In response to the comments from my post last week, part of the information collection by the program in Egypt was to survey the response to the ads; from the responses, they concluded that they needed a new logo that would be better accepted and more positively viewed. Also, BRAC’s approach to the ORT distribution was very unique and has saved very many lives. I won’t go into too much detail here, but they implemented more of a one-on-one approach to mobilize the local individuals and increase the sustainability of the project with the local manpower and support and using common household tools to measure the portions for home-made ORT. The campaign was largely effective because of the constant evaluation by BRAC to see what the limiting points were, and they addressed those issues to best cater the campaign to the community. If you would like to know more about the campaign in Bangladesh, let me know and I can include more details about this case study – it’s very interesting! It just doesn’t quite fall under my topic of information and communication technology, but I would be happy to tell you more about it!
As mentioned last week, this week I will be talking about diabetes and telemedicine. Instead of focusing on an international case study of public health like last week, this week I’m turning to look at a growing problem in the United States and other countries, diabetes. According to the American Diabetes Association, there are currently 23.6 million children and adults with diabetes in the U.S., accounting for 7.8% of the population. Unfortunately, there are often other comorbidities and complications that come along with being diabetic, especially for those with type II diabetes. With evidence supporting a structured approach to diabetes care, especially diabetes self-management education, information and communications technology form a great medium for innovation in diabetes management.
One demonstration project, the Informatics for Diabetes Education and Telemedicine (IDEATel) project, looks at the effectiveness of telemedicine with diverse, medically underserved diabetes patients. From the study, it was found that self-efficacy, or “one’s belief that (s)he can successfully engage in a behavior,” is a relevant construct for older diabetes patients (Trief). The results from the study indicated that over the course of the study, there were net improvements in health indicators, such as LDL cholesterol, blood pressure levels, and HgbA1c (simply described, a test for blood sugar) (Shea). One significant thing about these results is that this program could reach the medically underserved population, opening up a lot of doors for improving the quality of care in this country. However, another study looked at the cost-effectiveness and clinical outcomes of IDEATel, and concluded that there was a modest effect on clinical outcomes, but the associated Medicare costs were not reduced compared to other programs with similar impacts (Moreno). From the combination of these two studies, telemedicine seems to have a potential in increasing self-efficacy and therefore improving diabetes management, if there is a way to keep the costs down.
While the studies mentioned above might not seem too promising for the use of ICT and diabetes management, the field is still promising, as ICT, more specifically telemedicine, can offer a connection for the patient with the health care provider or a means of managing their diabetes. It also allows for patients who are far away or not capable of seeing a doctor regularly to receive at least some care – as the IDEATel project indicates, these medically underserved individuals had better health indicators with the telemedicine programs that improved self-efficacy. Another study that looked at diabetes self-management education via telemedicine found evidence that suggests that telemedicine may offer more opportunities for diabetes management for the rural, underserved communities (Balamurugan). This is important because these are often the populations that are left out of treatment, and for a chronic disease like diabetes, it is imperative that these populations also have access to programs and interventions that work for them.
To conclude, ICT has a promising future in diabetes management, especially telemedicine. This has a huge potential impact on underserved communities, and can improve the communication between health care providers and patients. Hopefully, more health care providers will look into this form of medicine and come up with innovative ways to improve it so that it can be more cost-effective and have greater improvements in health outcomes.
Sources:
American Diabetes Association - http://www.diabetes.org/about-diabetes.jsp
Trief, Teresi, Eimicke, Shea, et al. “Improvement in diabetes self-efficacy and glycemic control using telemedicine…” http://ageing.oxfordjournals.org/cgi/content/abstract/38/2/219
Moreno, Dale, Chen, and Magee. “Costs to Medicare of the IDEATel Home Telemedicine Demonstration…” http://care.diabetesjournals.org/cgi/reprint/dc09-0094v1
Shea, Weinstock, Teresi, Palmas, et al. “A randomized trial comparing telemedicine case management with usual care…” http://www.jamia.org/cgi/content/abstract/M3157v1
Balamurugan, Hall-Barrow, Blevins, et al. “A pilot study of diabetes education via telemedicine in a rural underserved community…” http://tde.sagepub.com/cgi/content/full/35/1/147
Telemedicine would certainly be more accessible to under-served populations and sounds like a promising breakthrough in health care reform. Internet fora are popping up where individuals can post questions and licensed MDs respond with real advice at no charge. Web-education resources (e.g. WebMD) also supplement this. Two pressing problems need to be addressed, however. 1) How do we get people to be more responsible about self-care? 2) How should the legal system address mistakes arising out of telemedicine advice (wrong prescription/diagnosis) be ?