THIS MONTH'S NEWS

Diabetes OM Programme Improves Outcomes and Saves Costs

... Using 'Diabetes NetCare', the Diabetes Treat­ment Centers of America's (DTCA) comprehen­sive disease management (DM) system, improves clinical outcomes and reduces costs in patients with diabetes mellitus, according to Managed Healthcare magazine.

The 'Diabetes NetCare' programme uses a com­prehensive approach that does not just focus on blood glucose control, but manages the total health­care needs of patients with diabetes mellitus. At a large, self-insured employer in the Mid-Atlantic region in the US, the DTCA programme reduced direct healthcare costs from $US547/patientlmonth 12 months before implementation to $US406/ patient/month 6 months after implementation. This represents a decrease in costs of 25.8%.

Reduction in Admission

Furthermore, patient outcomes improved con­siderably. In particular, glycosylated haemoglobin levels decreased by 9% for patients with type 2 (non-insulin-dependent) diabetes mellitus and by II % for those with type 1 (insulin-dependent) di­abetes mellitus. The percentage of patients receiv­ing retinal eye exams and foot exams increased from 28 to >80% and from 3 to 99%, respectively. In addition, days of inpatient care decreased by 85% and the number of inpatient admissions by 83%.

A 'comprehensive approach, when properly im­plemented and managed, can pay for itself within an I8-month period', says Robert Stone, executive vice president of DTCA. Diabetes Treatment Centers of America. New data show that investing in diabetes care now can save money and improve clinical outcomes. Media Release: [2 pages], 1997 Nov 5

CHF Programme Achieves Dramatic Results

... 12-month data from a disease management programme* targeting congestive heart failure (CHF) show major improvements in the rates of emergency-room visits and hospital admissions among participants. These improvements translate

Dis Manage Health Outcomes 1997 Dec; 2 (6): 318-322 1173-8790/97/0012-0318/$02.50/0

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into cost savings of >$US9 million, according to data presented recently at the National Managed Health Care Congress in the US.

Substantial Cost Savings Realised

The CHF programme involved intensive drug therapy and dietary management. Consequently, pharmaceutical costs for the 1915 patients with CHF participating in the programme increased by $US243 000 (60%), compared with 1995 costs for a comparable patient group. However, this in­creased expenditure was more than offset by the $US9.3 million saving in other medical costs. Prior to the CHF programme, 20% of the patients were hospitalised at least once per month; this decreased to 8% under the programme.

Other positive study findings include: • a 78% decrease in hospital costs for CHF, with

an associated cost saving of $US4.1 million • a 62% reduction in total hospital costs (from

$US12.4 million to $US4.7 million) • a 58% decrease in the number of days in hospital

(from 10623 to 4450 days) • a 52% reduction in home-care and other outpa­

tient costs.

QOL Benefits Seen

Analysis of the data also showed significant di­etary improvement, with a 20% decrease in sodium intake. Notably, measurements offunctional status improved by 15%, indicating better patient quality of life. Overall, 90% of participants surveyed in the most recent 3 months reported full satisfaction with the effects of their treatment. * The programme, conducted in partnership between Cardiac Solutions (a subsidiary ofRalin Medical Inc.) and Humana Inc., focuses on drug therapy and dietary management and uses a home-based, physician-directed and nurse-monitored approach. Humana Inc. is one of the largest US managed-care companies with >6 million health plan members.

Ralin Medical Inc. Humana health plan/cardiac solutions release dramatic new findings in care and treatment of the sickest of the sick. Media Release: [2 pages], 1997 Nov 6

Better Care in Alzheimer's Disease? ... The number of managed-care plans for the treatment of patients with Alzheimer's disease

This Month's News

(AD) is likely to increase in the US, according to a new report from Datamonitor.

The report states that the care for patients with AD in the US remains poor. Therefore, new initia­tives, involving health maintenance organisations, Medicare and pharmaceutical companies, have been launched in an attempt to improve the quality of care in the managed-care setting. Improvements in the management of AD may also generate cost savings, suggests Datamonitor.

The report adds that recent and future drugs used in the treatment of patients with AD will be supported at launch by disease management (DM) programmes that will be introduced simulta­neously. Such DM programmes have already been developed and implemented in line with the mar­keting of some medications: e.g. 'The Family Care System' was developed by Warner-Lambert in as­sociation with tacrine, and TriAD, although not a product-specific programme, was launched by Eisai and Pfizer in association with donepezil. Datamonitor. Pharmaceutical companies, HMOs and disease as­sociations take new initiatives to improve the management of Alzheimer's disease. Media Release: [5 pages], 1997 Nov 17

Improving the Implementation of Asthma Management Guidelines

... Despite the presence of clinical practice guide­lines for the management of asthma, and the avail­ability of effective therapy, many patients with asthma do not receive optimal care, says Dr Charles Homer from the Children's Hospital, Boston, US.)

Consistency Between Guidelines

Dr Homer notes that the core recommendations of various clinical practice guidelines for the man­agement of asthma are consistent. For example, all guidelines recommend the use of anti-innamma­tory agents (e.g. inhaled corticosteroids) as main­tenance therapy for all patients with asthma, except those with mild disease. The guidelines also em­phasise the importance of: monitoring patients' peak expiratory now rates and FEY 1; providing patients with written asthma management plans; and educating them about the proper use of inhalers and factors that worsen asthma.

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In addition, the most recent guidelines from the US National Asthma Education and Prevention Program recommend that long-acting inhaled ~­agonists or theophylline may be used in combina­tion with medium-dose inhaled corticosteroids as an alternative to initiating high-dose corticosteroid therapy. This recommendation is supported by the results of the recently published Formoterol and Corticosteroid Establishing Therapy International Study Group (FACET) study investigating the use of the long-acting inhaled agonist formoterol in combination with inhaled budesonide in patients with asthma.2 It has also been supported by another study investigating the use of low-dose inhaled budesonide plus theophylline or high-dose inhaled budesonide alone in patients with moderate asthma.3

Dr Homer notes that the organisational and so­cial barriers have a major impact on delivering asthma care that is consistent with the practice guidelines.) For example, some physicians may not have access to spirometry equipment, there may be no funds for nurse educators, and the refer­ral of patients to specialists may be restricted by managed-care organisations.

Disease Management Programmes Helpful?

Dr Homer suggests that disease management programmes may be of use in overcoming some of these barriers. Disease management programmes integrate the various components of the healthcare delivery system in an attempt to improve clinical results and reduce costs. Dr Homer explains that dis~ase management firms are able to identify pa­tients with asthma (using pharmacy claims and out­patient visit and hospital records) and categorise them according to the cost of care. Patients in each cost group can then be targeted with specific ser­vices to improve the management of their condi­tion.

Dr Homer concludes that such disease manage­ment programmes are promising in that they may be able to address many of the barriers to good care. However, there are also concerns associated with disease management programmes (e.g. they may fragment care in patients with multiple conditions) and more data assessing the efficacy of such pro­grammes are required.

Dis Manage Health Outcomes 1997 Dec; 2 (6)