Effects of nurse telesupport on transition between specialized and primary care in diabetic patients: study protocol for a randomized controlled trial

Abstract

BackgroundAccording to the Global Diabetes Plan, a unified health system with preventive and educational strategies is essential to proper diabetes care and primary settings should be the main site of care. In Brazil, there is limited access to outpatient hospital diabetes services, while primary-care diabetes support is underutilized. Telemedicine can be a useful adjunct to support discharge of stable patients with type 2 diabetes to the primary care setting. In this paper, we present a randomized controlled trial (RCT) protocol designed to evaluate the effects of telehealth support for stable type 2 diabetes patients discharged from hospital outpatient diabetes clinics.MethodsWe designed a RCT. Patients with stable type 2 diabetes (glycated hemoglobin < 8%) considered eligible for discharge from specialized to primary care will be included. Those with uncontrolled ischemic heart disease, severe neuropathy, and stage IV/V nephropathy will be excluded. Enrolled patients will be randomized into two groups: follow-up supported by periodic phone calls by a nurse (intervention group) plus primary care or routine primary care only (control group). The intervention group will receive regular telephone calls (every three months for one year) and will have a toll-free number to call in case of questions about disease management. The main outcome measure is a comparison of glycemic control between groups (assessed by glycated hemoglobin) at one-year follow-up.DiscussionWe plan to evaluate the effectiveness of a telephone-based intervention on glycemic control in patients with type 2 diabetes followed by primary care teams. Telemedicine can be an important adjunct in type 2 diabetes management, improving patient education and knowledge about the disease. Furthermore, it can help the healthcare system by alleviating overload in specialized care settings and supporting the stewardship role of primary care.Trial registrationClinical Trials, NCT02768480. Registered on 29 April 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-1954-z) contains supplementary material, which is available to authorized users.

Telessaúde como eixo organizacional dos sistemas universais de saúde do século XXI

“…[27][28][29] Uma forma de vencer a natural resistência em relação às inovações é a inclusão das ferramentas de telessaúde (exemplo: teleconsulta, teleconsultoria, telediagnóstico e telemonitoramento) como mecanismos de coordenação assistencial, 21 de regulação do acesso (sistema de referência e contrarreferência) 20,30 e de transição de cuidado (APS-Hospital-Domicílio). 31,32 Outra forma de vencer as barreiras iniciais é permitir que a telessaúde também seja ofertada por meio de interação direta com os usuários do sistema de saúde, 22,23 já que amplia diretamente o acesso. Inclusive, há mais aceitação pelo uso da telessaúde entre usuários (pacientes) do que entre provedores de saúde.…”

“…Dessa forma, a telessaúde aumenta a resolutividade, facilita a coordenação do cuidado e a adesão terapêutica, inibe as reinternações e estimula a prática da prevenção quaternária. 13,14,19,31,32 Mas, o papel da telessaúde pode ser ainda maior: a telessaúde pode ser o tecido de integração das RAS.…”

Three decades of telemedicine in Brazil: Mapping the regulatory framework from 1990 to 2018

“…Nursing has also played a leading role in the introduction of information technologies in healthcare [67]. Although responsible for several studies on this subject in Brazil [68][69][70], the Nursing Federal Council generated few regulations detected in this analysis, which requires further investigation.…”

Adherencia terapéutica en pacientes con diabetes mellitus tipo II y el uso de la tecnología móvil básica: una revisión sistemática = Therapeutic adherence in patients with diabetes mellitus type II and use of basic mobile technology: a systematic review

“…Por otro lado, algunos de los artículos identificados no pudieron incluirse en la revisión ya que trataban de protocolos de ensayos clínicos (Desveaux et al, 2016;Dobson et al, 2016;Moreira et al, 2017;Nelson et al, 2018). Gran parte de los ensayos clínicos identificados no presentaron una calidad metodológica óptima.…”