Using health information technology to prevent and treat diabetes

Abstract

Patients with diabetes need a complex set of services and supports. This chapter presented a cross-section of the year's publications regarding how information technology can help patients can get the services and supports they need to prevent or manage their diabetes. One of the key themes that emerges from these papers (and from my own experience) is that the challenge of integrating the array of services and supports into the diabetes regimen can be successfully overcome through self-management support interventions that are clinically linked and technology-enabled. Why self-management support? A large proportion of the prevention and treatment of diabetes is dependent on the knowledge, attitudes, skills and behaviours of the individual, and providing education and needed support is so important in getting good outcomes. Why interventions? Theory-based, evidenceproven, long-term, longitudinal programmes that are designed for each patient based on his or her unique characteristics, changing needs and performance over time are most likely to get the desired results. Why clinically linked? Patients respond best and are more likely to adopt new behaviours when the approach is in the context of a trusted therapeutic relationship and within an effective medical care system. Why technology-enabled? Capitalising on the amazing power of the ever-improving information technology landscape leads to the delivery of cost-effective, scalable, engaging and holistic solutions to complex clinical challenges such as the management of diabetes. The future for these types of interventions is uncertain. What is known is that self-management education and support can change behaviours and when technology is used appropriately it can improve outcomes. Regardless of the structure of these interventions there are a core set of elements that need to be included in any intervention to maximise the effect. They include approaches to identify patients, encourage programme participation, assess baseline status, provide teaching and learning, set goals, motivate toward goal attainment, measure results towards goals, receive and provide social support, find needed help, provide coaching support. Since the complexity of healthcare settings makes implementation challenging, there need to be efforts to understand how to implement these approaches in diverse clinical settings. One key issue is that clinicians need to be prepared for changes in their education and support roles. The cost to develop, implement and test these types of interventions is considerable, but once they are ready to go to scale the cost to bring them to large numbers of people is relatively low per patient. What is needed is the capital to build them and that will be available if there are ways to pay for an intervention once it is proven effective. Time will tell if the healthcare systems of the world will catch up to these innovative approaches and provide the financial coverage needed to be able to serve those who need education and support to improve diabetes outcomes. © 2012 Blackwell Publishing Ltd.