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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.
 
The clinicians
"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."
 
Patient survey
 
During the six- week project, over 50% of diabetes patients opened the emails sent, and watched the information videos about their condition.
  • 75% of respondents say that they would like to have more reliable information to help them to manage their diabetes
  • 44% regularly search the Internet for healthcare information about diabetes, and 20% are undecided
  • Only 9% say that they can differentiate between good and bogus online healthcare information about diabetes
  • 68% found the video information they received by email helpful
  • 21% regularly visit Diabetes UK website
  • 71% want GPs to provide more healthcare information via email
  • 50% prefer to receive healthcare information about diabetes in video format, and 23% are undecided
  • 71% believe it's important to access healthcare information about diabetes at anytime, from anywhere and on any device.
It's important for me to quickly access premium and reliable healthcare information about my condition at anytime, from anywhere and on any device
NICE relaxing guidelines
These findings, if indicative of patient views, are significant. Recently, the National Institute of Health and Care Excellence (NICE) issued new draft guidelines to make more people eligible for weight-reduction surgery. According to NICE, such surgery would reduce the debilitating complications associated with type 2 diabetes.

Until now, people with type 2 diabetes only could be considered for weight loss surgery at a BMI of 35. The new guidance could mean that more than 850,000 people could be eligible for a stomach-reduction surgery if their doctors think they are suitable.

A costly therapy
Over the past five years, there has been a significant increase in the number of people receiving weight loss surgery. According to the UK's Health and Social Care Information Centre's latest report: in 2012-13, about 8,000 people received stomach-reduction surgery for potentially life threatening obesity when other treatments failed.

A mounting body of evidence suggests such surgery improves symptoms in around 60% of patients, which in turn, may result in a reduction in people taking their type 2 diabetes medications, and even in some cases needing no medication at all.

Stomach-reduction surgery, which costs between £3,000 and £15,000, does not mean that type 2 diabetes has been cured, and there are raised concerns that the NHS will not be able to afford the treatment, even if there are savings in the longer term. Furthermore, an irreversible procedure that does have surgical risks attached to it does not make it an attractive option for everyone. 
 
Takeaways
"We know about the escalation of the diabetes burden. We know that established therapies, diets and lifestyles could effectively reduce the burden of diabetes. And yet the burden shows no signs of slowing. IF patient data from the Wandsworth Medical Centre are indicative of the situation more generally, we should seriously consider the way doctors communicate with patients. Doing 'more of the same' is not the answer. We need to find new innovative solutions to engage, interact and motivate as many people as possible," says Dr. Hussain.

 

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"The next ˜big thing" in healthcare . . . . is IT, which will dramatically change the way health professionals interact with patients. Every step of a patient's care will be determined by protocols on a hand-held device. This will make healthcare safer and shift many hospital activities into the home," says Dr Devi Shetty, world-renowned heart surgeon, founder and chairman of Narayana Health, India's largest multi-purpose hospital group and the person said to have, "the biggest impact on healthcare on the 21st century".

Shetty also warns that, "Despite the advantages of such technologies, the medical community is reluctant to accept them."

Although doctors and patients have iPads and smartphones and use social networks, the healthcare community, "fights like mad to resist change", and fails to embrace life-saving technologies, which would improve patient care and reduce costs. ld improve patient care and reduce costs.
 
Open systems
In 2012 UK Health Secretary Jeremy Hunt issued a Mandate that by 2015, modern communications technology would play a substantially bigger role in the UK's healthcare system. The NHS remains a near bankrupt, inward looking public monopoly driven by proprietary systems rather than customer needs.

 

Saving lives didn't invoke change
Healthcare professionals invariably refer to privacy and security issues to protect the status quo, but these are equally applicable to other sectors, such financial services, which have embraced change and open standards.
 
An explanation why healthcare systems resist change is in a 1970 BBC Reith Lecture by Donald Schon, formerly Professor of Philosophy, University of California.
 
Schon borrowed a story from Elting Morison's 1968 book, Men, Machines and Modern Times, to describe entrenched social systems' resistance to change. 
 
