Value in Healthcare: The Patients Perspective
Today, patients and carers are taking more and more responsibility for their health and are progressively demanding more patient centric services. They are increasingly demanding to be given the tools to manage their own health.
Global healthcare systems are confronted with major challenges when tackling chronic disease. Amongst the long-term conditions doctors treat, diabetes places one of the greatest burdens on health services. The number of patients with the disease is rapidly increasing.
Around one in twelve adults has diabetes. More than 90% have been diagnosed with Type 2 diabetes - a lifelong condition that causes a person’s blood sugar level to become too high. Many more adults don’t even realise they have this condition, increasing by fifty percent their chances of suffering heart disease.
The latest International Diabetes Federation (IDF) Atlas1 predicts there will be over a billion people globally with diabetes or impaired glucose tolerance in the next 20 years. Treating diabetes already accounts for ten per cent of the health spend worldwide. A figure which is likely to rise massively unless immediate action is taken.
This upwards trend could be reversed though, with the right approach, for example, with a healthy diet and physical activity. According to John Grumitt, IDF’s Vice President, as many as 150 million cases could be prevented by 2035 through educating people about healthy lifestyles.
Healthcare professionals and the healthcare industry have the power to change lives through providing sufficient support to patients, in addition to initial treatment plans. The right support could influence the 50% of people not currently adhering to their treatment. It could also successfully address the imbalance in health spend as well as reduce current demand on health services.
This extra support is not yet widely available. At most, people with diabetes spend five hours per year with healthcare professionals; for the other 8,755 hours of the year, they must manage their diabetes alone(1).
In addition, education programmes geared towards enabling diabetes patients to manage their condition are poorly attended. Less than 3% of people with diabetes in England and Wales attended such programmes in 2012- 13, according to the National Diabetes Audit(2).
Those who do attend an education session are told what to do and are then expected to be experts at managing their own condition. This is not enough to change their behaviour. Instead, the way forward is through structured/ efficient education and sharing information with patients, then supporting them to make decisions and improve their lifestyle.
Educating people online via the internet, creates greater access to information and learning than classroom based programmes. The advantage is that patients learn in their own time and decide how many hours they spend learning. Importantly, just making information available is not enough. We need to change behaviours to implement what we learn and this requires supported self-management.
However, there has been considerable resistance to change from providers who are largely focused on offering classroom based courses, rather than creating information and learning delivered in a way that is easy to access and relevant to patients.
Giving patients with a chronic condition information about their progress (or lack of) can dramatically improve health outcomes. Nevertheless, there is a huge difference between data and information. Data is pointless unless it can be understood by patients. The healthcare industry has failed to focus on what patients want. For example, only one research study has ever asked patients what they need from their insulin pump service(3).
The power of patient groups cannot be underestimated. The healthcare industry is starting to examine both what patients want and how they themselves can improve outcomes.
The combination of healthcare regulations, budget constraints and multiple stakeholders make any change difficult and true transformation of the healthcare system complicated. Patients in this environment are driving change through numerous ways including: sponsorship which is helpful, but not essential; creating a voice by pushing for businesses to provide healthy living choices to their customers; better standards of care which will engage decision makers in listening to patients and enabling them to participate in delivery of their healthcare services.
On the other hand, the developing world has begun to provide a great platform for innovation. Their even more limited budgets, ever expanding population, young and limited health systems as well as minimal regulatory processes in place, all together create a fertile ground for new approaches. Technology is enabling providers to deliver the relevant information to large populations which in turn is helping patients to take control of their health and make the necessary lifestyle changes.
1 Diabetes: the hidden pandemic and its impact on the Middle East and Northern Africa, 2010 – Mena Diabetes Forum, Dubai, https://www.novonordisk.com/content/dam/Denmark/HQ/aboutus/documents/MENA_Diabetes_briefing_book_EN.pdf
2 Diabetes Prevalence, Diabetes.co.uk, http://www.diabetes.co.uk/diabetes-prevalence.html
3 United Healthcare Restricts Insulin Pump Choice: The Diabetes Community Responds! Written by Mike Hoskins, - 5 may 2016 - http:// www.healthline.com/diabetesmine/unitedhealthcare-insulin-pumps