Wednesday, August 28, 2013

It’s Wonderful To See Some Real Evidence Of E-Health In Australia Making A Difference - Again In The Private Sector.

This abstract appeared in the Medical Journal Of Australia last week.

Impact on diabetes management of General Practice Management Plans, Team Care Arrangements and reviews

Leelani K Wickramasinghe, Peter Schattner, Marienne E Hibbert, Joanne C Enticott, Michael P Georgeff and Grant M Russell
Med J Aust 2013; 199 (4): 261-265.
doi: 10.5694/mja13.10161
Objectives: To investigate whether General Practice Management Plans (GPMPs), Team Care Arrangements (TCAs) and reviews of these improve the management and outcomes of patients with diabetes when supported by cdmNet, a web-based chronic disease management system; and to investigate adherence to the annual cycle of care (ACOC), as recommended in diabetes guidelines.
Design, participants and setting: A before-and-after study to analyse prospectively collected data on 577 patients with type 1 or 2 diabetes mellitus who were managed with a GPMP created using cdmNet between June 2008 and November 2012.
Main outcome measures: Completion of the clinical tests in the ACOC (process outcome) and values of six of these clinical measurements (clinical outcomes).
Results: Significant improvements were seen after creation of a GPMP in the proportion of ACOC clinical tests completed (57.9% v 74.8%, P < 0.001), total cholesterol level (P < 0.01), low-density lipoprotein (LDL) cholesterol level (P < 0.001) and body mass index (BMI) (P < 0.01). Patients using GPMPs and TCAs also improved their glycated haemoglobin (HbA1c) level (P < 0.05). Patients followed up with irregular reviews had significant improvements in the proportion of ACOC clinical tests completed (59.2% v 77.6%, P < 0.001), total cholesterol level (P < 0.05), and BMI (P < 0.01), but patients with regular reviews had greater improvements in the proportion of ACOC clinical tests completed (58.9% v 85.0%, P < 0.001), HbA1c level (57.7 v 53.0 mmol/mol, P < 0.05), total cholesterol level (4.8 v 4.5 mmol/L, P < 0.05), LDL cholesterol level (2.8 v 2.4 mmol/L, P < 0.01) and diastolic blood pressure (76.0 v 74.0 mmHg, P < 0.05).
Conclusion: There were significant improvements in process and clinical outcomes for patients on a GPMP or a GPMP and TCA, particularly when these were followed up by regular reviews. Patients using cdmNet were four times more likely to have their GPMP or TCA followed up through regular reviews than the national average.
The article is here (full access freely accessible):
I was also sent a press release with some commentary:
Melbourne 19 August 2013
As diabetes looms as a runaway epidemic in Australia, a Monash University study suggests that Internet technologies may be key to overcoming this challenge to our healthcare system.  
The study monitored 577 diabetes patients over 14 months. It showed significant improvements in quality of care and clinical outcomes for patients whose care was supported by an internet-based care management service called cdmNet. The study is published in the Medical Journal of Australia issue of 19 August.
cdmNet assists General Practitioners (GPs) and patients to manage chronic diseases and other illnesses.  Using cdmNet, any member of the patient’s care team can access the patient’s health record and care plan, including the GP, specialists, allied health, pharmacists, and the patient themselves. They can do this from anywhere, anytime, while maintaining data privacy and security. Everyone on the team knows what everyone else is doing, all the time.
The results of the study show that 80% of patients on a care plan created and managed using cdmNet were regularly reviewed and followed up compared with national figures indicating fewer than 20% follow up of (non-cdmNet) patients. 
Furthermore, of those patients who received regular reviews, 85% adhered to best practice care compared with 59% otherwise.
Comparing patients before and after the use of cdmNet, significant improvements were observed in
·         HbA1c*, the surrogate measure of blood glucose levels, fell from a mean of 8.4% to 7.4% for patients with an initially high HbA1c
·         Lower total cholesterol (4.6 to 4.3 mmol/L); and
·         Lower LDL (bad) cholesterol (2.6 to 2.3 mmol/L)
The greatest improvements were in patients who had regular reviews of their care plan.
Professor Michael Georgeff, CEO of Precedence Health Care, the company that developed cdmNet, said the study suggests that improvement in clinical outcomes is related to the level of coordination among the care team and with the patient. It also indicates that patients are more likely to adhere to their plan when it is regularly reviewed and followed up by the GP and the care team.
“How to put this into practice is the challenge. GPs’ waiting rooms are full of people with a chronic illness. Trying to keep track of what everyone is doing or not doing places a huge burden on GPs and practices, especially when communications among the team are limited to fax, telephone tag and hand delivery of patient information.
“Without the use of advanced Internet and mobile technologies, one simply cannot achieve the level of coordination and follow up needed for these patients.
“More than seven million Australians have a chronic disease, costing the health care system more than $70 billion per year. The losses to the economy through reduced workforce participation rates and productivity are more than $8 billion per year. Diabetes alone accounts for nearly a quarter of avoidable hospitalisations and 9% of deaths.
“It will be impossible to maintain a sustainable health care system without the use of these technologies,” Professor Georgeff said.
For GPs on the front line who have adopted cdmNet as a patient management tool, the results speak for themselves. Dr Tim Denton, GP in Anglesea, Victoria and chair of the Barwon Medicare Local, said: "Since using cdmNet for ensuring quality of care, we have not had any amputations, strokes or progressive retinopathy in our patients with diabetes. People have fewer complications, are living better lives and living longer."  
Professor Paul Zimmet, AO, Director Emeritus at the Baker IDI Heart and Diabetes Institute and Adjunct Professor at Monash doesn’t hold back on the level of concern he holds for the “rise and rise” of diabetes in Australia.
“Diabetes in the 21st century is the equivalent of cholera in the 19th century and HIV/AIDS in the 20th century. During this millennium, diabetes is well on the way to cementing its place as the fastest growing epidemic in human history. And the situation in Australia is daunting both from the personal cost to individuals for medical and support care and the economic cost to the nation due to reduced national productivity as type 2 diabetes is now affecting the workforce age group and even children and adolescents.
“In Australia, there are at least 1.5 million known cases of diabetes and a similar number with pre-diabetes. Moreover, for every diagnosed person with diabetes, there is likely to be one undiagnosed case. So, we are looking at potentially more than 4 million people, either with diabetes or who are at risk. It is possible therefore that some 20% of the Australian population is affected by diabetes in some way.
“The medium to long-term answer, of course, is prevention. But, in the meantime, to reduce the burden of this epidemic, people with diabetes require comprehensive support and care from a whole range of allied health professionals along with GPs and specialists. It is a unique healthcare challenge and its treatment is best administered through a management plan involving a complete care team.
“Web-based tools appear to enable this kind of care more easily and, as the Monash study indicates, clinical outcomes are worthwhile and likely to reduce the burden of the sometimes devastating complications of diabetes.
“Diabetes is potentially the greatest epidemic in the history of world. By 2020, the condition will bankrupt the economies of many nations unless urgent action is taken,” Professor Zimmet added.
For further information
Professor Michael Georgeff
CEO Precedence Health Care
Mobile + 61 411 193 247
Office +61 3 9023 0800 during business hours
The release is here:
I think this is really very encouraging and shows how sensible planned progress can make a difference as compared with expensive overly complex and ambitious national programs.
Well worth reading the full paper.

1 comment:

Trevor3130 said...