K.J.LEW1, W.L.D.NG1, S.S.J.TING1, J.W.KONG1, K.W.TAN1, Z.LIM1, W.S.C.CHONG1, C.S.E.SIM1, E.S.LEE1, K.W.S.WONG1
Video-consultations (VC) were implemented for the care of chronic conditions in National Healthcare Group polyclinics during the Covid-19 pandemic. We evaluated the clinical effectiveness of VC in comparison to usual face-to-face (FTF) consultations for chronic disease management.
Observational data was obtained from the medical records database for eligible patients who had a VC for diabetes, hypertension or hyperlipidaemia. We conducted 1:2 propensity score matching to identify a FTF comparison group using demographic and disease-related variables. Linear mixed models were used to conduct a difference-in-differences analysis (DiD) for HbA1c, blood pressure and LDL-cholesterol outcomes at 6 months, for patients with and without diabetes. Data analysis was conducted using the R statistical package.
We compared 922 VC consults with 1844 FTF consults. HbA1c levels of VC patients with diabetes six months after consultation was non-inferior to that of FTF consultations (DiD:-0.058%; 95%CI:-0.167%,0.052%, using a non-inferiority margin of 0.4%). VC patients had a greater reduction in blood pressure over six months for patients without diabetes (DiD:-1.91 mmHg; 95%CI:-3.53,-0.30) though it was not statistically significant for those with diabetes (DiD:-1.01 mmHg; 95%CI:-3.03,1.01). Low-density lipoprotein (LDL) cholesterol levels was not significantly different between VC and FTF consultations for both patients with diabetes (DiD:0.010 mmol/L; 95%CI:-0.139,0.159) and without diabetes (DiD:0.111 mmol/L; 95%CI:-0.026,0.247).
VC for patients with diabetes, hypertension or hyperlipidaemia was comparable to FTF over a six-month period indicating its clinical effectiveness and safety over the short term. Future longitudinal evaluation needs to be conducted to assess the differences for clinical effectiveness over the long term.