telephone and video consultations and remote patient monitoring, can be safe and cost-effective alternatives to traditional face-to-face chronic disease management programs. Virtual care is associated with equal or improved clinical outcomes, as well as efficiency improvements, such as reduced failure to attend rates.
What does this paper add? The increasing burden of chronic disease across Australia, as well as the need to minimise the risk of vulnerable patient groups attending in-hospital appointments where it is safe and appropriate to do so, means that expanding the delivery of virtual chronic disease management will become increasingly necessary. The results of this study provide an opportunity to learn from a rapid rollout of virtual care for these staff and patient groups and will help inform advances in this area.
What are the implications for practitioners? Existing evidence, demographic pressures and the COVID-19 pandemic response all point to virtual care as a viable and safe alternative to traditional models of chronic disease management. The lessons presented here provide more detailed guidance on the support that staff and patients require to ensure virtual care is a seamless and safe alternative or adjunct to traditional chronic disease management programs.
References
[1] Anderson J, Ganguli I. Unpacking the potential for virtual care. J Gen Intern Med 2019; 34 2906–7.| Unpacking the potential for virtual care.Crossref | GoogleScholarGoogle Scholar | 31342331PubMed |
[2] Buvik A, Bugge E, Knutsen G, Småbrekke A, Wilsgaard T. Patient reported outcomes with remote orthopaedic consultations by telemedicine: a randomised controlled trial. J Telemed Telecare 2019; 25 451–9.
| Patient reported outcomes with remote orthopaedic consultations by telemedicine: a randomised controlled trial.Crossref | GoogleScholarGoogle Scholar | 29973130PubMed |
[3] Snoswell CL, Caffery LJ, Haydon HM, Thomas EE, Smith AC. Telehealth uptake in general practice as a result of the coronavirus (COVID-19) pandemic. Aust Health Rev 2020; 44 737–40.
| Telehealth uptake in general practice as a result of the coronavirus (COVID-19) pandemic.Crossref | GoogleScholarGoogle Scholar | 32853536PubMed |
[4] Greenhalgh T, Vijayaraghavan S, Wherton J, Shaw S, Byrne E, Campbell-Richards D, Bhattacharya S, Hanson P, Ramoutar S, Gutteridge C, Hodkinson I, Collard A, Morris J. Virtual online consultations: advantages and limitations (VOCAL) study. BMJ Open 2016; 6 e009388
| Virtual online consultations: advantages and limitations (VOCAL) study.Crossref | GoogleScholarGoogle Scholar | 26880671PubMed |
[5] Scalvini S, Bernocchi P, Zanelli E, Comini L, Vitacca M, MCTT Maugeri Centre for Telehealth and Telecare Maugeri Centre for Telehealth and Telecare: a real-life integrated experience in chronic patients. J Telemed Telecare 2018; 24 500–7.
| Maugeri Centre for Telehealth and Telecare: a real-life integrated experience in chronic patients.Crossref | GoogleScholarGoogle Scholar | 28537509PubMed |
[6] Bashshur RL, Shannon GW, Smith BR, Alverson DC, Antoniotti N, Barsan WG, Bashshur N, Brown EM, Coye MJ, Doarn CR, Ferguson S, Grigsby J, Krupinski EA, Kvedar JC, Linkous J, Merrell RC, Nesbitt T, Poropatich R, Rheuban KS, Sanders JH, Watson AR, Weinstein RS, Yellowlees P. The empirical foundations of telemedicine interventions for chronic disease management. Telemed J E Health 2014; 20 769–800.
| The empirical foundations of telemedicine interventions for chronic disease management.Crossref | GoogleScholarGoogle Scholar | 24968105PubMed |
[7] Marcolino MS, Oliveira JAQ, D’Agostino M, Ribeiro AL, Alkmim MBM, Novillo-Ortiz D. The impact of mHealth interventions: systematic review of systematic reviews. JMIR Mhealth Uhealth 2018; 6 e23
| The impact of mHealth interventions: systematic review of systematic reviews.Crossref | GoogleScholarGoogle Scholar | 29343463PubMed |
[8] Villani A, Malfatto G, Compare A, Rosa FD, Bellardita L, Branzi G, Molinari E, Parati G. Clinical and psychological telemonitoring and telecare of high risk heart failure patients. J Telemed Telecare 2014; 20 468–75.
