{"id":55151,"date":"2021-02-09T17:09:18","date_gmt":"2021-02-09T22:09:18","guid":{"rendered":"https:\/\/diabetesquest.ca\/?p=55151"},"modified":"2021-04-01T16:09:52","modified_gmt":"2021-04-01T20:09:52","slug":"rising-to-the-occasion-how-challenges-unleashed-by-covid-19-will-improve-diabetes-care-for-years-to-come","status":"publish","type":"post","link":"https:\/\/diabetesquest.ca\/rising-to-the-occasion-how-challenges-unleashed-by-covid-19-will-improve-diabetes-care-for-years-to-come\/","title":{"rendered":"Rising to the Occasion: How Challenges Unleashed by COVID-19 Will Improve Diabetes Care for Years to Come"},"content":{"rendered":"

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\"Educational

Educational resources for people with diabetes on the new St. Michael\u2019s Hospital patient portal.<\/span><\/em><\/p><\/div><\/p>\n

February 9, 2021<\/strong><\/p>\n

It\u2019s no understatement to say 2020 was a year of upheaval, with practically no aspect of life\u2014or healthcare\u2014untouched by the COVID-19 pandemic. Diabetes care, which relies on a high level of cooperation and coordination between patients and multidisciplinary teams of care providers, has been no exception.<\/p>\n

\u201cWe have spent the last five years working to improve upon a collaborative chronic disease model of diabetes care,\u201d says Dr. Phillip Segal, Medical Director of the Diabetes Program at the University Health Network and Chair of the QUEST Committee at the University of Toronto\u2019s Banting & Best Diabetes Centre. \u201cWe perfected multidisciplinary in-person visits with many different professionals and the patient in the same room. We spent money retrofitting our education rooms.\u201d<\/p>\n

But when the pandemic hit in March, Dr. Segal says, \u201call that stopped overnight.\u201d<\/p>\n

Across the Greater Toronto Area (GTA), Ontario, Canada\u2014the world\u2014mainstays of patient care had to be put on pause. \u201cThe hospital was prohibiting us from having patients come to the\u00a0clinic,\u201d Dr. Segal recalls. \u201cMoreover, patients were too afraid to even go to the lab to do their blood tests.\u201d<\/p>\n

But with these once-in-a-lifetime challenges have come new opportunities, as the pandemic forced clinics to re-envision all aspects of diabetes care. Some of those obstacles remain ongoing. But in many cases, the creative and innovative tactics clinics had to employ will create lasting improvements to patient care that will persist long beyond the pandemic.<\/p>\n

Pivoting to Virtual Care<\/strong><\/p>\n

In the early days of the pandemic, a deal between the Ontario Medical Association and the Ministry of Health unlocked the ability to provide telehealth services to patients. But diabetes clinics were ill-prepared to instantly turn on virtual care, necessitating a rush to enable new tools and workflows.<\/p>\n

University Health Network (UHN) rapidly invested in equipping every room in the clinic with video capabilities. At the same time, UNH Digital was engaged to create new electronic templates that would replace paper charts and improve communication between all members of the team. At the Centre for Diabetes and Endocrinology at St. Michael\u2019s Hospital, a new patient portal became a go-to resource, housing step-by-step guides for insulin pumps and glucose monitors, along with appointment reminders. (Moving forward, the team hopes to expand the portal to facilitate workflows such as consent for email communication and COVID screening.)<\/p>\n

Learning to work with these new tools wasn\u2019t always easy. \u201cThere was definitely a learning curve,\u201d says Elizabeth Jung, an advanced practice nurse at Sunnybrook\u2019s Diabetes in Pregnancy program. \u201cSome team members were more tech savvy and found learning new technologies easy and quick and more efficient, whereas those who were less tech savvy experienced a more difficult and bigger burden.\u201d<\/p>\n

But as staff grasped new technologies, they, in turn, helped their colleagues to learn and adapt. \u201cThe clinic constantly evolved until a balance and a \u2018new normal\u2019 was found. We\u2019ve been running very smoothly for many months now,\u201d says Jung.<\/p>\n

Striking a Balance Between Online and In-person<\/strong><\/p>\n

Part of the delicate dance of providing diabetes care in a pandemic was not only determining what could be handled virtually but also identifying when virtual care would not be appropriate. Sometimes\u2014such as when blood sugars become dangerously high\u2014patients must be seen in person. For such acute instances, Mount Sinai Hospital and UHN quickly partnered on an urgent diabetes clinic, allowing for faster referrals for patients who needed to be seen in person.<\/p>\n

