Remotely Delivered Monitoring and Management of Diabetes-Related Foot Disease: An Overview of Systematic Reviews

Drovandi, Aaron; Wong, Shannon A.; Seng, Leonard; Crowley, Benjamin; Alahakoon, Chanika; Banwait, Jasmin; Fernando, Malindu E.; Golledge, Jonathan

doi:10.1177/19322968211012456

Cited by 17 publications

(35 citation statements)

References 52 publications

(177 reference statements)

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“…The finding that remote checks are perceived to be safe accords with other research, but there is as yet no evidence on the effectiveness or safety of this model. 14 …”

Section: Resultsmentioning

confidence: 99%

“…The finding that remote checks are perceived to be safe accords with other research, but there is as yet no evidence on the effectiveness or safety of this model. 14 Remote consulting also created risks for maintaining the holism of general practice and the role of medical generalists in assessing and treating patients within their family and social context (risk 5B). The transactional nature of remote consulting described above, frequently negated accessing wider contextual information about patients.…”

Section: Risk Domain 5: Population and Public Healthmentioning

confidence: 99%

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Clinical risk in remote consultations in general practice: findings from in-COVID-19 pandemic qualitative research

et al. 2022

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BackgroundThe Covid-19 pandemic-related rise in remote consulting raises questions about the nature and type of risks in remote general practiceAimTo develop an empirically-based and theory-informed taxonomy of risks associated with remote consultations.Design and settingQualitative sub-study of data selected from the wider datasets of three large, multi-site, mixed-method studies of remote care in general practice prior to and during the Covid-19 pandemic in the UKMethodSemi-structured interviews and focus groups with a total of 176 clinicians, and 45 patients. We analysed data thematically, taking account of an existing framework of domains of clinical risk.ResultsThe Covid-19 pandemic brought changes to estates (eg, how waiting rooms were used), access pathways, technologies, and interpersonal interactions. Six domains of risk were evident in relation to[1] practice organisation and set-up (including digital inequalities of access, technology failure and reduced service efficiency); [2] communication and the therapeutic relationship (including a shift to more transactional consultations); [3] quality of clinical care (including missed diagnoses, safeguarding challenges, over-investigation and over-treatment); [4] increased burden on the patient (eg, to self-examine and navigate between services); [5] reduced opportunities for screening and managing the social determinants of health; and [6] workforce (including increased clinician stress and fewer opportunities for learning).ConclusionNotwithstanding potential benefits, if remote consultations are to work safely, risks must be actively mitigated by measures that include digital inclusion strategies, enhanced safety-netting and training and support for staff.

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“…The finding that remote checks are perceived to be safe accords with other research, but there is as yet no evidence on the effectiveness or safety of this model. 14 …”

Section: Resultsmentioning

confidence: 99%

Section: Risk Domain 5: Population and Public Healthmentioning

confidence: 99%

Clinical risk in remote consultations in general practice: findings from in-COVID-19 pandemic qualitative research

et al. 2022

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“…There are several avenues to address this challenge, including focusing the program on adherence to self-care activities, which may be enhanced through emerging technologies such as home foot temperature monitoring and sending photos to health professionals by smartphone. 32 Complementing these approaches would be multidisciplinary teams within local service provider clinics who are involved in the ongoing care of the patient. For example, the participant in the program could be encouraged to consistently wear their offloading footwear, and every 3 to 6 months, they would be directed to visit their local pedorthist, podiatrist, or orthotist for a footwear assessment.…”

Section: Discussionmentioning

confidence: 99%

Health Professionals’ Opinions About Secondary Prevention of Diabetes-Related Foot Disease

