To evaluate whether telemedicine (TM) follow-up of patients with diabetes-related foot ulcers (DFUs) in primary health care in collaboration with specialist health care was noninferior to standard outpatient care (SOC) for ulcer healing time. Further, we sought to evaluate whether the proportion of amputations, deaths, number of consultations per month, and patient satisfaction differed between the two groups.
Patients with DFUs were recruited from three clinical sites in western Norway (2012-2016). The cluster-randomized controlled noninferiority trial included 182 adults (94/88 in the TM/SOC groups) in 42 municipalities/districts. The intervention group received TM follow-up care in the community; the control group received SOC. The primary end point was healing time. Secondary end points were amputation, death, number of consultations per month, and patient satisfaction.
Using mixed-effects regression analysis, we found that TM was noninferior to SOC regarding healing time (mean difference -0.43 months, 95% CI -1.50, 0.65). When competing risk from death and amputation were taken into account, there was no significant difference in healing time between the groups (subhazard ratio 1.16, 95% CI 0.85, 1.59). The TM group had a significantly lower proportion of amputations (mean difference -8.3%, 95% CI -16.3%, -0.5%), and there were no significant differences in the proportion of deaths, number of consultations, or patient satisfaction between groups, although the direction of the effect estimates for these clinical outcomes favored the TM group.
The results suggest that use of TM technology can be a relevant alternative and supplement to usual care, at least for patients with more superficial ulcers.
BACKGROUND: Our aim was to combine several regional studies in order to estimate the prevalence of diabetes in Norway. MATERIAL AND METHODS: We used data from a nation-wide registration of type 1 diabetes in the age group or =30 years. The estimated increase in prevalence of known diabetes over time was 1.4% per calendar year, with variation between sub-groups. The number of unknown cases may be nearly equal to the number of known cases in the age-groups > or =30 years, but this is uncertain. INTERPRETATION: There are probably about 90,000 to 120,000 people with diagnosed diabetes in Norway. Nearly as many may have undiagnosed diabetes, but this is uncertain. Studies representative of the Norwegian population using the oral glucose tolerance test are needed.
Use of shared electronic health records opens a whole range of new possibilities for flexible and fruitful cooperation among health personnel in different health institutions, to the benefit of the patients. There are, however, unsolved legal and security challenges. The overall aim of this article is to highlight legal and security challenges that should be considered before using shared electronic cooperation platforms and health record systems to avoid legal and security "surprises" subsequent to the implementation. Practical lessons learned from the use of a web-based ulcer record system involving patients, community nurses, GPs, and hospital nurses and doctors in specialist health care are used to illustrate challenges we faced. Discussion of possible legal and security challenges is critical for successful implementation of shared electronic collaboration systems. Key challenges include (1) allocation of responsibility, (2) documentation routines, (3) and integrated or federated access control. We discuss and suggest how challenges of legal and security aspects can be handled. This discussion may be useful for both current and future users, as well as policy makers.
Cites: J Diabetes Sci Technol. 2011 May 01;5(3):768-77 PMID 21722592
Cites: Stud Health Technol Inform. 2011;169:417-21 PMID 21893784
Cites: JMIR Res Protoc. 2016 Jul 18;5(3):e148 PMID 27430301