JMIR Publications

ABSTRACT

Background:

As a means to mitigate the risk of viral transmission for both patients and clinicians during the COVID-19 pandemic, many health systems rapidly converted 70% or more of their outpatient visits to virtual care via phone or video delivery. Extensive literature supports virtual care as a supplement or adjunct to in-person care for the management of chronic conditions like congestive heart failure (CHF) and type 2 diabetes mellitus (T2DM). Specifically, evidence is needed as little research exists to support the use of virtual care as an equivalent and equitable replacement for in-person care, and potential adverse effects were not well defined.

Objective:

We conducted a systematic review to identify the effect of synchronous virtual care (ie, phone and/or video) compared to in-person care (or phone vs video) for the chronic management of 3 common diseases (CHF; T2DM; chronic obstructive pulmonary disease, COPD) on key clinical outcomes and health care utilization.

Methods:

This review followed established systematic review methodologies, including literature searches of 2 databases, with dual review to identify eligible studies and to extract structured data. We included randomized or quasi-experimental studies that evaluated the effect of synchronously delivered virtual care for relevant chronic conditions that occurred over ≥ 2 encounters and in which some or all in-person care is supplanted by care delivered via phone and/or video. Due to the small number of studies and conceptual heterogeneity of identified interventions, we did not conduct meta-analysis. Rather, we described findings narratively.

Results:

We identified 8,662 citations and 129 were reviewed at the full-text stage. Five articles were retained for data extraction, all of which were randomized trials. The one high risk of bias (ROB) CHF study randomized patients (n=210) to receive quarterly automated asynchronous web-based review and follow-up of telemetry data vs synchronous personal follow-up (in-person vs phone based [comparison of interest]) for 1 year. A 3-way comparison across study arms found no significant differences in reported clinical outcomes. Four studies (n=466) evaluated synchronous care for patients with T2DM (ROB judged low for 2 studies and high for 2 studies). There was one study adequately powered to assess A1c difference between groups, and no significant difference was found. Intervention approaches to the use of virtual care varied greatly from remote monitoring of blood glucose combined with video versus in-person visits, an endocrinology clinic that individually tailored the frequency of virtual visits to a brief, 3-week intervention to stabilize uncontrolled diabetes remotely. No articles were identified for COPD.

Conclusions:

There is a strong body of evidence that virtual care modalities can improve health outcomes through the supplementation of in-person management of certain chronic diseases, particularly with approaches such as remote monitoring and patient education. However, we found that the research in this field remains insufficient and methodologically inconsistent. Clinical Trial: This study was registered and followed a published protocol (PROSPERO: CRD42021239756).