Background/Introduction:
Gestational Diabetes Mellitus (GDM) is a common metabolic complication in pregnancy and currently affects an estimated 18% of pregnancies in Australia, a figure expected to rise. In recent years, mobile health (mHealth) technology has emerged as a promising tool to enhance the management of GDM. mHealth may offer benefits including real-time feedback of glucose data, the ability to monitor glucose readings remotely, increased patient engagement and empowerment, reduction in healthcare resource utilisation and healthcare costs and improved glycaemic control whilst maintaining high levels of patient satisfaction.
The NET-Health application allows automatic, real-time glucose upload to a central server enabling remote glucose monitoring via a software that generates alerts for the clinical team with abnormal glucose readings and contains a bidirectional interactive messaging platform. This system was implemented at Eastern Health, a level 5 maternity service since November 2022 as a novel model of care for GDM.
Aim:
To evaluate changes in healthcare resource utilisation and costs following the introduction of the NET-Health application.
Methods:
This prospective observational study compared healthcare interaction data from 442 women with GDM using NET-Health (from June 1, 2023) to a historical cohort of 486 GDM-diagnosed women in 2019. Data included all interactions (in-person, telehealth, telephone, SMS, email) with diabetes care providers (Endocrinologist, Credentialed Diabetes Educator (CDE) and Dietitian). Costs were calculated using the Medicare Benefits Schedule for Endocrinology, CDE and Dietetics and factoring the cost of NET-Health at $80 per patient.
Results:
Baseline demographics were similar between groups. More women in the prospective group were treated with insulin (64% vs. 57%, p=0.035), but early diagnosis rates were comparable (29% vs. 30%, p=0.52). Total healthcare interactions-per-person (IPP) were not significantly different between historical and prospective groups (8.46 vs. 8.73, p=0.334). There was a significant increase in synchronous Endocrinologist (3.1 vs. 2.7 IPP, p=0.0002) and asynchronous (SMS and electronic mail) CDE interactions (1.9 vs. 0.5 IPP, p<0.0001), with a reduction in in-person CDE interactions (1.6 vs. 2.2 IPP, p<0.0001). The average cost of outpatient GDM management per person increased in the prospective group ($906.72 vs $776.26).
Conclusion:
The NET-Health application maintained similar overall healthcare resource utilisation but increased Endocrinologist interactions and resulted in a shift from synchronous to asynchronous CDE interactions, resulting in higher overall costs per patient. Further exploration is needed to understand the reason for increased Endocrinologist interactions. Although cost is increased, the impact of the NET-Health application on clinical outcomes and patient and clinician experiences needs to be considered.