FITE diabetes: florida initiative in telehealth and education. Approach to diabetes care for children

Abstract

Remote clinics for children with diabetes in under-served areas are necessary due to increasing numbers of patients, and shortages and centralisation of specialists at tertiary care centres. Lack of resources (professional and financial) to continue travelling to remote clinics. Lack of resources to allow for families to travel to hub clinics. Poor metabolic control and high rate of hospitalisation for the under-served population of the remote clinic. Lack of medical home contributing to a low rate of phone management of acute illness and a high rate of emergency department visits. Disproportionate use of financial resources for a small number of children with poor adherence to the medical plan. Lack of financial incentive and time for diabetes education, coupled with the correlation of adherence with education. Low rate of literacy and ‘new readers’ in the target population to be educated. Lack of adequate education programme to address the needs of this programme. Telemedicine clinic offered semi-monthly allowing improved frequency of patient visits without the necessity for families or providers to travel. Provision of a medical home with clear instructions regarding whom and when to call for additional guidance. Link secondary care providers in the school with the family and health care team for assimilation of all data collected through the day. Improved accountability of non-adherent patients by incorporating all data and increasing interaction with the health care team. Creation of web-based animated instruction covering all aspects of diabetes care. Pre- and post-testing provides the health care team with progress reports on patients enrolled. Access to website for patients and secondary caretakers (for example, teachers, grandparents, school nurses). Continuing education units offered to nurses to increase the understanding of diabetes by the health workforce. Establishment of a medical home and guidelines of when to call has reduced the frequent emergency department visits and hospitalisations for the group. Avoidance of travel costs, and work and school absences for travel to hub clinic by families. Efficiency of the health care team improved by avoiding travel to a remote clinic. Web education of new caretakers, guardians and others does not incur additional cost. Web education is available statewide. Line charges and equipment costs (amortised over five years) were £9993. (The line charges are dramatically reduced now as we are using one or two ISDN lines versus three.) The reduction in hospital days saved £23 572/year. The reduction in emergency department visits saved £1202/year. Additional savings of £34 462/year if Medicaid family transportation costs to the hub were necessary in the absence of the telemedicine clinic. Many academic centres provide health care by travelling to remote centres. Replication of this programme elsewhere has the potential to improve the efficiency of, and save time for, physicians and diabetes treatment teams already trying to meet the demands of their busy schedules. Reduction in line charges, through creative technology such as Internet Protocol encryption, will allow a more cost-effective provision of service than in-person visits to outreach sites. When other cost reductions such as decreased hospitalisation and emergency department use are considered, the costs of telemedicine services are readily justified.