GHP September 2015

ghp September 2015 | 21 research and development In the healthcare industry, “management” is a magic word that blankets all manner of excuses and that often fails to address basic issues such as “disease education”, which is the axis on which healthcare should be balanced. There are as many definitions of disease management as there are disease manage- ment programs. The confusion is perhaps rooted in a fundamental paradox: In disease management, we really should try and manage patients, not diseases. All managed healthcare programs should have a com- mon goal. They should focus on an integrated, pro-ac- tive approach to delivering healthcare services to patients who have a particular disease to achieve good outcomes at the most reasonable cost. It is absolutely pointless to tell a patient to purchase a blood pressure monitor and to monitor himself regularly if the patient is not made aware of what he is attempting to control and what his parameters are. As a manufacturer of BP monitors, receives information regularly informing us that patient’s blood pressure has fluctuated by “four whole points” in a day or that doctors are informing patients that their BP was 120/80. Some users of our technology ask why the Microlife Blood Pressure Monitor tell them that their BP is 128/74? This could mean that they do not understand their disease and that they therefore cannot control it. We believe that an understanding of the parameters of hypertension is essential to its eventual successful control. Health is more than just the absence of disease… Doctors, treating one patient at a time, have to focus on the unique needs of each individual patient. Some South African doctors are fighting with South African medical aids using the contentious argument that standardized guidelines promote a “cookbook” approach to patient care that cannot account for the variation and complexity they encounter in the examination room. The challenge for medical aids is to find a practi- cal way to implement standard guidelines with the flexibility for doctors to tailor-make plans for the needs of individual patients. Measuring and analyzing pa- tient-centered data can help meet this challenge. Doctors are more likely to support disease manage- ment methods if they allow for doctors to consider the needs of individual patients. And vice-versa, patients are more likely to benefit from disease management if guidelines can be tailored to their specific circum- stances and experience. Armed with clinical and patient-centered data, doctors can design and implement structured plans matched to the individual needs of their patients. Hence, dis- ease management need not be viewed as an inflexible “cookbook” approach to healthcare. The single most important step for doctors treating hypertension is to enlist their patients as partners in their own healthcare. If a doctor recommends that patients take their BP measurements at home, they must make sure that the patient is doing it right, making sure that they are testing their BP at the same time every day and ensuring that the patients use monitors that are validated by the BHS or the AAMI. Since the medical use of mercury is being more and more restricted around the world, the calibration and accuracy of non-mercury devices is becoming increasingly important. The doctor must compare the patient’s readings with theirs to determine accuracy. Blood pressure values obtained by home measure- ments are several mm/Hg lower than those obtained by office measurements with home blood pressure values of around 125/80 mm/Hg corresponding to clinic pressures of 140/90 mm/Hg; home blood pres- sure measurements also provide numerous values on different days in a setting closer to daily life condi- tions than the doctor’s office. It also favorably affects patient’s perceptions of their “hypertension” problems and improves adherence to treatment. A new plan due to be unvieled soon aims to reduce the cost of blood pressure monitors by over 50% in South Africa. This program will also be aimed at im- proving patient compliance to drug medication sched- Germany has the biggest market in the world for blood pressure monitors. Last year alone, 2.8mn blood pressure monitors were sold in Germany. From the point of view of a manufacturer of blood pressure monitors, this is wonderful. It is good business. However, we must also ask a question that has an unpleasant answer… Is this also good health management? Unfortunately, from a person who prefers to view blood pressure monitors as useful only if used in the context of a managed healthcare pro- gram, the answer is an emphatic no. Do German people who buy a blood pressure monitor have a better cardiovascular risk profile than those who don’t? The answer is “not really”. The rea- son for this is that many people who buy a blood pressure mon- itor do so to assuage their guilt about their poor lifestyle but do not really change their lifestyle.