Structured educational courses to help people living with diabetes manage their condition are not working.
A few closed service providers dominate diabetes education in the UK, and according to the last National Diabetes Audit, less than 2% of the 3.8 million diagnosed with diabetes attend any form of structured education.
The non-dramatic, insidious and chronic nature of diabetes masks the fact that it has become a global epidemic with the potential to overwhelm national health systems, if education can’t halt its progress.
Although advances in diabetes research are significant, the horizon for a cure is still distant. At this moment in time, the best option to halt the progression of diabetes is convenient, fast and effective education.
Was the UK Department of Health (DH) right to axe its telehealth project?
Telehealth is a combination of medical devices and communication technology used to monitor diseases and symptoms, and support health and social care remotely. It represents a solution to the challenges of rising healthcare costs, an aging population, and the increasing prevalence of chronic diseases.
The Whole Systems Demonstrator Project
The DH’s Whole Systems Demonstrator (WSD) project was an ill-conceived top-down endeavour doomed to fail. It cost £31m, and was the world’s largest randomised control trial of telehealth involving 7,000 patients, 240 primary care practices across three UK sites.
In 2011 an interim evaluation concluded that the WSD project could achieve a 45% reduction in mortality rates, a 15% drop in A&E visits, a 14% reduction in bed-days, and an 8% reduction in tariff costs.
These estimates are in line with international findings. Based on a review of some 2,000 studies, GlobalMed concludes that telehealth has reduced hospital re-admissions by 83%, decreased home nursing visits by 66%, and lowered overall costs by more than 30%. Nothing else has worked to reduce such costs.
It was projected that by 2017 three million people in England with long term conditions would be recording their medical data and vital signs remotely, and sending them, via email and text, directly to GPs. This could save the NHS £1.2 billion a year, and significantly enhance the quality of patient care.
Diabetic foot ulcers (DFU) are responsible for more hospitalizations than any other complication of diabetes, and the biggest cause of amputation. Of the 26 million people in the US, and some 3.8 million in the UK diagnosed with diabetes, as many as 25% may experience a DFU in their lifetime.
People living with diabetes are at risk of nerve damage (neuropathy), and problems with the blood supply to their feet (ischaemia). Nerve damage results in a reduced ability to feel pain, and therefore injuries often go un-noticed. Ischaemia can slow down wound healing. Both ischaemia and neuropathy can lead to DFUs. Infections in DFUs can lead to amputation.
The burden of DFUs
DFUs impose a substantial burden on public and private payers, doubling care costs per patient compared with diabetic patients without foot ulcers. In the US, ulcer care adds around US$9 to US$13 billion to the direct yearly costs associated with diabetes, and in the UK, around £650 million is spent on DFUs and amputations each year.
London heart attack sufferers taken to a specialist cardiac centre have a 60% chance of survival, whereas those taken to an A&E unit only have, at best, a 26% chance of survival: according to unpublished information from the London Ambulance Service.
Experts say that the current provision of cardiac services in north and east London have, "relatively poor patient outcomes in comparison to the rest of England", and suggest that St Bartholomew's Hospital in central London should be transformed into a huge cardiovascular surgery unit, and a hub for a comprehensive network of care, which would embrace GPs and local hospitals.
For years, world-renowned heart surgeon and philanthropist Devi Shetty, has argued that, “One hundred or 200 bed hospitals are not the solution.” Shetty is the founder and chairman of Narayana Health, which boasts Asia’s largest cardiac centre providing world-class cardiac care at affordable prices. “Large specialist cardiac centres, treating high volumes of patients, staffed by specialists and equipped with the latest technology, save lives, reduce complications, lower costs, and are the hospitals of the future,” says Shetty.
Evidence from a recent survey of people with diabetes, suggests patient outcomes will improve if GPs provide healthcare information in video clips rather than paper pamphlets.
Traditional patient information is failing
“An indication that the current paper and web-based diabetes information is failing to improve patient outcomes is the fact that the incidence rates of diabetes in the UK are escalating. Currently, a plethora of diabetes information is provided either in paper pamphlets or as digitalized text on websites, but patients want healthcare information in video clips, and greater connectivity with their health providers,” says Dr Seth Rankin, managing partner, Wandsworth Medical Centre, who conducted the survey.
