In Austria, there are two pilot projects for telemedical care of people with diabetes: One of them is called "Diabcare" and is offered in Tyrol. Throughout Austria, the "Diabetes Mellitus Health Dialogue" aims to improve the care situation. The national program is not yet available to all people with diabetes living in Austria - only to those who are insured with the Austrian insurance fund for civil or public servants, miners and persons employed with the federal railways (BVAEB). "In principle, this is not a disadvantage, because it should be checked whether the telemedical care programs also have a benefit before they are used nationwide. Since the pilot projects are not yet offered to all diabetics, comprehensive comparative evaluations are possible. This means that regions in which the programs have been implemented can be compared with those in which they have not been implemented", explains study leader Goetz.
Currently, the digital health applications (DiHAs) "DiabCare" and "DiabMemory" developed for the two Austrian pilot projects are still isolated solutions and must primarily be compatible with the doctor's software. A connection to the electronic health record (ELGA) is planned but currently not possible. According to the expert, there is a need for improvement above all in the definition of the objectives and the evaluation of the two programs: "The objectives are broad and thus formulated somewhat imprecisely. For a meaningful evaluation, however, clear objectives are necessary, which in turn determine the choice of measuring instruments.”
The expert sees another shortcoming in the fact that compliance, i.e. the active participation of patients in the telemedical diabetes programs, was relatively low with drop-out rates of up to 40 percent.
In addition, efforts are currently being made in Austria to design a transparent process for the evaluation and reimbursement of DiHAs. "It is important that the criteria and requirements for broad reimbursement and implementation (e.g. data protection, benefit assessment, etc.) used in future are also applied to DiHAs embedded in telemedical care programs", explains Goetz.
For the evaluation of international telemedicine-assisted diabetes projects, 20 studies in 25 publications were identified, in which 17 endpoints were collected. The endpoints aimed to examine any medical, social and organizational care effects. Most of the endpoints were assessed quantitatively, primarily using standardized questionnaires.
Only randomized controlled trials (RCTs) were considered for the systematic review on the additional benefit of telemedical care programs compared to usual diabetes care. The results showed that there are some signs of possible medical, social and organizational care effects. For example, some telemedicine-assisted care programs were associated with an improvement in quality of life, an increase in satisfaction/acceptance of diabetes therapy and a reduction in the use of medical services. The care effects are strongly context-dependent: The organizational framework conditions of the care programs were very heterogeneous (e.g. with regard to personnel resources, training, coaching elements).
For the further development of Austrian telemedical care programs, these results can be of inspiration for conceptual improvement. However, careful planning taking into account the health literacy and ICT affinity of the patient population concerned is advisable in order to strengthen compliance.
In Austria, observational studies are currently considered to be sufficient, although results of these studies do not allow any causal conclusions on the additional benefit of telemedical care programs. "The analysis of international studies has shown that RTCs based on validated measuring instruments are possible," emphasizes the study leader. It is also important "that the objective is clearly defined in advance and that the various endpoints, such as health literacy, quality of life, improvement of self-management or the need for therapy adjustment, are determined with already established –and validated measurement instruments", explains Goetz.
MEDICA-tradefair.com; Source: Austrian Institute for Health Technology Assessment GmbH
