Overcoming Obstacles: Barriers to Diabetes Treatment and How Telehealth Can Help

Diabetes mellitus is an important health issue in Latin America and the Caribbean as it accounts for 4.3% of the disease burden in the region. Disease management programs (DMPs) aim to improve chronic disease care, but they are often complex, involving a wide range of healthcare professionals-doctors, nurses, nutritionists, and specialists-who need to interact regularly with patients.

So, despite their potential, patients may find it difficult to enroll and engage in DMPs. In Colombia, where diabetes accounts for 3.2% of the disease burden, we recently spoke with 40 patients and 39 healthcare professionals from two Health Promoting Entities (EPS) about challenges to effectively using DMPs, and whether telehealth could help. Below, we highlight some of our key findings.

What Are the Key Barriers Preventing Patients from Adhering to Their Diabetes Treatment?

When it comes to managing chronic diseases like diabetes, the road is full of challenges. We identified five main groups of barriers:

1. Administrative and Systemic Barriers: Some patients must wait up to three months just to see a specialist. Patients face these kinds of delays regularly-whether it's trying to book an appointment, waiting for authorization for procedures, or dealing with expired referral orders. Additionally, care is often fragmented. Many patients end up having to travel between different facilities, increasing both costs and stress.

"It's not always easy to get an appointment. For example, I was supposed to have my appointment at the end of January, early February, and when I called to schedule it, they gave it to me for March," said one of the patients of the study.

1. Psychosocial and Support Barriers: Older adults are generally better at following treatment plans, while younger patients often struggle even to accept their diagnosis, let alone manage it properly. For many patients, the lack of support systems makes adhering to treatment plans a struggle. This is worsened by the lack of psychological support.

"I think it's really important to consider mental health and the role of psychology, which is very limited in the diabetes program. One issue is that patients don't have an adequate process of acceptance, and their support network isn't always strong enough. There needs to be a strong mental health component to help patients accept their diagnosis and to encourage families to get more involved in supporting the patient," explained a health care professional.

1. Educational and Informational Barriers: It's not just about what patients know-it's also about what they don't know. Many patients haven't received enough education about their condition, leaving them unsure of how to manage it effectively. Other patients have too much information, often from unreliable sources. With the rise of social media, many turn to questionable online advice.

"With so much information available, patients are bombarded by the internet. Sometimes they challenge us, saying things like: 'Google says that's not right, the treatment should be…'," a health care professional remarked.

1. Behavioral and Lifestyle Change Barriers: Many patients struggle with the lifestyle changes needed to manage their disease-whether it's adjusting their diet or establishing healthier routines. A lot of it comes down to cultural attachment and deeply ingrained habits.

"The biggest challenge for patients is the cultural aspect of their experiences and habits… Getting them to understand that they need to change those habits has been the toughest part," noted one of the nurses.

1. Structural Barriers in Healthcare Delivery: Limited consultation times make it hard to properly address patient needs. On top of that, there can be problems with delivering and dispensing of medications.

"Time is a real obstacle; we're constantly racing against the clock. If I spend too much time writing everything an auditor requires-filling out forms, completing the clinical history-I won't even have time to look the patient in the eye, because there's always another patient waiting. That's a huge barrier," explained one of the health care professionals.

Can Telehealth Help?

The patients and professionals we spoke with saw plenty of opportunities for telehealth:

• Patients appreciated receiving follow-up calls and texts from healthcare professionals, as well as invitations to participate in educational activities. This can provide a new layer of support, especially for those without strong support networks.

• Receiving some services via telehealth is convenient, as it saves time and money compared to traveling to health facilities for in-person visits. That can also expand services--for example, adding more check-ins--and is especially important for those with accessibility issues.

• Patients also found value in common tools for appointment reminders, such as text messages, calls, and emails, which they felt helped support disease management and monitoring.

• Digital tools can help speed up some administrative tasks. Appointment scheduling could reduce wait times, medication dispensing could become more efficient, and medical authorizations could be managed faster.

As a patient described, "The EPS has a system for that. As soon as you have the consult, the payments appear, and the day before, you're reminded of the appointment… it's excellent."

But they also highlighted several challenges:

• For telehealth to be effective, patients and their support networks need to be trained on how to use the technology. Without this, many patients struggle to navigate telehealth platforms due to a lack of digital literacy, making it difficult for them to use smartphones and other devices.

"Around 68% of our population over 60 doesn't have a smartphone, which makes using WhatsApp difficult. That's one of our biggest challenges-reaching those patients who don't have access to technology," as shared by one of the nurses from the study.

• Some patients have expressed concerns about telehealth, mentioning a sense of depersonalization from healthcare professionals and challenges during virtual visits. Many patients still prefer in-person consultations.

"Imagine showing your foot to a doctor over the computer-'Show me your feet'… no, the doctor needs to physically see it. With us diabetics, they need to check circulation, examine the body, look at the toes, ask questions, and even check our eyes," said a patient.

What Needs to Happen Next for Telehealth and Diabetes Treatment?

Both patients and healthcare providers see the potential of telehealth to improve disease management, but there are still challenges - with overcoming barriers to effective management and with using telehealth. Enhancing access to technology, ensuring strong internet connections, and creating user-friendly systems are essential. For telehealth to truly be effective, patients need to be educated on how to use the tools.

Telehealth is here to stay, and it could become a major component of diabetes care in Colombia and across the region. It is already saving patients time and helping doctors reduce administrative work, allowing them to focus on what truly matters: patient care.

In the words of a healthcare professional, "I think telehealth worked well when it was needed in the pandemic… but we, as doctors, also need to open our minds and see it as an advantage."

As with any approach, we must be thoughtful about when and how to use telehealth. The primary goal should always be improving patient outcomes, and telehealth can play a crucial role in helping us achieve that.

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