During wartime, a young Naval officer named Sims invented a device that improved the accuracy of guns on ships by 300%, but the US Navy rejected it.
 
The device, "continuous-aim firing" used a simplified gearing mechanism that took advantage of the inertial movement of a ship. What previously a whole troupe of well-trained men had done, now one person, keeping his eye on the sight and his hands on the gears - could do.
 
To survive and grow, every major industry in today's network-centric world, except healthcare, has abandoned proprietary systems, embraced open standards and actively licensed technologies.  

 

 
Rejected on scientific grounds
Despite it's obvious advantages especially in a time of war, Sims found it extremely difficult to get his device adopted by the US Department of Navy. When finally the Navy did agree to test his system, they did so by taking it off the moving ship and strapping it onto a solid block on land. Since the device depended on the inertial movement of the ship, it didn't work and the Navy rejected the device on "scientific" grounds.
 
Eventually, Sims attracted the attention of Theodore Roosevelt, who saw the advantages of the device and immediately insisted that it be adopted in the Atlantic and Pacific war theatres where it achieved a 300% increase in accuracy.
 
The American Navy's rejection to Sims's lifesaving technology is similar to Healthcare systems' reluctance to embrace technologies, which improve patient care and lower costs.
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Diabetes is a complex, chronic illness, which requires continuous medical care and risk reduction strategies over and above glycemic control. Education and on-going patient self-management and support are critical to preventing complications and reducing the risk of long-term acute complications.

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joined 10 years, 9 months ago

Alan Gelb

Senior Fellow, Center for Global Development

Alan Gelb is a senior fellow at the Center for Global Development. His recent research includes aid and development outcomes, the transition from planned to market economies, the development applications of biometric ID technology, and the special development challenges of resource-rich countries. He was previously director of development policy at the World Bank and chief economist for the bank’s Africa region and staff director for the 1996 World Development Report “From Plan to Market.


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Africa is sick. Ninety per cent of the world’s cholera cases occur in Africa. Meningococcal meningitis is epidemic in most African countries. Yellow fever is endemic in 23 African countries. Africa has more than 28 million HIV/AIDS cases and 75% of the world’s AIDS population live in sub-Saharan Africa. Of the one million annual malaria deaths, 90% occur in the same region. Measles are common throughout Africa and result in high levels of morbidity and mortality. Lassa fever accounts for about 0.4 million deaths each year and avian influenza is endemic in many African countries.

This is not the whole story. In addition to being plagued with infectious diseases, Africa has a neglected epidemic of chronic non-communicable disease (NCDs). Over the next decade the continent is projected to experience the largest increase in mortality rates from cardiovascular disease, cancer, respiratory disease and diabetes.

Although, international health agencies and national governments are beginning to recognize and confront the significant global burden of NCDs, its awareness in Africa is still relatively low and political leaders there have not shown much interest in NCDs and this has been reflected in the allocation of health budgets. This neglect compounds Africa’s healthcare and development challenges, since the projected rise in NCDs throughout the continent is expected to occur on a compressed timeline compared to high income countries and Africa has restricted capacity to respond to the magnitude of its disease burden.

International organisations have flagged the magnitude and the urgency of the challenge. Healthcare advice from numerous non government agencies in the developed world on ways to deal with Africa’s escalating disease burden is forthcoming. This has been especially the case over the past decade when humanitarian aid budgets have peaked. Agency recommendations have been high on overall strategy and low on cost effective and scalable means of delivering such strategy. 

 

Most advice includes epidemiological surveillance, primary programmes that target healthy populations and secondary preventative programmes aimed at reducing complications in affected populations. All agencies agree that human resources are crucial to viable African health systems. Hitherto, human resources have been a neglected component of African healthcare. A common implementation strategy recommended and implemented by several non government agencies is to organise health workers from the developed world to spend time in African countries teaching the teachers. To assist such programmes, some agencies recommend that African governments build more roads to enable health workers to gain better access to rural areas where healthcare provision is poor or non-existent. Education is crucially important, but the key question is, how do you educate enough people to make a difference?

