Screening of people with diabetes for complications or their well-known risk factors is an important part of prevention. Unfortunately, it is also one that too often gets neglected or missed, especially in people living in rural and remote areas, far away from general practitioners or other trained healthcare providers.
A new study from France describes the results of a telemedicine screening program. A mini-van drove through various remote areas in the French mountains (Midi-Pyrenees). Inside this vehicle was a registered nurse and equipment to test for retinopathy, nephropathy and foot ulcer risk (ABI, neuropathy and plantar pressure). Screening results could be transferred via satellite to designated specialists for analysis and treatment recommendations.
The addition of particularly the foot ulcer screening tests is an important aspect of this program, as retinopathy screening is more often performed via telemedicine. Screening 1,545 patients on 228 screening days, the authors found 405 patients (29%) at high risk of foot ulceration (grade 2 or 3). Of these patients, less than 1 in 5 received podiatric care, even though this is reimbursed in France.
Operating costs per patient were relatively low (approximately 150 AUSD), however, an investment of 175,000 AUD was also needed for this program. It remains to be seen if such a screening program can be cost-effective, but it can be expected that much more than the 1,545 patients need to be measured to reach that. A limitation of the article was the lack of information on follow-up care. GPs indicated that they would follow patients with complications more closely, but no data were presented on follow-up podiatric care or other ulcer prevention strategies. Screening can only prevent foot ulcers when appropriate follow-up care is started afterwards.
In conclusion, this study shows the feasibility of a satellite operated telemedicine screening program, with a nurse visiting rural and remote patients in a vehicle. High-quality data can be obtained in such a manner, and this can be safely transmitted to high-end specialists for analysis. This is surely interesting for Australia, to improve foot care and ulcer prevention in our rural and remote areas.