Evaluating the utility of texting in the ambulatory care of paediatric patients with type 1 diabetes: a quality improvement report.

Abstract

Introduction: Type 1 diabetes (T1D) is a chronic and costly disease that is often diagnosed in childhood. Achieving excellent glycaemic control during this period requires attention to multiple factors. Advances in technology now allow clients (patients/family members) to fine-tune their insulin delivery, necessitating support from highly skilled nurses, dietitians and physicians (clinicians). Despite quarterly team-based appointments, interim issues and questions often arise, and families may not always reach out for support. The incidence of T1D is rising, and yet barriers exist to expanding the clinical team. Additionally, clinicians are not necessarily colocated, making timely and efficient communication challenging. We postulated that offering texting as a communication modality would increase client interactions by 20%, and that clients and clinicians would find it a desirable tool in the delivery of efficient and timely ambulatory care.

Methods: A prospective interventional quality improvement project was conducted between July 2022 and August 2023. Baseline data were obtained for the number of interactions. Parents, caregivers and age-appropriate patients were then registered onto the texting platform (N=125) and received a weekly check-in message. The number of interactions and clinical time spent texting and providing care because of a text interaction were collected.

Results: There were approximately 30 interactions per week, an increase of >2300%. The average additional clinical time required was 56 min per week (average of 30 s/interaction). Qualitatively, 100% of our clients expressed a desire to continue texting with the team. 97% of clients felt that texting was an important way for them to contact their diabetes team. Our clinicians also wished to continue texting, valuing the improved efficiency of communication and experiencing a greater degree of connection with their clients.

Conclusions: Texting is a welcome modality of communication between clients and their clinical care team in the setting of ambulatory T1D care, resulting in increased engagement.