Drovandi

Seng

Crowley

et al. 2022

The Science of Diabetes Self-Management and Care

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Purpose: The purpose of this study was to explore the perceptions of health professionals regarding the ideal design of a remotely delivered diabetes-related foot disease (DFD) secondary prevention program. Methods: A qualitative study involving 33 semistructured phone interviews was conducted with health professionals with experience managing DFD. Interviews discussed the role of health professionals in managing DFD, their experience in using telehealth, perceived management priorities, preferences for a secondary prevention management program, and perceived barriers and facilitators for such a program. Interviews were audio-recorded and transcribed, and inductive thematic analysis was used to derive key themes. Results: Three themes were derived: (1) barriers in current model of DFD care, (2) facilitators and ideas for a remotely delivered secondary prevention program, and (3) potential challenges in implementation. DFD care remains acute-care focused, with variability in access to care and a lack of “clinical ownership.” Patients were perceived as often having poor knowledge and competing priorities, meaning engagement in self-care remains poor. Participants felt a remote secondary prevention program should be simple to follow and individualized to patients’ context, with embedded support from a case manager and local multidisciplinary service providers. Challenges to implementation included limited DFD awareness, poor patient motivation, patient-related issues with accessing and using technology, and the inability to accurately assess and treat the foot over telehealth. Conclusions: Health professionals felt that an ideal remotely delivered secondary prevention program should be tailored to patients’ needs with embedded support from a case manager and complemented with multidisciplinary collaboration with local service providers.

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“…Remotely delivered risk factor management programs have been proposed as a more efficient way to control multiple risk factors (14)(15)(16)(17)(18). Risk factor monitoring, healthcare consultations, medication prescription and behavioral support can occur remotely to facilitate optimizing blood glucose, blood pressure and lipids (17)(18)(19).…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Remotely Delivered Interventions to Simultaneously Optimize Management of Hypertension, Hyperglycemia and Dyslipidemia in People With Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

et al. 2022

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BackgroundRemotely delivered interventions may be more efficient in controlling multiple risk factors in people with diabetes.PurposeTo pool evidence from randomized controlled trials testing remote management interventions to simultaneously control blood pressure, blood glucose and lipids.Data SourcesPubMed/Medline, EMBASE, CINAHL and the Cochrane library were systematically searched for randomized controlled trials (RCTs) until 20th June 2021.Study SelectionIncluded RCTs were those that reported participant data on blood pressure, blood glucose, and lipid outcomes in response to a remotely delivered intervention.Data ExtractionThree authors extracted data using a predefined template. Primary outcomes were glycated hemoglobin (HbA1c), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), systolic and diastolic blood pressure (SBP & DBP). Risk of bias was assessed using the Cochrane collaboration RoB-2 tool. Meta-analyses are reported as standardized mean difference (SMD) with 95% confidence intervals (95%CI).Data SynthesisTwenty-seven RCTs reporting on 9100 participants (4581 intervention and 4519 usual care) were included. Components of the remote management interventions tested were identified as patient education, risk factor monitoring, coaching on monitoring, consultations, and pharmacological management. Comparator groups were typically face-to-face usual patient care. Remote management significantly reduced HbA1c (SMD -0.25, 95%CI -0.33 to -0.17, p<0.001), TC (SMD -0.17, 95%CI -0.29 to -0.04, p<0.0001), LDL-c (SMD -0.11, 95%CI -0.19 to -0.03, p=0.006), SBP (SMD -0.11, 95%CI -0.18 to -0.04, p=0.001) and DBP (SMD -0.09, 95%CI -0.16 to -0.02, p=0.02), with low to moderate heterogeneity (I²= 0 to 75). Twelve trials had high risk of bias, 12 had some risk and three were at low risk of bias.LimitationsHeterogeneity and potential publication bias may limit applicability of findings.ConclusionsRemote management significantly improves control of modifiable risk factors.Systematic Review Registration[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=258433], identifier PROSPERO (CRD42021258433).

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Remotely Delivered Monitoring and Management of Diabetes-Related Foot Disease: An Overview of Systematic Reviews

Cited by 17 publications

References 52 publications

Clinical risk in remote consultations in general practice: findings from in-COVID-19 pandemic qualitative research

Clinical risk in remote consultations in general practice: findings from in-COVID-19 pandemic qualitative research

Health Professionals’ Opinions About Secondary Prevention of Diabetes-Related Foot Disease

Effectiveness of Remotely Delivered Interventions to Simultaneously Optimize Management of Hypertension, Hyperglycemia and Dyslipidemia in People With Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

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