On June 24th, we held the first of our virtual town hall meeting series on The Changing Pace and Digital Face of Diabetes Care During COVID-19 featuring Jay Shubrook, DO, a board certified family physician and diabetologist, and facilitated by Korey Hood, PhD.
What makes diabetes care different, during COVID-19?
According to Dr. Shubrook, his family medicine team has learned a whole new set of efficiencies during the pandemic. “There are ways that we see patients more frequently but not face-to-face, and we've learned to do that well. We've also learned that people like connection.” For patients who have been so diligent about social distancing, they taking a psychosocial and mental health hit from being so isolated. I underestimated how hard it is for people to socially distance and shelter-in-place. We've learned that, as much as technology has served us, that when the paradigm and the interaction changed, we had to adjust all the workarounds and work flows.”
How do you start a telehealth visit?
Shubrook said, “If it's a brand-new patient, the visits are similar to in-person visits [in terms of questions]. I always ask someone, 'Could you tell me your diabetes story? When were you diagnosed, how were you diagnosed, what was your experience,' and that open-ended question provides a lot of valuable information as we try to develop a treatment plan. For virtual visits, I always ask about families and make sure I'm connecting [emotionally], because [the pandemic] is a bigger thing than 'just diabetes,' and it's affecting all of our health.”
For many people, not having to drive to the office, not having to wait for a long time is a plus. Using telehealth apps and text communication makes things more convenient for patients and clinicians alike. But when technology fails - for example, if a video meeting becomes a phone call - it can be frustrating.
“In the long-haul, I see us doing a hybrid of this [telehealth and in-person visits],” said Dr. Shubrook. “We didn't do a lot of telehealth before, but now, particularly for focused problem solving between visits, this gives our patients with diabetes more access. And that's a good thing. I'm actually seeing people more frequently than I was before, taking smaller issues and smaller pieces of information and addressing those one at a time.”
What's your take on using diabetes devices and technologies, from a family medicine perspective?
Dr. Shubrook said, “In family medicine, diabetes devices are not as widely used, and I think that it's a lack of knowledge and experience with it. I think technology makes our visits more efficient, allowing us to see patterns and focus on problem solving things that are not isolated events. During telehealth visits, it's a little trickier because people with diabetes have to be able to upload their data from home so we can look at it, and we also haven't developed the infrastructure to view that data in a timely way.”
He also added, “I'm seeing less variability in my patients as a result of COVID-19 and less scheduling variability. People aren't going out, so sometimes they use their technology less. But I feel that life is entirely different now and patients might see a new pattern, so technology is useful. If they want to use tech less and they're still meeting their goals, that's not a problem.”
Any issues with patients not getting their refills on time during the pandemic?
“Our practice had a policy of providing enough medicine refills until the next appointment, so if someone called for refill, it would trigger us to check to see if they need an appointment,” said Dr. Shubrook. “But during the time of COVID, we saw our office rejecting refills, and we had to reassess that practice and make sure patients could access their medications. There's been a lot of job losses, a dramatic decrease in appointments, and it's our job to say we're still here for patients and that we're going to connect in a different way.”
How about starting on new devices during the pandemic?
“We recommend using DiabetesWise.org to help them decide what devices they would be interested in, and we also send patients to commercial websites for more information,” offered Dr. Shubrook. “We have provided both telehealth pre-pump and pre-sensor training, and a lot of device companies have done the same. While it's not hands-on and it may not be for everyone, but it does help get people set up and supported.”
How do you see diabetes care in the future?
“We're learning as we go along,” said Dr. Shubrook. “With more ways to engage with patients, that's a positive thing. I think we have to get past the message that just having diabetes is going to be a death sentence with COVID. I have many patients who are afraid, and I reiterate that if they have good metabolic control, they have a much lower risk. I think it's helpful for people to know their risk so they can engage in their life and in their diabetes. And I hope that we start to develop more things like this town hall series and online support because we are going to have to rely on more distance learning as part of our experience going forward.”