Dr Doaa Azhr Alhaboby, Consultant Chronic Care Management, Medcare
What was the idea behind starting the chronic care management programme at Medcare?
Whenever patients are diagnosed for any chronic condition, they take the medication and leave. Patients usually don’t visit on regular basis, or do so every three months. Living with a chronic condition is not easy. It means taking your medication on time, monitoring yourself regularly, and changing your lifestyle. We took this holistic approach to offer continuous care of patients in a unique multi-dimensional approach.
At Medcare, we aim to empower patients to change their lifestyle, to get them to self-monitor, take the medication and most of all also regularly visit their doctors without missing their appointments for examinations, and lab tests
Medcare’s chronic care management programme is an evidence-based intervention that includes a closed loop of communication between the treating physician, the case manager and the patient. We aim to empower patients to change their lifestyle, to get them to self-monitor, take the medication and most of all also regularly visit their doctors without missing their appointments for examinations, and lab tests.
Once patients enrol for this programme, what can they expect?
Anyone enrolling for this programme will get a personalised care plan from their doctors, and also a dedicated case manager to track their progress. The programme has 12 sessions that are structured on monthly basis for a year. Patients will also get the required technology to keep us updated on their progress such as Bluetooth-enabled glucometers and blood pressure monitors.
These allow us to see if patients are monitoring their condition or if there is something wrong, we can get in touch with the treating physician and get back to the patient on what to do. The technology also enables us to track if the targets set are being followed.
Patients within the chronic care management programme also get access to teleconsultations and home services so that they never miss an appointment or examination. If they are not able to see their doctors they can get connected on the teleMEDCARE consultation platform and if they can’t make it to the hospital for their lab tests we will send someone home to take their samples. It is ideal during the pandemic, especially for elderly patients, who can’t leave their homes to go to the clinics.
Dr Abdul Jabbar, Consultant Internal Medicine and Endocrinologist, Medcare
What is chronic care management?
It is a system of coordinated healthcare intervention and communication. The biggest health problem the world faces is from non-communicable disease or chronic disease, such as diabetes and hypertension, and hypercholesterolemia. If not managed well they lead to heart and kidney problems as well as other complications because this is a chronic disease issue. Helping patients with self-care empowers them and healthcare providers to manage the disease well and prevent complications. At Medcare we explain the process to patients and they often develop interest and register for the programme. This was very evident during the Covid-19 lockdown.
How dangerous is diabetes if not detected at all?
Diabetes is usually asymptomatic, which is where the problem arises. The Emirates Diabetes Society guideline, of which I am one of the authors, and is similar to international American guidelines, suggests that if you are 40 or above, you should check your sugar at least once a year. Considering diabetes is being detected early in our part of the world, the Society now recommends going for a check-up once a year after you turn 30. In terms of symptoms, check if your blood sugar is 150 instead of the regular 120. This translates to an additional 30 mg of glucose in your blood per 100 ml that is passing through your heart, eyes, kidneys and brain every minute. So if your diagnosis is delayed even by just three to six months, a lot of damage has already been done, and this cannot be reversed.
There’s a new group of tablets called SGLT 2i inhibitors, which is very good because in the last ten years, we have so much data available. They are good in terms of not only controlling blood sugar, but for the majority of patients who are overweight. They make you lose weight as well. And in the long run, after five or ten years, research data has shown that the newer agents are helpful in decreasing complications arising from heart attacks, strokes, heart failure and kidney disease. So moving to new medication is a good idea.
What’s important to note is that up to 90 per cent of diabetes cases are seen to suffer from obesity and weight gain, which is usually followed by prediabetes, which at times is not easy to diagnose when checking your sugar. In essence, if you have a family history, are overweight and above 30, you must check if you don’t have symptoms. Number two, if you are below 30, overweight and there are cases of diabetes within the family, be sure to avail of a check-up. For the record, a person with prediabetes can enrol for the Medcare programme.
How careful do patients need to be during the current pandemic?
For the record, diabetes patients who take all Covid precautions including wearing masks, maintaining social distancing and avoiding crowds are as much at risk as the normal population from contracting the Covid virus. And for diabetics, any infection could lead to hyperglycaemia and high glucose levels. Poor diabetes control will lead to glucose levels going up.
