A paper out of the UK entitled "A Virtual Clinic for Diabetes Self-Management: A Study" was published in the current issue of the Journal of Medical Internet Research. The study, conducted by the Warwick Medical School, is not huge in size, nor were the results particularly exciting in and of themselves in a clinical sense, though they were very interesting.. But the study does serve as an important sign post on the utility of those in healthcare not only to keep up with the developments in medicine and healthcare and Web 2.0, but to understand the changes and to connect the dots in terms of what it strategically means for the future.
A note about the journal itself – according to the home page, it is the "leading, open access, peer reviewed trans-disciplinary journal on health and healthcare in the Internet age." The Journal is published out of Canada by the Centre for Global eHealth Innovation. And in case you think it just came along, it has been in publication since 1999. Here is the abstract itself:
Background: Internet-based interventions to assist in diabetes management have the potential to provide patients with the information and support they need to become effective self-managers.
Objective: To assess the feasibility, acceptability, and effectiveness of an Internet-based virtual clinic designed to facilitate self-management in patients who used insulin pumps to manage their diabetes.
Methods: For a period of 6 months, 17 patients joined the virtual clinic. The system allowed patients to communicate with health professionals, interact with peers and access information. HbA1c, quality of life, and self-efficacy were monitored at baseline and after 6 months. Questionnaires and qualitative interviews examined patient experiences.
Results: Participants found the virtual clinic easy to use and positively rated its design. Peer support was the most valued aspect and the discussion boards the most used component. All participants highly rated the virtual clinic in terms of improving communication with peers, but few agreed it had improved communication with health care professionals. No significant improvements in physiological and psychological measurements were found. Regarding HbA1c measurements, there was no significant difference found between the pre- and post-test results (P = .53). Mean ADDQoL scores at baseline were -2.1 (SD 1.1, range -3.4 to -0.5) compared to -2.0 (SD 1.2, range, -4.6 to -0.4) post-test (n = 12), (P = .62). Surprisingly, patients’ confidence in their ability to perform self-care tasks was found to be significantly reduced from baseline to follow up (P = .045).
Conclusions: An Internet-based system to aid the management of diabetes appears feasible and well accepted by patients. The pilot study did not identify evidence of an impact on improving quality of life or self-efficacy in patients who used insulin pump therapy.
Methods: For a period of 6 months, 17 patients joined the virtual clinic. The system allowed patients to communicate with health professionals, interact with peers and access information. HbA1c, quality of life, and self-efficacy were monitored at baseline and after 6 months. Questionnaires and qualitative interviews examined patient experiences.
Results: Participants found the virtual clinic easy to use and positively rated its design. Peer support was the most valued aspect and the discussion boards the most used component. All participants highly rated the virtual clinic in terms of improving communication with peers, but few agreed it had improved communication with health care professionals. No significant improvements in physiological and psychological measurements were found. Regarding HbA1c measurements, there was no significant difference found between the pre- and post-test results (P = .53). Mean ADDQoL scores at baseline were -2.1 (SD 1.1, range -3.4 to -0.5) compared to -2.0 (SD 1.2, range, -4.6 to -0.4) post-test (n = 12), (P = .62). Surprisingly, patients’ confidence in their ability to perform self-care tasks was found to be significantly reduced from baseline to follow up (P = .045).
Conclusions: An Internet-based system to aid the management of diabetes appears feasible and well accepted by patients. The pilot study did not identify evidence of an impact on improving quality of life or self-efficacy in patients who used insulin pump therapy.
(J Med Internet Res 2009;11(1):e10)
doi:10.2196/jmir.1111
One of the things that was most interesting – other than the nature of the study itself, is that in the assessment, some patients commented on the utility and accessibility of support and advice from others in the virtual clinic. Whether or not such virtual clinics become commonly used in the future, it seems clear that mechanisms for contact and between patients and other patients, as well as patients and their providers, is going to become commonplace.
But there is clear evidence that the healthcare industry is behind the curve when it comes to Web 2.0 – that is not only true of the pharmaceutical industry, hobbled by a lack of regulatory guidance, but the agency that regulates them – the FDA. In addition, the healthcare IT industry in the U.S. is seriously behind in implementation by practicing physicians. (Note – Google Health, which allows you to store your medical records is a neat tool, but my doctor's records are all written by hand) with some still absurdly arguing that healthcare IT may not make an impact in cost savings and quality control. But studies like this one, exploring the virtual clinic, clearly point the way for all stakeholders to consider their respective role in such inevitable clinics and define and strategize both the regulatory pathways and involvement.
Naysayers and laggards can put in an 8-track tape, sit back and adjust the rabbit ears on the TV set and call it a night.