| Clinical and psychological telemonitoring and telecare of high risk heart failure patients.Crossref | GoogleScholarGoogle Scholar | 25339632PubMed |
[9] Gokalp H, de Folter J, Verma V, Fursse J, Jones R, Clarke M. Integrated telehealth and telecare for monitoring frail elderly with chronic disease. Telemed J E Health 2018; 24 940–57.
| Integrated telehealth and telecare for monitoring frail elderly with chronic disease.Crossref | GoogleScholarGoogle Scholar | 30129884PubMed |
[10] Patel S, Hamdan S, Donahue S. Optimising telemedicine in ophthalmology during the COVID-19 pandemic. J Telemed Telecare 2020;
| Optimising telemedicine in ophthalmology during the COVID-19 pandemic.Crossref | GoogleScholarGoogle Scholar | 32799736PubMed |
[11] Knox L, Rahman RJ, Beedie C. Quality of life in patients receiving telemedicine enhanced chronic heart failure disease management: a meta-analysis. J Telemed Telecare 2017; 23 639–49.
| Quality of life in patients receiving telemedicine enhanced chronic heart failure disease management: a meta-analysis.Crossref | GoogleScholarGoogle Scholar | 27450573PubMed |
[12] Rush KL, Hatt L, Janke R, Burton L, Ferrier M, Tetrault M. The efficacy of telehealth delivered educational approaches for patients with chronic diseases: a systematic review. Patient Educ Couns 2018; 101 1310–21.
| The efficacy of telehealth delivered educational approaches for patients with chronic diseases: a systematic review.Crossref | GoogleScholarGoogle Scholar | 29486994PubMed |
[13] Varnfield M, Karunanithi M, Lee C, Honeyman E, Arnold D, Ding H, Smith C, Walters DL. Smartphone-based home care model improved use of cardiac rehabilitation in post myocardial infarction patients: results from a randomised controlled trial. Heart 2014; 100 1770–9.
| Smartphone-based home care model improved use of cardiac rehabilitation in post myocardial infarction patients: results from a randomised controlled trial.Crossref | GoogleScholarGoogle Scholar | 24973083PubMed |
[14] Gorst SL, Armitage CJ, Brownsell S, Hawley MS. Home telehealth uptake and continued use among heart failure and chronic obstructive pulmonary disease patients: a systematic review. Ann Behav Med 2014; 48 323–36.
| Home telehealth uptake and continued use among heart failure and chronic obstructive pulmonary disease patients: a systematic review.Crossref | GoogleScholarGoogle Scholar | 24763972PubMed |
[15] Kao DP, Lindenfeld J, Macaulay D, Birnbaum HG, Jarvis JL, Desai US, Page RL. Impact of a telehealth and care management program on all-cause mortality and healthcare utilization in patients with heart failure. Telemed J E Health 2016; 22 2–11.
| Impact of a telehealth and care management program on all-cause mortality and healthcare utilization in patients with heart failure.Crossref | GoogleScholarGoogle Scholar | 26218252PubMed |
[16] Hamine S, Gerth-Guyette E, Faulx D, Green BB, Ginsburg AS. Impact of mHealth chronic disease management on treatment adherence and patient outcomes: a systematic review. J Med Internet Res 2015; 17 e52
| Impact of mHealth chronic disease management on treatment adherence and patient outcomes: a systematic review.Crossref | GoogleScholarGoogle Scholar | 25803266PubMed |
[17] Bohingamu Mudiyanselage S, Stevens J, Watts JJ, Toscano J, Kotowicz MA, Steinfort CL, Bell J, Byrnes J, Bruce S, Carter S, Hunter C, Barrand C, Hayles R. Personalised telehealth intervention for chronic disease management: a pilot randomised controlled trial. J Telemed Telecare 2019; 25 343–52.
