Monday, January 16, 2006

$0.50 per Patient per Year

Capital I for Internet (it's the only one)

I run across many diabetes programs, technology and clinical trials for new twists on diabetes programs and of course, each one is special and each one involves the people with knowledge looking to impart that knowledge on those with diabetes. In classic educational system style, knowledge osmosis is believed to flow across all participants and hopefully some patients can retain and apply this newly imparted knowledge to their own benefit.

This paradigm has certainly benefitted millions of people with diabetes so far. However, the pace at which diabetes is expanding is far exceeding the System's ability to keep pace. Note the recent series in the New York Times - a raw piece of journalism that was quite honestly difficult for me to read due to its honest portrayal of diabetes and its lack of 'sugar-coated' personal interest styling.

One piece of information that I came across not too long ago has been especially troublesome for me. In the arena of Public Health, the goals are not necessarily or realistically applied to individuals but to improving the lot of a larger population. One population based diabetes program in the NYC area, coincidentally, told us that they only have a diabetes program budget of 50 cents to spend for each patient in the greater Metropolitan area of several million people. Consider that approximately 7% of the population has diabetes. That's a lot of patients. I'm just not sure how much you can really expect to accomplish within a classical education paradigm given that one stamp per patient per year could consume 74% of that program's budget! "Aha, then let's put up a website and save that postage." With the rise of the Internet, unfortunately too much of the research and focus of diabetes program managers has the Internet at the center of their diabetes education strategy. Consider that there are still millions of patients who lack convenient access to the Internet and that this same demographic also has a disproportionate share of the diabetes in this country. Alas there is no panacea for getting the word out. No one size fits all approach to improving our future.

There is no shortage of technology; no shortage of test strips. No shortage of paper or Emergency Room trips. But what will come to light in 2006 is how much emphasis must be placed on interpersonal communication as a powerful diabetes program and not from a program designed in the classical diabetes education model.