Abstract
Objective
Our aim in this study was to evaluate the impact of virtual care for gestational diabetes
mellitus (GDM) in the context of the COVID-19 pandemic.
Methods
This multiple methods program evaluation used the Quadruple Aim Framework. The impact
on patient experience, cost and provider satisfaction was assessed using surveys and
interviews. Chi-square and Poisson statistics were used to compare clinical outcomes
before (April 2019 to February 2020) and after (May 2020 to March 2021) the shift
to virtual care.
Results
Patient experience surveys were completed by 85 women. Most of them rated their virtual
care experience as good or excellent (93%), with a preference for continued virtual
visits in the future (84%). Most respondents felt virtual care saved them money (93%)
and time (98%). Six health-care providers at the Diabetes in Pregnancy Clinic were
interviewed and all believed the switch to virtual care was largely positive. Overall,
interview transcripts revealed that health-care providers were happy with the transition,
although nurses initially perceived an increased workload. There were no significant
differences in rates of cesarean section procedures, macrosomia, neonatal intensive
care unit admissions or the proportion of appointments at which insulin was initiated
between in-person and virtual care patient outcomes. There was a decreased proportion
of missed appointments after the switch to virtual care (6.15% vs 1.21%, p<0.0001).
Conclusions
There has been high patient and provider satisfaction with virtual GDM care, with
no difference in clinical outcomes and fewer missed appointments. Virtual GDM care
should remain an option in the future.
Résumé
Objectifs
Évaluer les répercussions des soins virtuels offerts aux femmes atteintes de diabète
gestationnel (DSG) dans le contexte de la pandémie de la COVID-19.
Méthodes
La présente évaluation du programme par méthodes mixtes reposait sur le cadre aux
objectifs quadruples (Quadruple Aim Framework). Les enquêtes et les entretiens ont
permis d’évaluer les répercussions de l’expérience des patientes, les coûts et la
satisfaction des prestataires de soins. Le test statistique du khi-carré et la loi
statistique de Poisson ont été utilisés pour comparer les résultats cliniques avant
(avril 2019-février 2020) et après (mai 2020-mars 2021) la transition vers les soins
virtuels.
Résultats
Quatre-vingt-cinq femmes ont rempli les enquêtes sur l’expérience des patients. La
plupart considéraient que leur expérience des soins virtuels était bonne ou excellente
(93 %) et préféraient que dorénavant les rendez-vous se poursuivent virtuellement
(84 %). La plupart des répondantes estimaient que les soins virtuels les faisaient
économiser de l’argent (93 %) et leur temps (98 %). Les 6 prestataires de soins de
la clinique de diabète gestationnel interrogés trouvaient la transition vers les soins
virtuels très positive. Les transcriptions des entretiens révélaient que dans l’ensemble
les prestataires de soins étaient satisfaits de cette transition, bien que les infirmières
aient initialement perçu une augmentation de la charge de travail. Aucune différence
significative n’était observée dans les taux de césariennes, de macrosomie, d’admissions
à l’unité des soins intensifs néonatals (USIN) ou la proportion de rendez-vous lors
desquels l’insuline était amorcée entre les cohortes des soins virtuels et en personne.
Une proportion moindre de rendez-vous étaient manqués après la transition vers les
soins virtuels (6,15 % vs 1,21 %, valeur p < 0,0001).
Conclusions
La satisfaction des patientes et des prestataires à l’égard des soins virtuels était
élevée, les résultats cliniques ne montraient aucune différence et moins de rendez-vous
étaient manqués. Les soins virtuels offerts aux femmes atteintes de DSG devraient
dorénavant demeurer une option.
Keywords
Mots clés
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Article info
Publication history
Published online: December 16, 2022
Accepted:
December 10,
2022
Received in revised form:
November 30,
2022
Received:
June 7,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Canadian Diabetes Association.
