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Health Today: Chronic disease management programs

by Richard Goldstein, MD, vonRoenn Family Chair in Surgical Endocrinology last modified Aug 30, 2010 11:40 AM

(Editor's Note: Health Today is a regular column from health care professionals at UofL that features information ranging from health issues to UofL faculty/staff benefits.)

In 1900, the average human could expect to live about 40 to 45 years. Since then, life expectancy has doubled. Along with that increase in life expectancy, is the realization that most of us will develop some type of chronic disease — such as diabetes, hypertension, asthma, chronic obstructive pulmonary disease, cardiovascular disease and depression — during the course of our lives. Critical to one's living as healthy a life as possible, even in the face of a chronic disease, is having the knowledge to manage one's health and having access to efficient and high-quality health care.

At the University of Louisville, teams have been assembled to create innovative approaches to the management of chronic diseases for people covered under all of UofL's health care benefit packages. The first one is focused on diabetes.

Diabetes management has been a tremendous challenge for health care providers and their patients. About 7 percent of the adult population in the United States is diabetic and they account for 10 percent to 12 percent of health care costs.

At UofL, almost one quarter of the health care dollars spent are associated with people who have diabetes, and those costs increased by 17 percent last year. The average diabetic is on eight medications. These medications are not just diabetic medications, but include those for high blood pressure and high cholesterol.

An initial look at the health of our UofL "family" with diabetes suggested that many had poorly controlled diabetes and poorly coordinated health care.

Armed with this information, UofL leadership challenged a team representing many aspects of health care delivery to "do better," to create a program that would deliver state-of-the-art diabetes care to the UofL "family" in an efficient and well-coordinated manner. Leadership also challenged the team to create a program that would remove money as a barrier to a someone receiving great care.   

In April, 2010, with the strong support of the university provost and the executive vice president for health affairs, UofL initiated a diabetes program for any person covered by UofL's health plans who has diabetes.

Tina Claypool, PharmD, a pharmacist with additional training in diabetes management, serves as a personal coach for our diabetics as well as the primary "point of touch." Her office is in the outpatient pharmacy on the first floor of the UofL Health Care Outpatient Center.

When a diabetic attends her or his first scheduled visit, she spends close to an hour assessing their knowledge of diabetes and self-management skills, reviews the medical and medication record, identifies the primary care physician, does a foot check, reviews laboratory data including the HbA1c level (this is a measure of how well their sugars are controlled) and explains the diabetes program. She then schedules the next visit, stays in touch with the primary care physician and helps coordinate needed care with other physician specialists.

In return for participating in the program, each diabetic receives four hours of nutritional and diabetes education. Additionally, there are no co-pays for all diabetes, blood pressure and lipid medications, as well as diabetic supplies. This means that for people at UofL with diabetes, these medicines and supplies are free! Because of this program, lack of money should never be a reason that diabetics in the UofL family cannot get their insulin or other critical medications needed to maintain and improve their health.

Understanding one's medications and having the access to these medications should result in improved health — fewer trips to the emergency room and fewer hospital admissions.

Already, more than 130 people have enrolled in the program, and the results have been exciting. Those enrolled have been thrilled with the program and, on average, participants have experienced a full 1.0 percent drop in their HbA1c levels.

We know that for every 1.0 percent drop in the HbA1c level, there should be a 40 percent drop in eye, nerve and kidney complications from diabetes. So far, we think we are doing better!

What's next? Another pharmacist Janet Mills, PharmD, has been added to the diabetes team as enrollment has increased. And additional programs for people with depression and chronic obstructive lung disease (COPD) should be in place by January. Plans are in the works for even more programs. At UofL, we are very committed to delivering high quality and affordable health care for our family.

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