Despite the NHS spending £10 billion each year on diabetes care, between 2006 and 2011 the number of people diagnosed with diabetes in England increased by 25%: from 1.9 million to 2.5 million. Today, 3.8 million people have diabetes, and this number is expected to increase to 6.2 million by 2035. In 2013 there were 163,000 new diagnoses of diabetes in the UK, the biggest annual increase since 2008, and the five-year recurrence rates of diabetic foot ulcers are as high as 70%. The population increase over the past decade only explains some of these increases.
In July 2014 the European Translational Research Network in Ovarian Cancer (EUTROC), held its annual conference in London. High on its agenda was cancer’s resistance to established drugs.
Cancer is a complex disease. It arises from random “errors” in our genes, which regulate the growth of cells that make-up our bodies. Error-laden cells either die or survive, and multiply as a result of complex changes that scientists don’t fully understood.
Translational medicine is a rapidly growing discipline in biomedical research, which benefits from a recent technological revolution that allows scientists to monitor the behaviour of everyone of our 25,000 genes, identify almost every protein in an individual cell, and work to improve cancer therapies.
Early in 2014, the Sunday Times kicked-off a campaign to give more people who would benefit from radiotherapy access to it, suggesting that NHS radiotherapy equipment is either out-dated or underutilised.
According to Lawrence Dallaglio, the former English rugby captain who campaigns for increased access to radiotherapy, “Cancer clinicians are being denied the use of technologies to treat patients that the rest of the civilised world uses as a matter of routine.”
Dallaglio’s intervention prompted a government plan to improve access to quality radiotherapy. Is it happening?
Keen to discover the effectiveness of short healthcare videos as a communication tool for patients, Dr. Seth Rankin, the managing partner of Wandsworth Medical Centre, London, emailed his patients living with diabetes short videos about their condition, and surveyed their opinions afterwards, which we report.
“Healthcare information in video format distributed directly to patients’ mobiles is a more effective way to educate people living with diabetes, and propel them towards self management with an eye to slowing the onset of complications,” says Rankin.
According to Dr. Sufyan Hussain,an endocrinologist and lecturer from Imperial College, London, Clinical Lead on the Wandsworth project, “Despite accounting for 10% of the NHS budget and 8% of UK's population diabetes healthcare systems still need considerable improvement, particularly in management, strategy and infrastructure. Communicating important health information via video, can help significantly to improve the quality of care and efficiency in an over burdened healthcare system.”
The UK’s National Institute for Health and Care Excellence (NICE) recently recommended that primary care doctors should identify people eligible for state-funded slimming classes run by private companies, such as Weight Watchers, an American company that offers various products and services to assist weight loss and maintenance.
Obesity costs NHS England £5.1bn a year
25% of adults in England are obese
42% of men & 32% of women are overweight
A BMI of 30-35 cuts life expectancy by up to four years
A BMI of 40 plus cuts life expectancy by up to 10 years
Lose weight and save millions
NICE suggests that health professionals should raise the issue of weight loss in a "respectful and non-judgmental" way, by measuring their body mass index (BMI) to identify people who are eligible for referral for lifestyle weight management services. BMI is a person’s weight in kilos divided by their height in meters squared.
What does the nephew of the 41st American President and the cousin of the 43rd have in common with an Indian doctor?
They’re both passionate about using new technologies to provide high quality healthcare at affordable cost.
Bush and Shetty
Jonathan Bush, a relative of two former American Presidents, is the co-author of Where Does it Hurt? which calls for a healthcare revolution to give patients more choices, and affordable quality care.
A former Army medic and ambulance driver, Bush is the cofounder and CEO of athenahealth, one of the fastest growing American cloud-based service companies, which handles electronic medical records, billing, and patient communications for more than 50,000 US health providers.
Dr Devi Shetty is a brilliant heart surgeon, and veteran of more than 30,000 operations. However, his growing international reputation rests less on his medical skill, and more on his business brain. He wants to do for healthcare what Henry Ford did for the motorcar: “make quality healthcare affordable.”