Internet helps track chronic disease status
Internet helps track chronic disease status
Physicians alerted when there are problems
Congestive heart failure patients in California are using the Internet to track and monitor their conditions, making daily contact with a disease management program that alerts their physicians when anything is amiss.
"The program has been very well-accepted by our senior population," says Les Cordes, MD, medical director of Physicians Medical Group of Santa Cruz, CA, an organization of 225 physicians participating in a full-risk insurance product for 5,500 senior citizens. "Not only do they find the computer easy to use, but they like the entire medical management process,"
Physicians Medical Group is part of a pilot project being conducted by LifeMasters Supported SelfCare, a Newport Beach, CA-based disease management company that has developed an Internet component combining high technology with traditional disease management programs.
"Because of the structure of our organization, we are concerned about chronic disease management and are looking at ways to manage these patients more efficiently with a better cost model and with high-quality service," Cordes says.
The Internet provides a low-cost way to create customized disease management programs, says Chris Selecky, president and chief executive officer of LifeMasters.
The company has been marketing its interactive voice response disease management program for two years to manage a range of diseases including congestive heart failure, asthma, chronic obstructive pulmonary disease, diabetes, hyperlipidemia, hypertension, and coronary heart disease.
The Internet pilot project is being funded in part by an investment from Intel Corp., which has given personal computers to the patients in the pilot project.
The project began about six months ago using 50 congestive heart failure patients who are being treated by Physicians Medical Group. It will soon be expanded to include 50 diabetic patients being treated by another group, according to Selecky.
The program aims to compare compliance among patients using the Internet program with compliance among patients who are using LifeMasters’ integrated voice response disease management program, and with those in a control group who receive calls from staff nurses.
Although it’s too soon to see any definitive results, the Physicians Medical Group has found that 85% to 90% of the patients enrolled in the Internet program are supplying the requested information every day.
Here’s how the Internet program works: All patients whose diseases are managed by LifeMasters are assigned a nurse who acts as a "personal trainer" in disease management, helping the patients make lifestyle changes, Selecky says.
Every day, patients log onto a LifeMasters Web site and go to their own personalized home page, which contains a customized list of questions based on accepted disease management guidelines and input from the patient’s physician. The program starts off with standard questions and adds whatever additional areas the physician wants to monitor.
For instance, guidelines from the Agency for Health Care Policy and Research say a five-pound weight gain in a week may indicate problems for a patient with congestive heart failure. However, a physician may want a call if a particular patient’s weight fluctuates by just two pounds.
The patients enter the data into the LifeMasters database. If the data show any problems, the LifeMasters nurse assigned to that patient will be alerted. The nurses are alerted in two ways: by a message on the computer screen and by pager in case they are away from their computers.
"Generally, it’s not an emergency problem. It’s something that requires the nurse to get back to them within the day," Selecky says.
The nurse calls the patient to determine whether the doctor needs to be notified. This happens in about 10% of the cases, she adds.
LifeMasters faxes or e-mails the physicians a report that includes a list of all the drugs the patient is taking, two weeks’ worth of vital sign information, and a note from the nurse about what she had found.
"In the other 90% of the cases, the alert gives the nurse the opportunity to coach the patients and reinforce the information they need to manage their disease," she adds.
For instance, the cause of elevated blood pressure may be that the patient missed his or her medication or ate a high-salt meal the previous day.
Regular phone calls
Some patients are so forgetful that the company gives them pagers to alert them when it’s time to take their medication. The nurses also make regularly scheduled telephone calls to check on the patients.
"It’s a combination of tech and touch," Selecky adds.
Patients also use the Web page for weekly disease management lessons, to review past lessons, and test their proficiency on disease management techniques. In addition, the Web page contains a list of frequently asked questions about the disease and links to other medical sites. If patients don’t find answers to their questions, they can send their questions to the nurse by e-mail.
The Internet makes it possible to custom-tailor a disease management program to each individual patient, Selecky points out. For instance, one diabetes patient may have a weight problem, while another may have normal weight but needs help in cutting down on sugar in his diet.
The program for the first patient can include weight loss education and questions about weight, while the second patient’s program would have information about sugar content of foods and recipes without sugar.
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