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A clinimetric study of outpatient diabetes consultations: the potential for telemedicine substitution.

BACKGROUND
The purpose of this study was to identify the clinimetric characteristics of specialist outpatient consultations for people with diabetes and to evaluate the possibility of providing such consultations remotely using telemedicine.


MATERIALS AND METHODS
The process of care was analyzed during the specialist consultations provided by five endocrinologists in a tertiary hospital diabetes outpatient clinic. The specialists' opinion of the possibility of providing each consultation remotely was also sought.


RESULTS
In total, 50 consultations were analyzed. The patients had type 1 and type 2 diabetes in 28% and 64% of the cases, respectively; 68% had at least one diabetes complication. Diabetic neuropathy was the most prevalent (42%) complication. Physical examination was not performed by the specialists in 34% of cases. General foot inspection, the most frequent examination, was performed in 54% of the consultations. After "general advice," ordering laboratory tests was the most frequent recommendation (80%), followed by adjustment of an insulin regimen (52%). In 86% of consultations, the specialists believed that it would have been possible to provide that consultation remotely via videoconferencing to a patient with the general practitioner present. In their opinion, communicating with the patients through e-mail was the least possible alternative means of providing the consultations.


CONCLUSIONS
Endocrinologists with little telemedicine experience believe that a considerable proportion of outpatient specialty consultations for people with diabetes can be provided remotely via videoconferencing. The clinimetric analysis of 50 consultations supports this opinion.