Appalachian Clinic Chronic Patient Education Solutions

Anita Dodson Boseman

Mobile Clinics—Appalachian RegionThe Foundation has two mobile medical clinics (this picture is generic for this class). Each clinic has a permanent staff that travels a set route each month. This offers the patients the stability of knowing their healthcare professionals and being assured that the same day and time each month they can see their medical team.

Need—Diabetes is a Chronic Disease with a higher incidence in Appalachia

• The people of Appalachia have a higher percentage afflicted with diabetes than any other group whether in the region or in other parts of the country (Ludke, 2009).

• Diabetes has a negative stigma attached to it by the people.

• Without proper care, side effects can be serious and/or deadly.

• Caregivers, family members, as well as the patients need education in proper care.

Need—(continued)

• Type II—Adult Onset Diabetes is the most prevalent, but Type I—Juvenile Diabetes is also found.

• Patient Education, Monitoring, and Education of Family and Caregivers is essential to long-term management of the disease.

• Stigma of lack of self control, laziness, and idleness are attached with diabetes.

• , “40 to 80 percent of medical info provided by doctors and practitioners is forgotten almost instantaneously. Pamphlets are static and confusing, and get discarded quickly” (Empson, 2014).

Need (continued)

• Past efforts have been unsuccessful and patient personal care has suffered.

• Diabetes is a “unique chronic disease in which the decisions most affecting the health and well-being of patients are made by the patients themselves” (Dyer, 2013).

• One-on-one counseling with medical staff involving patients, family, and caregivers has included:– Brochures– Printed Fact Sheets– Provision of Daily Log Books– Various other books and pamphlets

GlookoGlooko Meter Sync is the product and system that has been found to help solve the problem. The device will read blood sugar levels from 30 different blood glucose meters and transfer the information to applications available on Android and iOS systems. Applications available on these phone systems will also allow the patients and caregivers the opportunity to also input medication information, heart, diet, O2 levels, and various other facts that when transmitted to medical personnel, will allow them to remotely monitor patient conditions that might herald dangerous situations that if cared for immediately, might save the patient a trip to the Emergency Room or potential devastating side effects.

Glooko (continued)

• There is currently a high percentage of people in these regions that have Android or iOS devices.

• Applications for patient care and monitoring are readily available.

• Patient, family, and caregiver education can be delivered via mobile devices.

• By monitoring the various elements in their care, patient’s are empowered to help care for themselves.

RESEARCH

Now we know the problem and we think we have a solution, what is the research behind this solution?

Research

• Jennifer Shine Dyer, M.D. conducted a study on the effects of “Pattern Management or the systematic approach to help patients identify patterns in their own blood glucose readings to determine whether changes are needed to optimize their glucose control” (Dyer, 2013).

Research (continued)

• Dr. Dyer looked at seventeen studies that used the “systematic telemonitoring of adults with diabetes” (Dyer, 2013) and they each showed that adults with diabetes who used the devices consistently were found to “have a positive impact on patient and clinician behavior” (Dyer, 2013).

• Glooko, the system this project will investigate, uses “structured monitoring (which) puts patients in charge of their diabetes” (Dyer, 2013).

• Patients that used this system tended to use fewer test strips, achieved lower A1C (long-term control) levels, and had more confidence in their own care.

DEVELOPMENT

“We are a team dedicated to helping people with diabetes live life while effortlessly managing their diabetes (Glooko, 2014).”

Development

• “In June 2010, Yogen Dalal, Sundeep Madra, and Chamath Palihapitiya conceived the idea behind Glooko because each one of them was touched by diabetes in a meaningful way. Since then Glooko has become an innovative Silicon Valley company that delivers a mobile and cloud based, diabetes & chronic disease management system. We strive to improve health outcomes for people with diabetes and reduce the costs associated with diabetes population management. Glooko is dedicated to bringing innovation to diabetes management around the world” (Glooko, 2014).

Development (cont.)

• Glooko first appeared on the market November 15, 2011, was compatible with 13 meters and had 1 application.

• October 2, 2014, Glooko is compatible with almost 40 meters, several applications, and can transfer information from meters to iOS or Android phones or pads via Bluetooth Technology.

