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 Disease Management

How to manage diabetes - not be managed by it

mHealth solutions are paving the way toward better disease management.

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   By Geeta Nayyar, December 2012

Geeta-Nayyar

Geeta Nayyar is chief medical information officer, AT&T ForHealth.For more on AT&T

ForHealth: AT&T ForHealth

As the nation looks for ways to improve healthcare quality, mHealth is being looked to as an area of promise for realizing some of those goals. Chronic disease continues to make up the majority of the costs in today’s healthcare system. Only by addressing chronic diseases, such as diabetes, can we hope to truly make a dent in the cost curve challenging today’s healthcare industry.

The majority of chronic disease treatment happens outside the four walls of the hospital or doctor’s office. That’s why it’s critical to look to mHealth innovations to break those walls and reach the patient, wherever and whenever they need clinical guidance or intervention. It’s this extension of care that will allow for the potential of averting unnecessary hospitalizations and emergency room visits, which will drive to improved outcomes and improved quality of care for patients.

For example, when physicians see diabetic patients, they often ask them to schedule follow-up visits every six to eight weeks. The reality is that their physician doesn’t really know when they truly need to be seen again. It could be two weeks or eight weeks, depending on how that patient is doing at home. With mHealth technologies, we are able to shift this paradigm and take this type of “just-in-case” care to “just-in-time” care. These insights into the home setting will help doctors say, “I need you to come in when your sugars are too high,” rather than, “I will see you back in six to eight weeks – just in case.”

With the proliferation of smartphones, connected devices and mobile apps, it’s easy to see that mHealth solutions will play an increasingly important role in potentially improving patient care. This is demonstrated by an explosion of health and wellness apps – from food trackers to workout logs. Today, there are hundreds of apps available to evaluate dinner choices. Yet, many of these apps fall short of being truly impactful. Most can’t track how the meal may impact blood glucose levels or prescribed medications, few have the ability to aggregate that data into trends and almost none can convey that information. The real power in mHealth technologies will be not only collecting data, but connecting the data in meaningful ways for both providers and patients. 

Creating connected solutions: Walking the walk

There is a need for tools that offer real-time feedback and coaching – solutions that are based on an individual’s data. AT&T mHealth Solutions’ DiabetesManager, for example, can enable healthcare providers and caregivers to have real insight into what is happening with a patient – at home or on the move – and bridge that gap. DiabetesManager provides coaching tools and other useful information to patients and allows them to enter blood glucose data with a recheck timer that reminds them when it’s time to retest. DiabetesManager is not intended to replace the care provided by a licensed healthcare professional, including prescriptions, diagnosis or treatment.

At AT&T, we’re actually using DiabetesManager, and our HR/benefits team has a high bar for what we pilot with our employees, retirees and dependents.

The solution was rolled out to a select group of employees in pilots at AT&T and Health Care Service Corporation (HCSC). 

The results are in

There were 181 participants (employees, retirees and dependents) with high-acuity type 2 diabetes who were enrolled to use DiabetesManager in the AT&T employee pilot. Participants made tens of thousands of blood glucose, medication and carbohydrate entries during a six-month period. Initial review of the data finds high adoption and engagement of the solution.

End-user feedback from an online survey of AT&T pilot participants indicates that:

  • 72 percent rated DiabetesManager as a “highly useful” tool to help them manage their diabetes (rated 4-5 on a five-point scale).
  • 81 percent would continue to use the solution after the initial pilot period.
  • 91 percent would recommend the solution to someone else.

There were 156 HCSC employees that participated in the pilot, including type 2 diabetics across all categories of acuity level – catastrophic, high, medium and low. HCSC employees received unique and customized coaching from staff nurses. Blue Care Connection registered nurses (RNs) were available throughout the pilot during regular business hours, ready to monitor the data entered by participants, help answer any questions and reach out to participants, as needed, confidentially.

Geeta-Nayyar
©2011 AT&T Intellectual Property. AT&T and AT&T logo are trademarks of AT&T Intellectual Property. WellDoc, the WellDoc logo, DiabetesManager and the DiabetesManager logo are trademarks of WellDoc, Inc.

“Working on the mHealth DiabetesManager pilot has been rewarding and educational for me,” says HCSC’s case management nurse, Denise Harper-Saxon. “My interactions with the pilot participants have allowed me to respond to issues members face closer to their occurrence via the portal, making my intervention relevant because the issue is more recent, instead of offering retrospective advice.”

End-user feedback from an online survey of HCSC pilot participants indicates that:

  • 88 percent rated DiabetesManager as a “highly useful” tool to help them manage their diabetes (rated 4-5 on a five-point scale).
  • 78 percent would continue to use the solution after the initial pilot period.
  • 93 percent would recommend the solution to someone else.

We are able to learn from these findings and use them as a springboard for future mHealth solutions. As we drive to broad-based adoption, the feedback from patients and nurse case managers is very encouraging. People are actually using these technologies to take control of their health and wellness, managing their disease and providing actionable information that the patient can use and their case manager or caregiver can act on and intervene when necessary. These results are promising; mHealth solutions really can make a difference for both patients and providers.        


Tags:  Disease Management