Online management comes of age for chronic conditions

October 1, 2009

Online virtual lifestyle management must include evidence based programs that are flexible and integrated

ONLINE PATIENT SELF-MANAGEMENT provides a dynamic and economically feasible means for physicians to interact with patients. It can extend the practice of medicine to reach more patients, more frequently to improve their health outcomes.

Those with obesity, for example, are at increased risk for cardiometabolic disorders: type 2 diabetes, high blood pressure, high cholesterol, cardiovascular disease as well as premature death. The complications of type 2 diabetes alone add about $23 billion a year to the nation's healthcare costs, with obesity-related illnesses resulting in more than $117 billion in annual healthcare expenditures.

Yet, the ability of the medical community to create significant and sustainable changes in patient lifestyle choices has been limited for a variety of reasons. Healthcare providers have been restricted by the availability of clinical personnel, the cost of providing the needed services in an exclusively one-on-one environment, and by the difficulties patients have in accessing information and support.

Today, chronic care is being dramatically altered by the confluence of several trends, such as patients wanting an active role in managing their own health and a collaborative relationship with their healthcare providers and their health plan; widespread, low-cost internet access; advanced Web 2.0 technologies; wireless health monitoring devices, such as accelerometers, blood glucose meters, scales, and blood pressure sensors; and plans' integrating population-based risk assessments with disease management and wellness services.

Patient self-management supported by information technology is becoming an important factor in the way providers deliver healthcare. Clinicians can support patient behavior change in an economical, practical, and profitable manner. Health plans can offer a new paradigm of care delivery with improved services to its members that are an extension of the onsite clinical setting.

Creating and maintaining such multidimensional education and support systems requires a wide range of technologies. Using modern software development methodologies ensures requirements and solutions that will evolve through collaboration between these cross-functional teams. Additionally, healthcare organizations can contract for services, rather than buying programs and the computer hardware on which to run them, in what is usually referred to as a software-as-a-service (SaaS) model.

For example, the Virtual Lifestyle Management service (VLM) is an online program based on the Diabetes Prevention Program (DPP), a weight management approach developed by the University of Pittsburgh faculty under a federal research grant from the National Institutes of Health. Through Web-based technology, the VLM delivers the DPP research-proven lifestyle interventions aiming to enhance the efficiency and success of healthcare provider weight management programs.

The DPP was a multi-year study with 3,234 adults with pre-diabetes in 27 U.S.-based centers, in which an intensive behavior change intervention was used to increase patients' physical activity, improve nutrition and decrease weight by 5% to 7%.

The DPP decreased the progression to diabetes by 58% (5% vs. 11% for the control) and by 71% for those individuals over 60 years of age. It was more effective than the diabetes drug tested (metformin). The intervention consisted of face-to-face, individual counseling sessions with a skilled coach at a per patient cost of about $3,540 over three years.

A recent 50 person year-long pilot study of the DPP, delivered online as the VLM service, demonstrated 38% of the participants lost at least 7% of their body weight.

To be successful, these programs must be:

The industry is moving to a medical model in which patients are given the tools they want and need for self-management with the process remaining under medical guidance and oversight. A new means of interaction is necessary if the industry is to have a functionally useful role in patient self-management and behavior change. The one-on-one paradigm typically cannot deliver, in a cost-effective way, what is needed.

-Neal Kaufman, MD

Neal Kaufman, MD, MPH, founded DPS Health, and is co-founder of the UCLA Center for Healthier Children, Families and Communities. He is a professor of pediatrics and public health at the UCLA Schools of Medicine and Public Health.