COMMERCIALIZATION

Diabetes is a chronic disease that affects a large percentage of the American population. It costs billions of dollars a year to treat and

is constantly in the medical and medical-research news.

Commercialization

• Glooko has a corporate website, https://glooko.com/ where the item and the attending applications for Android and iOS devices are available.

• The site has a patient portal where additional information is available.

• The website has the provider’s portal where medical personnel can find additional applications for patient care and tracking.

• Patient, family, and caregiver educational applications would be provided through the Foundation as well as the devices. Each device is about 30 USD.

Timeline for Adoption

• The Foundation would be adopting the technology in three phases over a period of 18 months.– The first phase would include the medical personnel,

designers, and educators.• Medical personnel would be trained in the use of the items,

would be asked to identify specific individuals that would be targeted for Early Adoption, and asked to identify any possible problems with the target population.

• The designers would need to integrate the specific applications used by Glooko into the Foundation’s usage channels.

• Educators would need to fashion the specific training materials needed to train up and down the flow line.

Timeline for Adoption (cont.)

– The second phase will be the rollout of Glooko to those identified as Early Adopters by the medical personnel in the two medical teams.

• The Early Adopters will be given special training on the use of the technology and asked to help those in their area who have questions or problems.

• People who have also been identified by our personnel who have prestige and influence in the community will also be approached for their support.

• A program of handbills, flyers, posters, and brochures will be accompanied by notices on their phones via text-message.

Timeline for Adoption (cont.)

• The third phase of the rollout will entail the more aggressive push to have Early Majority Adopters start using the product.

• If the Early Majority and Early Adopters can encompass the majority of the patients, the Laggards should not be far behind.

• There will be some who will never adopt for various reasons but it is more important to have them as patients than to push a technology they will never use.

Key Figures Needed for Adoption

• The members of the clinic teams that are native of the Appalachian Region must take the lead in identifying those people who will be the opinion leaders for this device’s acceptance.– This will be done by observation– This will also be achieved by identifying key

informants

Optimal Opinion Leaders

Once identified, the opinion leaders need to:• Have the necessary stature among the

patient population to garner their respect and admiration

• They must be accessible• Outside of the patient population, these

opinion leaders must have the respect of the community at large

Why Glooko?

Glooko has not been in the market for long, but the market is new.

Many patients need to have an easy way to log their meter readings and doctors need to stay on top of their patient’s needs.

The meters will allow for more than blood-glucose readings and will help promote better health among the patient population.

Glooko is easy to use, merges well with existing technology, is cost effective, and would help the patients and their health care professionals.

The educational needs for the use of the device is simple and easy to learn.

S—Curve Based on Foundation Numbers

S--Curve based on Foundation NumbersPeople Time

Innovators 11 1Early Adopters 57 3Early Majority 145 8Late Majority 145 8Laggards 68 4Total 425 24

Inno

vato

rs

Early

Adopt

ers

Early

Majo

rity

Late

Majo

rity

Lagg

ards

0

40

80

120

160

S--Curve Based on Foundation Numbers

Ad

op

ters

Works Cited

• Dyer, J. S. (2013). Effects of Consumer-Facing Technologies on Patient Engagement, Behavior Change, and Type 2 Diabetes-Related Health Outcomes. Diabetes Spectrum, 98-101.

• Empson, R. (2014, March 25). YC-Backed CareMessage is On a Mission to Improve Health Literacy by Bringing Mobile Healthcare to the Underserved. Retrieved from TechCrunch.com: http://techcrunch.com/2014/03/25/y-combinator-backed-caremessage-is-on-a-mission-to-improve-health-literacy-by-bringing-mobile-healthcare-to-the-underserved/

• Glooko, Inc. (2014). Retrieved from Glooko: https://glooko.com/ • Ludke, R. L. (2012). An Appalachian Neighborhood's Response to

Diabetes. Journal of Appalachian Studies, 176-188.• Smith, S. L. (2008). Cultural perspectives on diabetes in an

Appalachian population. American Journal of Health Behavior, 291-301.