| Personalised telehealth intervention for chronic disease management: a pilot randomised controlled trial.Crossref | GoogleScholarGoogle Scholar | 29793387PubMed |
[18] Sohn S, Helms TM, Pelleter JT, Müller A, Kröttinger AI, Schöffski O. Costs and benefits of personalized healthcare for patients with chronic heart failure in the care and education program ‘Telemedicine for the heart’. Telemed J E Health 2012; 18 198–204.
| Costs and benefits of personalized healthcare for patients with chronic heart failure in the care and education program ‘Telemedicine for the heart’.Crossref | GoogleScholarGoogle Scholar | 22356529PubMed |
[19] Celler BG, Sparks R, Nepal S, Alem L, Varnfield M, Li J, Jang-Jaccard J, McBride SJ, Jayasena R. Design of a multi-site multi-state clinical trial of home monitoring of chronic disease in the community in Australia. BMC Public Health 2014; 14 1270
| Design of a multi-site multi-state clinical trial of home monitoring of chronic disease in the community in Australia.Crossref | GoogleScholarGoogle Scholar | 25511206PubMed |
[20] Barken TL, Thygesen E, Söderhamn U. Unlocking the limitations: living with chronic obstructive pulmonary disease and receiving care through telemedicine – a phenomenological study. J Clin Nurs 2018; 27 132–42.
| Unlocking the limitations: living with chronic obstructive pulmonary disease and receiving care through telemedicine – a phenomenological study.Crossref | GoogleScholarGoogle Scholar | 28425194PubMed |
[21] De San Miguel K, Smith J, Lewin G. Telehealth remote monitoring for community-dwelling older adults with chronic obstructive pulmonary disease. Telemed J E Health 2013; 19 652–7.
| Telehealth remote monitoring for community-dwelling older adults with chronic obstructive pulmonary disease.Crossref | GoogleScholarGoogle Scholar | 23808885PubMed |
[22] Shea S, Weinstock RS, Teresi JA, Palmas W, Starren J, Cimino JJ, Lai AM, Field L, Morin PC, Goland R, Izquierdo RE, Ebner S, Silver S, Petkova E, Kong J, Eimicke JP, IDEATel Consortium A randomized trial comparing telemedicine case management with usual care in older, ethnically diverse, medically underserved patients with diabetes mellitus: 5 year results of the IDEATel Study. J Am Med Inform Assoc 2009; 16 446–56.
| A randomized trial comparing telemedicine case management with usual care in older, ethnically diverse, medically underserved patients with diabetes mellitus: 5 year results of the IDEATel Study.Crossref | GoogleScholarGoogle Scholar | 19390093PubMed |
[23] Vatnøy TK, Thygesen E, Dale B. Telemedicine to support coping resources in home-living patients diagnosed with chronic obstructive pulmonary disease: patients’ experiences. J Telemed Telecare 2017; 23 126–32.
| Telemedicine to support coping resources in home-living patients diagnosed with chronic obstructive pulmonary disease: patients’ experiences.Crossref | GoogleScholarGoogle Scholar | 26853926PubMed |
[24] Wright HR, Diamond JP. Service innovation in glaucoma management: using a web-based electronic patient record to facilitate virtual specialist supervision of a shared care glaucoma programme. Br J Ophthalmol 2015; 99 313–17.
| Service innovation in glaucoma management: using a web-based electronic patient record to facilitate virtual specialist supervision of a shared care glaucoma programme.Crossref | GoogleScholarGoogle Scholar | 25336582PubMed |
[25] Williams ED, Bird D, Forbes AW, Russell A, Ash S, Friedman R, Scuffham PA, Oldenburg B. Randomised controlled trial of an automated, interactive telephone intervention (TLC diabetes) to improve type 2 diabetes management: baseline findings and six-month outcomes. BMC Public Health 2012; 12 602
| Randomised controlled trial of an automated, interactive telephone intervention (TLC diabetes) to improve type 2 diabetes management: baseline findings and six-month outcomes.Crossref | GoogleScholarGoogle Scholar | 22857017PubMed |
