November 29, 2013

Technology Might Reduce Doctor Visits

Technology is wonderful, great, and holds many promises. Getting there will be the challenge and making it all work together still has to be worked out. This blog uses two articles and a previous blog of mine to preview some of the possibilities.

The first article points out what nanotechnology has in store for those of us with diabetes. It has had success in monitoring cancer in livestock and work is now being focused on diabetes. Both will require additional testing to pass FDA approval, but the future looks very promising. Using carbon nanotubes, hollow, one nanometer-thick cylinders made of pure carbon is drawing great interest as sensors.

Michael Strano, the Carbon P. Dubbs Professor of Chemical Engineering at MIT has his labs working on sensors for both short-term and long-term usage within the automatic pancreas. His lead person, Nicole Iverson, is working to make the sensors accurate enough to provide glucose readings that can work with the automatic pancreas, but as of yet the results have not been accurate enough. These sensors would be implanted under the skin and would provide data directly to the insulin pump so that it could start and stop when needed. Not only would there be no more finger pricking, but only the removal and re-implanting of new sensors after more than one year of use.
In mobile health apps and home monitoring, doctors will not need to see patients as often for acute problems and follow up visits. Presently, to make this happen, real-world clinical evidence will be needed to confirm the mobile health benefits. Then the apps will be on solid ground for patients, physicians, and payers. The central idea would mean that this would promote patient participation and partnership in their care.

In addition to reducing the number of unnecessary visits to physicians' offices and emergency departments, this would decrease the cost of care. Today, they noted, more than a third of physician office visits are related to an acute condition, and care for up to a quarter of patients presenting at emergency departments could have been managed in the ambulatory-care setting. Most mHealth devices have existed for all of the most common acute conditions and have the potential to allow individuals to forgo an office or emergency department visit through safe, effective and informed management in the home.

On July 18, 2013, I wrote a blog about people with type 2 diabetes that became microexperts. They would be allowed to self prescribe medications and do home A1C tests and have insurance reimbursement. Since then, I have heard from four doctors, two who were very much against this and two more that could accept this provided that the rules were in place and enforced. Three people with type 2 diabetes thought the idea was reasonable, but two were not enthused about the rule idea.

As far as I am concerned, the rules are necessary to prevent abuse and keep the system working properly. With the potential for new technology, mHealth, and other programs, the future does hold out hope for ways to get by even during a doctor shortage. If the new sensor technologies come to fruition, mobile health technologies continue to improve, the patients will benefit, costs may indeed come down and emergency rooms may not be utilized for problems that can be solved at home.

I would encourage everyone to follow the links and read about the possibilities.

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