Study: Diabetes self-management portal yields promising results
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“Chronic disease management works; there are plenty of examples,” he said. For example, Carter and Howard University created a diabetes self-management portal to study the impact health IT can have on chronic disease self-management, among minorities in particular.
With chronic diseases such as diabetes, if patients don't manage their condition well, they fall into a cycle of symptoms, utilization of health facilities and interventions, and improvement, causing repeated use of the healthcare system and emergency rooms, he said. “If you can show people how to self-manage, you can help decrease the number of times they get signs and symptoms, and when symptoms first show up, how to manage them. That is the ideal state.
“We decided to look at diabetes because it affects minorities significantly. We also knew that diabetes was a disease that would respond to self management. If we could show providers how to help patients help themselves, that would be the best way to intervene."
For the project, the researchers created an internet-based portal that included treatment plans that were uploaded from the physician into the portal, disease-specific education around diabetes, videos, self-assessments and links to other diabetes-related websites. The portal included alert capabilities so providers could alert patients on certain items, and patients could send information back to providers. In addition, the portal included a social networking component so patients in the program could talk with each other, said Carter.
Information was loaded into a commercial PHR and linked back to an EHR so the physician would be able to monitor patients.
The study included 47 patients, 21 of whom were placed in the control group, asked to fill out a questionnaire and given an initial clinic visit where their blood pressure, blood glucose and other biometric information was taken. The 26 patients in the test group had the same biometrics taken, but were also provided with a laptop computer that allowed them to check their blood pressure, blood sugar and weight, then upload those variables automatically. The laptops also included a video camera for virtual visits with a nurse diabetic educator.
Patients could take readings and upload information twice a month. The nurse educator could review these data with the patient and discuss diet, medication compliance and other disease management information. At the end of three months, the physician reviewed the information, “and on the back end we could see how many times [patients] accessed online educational materials, how often they accessed social networks, etc.,” said Carter.
At the start of the study, there was no significant difference in control group or study patients. However, “our intervention [group was] 4.6 times more likely to have a hemo A1C level drop below target line" than the control group. The project also yielded a significant relationship between being in the intervention group and achieving healthy body mass index, he said.
Another benefit for study participants was that they formed much closer relationships with their primary care physician and nurse through the videoconferences, according to Carter.
In addition, “there were a lot of attitudinal changes we didn’t anticipate,” he added. For example, patients wanted to go to their appointments more, and after the program, “they felt better physically and mentally."
Getting patients to use the technology was not an issue: The biggest obstacle was spotty broadband access in poorer neighborhoods. In some cases, “we couldn’t even get landlines. There was a lot of difficulty with broadband access, even wireless. That was the biggest challenge,” Carter concluded.