Firstly, it’s important to observe all Covid precautions without fail; Number two, if you think you have symptoms, go in for a check-up; Number three, keep monitoring your blood glucose levels. Patients with Covid who lose their appetite may have to decrease their dosages after checking their blood glucose levels. You may have to decrease your dosages as well to avoid low blood sugar or hypoglycaemia.
Have there been any advances in science that have helped in chronic care management?
There’s a new group of tablets called SGLT 2i inhibitors, which is very good because in the last ten years, we have so much data available. They are good in terms of not only controlling blood sugar, but for the majority of patients who are overweight. They make you lose weight as well. And in the long run, after five or ten years, research data has shown that the newer agents are helpful in decreasing complications arising from heart attacks, strokes, heart failure and kidney disease. So moving to new medication is a good idea.
There are also injectables or injection therapies available that are useful. New-age devices being used in continuous glucose monitoring or Flesche glucose monitoring also afford simple ways to check your sugar between 10 to 30 times a day, and without pricking yourself on your fingers.
Dr Zaineb Sabri, Specialist Internal Medicine, Medcare
How does the chronic care management programme work?
This programme has been running at all our facilities at Medcare for more than a year to help control chronic diseases, such as diabetes, hypertension, and also lipid problems. It’s a huge challenge to get people’s lives in order because they have not understood the concept of chronic diseases. They think if they take medicines for a period of time and then stop it, the disease will go away. The main aim is to make people more aware about their condition and advise them on how to maintain their medication and lifestyle. We enrol patients throughout the year and a case manager will keep a check on their medicine intake, adherence to lifestyle changes and achieving the target we have set for them from their first visit.
The main aim for the programme is to make people more aware about their condition and advise them on how to maintain their medication and lifestyle. We enrol patients throughout the year and a case manager will keep a check on their medicine intake, adherence to lifestyle changes and achieving the target we have set for them from their first visit
How does one enrol for the disease management programme?
The patient has to be diagnosed for chronic diseases. Either we diagnose them when they come for a check-up for any other ailment or they already know they have it and come for consultation. We advise those with chronic diseases to enrol for the programme and educate them on what it entails. Once they’re with us, we will keep a close eye on them and help them control their condition. Patients who are compliant have done very well in achieving the target set for them at the beginning of the programme.
And as far as the management of the disease is concerned, has anything changed in the way things are done?
We keep making changes to make it easy for patients. We have changed the fee structure and offer discounts on many facilities. It’s a free service for people who have insurance or if not we will advise them on something that works for them. We have dietitians on board in each facility for patients willing to follow a diet plan or a weight reduction programme. We also have some agreements with fitness facilities, cooking facilities and coaches so that patients can modulate their behaviours and achieve their target.
In the management of diabetes, do you encourage devices that can be used for testing at home?
It is very important in the management of the disease. We insist that patients who are newly diagnosed use the device because it will help us monitor their condition. Patients should be aware of what is the target and the ideal blood sugar level. If they have consumed a heavy meal and the blood sugar level is high, they would be aware that the meal is not good for them and change it. We have to let them know the target they have to achieve to control the disease and for that they need to understand a good reading from a bad one.
You also offer a complimentary consultation with the psychologist. Do you think that’s necessary for a diabetes patient?
Actually, it is, because some people are reluctant to understand that this is a chronic disease and are not willing to change or they think it doesn’t matter. We need to understand where they are in the process of change and therefore some reluctant patients should be counselled very well by an expert on their problems.
You will also receive a 30 per cent discount on Medcare’s Homecare Services for lab, nurses, physiotherapy and doctor visits.
TOOLS You will receive tools that will help you manage your condition — smartly. These include an easy-to-use app, portal, and convenient devices.
EDUCATION AND SUPPORT With the guidance of a dedicated case manager, you will receive monthly coaching calls, education, target setting, and educational material that will give you a deeper insight into your condition.
WELL-BEING MANAGEMENT You will be entitled to an optional discounted subscription to a healthy meal plan, personal trainer, gyms, and yoga sessions, healthy cooking classes, and a complimentary session with a psychologist.
— Call 800MEDCARE (6223373) or visit www.medcare.ae