The next six months are make or break time for the latest generation of chronic disease management programmes in Europe, as results start to roll in.
Many European national health services spend more on a single chronic illness, diabetes, than on cancer. So techniques which enable patients to manage chronic disease through telehealth have immense potential.
Results will start to roll in from a series of projects started in Europe, all covering different aspects of chronic disease management. Initial claims are very promising with one operator claiming a 52% reduction in hospitalisation and a fall in GP visits of a third. But will these survive more academic audits?
Largest is probably the DEHKO diabetes programme in Finland.
Active since 2003, it covers over a quarter of the Finnish population, some 1.5m in all. Those running the project have got initial figures, but by early 2010 should have definitive numbers on the impact of the programme.
The programme aims to educate Finns of the dangers of diabetes and how to avoid it, identify those most at risk and put them onto programmes, as well as providing the best treatment for those who have developed the condition.
In Germany, by this autumn, big healthcare insurer DAK will have crunched the numbers on the first 18 months of its programme for 42,000 diabetics.
Run by Healthways, the US service provider, initial results are positive. Patients are contacted by nurses in a central telesupport centre. Cornelius Erbe at DAK confirmed the initial positive results, but is cautious of giving out real figures just yet.
Meanwhile, in the UK this month (June 2009) we should see the publication of results from Birmingham Onehealth. This is a telehealth programme run at Birmingham East & North PCT since 2006 with service provider Pfizer Health Solutions.
The programme now covers diabetics, COPD, hypertension and heart failure, and the results are being measured against a control group by Birmingham University.
Other big programmes will also start to report results over the next six months.
In France, Health Dialog, the US service provider owned by BUPA, is running a programme for diabetics and, once again, early results are said to be positive.
In Spain, a smaller programme at the Barcelona Hospital Clinic should soon be reporting final figures.
Running since 2000, this 500 patient programme is believed to save 10-12 acute hospital beds at any one time. A new deployment study is extending the programmes to cover other co-morbidities and wellness and rehabilitation, and, for the first time, implanting it at other institutions.
Where else are programmes running in Europe?
The answer is almost everywhere.
In the Netherlands, many primary care groups are joining together to run programmes. One of the largest is run by the Diemuraal Foundation, and covers 10,000 type 1 and type 2 diabetic patients in the Eemland district. Manager Sieb Hagoort says he has not yet generated scientific results.
In Denmark, a pilot has been run in Copenhagen, involving the Institute of Public Health. One of the managers is academic Anne Frohlich. She says the project so far covers around 700, mainly diabetic, patients. Other programmes include smoking cessation.
Frohlich says: "When we talk to patients it seems very successful, but we haven’t got any definite numbers yet."
In Sweden there are other large-scale projects, mainly run from nurse-led healthcare centres specifically set up to help the chronically ill.
Pfizer is running other programmes in Italy and Finland.
These chronic disease management programmes are just the tip of the iceberg. Much depends upon how you define a programme; across Europe there are thousands of smaller initiatives, often carried out by family doctors, which are basically chronic disease management programmes in a smaller form.
