Woman and child with diabetes

Secondary care

Region Halland: Improved diabetes care at a lower cost

Åsa Söderlund

Peter Adolfsson is strongly committed to improving the lives of children and young people living with diabetes. He sees digital transformation and new technology as enablers of his primary goal: people living with a chronic illness should be able to live independent lives that are not bound to healthcare and only need to see a professional when this is really needed. So how does he think digital transformation and virtual care adding value to diabetes care? What are the biggest benefits, and what is required for more healthcare services to get started?

We spoke with Peter Adolfsson, Chief Physician and specialist at CGM (continuous glucose monitoring) at the Kungsbacka and Halmstad hospital in the Halland Region. In 2018, he initiated a project to investigate the process of replacing 50% of the standardised physical follow-up appointments in a paediatric diabetes clinic with more frequent video consultations and his study yielded excellent results. Today, he sees video consultations as a palpable and enhancing medium to meet his young diabetes patients and their relatives.

Improved continuity

The technical development in diabetes care has been vast during the last decade. Downloadable insulin pens make it possible to follow which doses the patient has taken and when. With the help of a sensor under the skin, sugar value can be measured every five minutes, day and night, for several days or weeks. Video consultations also improve continuity, providing the conditions for patients and healthcare professionals to meet more often, in shorter follow-up appointments – an aspect that has proven to be important for several patient groups. For example, an athletic diabetic patient needs more frequent feedback than the standardised three-month follow-up appointment. Offering digital appointments is a cost-effective alternative, says Peter.

With video consultations, we can keep communication alive continuously. Questions can be answered quickly, and this can help the patient, not just a notch but several

Just like a digital home visit

Meeting the patients via video consultations is something completely different than phone calls, Peter points out. Communication is much more than just listening to a voice. In a video consultation, you can have eye contact, make gestures and you can notice if someone is sad or happy. It is also great to get insights into someone’s home, it is a bit like a home visit, albeit digital.

Suddenly I’m in the kitchen at Amanda’s or Pelle’s house. I see how they feel at home and how their dog comes and sits on their lap. It adds so much to the conversation.

presence to a specific place. The patient or a relative can sit in a car, be traveling in New York or South Africa or anywhere, as long as there is an internet connection. At the same time, healthcare professionals can provide care to patients regardless of where they live. This applies to the patient in a remote rural area as well as those who live in metropolitan areas. That is not always the case: Sparsely populated areas can sometimes have a shortage of healthcare professionals and medical expertise – in these cases, you need to start thinking in different ways. Digital pathways create more opportunities for more equal care throughout the country.

Increased efficiency and participation

The duration of a video consultation can of course vary, says Peter, but on average it takes much less time than a face-to-face consultation.

For patients I am in close contact with, the video consultation takes about 10-12 minutes. This enables me to treat twice as many patients, compared to an on-site visit.

Moreover, the additional functionalities of a video consultation make it easier for patients to take part in their own treatment. They can prepare for the consultation from home, bring their own insights, they can take over the analysis, and show how they proceed. There are also plans to use recurring surveys in the future, where patients can mark on a scale how they feel about their condition, not only physically but also mentally, says Peter.

Patients get their lives back

Most patients and relatives are positive about meeting online, once they have tried it out. Many people remark that avoiding travelling to the reception is a benefit, when meeting via video is so easy and convenient. But for some, the benefits have manifested in an even bigger way. When Peter analysed the early outcome of an ongoing study* on how new technology affects treatment outcomes, it turned out that not only glucose levels improved, but life as a whole.

Three families replied that they got their lives back. It is powerful, to say the least.

An investment that yields a long-term return

People expressing that they got their lives back is difficult to measure in money. However, from a financial perspective, digital technology is not just a tool that can improve patients’ health. It is also cost-effective, as the investment costs are low in comparison to the gained value, says Peter. If diabetes care today costs short of £1 billion per year in Sweden, 70% of the cost is based on complications or other diseases linked to diabetes. Staff costs amount to approximately 20%, while 10% is pharmaceuticals and technology. Nevertheless, some aspects need to be seen as an investment rather than a cost. A present investment opens up the possibility of saving on the largest portion of expenses, i.e., complications and other diseases associated with diabetes.

Healthcare needs to be encouraged and think more long-term

How could more healthcare services see the value of digital pathways? It can be difficult for many to cross over that infamous threshold and embrace something new and unfamiliar, says Peter Adolfsson, who is himself an Early adopter, inclined to try new things. He often tries to encourage more people to get on board and pull them a little closer. However, the incentive may also need to come stronger from higher authorities.

You may need stronger incentives and accountability; a manager setting higher quota of video consultations. But the incentive needs to come as a complement to training and a demonstration of how easy it is.

At the moment, Peter works with two nurses who conduct video consultation after video consultation in their daily work. They think it works great and say themselves ‘oh goodness, how great and easy is this!’.

Messages make reaching a professional easy for patients

So what is destined to happen in the future? Even though quick and frequent feedback to patients is valuable, Peter hopes that they will soon be able to provide more contact opportunities to patients by starting to work with messages. Asynchronous chat enables patients to contact healthcare, send in questions, comments, and wishes. There may be some uncertainty as to when patients can expect an answer, but healthcare can easily plan and inform about this.

I want to be able to tell patients that they will receive an answer on Thursday afternoon. Afterwards, the nurses and I will take a few moments to go through all the questions and messages.

Nevertheless, Peter Adolfsson identifies even more areas for development. His vision of diabetics (or other chronic conditions for that matter) managing a healthy life with diabetes without constant healthcare supervision for as long as possible is still far ahead of technology applications. However, he is working on several fronts to take small steps forward. He is already looking forward to the day when he can sit in the ‘control tower’ and monitor measurement data sent from his patients; technology will flag him when a person needs his support, either physically or digitally. With other patients who have stable insulin levels, he wants to communicate via messages and positive feedback – they should perceive that he is in control, as it creates a feeling of security to patients, but he does not intervene if it is not needed.

Peter Adolfsson’s tips for other healthcare providers who want to integrate digital pathways into their operations:

  • Look beyond your own business, at others who have succeeded in their ventures. At the very least, our working methods could be applied to other areas related to chronic disease treatment.
  • Engage with those who are already on the digital move and ask about their experiences and roadmaps. Reach out not only to those who use video consultations but also to those who handle administration, scheduling, and calls: What smart solutions are they working with?
  • Start on a small scale with a few patients you already know. Find out for yourselves how flexible it is and build on that experience. The feeling will most likely be ‘wow, this is easy, now we’re rolling.

*Source: Ongoing study. Telemedicine within diabetes care in Region Halland, Peter Adolfsson