For those of us involved in the delivery or financing of healthcare, acutely feel the frustration of disease progression and increased healthcare costs due to patient non-compliance. While the term, “non-compliance of prescribed treatment” has now fallen out of favor, and “barriers to care” is now the preferred expression, regardless of the phrase used, the results are the same. That is, patients not following the advice of their health care providers results in increased office, or the significantly more expensive, emergency room visit. While this holds true in most avenues of health care, it is particularly obvious in the treatment of diabetes as compliance to the prescribed glucose testing protocol must be managed by the patients themselves.
The common barriers to care for those who aren’t checking blood sugar as often as they should are as follows:
1. The anxiety and pain of the repeated “fingerstick” (needle-phobia).
2. Lack of time or opportunity.
3. Cost of medical supplies, especially test strips.
4. Not being in a location where it is appropriate to test (e.g., driving).
5. Social embarrassment.
The anxiety and pain of the fingerstick is the most prevalent, and yet most controllable by the healthcare community. This article will describe three reasons how overcoming the barrier caused by the dreaded fingerstick will not only improve patient outcomes, but will also contribute to a significant reduction in healthcare costs.
The three reasons are:
1. When blood glucose checking doesn’t hurt, patients test more often.
2. When patients test more often, their A1c drops, frequently more than 1%, according to a 2011 study published in Diabetes Care.
3. With every 1% point drop in A1c, on average, there is an annual saving in healthcare costs of up to $1,457 per patient, as well as better outcomes, according to several studies, including those published in peer reviewed journals.
To further explain:
1. Patients test more often if it doesn’t hurt. Not only is this intuitively obvious, but there is evidence that those with diabetes claim to have many reasons for not testing. In one-on-one interviews, patients revealed that avoidance of fingerstick pain was the primary reason they didn’t test as often as possible.
This was understandable because traditional clinical thinking had been that only blood drawn from painful fingerpricks was valid. Fortunately, except for the very rare cases of rapidly changing blood glucose levels, evidence from clinical trials, including a study published in the American Association of Diabetes Educators verifies that testing from alternate sites; specifically the palms will provide readings virtually identical to fingers, within meter accuracy. In addition, the FDA, which is staying current on this new data, has recently cleared a standalone lancing device for alternate site testing.
Painless lancing is achieved by precisely controlling lancing depth so the needle only reaches the surface capillaries, not the deeper pain nerves. As soon as lancing is completed, vacuum is automatically applied to this very shallow site, drawing out the required blood drop.