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Virtual Care in the Age of COVID-19 Dos and Don'ts

Everything you need to know to manage your care from home

With Kaberi Dasgupta MD and Leanne De Souza PhD

In the absence of any major complications, diabetes care can be well managed virtually.

For most people, protecting your health in the age of COVID-19 is a matter of social distancing and wearing masks, and that can be hard enough. But if you have a chronic condition that requires regular care at a health center, safety becomes a difficult calculation.

A recent study from France showed that 10% of diabetics with Coronavirus die within 7 days of hospitalization. And nearly half of Americans admit they’ve delayed medical care because of the pandemic. Is the virus the greater risk right now? Do you delay care, or do you risk exposure to the Coronavirus with your usual outpatient appointments?

“For anybody living with a chronic condition, their concerns and apprehensions about going into any kind of hospital or care facility are understandable,” says Dr. Leanne De Souza, Course Instructor in the Department of Biology and member of the Obstetrics and Gynaecology Research Committee of the Women’s Health Care Centre at the University of Toronto. “It's very real.”

The answer is that, in general, doctors recommend against delaying care. Hospitals and health centers are doing everything they can to minimize your risk. But, in many cases, you may have another option: virtual care.

Now is a good time to find out what kind of care you can receive from the safety of your home and to gather everything you need to enable that care.

What is virtual care?

Virtual care, remote care, telemedicine – these are terms to describe getting care from your physician through desktop or mobile video chat. Instead of going to a physical office, you conduct your appointment live through a video call. In some limited cases, doctors can also provide care through a phone call.

“I think what the need to quarantine has taught us is that we need to optimize care in so many aspects,” says Dr. Kaberi Dasgupta, professor of Clinical Epidemiology, Endocrinology, and Metabolism at McGill University. “But also, if we were able to make the investments in being able to properly deliver this care remotely, we would be able to weather these types of situations, which, let’s face it, may be recurrent.” We may be leaving confinement through the summer, but we could have another period of sheltering-in-place in the fall or winter.

The good news is you don’t have to engage in virtual care alone, says Dr. De Souza. “There are so many resources, and care providers are coming up to par with standards of virtual care that have never been seen before.”

Many care providers had been setting up their practices for virtual care long before the pandemic in an effort to make better use of everyone’s time. So far, both patients and their providers have been reporting effective experiences. So, if you have diabetes or other endocrine conditions, there are a few things you can do right now, before a second wave of the virus hits, to set yourself up for optimal virtual care.

Get consistent with your home care

First of all, before you even begin thinking about telehealth, see to your daily health habits. For example, if you have Type 2 diabetes, now is the time to commit to consistent daily glucose monitoring. “There are patients who don’t do this routinely,” says Dr. Dasgupta.

There are phone apps that can remind you, but you can set up reminders with your phone’s calendar as well. Possibly even more helpful, you could try out what’s called habit stacking: This is when you add a new habit to another habit you’re already doing consistently. For example, if you walk your dog every morning, you could combine activities and test your glucose either right before or right after that walk.

Gather your tools

You don’t have to recreate your doctor’s office in your home to have a virtual visit, but having a few key pieces of equipment can be helpful, depending on your condition. Ask your doctor for specifics. Here are a few examples:

  • Computer or phone with camera and microphone
  • Blood pressure measurement device
  • A1C lab testing kit with postage
  • Digital scale

For video consults, you will need WiFi and you may need to download the application your doctor uses. Is video conferencing awkward and uncomfortable? It sure can be, especially at first. You are not alone in hating it, but it gets easier. There are grants and other resources available to support telemedicine (see below) if your doctor is new to it as well. In a perfect world, WiFi would be both accessible and affordable for every home as a matter of public health.

In addition to your blood glucose meter, it could be helpful to have a blood pressure measurement device. You can find these for under $100 and insurance may cover some of the cost. (Blood pressure apps have so far proven inaccurate and are not recommended.) Dr. Dasgupta says FreeStyle monitors could also help facilitate virtual visits, especially if they come down in price. Even A1C tests can be performed at home, at least partially; there are test kits you can mail into a lab that come with everything, including prepaid packaging.

Secure sharing of patient data via email

So, you’re gathering data to share with your doctor. Can you trust your information is safe if you’re sending it via email? “Your care providers will do everything they can to make sure that they're maintaining confidentiality and privacy,” assures Dr. De Souza. Ask about using encryption if your doctor doesn’t mention it. As for virtual visits, once you sign consent forms your physician must protect your confidentiality just like a live visit.

Should you stockpile medication?

“There's no need to necessarily hoard medication,” says Dr. De Souza, “but make sure you have your recurring prescription set up so you can just order it on the phone.” She adds that most pharmacies are implementing automation, so your prescription gets refilled every month and alerts you when it’s ready. Most even deliver now.

Beyond your prescription medications, though, do keep a supply of wound care, tools and equipment, and in the case of hypoglycemia, beverages or glucose tablets.

Know your body

If you choose telemedicine you need to be all the more observant of how you feel. Be alert to any changes, and take them seriously. “People know their own bodies,” says Dr. Dasgupta. “They may know when things are just not going right.” If something doesn’t feel right, check your sugar levels, for example. “Then reflect on your own body and try to make an honest assessment. Is something just not right that I don’t think I can blow off for another day?” If so, call your care provider.

Timely access to care is so critical for people who are self-managing at home,” says Dr. De Souza. It’s critical in any case, pandemic or not, but it’s especially important now.

Virtual care isn’t for every situation

“In the absence of any major complications, diabetes care can be really well managed virtually,” says Dr. De Souza. However, she adds, there are definitely times when you will need an in-person visit. You might have a complication or a need that outweighs the risk of exposure to Coronavirus.

“The first step would be to have that conversation virtually with your care provider and go through all the information about your self-management data, like your blood glucose levels, insulin levels, and medication side effects.” Your doctor can evaluate if your situation is worth going to the hospital or a clinic.

Even then, some preparation beforehand can keep that visit short. “If you go in with all of your self-management data, like your blood glucose levels, your medications, and your dosage, having a physical copy (i.e., a printout) could be handy so that that appointment can be as quick and efficient as possible,” says Dr. De Souza.

Zoom classes for pregnancy

For pregnant women diagnosed with gestational diabetes, Dr. De Souza says most care centers are pivoting to Zoom calls for their diabetes classes. Particularly now, the clinics providers normally work from may have limited hours or they may be open only for emergency situations. Start with a conversation with your doctor to figure out if you have the technology and you understand your condition well enough to take that leap.

Maybe you attend a first class in person, and then touch base with your provider remotely to review what you’ve learned. Your doctor may want you to do a demonstration with mock tools just to show you understand how to perform your protocol, and that can happen through a Zoom visit.

“Virtual visits can be a really excellent resource for patients and their care providers to provide timely, efficient, effective, and safe care,” says Dr. De Souza. And while there may be emergency situations that can only be handled in-person, it’s helpful to know how much routine care can happen from the safety of your home.

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