Descriptions of the types of providers involved in home telehealth for type 1 diabetes are scarce. When given, they tend to be cursory. Findings from other chronic diseases would suggest that nurses are usually responsible for patient contact and case management, but the evidence does not allow us to state this with certainty. Physicians appear to be the central providers in an unusually high number of instances.
The time commitment required of providers involved in home telehealth interventions appears comparatively low in most cases. Substantive patient-provider communication tends to be a weekly or bi-weekly occurrence rather than a daily one. Time spent reviewing data transmissions and contacting patients is as low as 5 minutes per patient per week, although we were unable to determine whether this figure includes training time and pre-appointment preparation. When home telehealth is used in place of office appointments, the time commitment is more in line with that seen in usual care. Technical problems can dramatically increase the amount of time needed to complete intervention-related tasks.
In home telehealth interventions for type 1 diabetes, providers usually contact patients at pre-arranged times. This contrasts sharply with the model used for some chronic diseases, in which providers aim to respond to patients’ data transmissions in real-time. Adopting a set schedule for patient-provider contact may make home telehealth easier to incorporate into provider workflow.
We found very little information on providers’ experiences of home telehealth. No information on uptake or satisfaction was available.
Uptake and Use of Technology
No studies reported on provider uptake or use of technology.
Effects on Practice and Patient Care
None of the quantitative articles retrieved reported on the effects of home-based telehealth on practice and patient care.
And on the qualitative side . . .
In Armstrong and Powell (2009), the authors recognize that there is some concern among health professionals about laypersons using the internet for health information. However, evidence from this study ‘[suggested] that, for the most part, lay people are well able to make reasonable assessments on appropriate information’ (p.7). Patients stated that they did not believe everything they read on the Virtual Clinic website featured in the intervention. In addition, participants seemed to make a mental distinction between questions they would ask their doctor versus questions they would rather ask their peers and community network. Patients did not value peer knowledge over medical advice, but the discussion board provided the peer support and immediate feedback that patients sometimes desired.
Cost and Time Savings
Summary: Only 1 study reports on provider cost and time savings. Savings varied dramatically depending on the performance of the telehealth equipment.
Study Details: In Jansa et al. (2006), providers carried out appointments through teleconsultation. The time needed was heavily dependent on whether technical problems occurred; with no technical problems (70% of connections), appointments took an average of 20-30 minutes. The remaining 30% averaged 1 hour. When this 30% was excluded, the diabetes team as a whole spent 3 hours total in following up with the intervention group, vs. 6 hours with the control group.