Management of Type 1 diabetes (T1DM) poses enormous challenges for healthcare systems and individuals across Europe. This chronic disease is usually diagnosed in childhood-youth, and thus it presents a long-term evolution. Moreover, the COVID-19 pandemic accelerated the use of video-consultations and other mHealth interventions instead of the usual face-to-face visits. In order to explore the potential of mHealth interventions and video-consultations for T1DM, the observational study "Impact of mHealth interventions and remote video-consultations on Diabetes Type 1 and hospital Management – The case of Hospital del Mar" was performed.
This Master Thesis Project aimed at evaluating the health outcomes and overall costs related to T1DM subjects’ follow-up, with the incorporation of mHealth interventions and remote video-consultations. The healthcare partner involved in the project was Hospital del Mar - Parc de Salut Mar, in Barcelona (Spain), with the participation of with Doctor Elisenda Climent Biescas and Doctor Juan José Chillarón, from the Endocrinology department. Also from Catalonia, Fundació TIC Salut i Social, through the eHealth expert Jesus Berdun Peñato, provided the collaborative framework for this study. Finally, Abdul Jabbar Omar Alsaleh, professor at the School of Economics and Management “Alma Mater Studiorum” (Università di Bologna) wasresponsible for the Thesis supervision.
The study performed
Diabetes is a chronic disease that, when mismanaged, can present long-term complications. Major complications are microvascular conditions including diabetic retinopathy or nephropathy, and macrovascular conditions such as ischemic heart disease, stroke or peripheral vascular disease. Diabetes also represents a financial burden for the affected individuals and their families as well as the national healthcare system (SNS) that, in Spain, as many other European countries, covers all medical expenses.
The study performed consisted in a quantitative analysis (using the statistical software “STATA 16” and “Microsoft Excel”) of the effects of mHealth interventions and telemonitoring on clinical parameters in terms of metabolic control, complication arise rate, monitoring adherence and correlated expenses. The costs were evaluated from the patient perspective, namely traveling costs, time loss and consequent absenteeism at work and productivity loss. Furthermore, the Spanish national healthcare system (SNS) perspective was also adopted to evaluate costs related to visits and hospitalization due complication arise.
T1DM and the two mHealth interventions
The two mHealth interventions constitute two distinct but interrelated and comprehensive platforms for diabetes management and monitoring. The first mHealth app, “Libreview” is connected to a thin and flexible fiber that is inserted under the patient’s skin in their arm with an applicator. The filament can be scanned by the app on the mobile phone thus all the information is directly uploaded into a personal cloud, and can be accessed by both the patient and the healthcare professional from the diabetes unit of Hospital del Mar. The second one is “Social Diabetes” whose main feature is the bolus calculator. The patients register their glucose value in the bolus calculator of the app (the glucose value is obtained from the glucose sensor in the Librelink app) and how much carbohydrates they are going to eat. With this information, the bolus calculator gives the patient a recommendation of how much prandial / fast insulin the patient must inject.
The selected patient cohort was a non-randomized group of T1DM affected individuals followed for a period of 2 years in the Endocrinology department of Hospital del Mar. The study evaluated the introduction of mHealth interventions and remote monitoring on the total costs and benefits for the patients across four period scenarios presenting different conditions. In Period 1 (March 2019 - August 2019) visits were performed in a face-to-face mode as had been realized in the past years, and patients were given appointments approximately every 3 months (every 6 months when not necessary) with physicians in the outpatient clinic. In Period 2 (September 2019 - February 2020) patients were offered to use the two apps “Libreview” and “Social Diabetes”. In Period 3 (March 2020 - August 2020) all visits were converted into online modality due to the epidemiological situation and as patients were not able to go to the hospital in person, but continued to use the two mHealth interventions. Then, finally in Period 4 (September 2020 - February 2021) Hospital del Mar managed to return to normality, combining face-to-face visits with virtual appointments visits were a hybrid version of face-to-face and online mode.
The pandemic has been an opportunity for the development and testing of new medical technologies. On this matter, this study has shown that despite all difficulties and barriers brought in clinical follow-up by the pandemic, the two mHealth interventions analysed and the remote video-consultations showed to be effective in maintaining the quality in the delivery of health services. Unaltered outcomes were encountered both when evaluating metabolic control and presence of acute and chronic complications in T1DM subjects. Moreover, the use of mHealth interventions and remote monitoring was also associated with lower overall costs for both patients and national healthcare system. Finally, from a society perspective these technological interventions are linked to lower absenteeism rate and reduced productivity losses as well as an improved quality of life thanks to a better time management. This analysis aimed at rationing healthcare resources available in European hospitals in the most effective way possible while maintaining a high quality of services; leading policy makers to make informed decisions based on quantitative and qualitative evidence. In fact, the evaluation of mHealth interventions and teleconsultations can influence decision making in choosing cost-effectiveness, leading to wise allocation of resources for the healthcare systems.
About the author
Roberta Giuliani is a Health Economist from Italy. She holds a bachelor’s degree in Biology and Natural Sciences from Maastricht University and a MSc in European Health Economics, Policy and Management (Eu-HEM) a European program jointly coordinated and held in the universities of Bologna, Innsbruck, Oslo and Rotterdam. She is currently working at EBMA, a Health Economics, Pricing & Market Access Consultancy company based in Milan and wishes to continue her career in the field of medical technology evaluation.
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