Africa has a population of over one billion; about 15% of global population,but only 2% of global GDP and its population is projected to double by 2050. Africa is exposed to multiple health risks combined with inadequate preventative healthcare and education. Projected trends of Africa’s disease burden and consequent rates of morbidity and mortality highlight the inadequacy of some popular traditional response to Africa’s healthcare challenge. In addition to the enormity of its disease burden, Africa, which has weak health systems, also has significant long standing structural, logistic, human and organisational barriers to the implementation of well intended traditionalhealthcare programmes many of which focus on teaching the teachers.

So, despite well intended traditional interventions, Africa’s disease burden continues to grow and its overall effect is likely to decrease productivity, lower competiveness, increase fiscal pressure, expand poverty and create greater inequity in most African countries. More scalable and effective solutions are required. These should build on Africa’s strength, which are her established and fast growing telecommunications networks and her relative absence of healthcare legacy systems. Current trends in disease prevalence and treatment costs will force African countries to make deliberate and innovative choices in order to address their disease burdens in sustainable and effective ways. Such choices are more likely to employ modern technology than to build more roads. In Africa, mobile penetration exceeds infrastructure development, including paved roads and access to electricity and the internet. According to the World Health Organization’s (WHO) Global Observatory for mHealth some 40 African countries are using mobile health services.

 

Africa is the fastest-growing mobile telephone market in the world and the biggest after Asia. Over the past five years the number of subscribers on the Continent has grown some 20% each year. By the end of 2012 it is projected that Africa will have 735 million mobile subscribers.The nature of Africa’s mobilemarket is also changing. Today, smart phone penetration rate in Africa is estimated to be about 18%: almost one in five and projected to reach 40% by 2015. While patchy, mobile penetration rates in Sub Saharan Africa, where the disease burden is greatest, are not low and the rate of smart phone penetration is estimated to be about 20%.

In 2007 Sarafaricom, a leading mobile phone network in Kenya, launched M-Pesa, a mobile phone‐based payment and money transfer service for people too poor to have a bank account. M-Pesa spread quickly and has become the most successful mobile phone‐based financial service in the developing world. Today there are some 17 million registered M-Pesa accounts in Kenya. It is only a small step to offer a mobile health information service for all M-Pesa account holders.

Africa’s new highways to carry healthcare information are virtual rather than physical. They already exist, they are extensive and, over the course of the next five years, are projected to rapidly expand and improve. With such an infrastructure one teacher can educate millions of people, which is significantly more cost effective and sustainable than traditional healthcare programmes.

Further, Africa will not be able to diagnose and treat its way out of its disease burden. Increasingly, healthcare programmes will need to emphasis prevention, alongside efforts to strengthen health systems to provide early diagnosis; targeted cost-effective and scalable treatments that are fiscally sustainable depending on countries’ epidemiological profile. Such solutions will need to fit complex, overstretched and under-resourced health systems; address the enormity of the escalating disease burden and bring about desired changes in specific African countries’ health systems. This cannot be achieved only by repeating traditional healthcare programmes delivered by non government agencies from developed countries.

According to the International Telecommunications Union there are some 5 billion wireless subscribers in the world today and over 70% of these reside in low and middle income countries. In 2011, Africa held its first mobile health summit in South Africa and firmly put mobile telephony at the centre of improving healthcare in poor countries. A 2011 WHO global survey of the use of mobile telephony in healthcare; mHealth, reported that commercial wireless signals cover over 85% of the world’s population. Eighty three per cent of the 122 countries surveyed in the Report used mobile phones for free emergency calls, text messaging and pill reminders.

Modern technologies have the scalability to provide the basis for Africa to develop country-congruent health policies that are locally applicable. Technological systems such as mobile telephony, the internet and biometric identification, which are appropriately implemented, have the capacity to empower individuals and encourage them to take care of their own health. Further, such technologies have the capacity to improve targeting, reduce fraud and increase access to healthcare. Technologically based healthcare strategies offer Africa an opportunity to leapfrog its ineffective traditional healthcare systems and begin to manage the enormity of its disease burden and, in turn, may benefit the whole world by demonstrating the benefits of patient centred healthcare.   

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