In
the current healthcare system, there is a lack of time for quality education,
communication, and follow-up from the physician. The lack of patient engagement
is exacerbated by a fragmented healthcare system where insurance coverage is
tied to employment and patients must change providers when they change jobs.
The
United Kingdom has been one of most successful in diabetes management out of
all developed countries. This achievement is very much a result of a
single-payer insurance system and strong patient engagement. Under the National
Health System (NHS), health insurance is provided by a single-payer – the
government - and funded by taxes. Patients are assigned to physicians to
maintain the continuity of care. Because Government insurance also eliminates
copays and caps on clinic visits, which allow patients to get more frequent
preventive care. A large supply of nurses facilitates the sharing of health
decisions with the patients through house visits and group education. For
example, diabetes-trained nurses help engage the patients in self-care through
educational and self-management courses like the Diabetes Education and
Self-Management for Ongoing and Diagnosed (DESMOND) or the Dose
Adjustment For Normal Eating (DAFNE).
Community matrons or nurses can provide in-home continuing care to chronic
patients, and help with physical and psychosocial wellbeing, which in turn
reduces visits to the physician or hospital admission.
Personalized healthcare, an approach being developed at Duke University, focuses on patient-centered
healthcare, personalized health planning (PHP), and patient engagement. Patients
are given the opportunity to engage with their own health by identifying areas
in their life where they are motivated to make changes for their health. In
initial visits, physicians assess the patients’ risk including family history,
genetic markers, lifestyle habits, and other biometric data during the
appointment. Then, the physician and patient work to create a timeline for
health improvement. Through the time frame of the plan, health coaches and nurses
monitor the patients’ progress and help them meet their health goals. It promotes the use of health coaches and nurses to
provide education, support, and outcome tracking for the patients, similar to
the United Kingdom approach. Shared Medical Appointments (SMA) allow patients
with the same diagnosis to receive group education from Medical Health
Technicians, discuss their goals with each other, receive psychosocial support,
and access a medical team together to improve the efficiency of physician
visits.
While
we are working on developing more effective approaches to chronic disease
management, we also need to develop better infrastructure to support patient
engagement. The central ideas of
personalized healthcare planning – intensifying the patient’s role in health
management, establishing a personalized health plan, and tracking the execution
of health goals – guide us in the right direction. The United Kingdom should
serve as a reference for us as we integrate prospective healthcare into our
healthcare system and begin to focus on preventive health.
Shelley Chen, is a senior at Duke University and a research intern at Duke’s Center for Research on Personalized Health Care.
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