By Ana Gajic
(June 22, 2020) – Many patients are seeing health-care teams through their screens. Now research teams across Unity Health are investigating ways to improve those virtual care appointments, which are a critical tool in health care delivery as a ‘new normal’ in the pandemic emerges.
As part of our series on how our research changes lives, we’re spotlighting two projects that explore the role of virtual care during and beyond COVID-19:
- Enhancing virtual care for patients with diabetes and understanding their experiences during the pandemic, led by Dr. Gillian Booth, Dr. Andrew Advani and Dr. Catherine Yu
- Providing specialized support in long-term care using virtual innovation, led by Dr. Amol Verma and Dr. Fahad Razak
Members of the Division of Endocrinology at St. Michael’s recognized right away that the virus, the public health interventions and the new methods of care delivery would impact people who live with diabetes.
For example, preliminary reports suggested that people with diabetes are at higher risk of dangerous outcomes of COVID-19, such as requiring critical care or ventilation.
Dr. Gillian Booth, Dr. Andrew Advani and Dr. Catherine Yu – three endocrinologists with different research focuses – launched the CONNECT study – short for COVID-19 and Diabetes: Clinical Outcomes and Navigated NEtwork Care Today.
“There was a lot of worry, fear and uncertainty amongst people with diabetes,” said Dr. Advani, who is also a researcher at the Keenan Research Centre for Biomedical Science. “Social distancing measures were introduced and persons with diabetes didn’t have the usual face-to-face contact with their usual support network that is critical for effective self-management.”
The CONNECT study aims to address these potential gaps. It has two parts and involves physicians in the Department of Medicine, researchers at the Li Ka Shing Knowledge Institute (LKSKI), a diabetes educator, a social worker, people living with diabetes, and researchers from other Toronto hospitals.
The first part addresses the risk of developing COVID-19 for those who are living with diabetes.
“We get a lot of questions from our patients about this,” said Dr. Booth, who is also a scientist at the MAP Centre for Urban Health Solutions. “Using large databases of hospital admissions, we aim to answer this question for our patients of whether diabetes really is a risk factor for poor outcomes from COVID-19 in Canada and, if so, what causes this increased risk.”
The team also hopes to learn whether fear of the virus stopped people with diabetes from accessing emergency care when they needed it. This information, the researchers say, will be useful to prepare for potential future waves of the virus.
The second part involves interviewing patients living with diabetes to learn how to make sure virtual care strategies make sense for them.
“By listening to patient voices, we hope to be able to continually improve the care of persons with diabetes,” said Dr. Catherine Yu, who is also a scientist at the LKSKI. “We hope that, by sharing these experiences, we will be able to help other health-care providers improve the care that they provide too.”
The research team is recruiting team members and aims to work with patients soon.
“It’s clear that virtual care is likely to be part of the fabric of the way health-care is delivered in the future,” Dr. Advani said. “It’s been a steep learning curve and we are all continuing to learn. If some type of virtual care is going to stay with us, we need to learn what works best for health-care providers, patients and their families so that we can deliver the best care, with the best patient experiences and the best outcomes.”
Residents in 36 long-term care homes across Toronto now have access to additional high-quality support from medical specialists, all with the click of a few buttons.
Led by Dr. Amol Verma and Dr. Fahad Razak, General Internal Medicine physicians and researchers at St. Michael’s, along with Dr. Ashley Verduyn, Chief and Director of Medical Affairs at Providence Healthcare; Dr. Fiona Menzies, a Geriatrician at St. Joseph’s and Dr. Camilla Wong, a Geriatrician at St. Michael’s, LTC Plus is a virtual care platform that connects long-term care homes with medical specialists to minimize the need to transfer residents to hospitals. Its development has been a collaborative effort across the long-term care and hospital sector, with leadership from Providence, Baycrest, Women’s College Hospital, the Centre for Quality Improvement and Patient Safety, and Sunnybrook Health Sciences Centre.
LTC Plus has reached homes with more than 4,000 residents across the province, and so far about 40 per cent of consultations have helped the long-term care home teams avoid transferring their residents to hospitals.
“Our hope is that this service will minimize residents’ exposures to hospital-acquired conditions including COVID-19 by providing additional medical support,” Dr. Verma said.
At a time when long-term care homes have been hit hard by the pandemic, the platform has served as an added tool in the fight against the virus, Dr. Verma said.
Unity Health is leading the data and analytic collection for this service, which involves near real-time data collection about transfers of LTC residents to hospitals and consultation services being delivered by LTC Plus. With an analytics dashboard that highlights where LTC Plus services have been used, the team will be able to more strategically implement the program and offer services where they are most needed. Through this platform, Unity Health’s specialists are supporting 10 LTC homes, with collaboration and leadership from physicians across Providence, St. Joseph’s and St. Michael’s.
“LTC Plus is designed to be a sustainable model of care that enhances services available in long-term care,” said Dr. Razak. “We hope that it will be part of the broader vision for continuing to improve the quality of care in this area.”
The data gleaned from this work will help inform how LTC Plus is used going forward, but also how similar virtual care models could support other services.
“Scientifically, LTC Plus is an innovative model of telemedicine and virtual care that has enormous potential to enhance the quality and sustainability of health-care in Canada,” Dr. Verma said.