Patient focus a challenge in treating chronic diseases like diabetes

As health care across the globe shifts to a more patient-focused model, one of the challenges is getting patients to be more accountable for their own health.

Nowhere is that truer than in the treatment of diabetes. Although it is a chronic disease, many patients tend to treat it as an acute illness, dealing with it only when they suffer its more serious impacts, Robert Ratner, chief scientific and medical officer for the American Diabetes Association, noted Tuesday at a Brookings Institution discussion on innovations in diabetes care.

Until then, they may forgo preventive measures and even treatment. That can result in a chronically expensive proposition in the long term, as the cost of treating a pre-diabetic is 30 times lower than that of treating a patient with diabetes, said Ricardo Mujica Rosales, executive director of Mexico's Carlos Slim Foundation.

Given the underdiagnosis of the disease and the aging of the population in many countries, diabetes is becoming a bigger burden worldwide, necessitating a move from a reactive treatment model to a predictive one.

While the Brookings event focused on public health policy and ways to pay for innovative diabetes care, it also showcased how health care providers, instead of looking for new drugs, are turning to technology to engage patients, encouraging them to take more responsibility for managing their own disease.

In India, SughaVazhvu Healthcare workers are going into remote villages with cell phones and apps to identify people who are at high risk for diabetes, said Zeena Johar, CEO and founder of the private organization. Rather than providing episodic care when a patient feels sick, the group bundles the general services diabetes patients may need – diagnostics, monitoring, affordable drugs and dosage adjustments – and takes those services to the patient.

Providing easy access to treatment is crucial in India, which needs three times the 400,000 doctors it currently has, Johar said. For a patient in a remote village, the cost of care includes not only the price of drugs, diagnostics and the doctor's visit but also daily wages lost due to travel. As a result, Indian patients define the quality of their health care as the time until they're back on their feet. They want treatment with an immediate impact.

Encouraging patient accountability, SughaVazhvu offers subscribers a cost savings. Even though only 15 percent of India's population has health coverage, which is mostly tied to hospitalization, Johar said patients who have been diagnosed but not yet impacted by diabetes aren't buying into the bundled services.

Dealing with chronic diseases like diabetes is also a challenge in Mexico, which rates No. 1 in the world for obesity, Mujica Rosales said, adding that from 9 percent to 15 percent of the population has diabetes. Working with public health clinics, his foundation goes into the field, using cell phones to quickly screen for obesity, blood pressure, diabetes and some kidney diseases. It also provides drug compliance monitoring and lab tests.

Mujica Rosales sees the use of phone apps and other technology as a vital tool in changing patients' behavior toward their disease. They have to understand that dealing with diabetes is a lifetime commitment; it's not like getting a one-time vaccine, he said.

Johar agreed that phone apps are needed to identify patients at risk for the disease, but she added that low-cost diagnostics and better testing also will help patients better understand the burden of their disease.

TECH LIMITATIONS

Relying on technology to improve health outcomes can have its own challenges.

Some of the U.S.-based speakers at the Brookings event bemoaned the limitations and lack of interoperability with electronic medical records (EMRs), which restrict broader use of the data being gathered.

The seven different EMR systems the Rio Grande Valley Accountable Care Organization (ACO) had to work with didn't have appropriate filters to identify the status of the disease for each diabetes patient, so the ACO had to develop its own system that would put the patient's risk factors and current levels front and center for the doctor, said Jose Pena, CEO and chief medical officer of the organization.

To change the diabetes care model, Mark McClellan, a senior fellow at the Brookings Institution, said information sharing is needed at the patient level. Instead of being distracted by information technology that doesn't work, providers require EMRs that can produce longitudinal pictures that can be shared across teams. And in countries where EMRs aren't possible, cloud-based phone apps should be developed to fill in the gaps.

Looking at the future of diabetes care, Charles Saunders, CEO of Healthagen Population Health Solutions, said the five most promising areas are:

• enlisting a patient's family or support group with technology;

• integrating biometrics;

• using a team-based approach in primary care;

• advancing analytics, going beyond what's being used currently;

• engaging the patient through technology.

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