ASSESS-DHT: Telehealth in diabetes: EU mapping and systematic evaluation of organisational aspects

Duration: April 2024 – October 2024
Language: English (with German summary)
Publication: HTA Project Report No. 161: https://eprints.aihta.at/1555/

Background:
Diabetes is a chronic disease that has a major impact on the lives of those affected. In 2019, around 59.3 million people in Europe aged between 20 and 79 were affected by diabetes, which corresponds to a prevalence of 6.3 %. This number is expected to rise to 68.1 million by 2045, which corresponds to a prevalence of 7.8 % [1]. Self-management is one of the most important strategies for people with diabetes to manage their disease through medication or lifestyle changes. Telehealth programmes offer a potential opportunity to support patients through continuous healthcare, monitoring and advice [2]. The importance of telehealth has further increased due to the COVID-19 pandemic [3], and many healthcare systems are increasingly relying on digital health technologies to improve access to healthcare [4].

There are a large number of different mHealth and telehealth products and services for diabetes patients with very different functions on the market. Studies have shown that telemedicine programmes that support adherence to medication and also enable interactions with healthcare professionals (HCPs) have a positive impact on HbA1c levels [5]. The effectiveness of the telemedicine programme was greater when patients received support and communication from their HCPs. However, it is unclear what kind of support and interaction telemedicine programmes offer, which programmes are being piloted, implemented and reimbursed in Europe, and what the experiences of patients and healthcare professionals are.

Project objectives and research questions:
The aim of the project is to document telehealth programmes for diabetics across Europe and to describe implementation aspects. The focus is on programmes that enable interaction and communication between patients and HCPs. We will analyse the following aspects: organisational features, such as types of interactions between patients and HCPs; process evaluation indicators, such as adherence or satisfaction; models of refunding; organisational outcomes, such as reduction of resource use or medical services; and patient-/ clinician-reported outcomes, such as their experience or acceptance.

The project aims to describe in detail the framework conditions of telehealth programmes for diabetics in Europe and thus also to support decisions in the development and implementation of similar programmes in Austria. The following research questions (RQ) are to be answered:

RQ1: What kind of telemedicine-supported programmes for diabetics that enable interactions between patients and HCPs are being piloted, implemented and reimbursed in Europe?

RQ2: What are the organisational characteristics of the programmes and how are the programmes evaluated?

RQ3: How are telemedicine-supported programmes for diabetics remunerated?

RQ4: What is the acceptance and experience of patients and healthcare professionals (HCPs): how are the programmes appraised by them?                                                                             

Methods:
We use the following methods to answer the research questions:

RQ1:     Systematic literature search in several databases (PubMed, Embase, the Cochrane Library, PsycInfo and the INAHTA database) and hand search (snowballing), as well as a survey of European diabetic associations via the International Diabetes Federation Europe (IDF).

RQ2-3: Systematic synthesis of published reports on telemedicine-supported programmes for diabetics, as well as grey documents such as evaluation reports, if necessary, follow-up for more detailed information using IDF contacts.

Data extraction and tabulation of quantitative indicators such as process evaluation indicators, organisational characteristics and organisational framework conditions, care effects, reimbursement models and patient/clinician-reported outcomes.

Qualitative synthesis of the information.

RQ4: Data extraction of qualitative information on acceptance and experiences of patients and HCPs. A quality assessment is carried out using the CASP checklist [6].

Qualitative synthesis of the information.

In this project, both quantitative and qualitative studies will be included in the systematic literature search. Two researchers (YH and GG) will independently screen the titles and abstracts and select the full texts. Data extraction will be carried out by one researcher (YH) and checked by a second (GG). Differing decisions are discussed. If no agreement is reached, a third person is consulted.

PICO and inclusion/exclusion criteria of the systematic literature search:

Time schedule:

References:

[1]          Saeedi P., Petersohn I., Salpea P., Malanda B., Karuranga S., Unwin N., et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes research and clinical practice. 2019;157:107843. DOI: 10.1016/j.diabres.2019.107843.

[2]          Boels A. M., Vos R. C., Dijkhorst-Oei L.-T. and Rutten G. E. H. M. Effectiveness of diabetes self-management education and support via a smartphone application in insulin-treated patients with type 2 diabetes: results of a randomized controlled trial (TRIGGER study). BMJ open diabetes research and care. 2019;7(1):e000981.

[3]          Rosta L., Menyhart A. and Mahmeed W. A. Telemedicine for diabetes management during COVID-19: what we have learnt, what and how to implement. Frontiers in endocrinology. 2023;14:1129793.

[4]          Quinn L. M., Davies M. J. and Hadjiconstantinou M. Virtual consultations and the role of technology during the COVID-19 pandemic for people with type 2 diabetes: the UK perspective. Journal of medical internet research. 2020;22(8):e21609.

[5]          Faruque L. I., Wiebe N., Ehteshami-Afshar A., Liu Y., Dianati-Maleki N., Hemmelgarn B. R., et al. Effect of telemedicine on glycated hemoglobin in diabetes: a systematic review and meta-analysis of randomized trials. Cmaj. 2017;189(9):E341-E364.

[6]          Singh J. Critical appraisal skills programme. Journal of pharmacology and Pharmacotherapeutics. 2013;4(1):76-77.