Tech, Pharma on Chronic Disease ManagementBy Miriam Bello | Mon, 11/29/2021 - 17:19
Mexico’s high prevalence of chronic diseases is an issue going beyond medicine treatment. To address this health and economic burden, experts suggest technology as a support to improve health outcomes, reduce, mortality and expenditure.
Disease management (DM) is the concept of reducing healthcare costs and improving quality of life for individuals with chronic conditions by preventing or minimizing the effects of the disease through integrated care, says the Academy of Managed Care Pharmacy (AMCP). DM cuts costs from avoidable complications by identifying and treating conditions more quickly and more effectively, thus slowing the progression of the disease. It facilitates healthy lifestyles by focusing on prevention and healthcare access.
Chronic disease management (CDM) programs are proactive, organized sets of interventions focused on the needs of a defined population of patients. The University of Wisconsin says that though designs may vary, CDM programs are usually multi-component efforts that include planned visits to teach patients about their disease and coach them on healthy behaviors including medication adherence and skills for self-management of chronic conditions in partnership with a coordinated, multidisciplinary care team. According to the AMCP. Programs should also support the provider-patient relationship and plan of care, optimizing patient care through prevention and proactive interventions based on evidence-based guidelines and incorporating patient self-management to continuously evaluate their health status and potential outcome improve overall health and quality of life.
Mexico’s urgency for CDM is based on the high prevalence of chronic diseases and poor health habits of the population. The country’s population pyramid shows that 75 percent of adults are under 55 years of age while, at the same time, millions of people at risk of developing a chronic disease are among the economically active population, explains the study “Mexico and the Challenge of Chronic Non-Communicable Diseases” by Barba Evia José.
José highlights obesity, diabetes, dyslipidemias, arterial hypertension, diabetes, metabolic syndrome, nonalcoholic fatty liver disease and chronic kidney disease as the most urgent diseases to be managed by proper programs that address unhealthy life styles and ensure proper treatment attachment.
One of the latest national efforts to manage chronic diseases, specifically obesity, diabetes and overweight in Mexico, began in 2013 with the National Strategy for Prevention and Control of Overweight, Obesity and Diabetes, whose objectives are to improve the population's well-being, to contribute to the sustainability of national development by slowing the increase in the prevalence of overweight and obesity in Mexicans and to reverse the epidemic of non-communicable diseases, particularly Type 2 diabetes mellitus, through public health interventions, a comprehensive model of medical care and intersectoral public policies. To date, this strategy has expanded and aims to have stronger, wider impact among the population, with earlier campaigns to ensure timely diagnosis and treatment of the selected diseases.
Another significant reason to strengthen CDM in Mexico is the cost burden of these diseases on the health system. A study by PLOS One, called “Medical Expenditure for Chronic Diseases in Mexico: The Case of Selected Diagnoses Treated by the Largest Care Providers,” found that the most expensive chronic disease for Mexico’s Ministry of Health (SSA) and IMSS was chronic kidney disease (CKD), with an annual unit cost per patient of US$8,966 for SSA and US$9,091 for IMSS. CKD, arterial hypertension, Type 2 diabetes and chronic ischemic heart disease accounted for 88 percent of the total chronic disease financial burden (US$1.42 billion) of SSA and 85 percent (US$3.96 billion) of IMSS. The financial burden of the nine diseases analyzed by PLOS One represent 8 percent and 25 percent of the annual health expenditure of SSA and IMSS, respectively.
Mexico’s strategy to address obesity, overweight and diabetes has not delivered as expected, according to Deputy Minister of Health, Hugo López-Gatell. “(The strategy) had implementation problems, the government did not have a technical program on health promotion in all states or performance and impact indicators. There was also a lack of inputs for detection, such as test strips for metabolic control of people with diabetes, among others.”
Despite being restructured under the current presidential administration, CDM programs have failed to include novel innovations that could make the strategy have a greater impact and it was until Sept. 2021 that the government announced the National Digital Strategy 2021-2024 to change this panorama . But it is not unusual to see traditional CDM programs fail, according to the Tony Blair Institute for Global Change. Factors such as limited and costly provider time, lack of visibility into care gaps, complexity of care coordination, insufficient personalization and an inconvenient patient experience are among the things that could fail when implementing a traditional CDM program.
The current digital era is propelling different support tools targeting engagement, patient participation and data analysis to better manage chronic diseases. The Tony Blair Institute enlists the following tech tools scaling CDM:
- Prediction and identification of patient care gaps through predictive analytics to identify patients who are at high risk of developing a chronic disease or not being provided with guideline-directed care.
- Care coordination and communication tools to coordinate care of complex patients between providers, as well as third parties, patients and caregivers.
- Evidence-based behavioral interventions and protocols delivered mainly through software to increase personalization and improve the patient experience.
- Consumer-friendly monitoring to facilitate the use of consumer-grade hardware and support technology to allow for more frequent and convenient data collection on patient vitals and behavior.
- Telemedicine through the use of video, audio and chat-based communication.
“Technology is key,” said Gabriela Allard, President, Mexican Diabetes Association, to MBN. According to Allard, it is not possible to effectively manage diabetes without technology. “Auto monitoring has advanced tremendously in recent years, from simple glucometers to sophisticated equipment that connects to computers and smartphones to keep track of the patient’s blood sugar, sending the information directly to the doctor. This data allows physicians to offer the most personalized diagnoses and treatments.”
While, systemically, Mexico waits to integrate technology into a national strategy, the private sector is already developing programs to address some of Mexico’s health burdens. “Sanofi is developing AI applications for devices that people use all the time: wearables. In Mexico, we have just presented a new application, ‘Delivering Patient Health’, which collects information from patients with diabetes or hypertension to facilitate monitoring their treatments from their mobile devices,” shared Fernando Sampaio, Country Lead and General Manager, Sanofi Mexico and Sanofi Pasteur, with MBN. According to Sampaio, Sanofi has a broad medicine portfolio for patients with Type 1 and 2 diabetes, which is currently complemented by the use of monitoring technologies to track glucose levels, alert the patient and their doctor of necessary adjustments and ensure adherence to the personalized treatment.
Bristol Myers Squibb (BMS) is another company betting on tech for disease management. Sandra Ramírez, General Manager, BMS Mexico and Colombia, told MBN of BMS’ innovative project called Vamos Contigo, which is an assistance and patient education program to ensure access to therapies through complementary assets. “This program was especially valuable during the pandemic to make sure patients had support from the company to ensure adherence to treatments and also for medicine supply continuity,” said Ramírez.
The healthcare system must be able to provide care continuity in different settings, says the International Journal of Environmental Research and Public Health. “This can be a daunting task when patient knowledge is limited, medical data on conditions is non-aggregated and healthcare professionals lack access to vital information to monitor, treat and counsel patients.” While some patients may not have access to healthcare living in remote areas, advances in technology and digital health are gaining momentum to improve access and engagement.