Diabetes and Telemedicine
This is the time of year when residents are interviewing for their chosen subspecialties. Sadly, endocrinology and pediatric endocrinology are not on the top of the list for lucrative salaries and an easy lifestyle. It clearly takes an interest in chronic care and a desire to care for patients in a longitudinal fashion to thrive in this specialty - thus developing relationships that can last for many years. Due to the dearth of endocrinologists and pediatric endocrinologists, there are many areas throughout the world that do not have enough necessary endocrinology care available, particularly for people who have insulin-dependent diabetes. As such, there must be a means to deliver care to those who live great distances from diabetes healthcare providers.
After the construction of our Children’s National Health System Washington Nationals Diabetes Care Complex that includes a telemedicine suite, we were able to begin seeing patients remotely. Several years ago, I wrote a blog announcing our new program. Over the last one and a half years, we have worked with children and adolescents from the Eastern Shore of Maryland, including the island of Tangiers, and Delaware through our telemedicine practice. Physically, in order to reach the Eastern Shore, one must drive over the Chesapeake Bay Bridge (a very big and long spanned bridge–akin to the Oakland Bay Bridge that connects San Francisco and Oakland). The drive is about two and a half hours from Washington, DC, making it very difficult for patients to come over the bridge for follow-up appointments, even in nearby Annapolis, Md. Through our telemedicine program, I have been visiting with these children and adolescents monthly, working jointly with a nurse practitioner that provides a "hands-on" approach to the patient, conducting a physical examination. We then look at insulin regimens and dosing, download glucose meters, discuss concerns, and develop treatment plans - all over a TV screen.
Initially, I was worried that I could not develop a close, working relationship with my patients due to the distance between Children’s National and Peninsula Regional Medical Center (PRMC) in Salisbury, Md., where many of my patients are seen. However, much to my relief, this has not been the case. We have been able to get to know each other, and with the help of my NP, Flora, these patients have been returning to see her between visits, enabling me to make treatment changes by communication with her at PRMC. In addition, as part of her thesis project, a pilot survey was conducted by a Nursing PhD student that demonstrated great satisfaction with the program.
As such, I was invited last Thursday evening to address the professional community residing on the Eastern Shore about our program and about "Innovations in Pediatric Diabetes." Much to my delight, many of my patients and families came to PRMC so that we could "meet and greet" prior to the discussion. Some of the families even attended the presentation. One family just came to quickly meet me in person and then immediately had to drive their child to participate in a sporting event. The fact that these families drove several hours to meet me in person meant so much to me personally and professionally and made the entire initiative worthwhile. It became very clear that we could, indeed, deliver quality care and develop a personal relationship without actually being physically present in the exam room.
As a result of our success with patients on the Eastern Shore, providing steady professional care and close follow-up in conjunction with the staff at PRMC, other specialties at Children’s National are planning to provide telemedicine services. We also are looking to expand our coverage to other rural areas that lack pediatric endocrinology or diabetes specialists in Virginia, Delaware, and other remote counties of Maryland and beyond.
Evidence-based reports have demonstrated that telemedicine is a very effective means of delivering healthcare. Indeed, though we are not the first healthcare team to provide this service, we would encourage its application as much as possible throughout the country-and worldwide- as means of delivering care to those who cannot physically reach a needed specialized healthcare team.
Fran Cogen, M.D., C.D.E., is the director of the Childhood and Adolescent Diabetes Program at Children’s National Health System. She wrote about diabetes for HealthCentral.