Diabetes Care Challenges Offer Hospitals Strategic Opportunities
"A lot of people are challenged in their lives and may not be coming to appointments," Bluml says. "We've heard amazing stories: Patients have really gotten their diabetes under control and are trying to do the right thing with food choices; they are also making sure they are taking their medications. It's an inspiring thing that you are helping people in some portion of their lives through a team-based process."
The care features one-on-one patient consultations, group educational classes, grocery food tours in conjunction with certain markets, and exercise programs. Some of the patients also receive discounted or free healthy lunches at employer worksites and discounted copayments for medication and supplies.
Despite the promising results, a significant problem is the lack of reimbursements.
"We feel very strongly that our model works and have data to show that patients are healthier once enrolled in our program," Beatty says. "Unfortunately, there is not a reimbursement structure available to pay pharmacists to provide these services alone or any additional reimbursement from a standard office visit with a physician by having a team of healthcare professionals involved.
"This makes it very difficult to hire healthcare providers, such as pharmacists, even though it has been shown that patients are healthier when providers are working together as a team to care for the patient. This has been a limitation to expansion of our model to more patients with diabetes or other disease states," he adds.
Success key No. 3: Overcoming nonadherence
Providers are working to overcome a significant obstacle to improving the condition of diabetic patients: nonadherence to medication prescriptions.
"Nonadherence is probably the most common barrier we observe that leads to poorly controlled diabetes," Beatty says.
The Ohio State University Medical Center was involved in a study presented during the American Diabetes Association scientific sessions in 2013 that showed disease education programs can have a positive impact on hospitalizations. Sara J. Healy, MD, a soon-to-be endocrinology fellow at the medical center, presented data on patients hospitalized from 2008, with a discharge diagnosis of diabetes and glycated hemoglobin (HbA1c) levels greater than 9%. There was a 30-day analysis of 2,265 patients and a 180-day analysis of 2,069 patients. According to the study, readmission rates were 5 percentage points lower for those who received the education (11%), than those who didn't (16%).
Wendle, head of Main Line Health's education program, says medication adherence is an important concern. Years ago, she says, physicians would tell patients they had a slight case of diabetes or were borderline: "That means nothing. The statement now is prediabetes. I had a woman who came into the program, and she had taken it four years ago and had fallen off the wagon and came back. Some prediabetics have warning signs, while there others who don't have any symptoms and become complacent."
The availability and convenience of some smartphone apps allows patients to "have information at their fingertips when they are going to a restaurant and have a GPS for walking. These can be extraordinary motivators to see cause and effect," she says.
One patient came in for education counseling because she heard Tom Hanks announced he had type 2 diabetes, Wendle says, noting "whatever it takes."
As Beatty sees it, there are ways hospitals and physicians can overcome barriers that keep patients from controlling their diabetes, such as areas involving cost, motivation, diet, nutrition, and follow-up care.
Cost: If patients believe they have problems meeting expenses associated with improving care, they can work closely with the OSUWMC Department of Pharmacy medication assistance program technicians and pharmacists, who will help patients with the paperwork for the program at no cost. "This has a significant impact on patient access to treatment, in particular insulin and supplies," which can cost as much as $300 per month for patients, Beatty says.
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