Opinion: diabetes management, healthcare portals

Patient portals could reduce the excessive burden of diabesity on the NHS

Diabesity, a new term for obesity-led type-2 diabetes, is demanding ever greater resources from health services globally. Whilst the NHS objective is to increase the management of such conditions in the community, the serious complications associated with diabetes result in numerous hospital admissions and outpatient appointments, whilst also reducing patients’ quality of life.

Many clinicians agree that greater patient empowerment is essential to improve weight and glucose management, yet individuals typically have little or no interaction with carers between appointments.

While the NHS is reported to have pulled back from the use of patient portals, a forthcoming pilot of a diabetes-specific portal that provides patients with access to clinical records, trusted information and the ability to track weight and glucose measures against targets, looks set to prove the value of improving day to day patient/clinician interaction. Mike Paylor of Hicom argues for increased use of patient portals to manage this growing healthcare problem.

The diabesity epidemic

The rapid increase in the prevalence of obesity, type-2 diabetes and associated complications (diabesity) is a major global health problem. In Europe alone, approximately 33 million adults will be suffering from diabetes by 2010, and obesity, which is a major recognised risk factor for type-2 diabetes, is itself rapidly increasing in prevalence resulting in a diabesity epidemic.

According to the latest figures, about half the adults in England and Wales are overweight. About one quarter is obese. The number of obese people in England and Wales has nearly trebled since 1980.

The current cost of type-2 diabetes in the European Union is €15 billion per year, and medical complications arising from diabetes account for up to 8% of total health costs in Europe.

This rapidly escalating cost is putting enormous pressure on the NHS at a time when budget cuts and Darzi-led efficiency drives are taking centre stage. Indeed, NHS organisations will be expected to make “very substantial efficiency savings” — around £2.3 billion — in 2010-2011, when the health service’s three-year settlement comes to an end.

And diabetes services are already struggling. According to an audit commissioned by the NHS Information Centre in 2007/8, 60% of patients with diabetes in England are not receiving the recommended level of care — just 40% of patients said they received all of the nine care processes as recommended by current NICE guidance.

Primary focus

It is the consistent delivery of these nine care processes that is essential to controlling the escalating costs associated with diabesity, by minimising the incidents of complications such as heart disease, eye problems, gum disease, kidney disease, circulatory problems and neuropathy.

It is also key to ensuring that those obese individuals without diagnosed diabetes (potentially 500,000 according to Diabetes UK) are made aware of the potential signs, since early diagnosis can reduce the risk of complications and improve long term quality of life.

Indeed, an estimated half of all diabetics suffer from neuropathy which manifests as numbness or pain in the hands, feet, arms or legs — although neuropathies can also affect the organs — resulting in admissions to hospital or regular outpatient appointments.

And while the NHS strategy is to reduce hospital admissions and increase management of chronic conditions such as diabetes within the community, many primary care trusts (PCTs) are still struggling to achieve this objective.

A growing number of clinicians now believe that patients need far more support and engagement in managing their own conditions. Diabetes is a constantly evolving condition that requires day-to-day management to assess the dangers of complications; patients need support in ensuring glucose levels are maintained and weight reduction goals reached and they need trusted information to support understanding of diabetes, its complications and associated treatments.

Patient engagement

Programmes for greater patient interaction, including expansion of the NHS Healthspace Personal Health Record project, is now reported to have been shelved. And the current raft of alternative patient portal solutions are no more than online tools that enable patients to track their own weight and glucose measures; or GP-based solutions to help patients manage appointments and view their own health records with no means of uploading clinical content.

As such, none of these systems provide timely interaction with clinicians and, hence, leave patients to locate their own online information via search engines — much of which is of dubious clinical value.

Other patient-focused alternatives include private sector monitoring solutions, using contact centres staffed with nurses to triage diabetes patients based on readings delivered via the mobile phone. But these solutions are incredibly expensive — and increasingly unaffordable — and also fail to build upon any relationship with the key care providers within the NHS.

Improvements in proactive management of the growing diabetic population can only be achieved by delivering continuous patient interaction. A truly interactive patient portal would provide the ongoing carer/patient relationship that is essential in managing these chronic conditions.

Combining a sub-set of the information available to consultants and GPs, including history of admission, treatment records, side effects and blood test results, with excellent, trusted information about diabetes, a portal delivers true patient empowerment. At the same time, the patient can upload onto the portal information about weight and glucose levels, mapping results against pre-agreed targets thus enabling ongoing engagement with clinicians.

Add in diary management and appointment reminders, and the ability to provide feedback to clinicians on the quality of service received, the patient has a single source of information that should enable improved management and control of the condition and ability to highlight potential danger signs that could indicate complications.

Conclusion

The global providers of healthcare are still struggling to reverse the diabesity trend, with weight management and pharmaceutical regimes, to date, having minimal impact.

And with the NHS taking a step back from patient portal developments, the focus is now on the commercial sector to prove the value of these systems to empower patients and improve both long and short-term outcomes.

What is now required are joint pilots between the NHS and specialist software vendors that can demonstrate the clinical and financial value associated with improved patient empowerment.

These pilots would go a long way to reinforcing the growing perception among clinicians that effective, proactive management of diabesity is key to enabling more patients to successfully control their diabetes within the primary care services, reducing the cost and pressure on the NHS Trusts.

Mike Paylor, Business Development Manager of Hicom.

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