Eating habits and physical inactivity cited as number of people with diabetes grows by four times since 1980.
For Mark Norman of London, an increasingly busy life meant that he had to find alternative means to manage his diabetes. As part of a new healthcare trend gaining popularity around the world, Norman has been using Skype to talk to his doctor for the past three years as part of a pilot programme that has been running in Newham, East London, since 2011.
“I can nip out of bed, turn on my [computer], and in 30 seconds be talking to my consultant at my own leisure,” the 22-year-old hotel worker says.
It was his diabetes specialist nurse at Newham University Hospital who first offered him the option of trying Skype appointments, recognising that Norman’s life as a psychology student at the University of East London was becoming increasingly busy.
Although initially reluctant to make the change as he had only been diagnosed with type 1 diabetes the summer before he began university, Norman has become convinced of the benefits of this consultation method.
“I just wouldn’t have gone to the appointments,” Norman says. “Juggling work, life and diabetes can be a pain. I am now in a better place to control [my diabetes] and Skype has made that easier.”
The student is not the only diabetic who has benefited from the programme, which initially offered regular Skype clinics to young people but has now expanded to provide access to all age groups. Since then, patient no-shows (called DNAs – or Did Not Attend) and appointment cancellations dropped to 16 percent from up to 50 percent previously.
Norman admits there are advantages and disadvantages to the scheme: “There is a lot less judgement over the internet,” he said, but added that “sometimes, with work, it is easier to do Skype when you know you should go in” to see a doctor. This puts increased responsibility on the individual, he believes, to be honest with themselves about when they might need a physical examination.
Although the doctor-patient relationship still works well for Norman, he recognises the fact that internet consultations mean that it is possible staff won’t be able to work out if patients aren’t coping with their illness without face-to-face interactions.
Still, the overall success of the Newham clinics has prompted the National Health Service (NHS) of England to update its advice to local healthcare commissioners encouraging the use of Skype and other social media to help keep young people engaged in their diabetes treatments as they transition from child to adult services. As a result, hospitals in Derby and Southampton are already in the process of setting up remote Skype consultations.
At Newham, approximately $30 for each appointment was saved in consultant time by improving the speed at which doctors can move from one patient appointment to the next. Add to this the reduction in DNAs in an NHS system that saw almost 19 million missed appointments in 2014 at a cost of around $182m for unattended general practitioner (GP) appointments alone, and the logic behind the move to go digital is clear.
However, a trial of GP Skype appointments in 2014 saw low demand despite high satisfaction. Ninety-four percent of those who had a Skype consultation with their doctor said that they were “satisfied or better”. Despite patient satisfaction with remote appointments, plans to extend bookable Skype sessions from two a week to five were scrapped after poor demand.
Behind this mixed picture, though, lies a benefit that could drive up the use of video telemedicine. Twenty-eight percent of all those patients involved in the trial claimed to have used the service from their place of work – suggesting that attending doctor appointments during working hours is not feasible for many patients living with long-term debilitating health conditions.
The restructuring of the NHS towards offering specialist care at fewer locations, coupled with patients’ increased inability to accommodate appointments in their schedules suggest that this “telemedicine” could be the future of healthcare.
Kaiser Permanente, a United States-based healthcare provider, introduced video appointments to help overcome the geographical vastness of the US, which often sees patients driving long distances to see specialists for particular ailments.
By 2018, the company is aiming to do more visits by video. Robert Pearl, Kaiser Permanente CEO, said: “Video truly will replace a visit as it provides [healthcare] in a way that the person doesn’t miss work.”
The UK, though, with its less consumer-focused and socialised healthcare model, lags behind in technological innovation. A recent report by the Nuffield Trust found that although 88 percent of UK adults used the internet, with 71 percent connecting via a smartphone, only 2 percent of the population reported any digital engagement with the NHS.
Barnaby Perks, CEO of Psychology Online, a NHS contractor of online mental health chat services, while believing digital uptake in the NHS can be “painfully slow”, also thinks businesses “totally underestimate” the regulations surrounding healthcare, particularly those meant “to protect patient records and prevent malpractice”.
Perks adds that utilising telemedicine through Skype will compromise patient and provider security.
These concerns aren’t unfounded. A 2015 KPMG survey of 223 healthcare payers and providers found that 80 percent say that their information technology has been compromised by cyber-attacks, with close to half of providers considering themselves unprepared to prevent these attacks.
To address security issues head-on, Airedale NHS Trust developed a partnership with Involve-Visual, an audio-visual technology company, to create special “tele-health hubs” where qualified nurses can see and speak with patients. The service is currently available to 300 care homes and to 100 people privately – as well as being offered to prisons nationwide – all areas in which it is difficult, costly or risky to travel due to health or security reasons.
The downside is that the NHS needs to provide each person or location with a secure laptop or tablet from which to access the tele-hub. While the technology spend is significantly higher than a Skype app, the Trust cut hospital admissions by 45 percent in the first year of operation, saving hospitals close to $470,000 in the process.
The demographic of Skype users may suggest that telemedicine may become a permanent part of the NHS landscape. Psychology Online typically has a self-referring demographic of 24 to 45-year-olds. This chimes with the Newham diabetes clinic, which saw 82 percent of its under-50 patients engage in Skype sessions.
There are still reservations about relying too heavily on Skype clinics. Emma Elvin, clinical adviser at the UK charity Diabetes UK, said there is not “enough data or evidence to say how [Skype clinics] should best work in practice yet”, adding that more trials are necessary before this means of healthcare is able to expand to different demographics.
“It would definitely need to be offered with an element of choice,” she says, recognising the possibilities of no internet access, socioeconomic factors, and those patients who simply prefer face-to-face contact.
While recognising there are still unknowns around the clinical risks online consultations might bring and the diversity of its appeal, Elvin is enthusiastic about the potential that Skype clinics have to reduce the number of people who have poorly controlled diabetes – especially in teens and young adults who are often harder to reach.
In East London, Norman, as a young user of the service, agrees: “Skype clinics are fantastic for most people who have grown up with the internet,” he says.
“For me, it’s as easy as pie.”