For those who did need to come in, appointments created new logistical challenges\u2014for example, coordinating patient drop-offs and pick-ups because family members and caregivers could no longer access waiting rooms. At the Centre for Integrated Diabetes Care at Women\u2019s College Hospital, staff members were frequently dispatched to a hospital entrance to hand over medications and supplies.<\/p>\n

But whenever possible, clinics pulled out all the stops to support patients without requiring them to come in.<\/p>\n

Women\u2019s College Hospital tapped into video tutorials and other educational resources from all available channels\u2014QUEST, blood sugar meter and insulin companies\u2014giving patients an arsenal of information to ensure the virtual continuity of care. Across clinics, everything from insulin start and pump program classes to Sunnybrook\u2019s pregnancy support and learning groups were transformed into regular online sessions.<\/p>\n

Ongoing improvements to care delivery are still underway. For example, some patients lack the computer access or know-how to download their own sensor data\u2014a problem that, nearly a year into the pandemic, still has no easy workaround,\u2014but Mount Sinai is working on a tool to provide clinicians with this vital information.<\/p>\n

\"New<\/a>

New diabetes Instagram account launched by St. Michael\u2019s Hospital.<\/em><\/span><\/p><\/div>\n


\u201cLots and Lots of Plain Hard Work\u201d<\/strong><\/p>\n

The pivot to virtual care, however, has required more than plugging in new technology and learning to use it. The shift to online delivery has created new workflow and administrative burdens on clinic staff, exhausting providers and support staff and increasing their risk of burnout. At St. Michael\u2019s, the problem was compounded as diabetes clinic staff were reassigned to the hospital\u2019s COVID assessment centre.<\/p>\n

\u201cThough we are not on the front lines, we are much busier than before performing tasks that may not \u00a0be designed to be done over the phone,\u201d says Dr. Segal. \u201cIt\u2019s been lots and lots of plain hard work.\u201d<\/p>\n

\u201cWorkflow has had to change to accommodate more requests by email, and most of our team has found a need to set aside time to respond to email questions or concerns, especially with our T1 population (with Type 1 diabetes),\u201d says Danielle Goudge, a certified diabetes educator at St. Michael\u2019s. With patients unused to virtual appointments, Goudge says, they required more scheduling reminders. \u201cMany patients do not value or are not respectful of the time for the scheduled appointment. Some patients feel that since it is just over the phone it is not a \u2018real appointment,\u2019\u201d says Leah Drazek, an advanced practice nurse in the Endocrinology department at Women\u2019s College.<\/p>\n

To that effect, Mount Sinai went as far as to develop virtual etiquette modules that have become part of the consent process prior to attending group sessions.<\/p>\n

A New Era of Care and Collaboration<\/strong><\/p>\n

Despite all these challenges, clinics say they continue to increase efficiency. Even better, new processes, best practices, and tools adopted during the pandemic will likely lead to lasting improvements and innovation in diabetes care.<\/p>\n

At Mount Sinai, the team\u2019s work developing indicators to help evaluate the safety, effectiveness and efficiency of virtual insulin start groups for GDM patients earned a QI innovation award. Meanwhile, other clinics have recognized the value of virtual access in improving compliance for certain groups. \u201cWe have moved to make video visits a default for the young adult diabetes clinic. Our no-show rates for the young adult clinic have dropped during the pandemic,\u201d says Dr. Eleni Dimaraki at Women\u2019s College.<\/p>\n

The need to replace in-person visits with new touchpoints has also encouraged new levels of creativity and experimentation. At St. Michael\u2019s this included launching the clinic\u2019s first Instagram account<\/a>. \u201cAs a team, we wanted to ensure that patients felt like they could maintain ongoing communication and a sense of connection with the clinic despite limited in-person interactions, especially if they had never met us before,\u201d says Goudge. \u201cThrough this account, we have been able to introduce community members to our staff, offer quick educational tips on how to prepare for virtual visits, and provide up-to-date information on COVID-19 and diabetes.\u201d<\/p>\n

Improvements born from necessity\u2014but that will provide benefits for people with diabetes, their families, and healthcare providers, even once the pandemic is long behind us.<\/p>\n

(We are grateful to individuals at the following hospital sites for their contributions to this article: Mount Sinai Hospital, St. Michael\u2019s Hospital, Sunnybrook Health Sciences Centre, University Health Network, and Women\u2019s College Hospital.)<\/em><\/p>\n

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