CASE STUDY:

Graft Treatment for Diabetic Foot Ulcers

CHALLENGE

Many patients had trouble offloading for the 3 months it took for their grafts to heal, and as a result, their grafts failed. Our client wanted a program that would support patients so they would be more likely to complete the full course of treatment applications, and have the best results for their graft.

HCS SOLUTION

We designed and delivered an omnichannel patient support program to promote self-care and increase adherence to therapy.

IMPACT

Our support program increased product use by 2.31 additional applications per patient during the course of treatment and increased revenue by 55% per patient.

A Patient's Experience

MEET DAVID

David*, a 59-year-old construction worker with painful foot ulcers caused by advanced type 2 diabetes, didn’t like going to the doctor. Eventually his poor health forced him into early retirement and he reluctantly made an appointment with his clinician.

STRUGGLING WITH TREATMENT

David left his doctor’s office with multiple prescriptions and an appointment to return for graft treatment for his foot ulcers. He was in pain, overwhelmed, and depressed. How could he keep track of his medications? Who would help him while he recovered from the grafts? How would he stay off his feet when he had to go grocery shopping?

ENROLLED IN THE PROGRAM

Dr. Landers* was concerned that David wouldn’t offload or keep his grafts clean. She also knew that David didn’t like going to the doctor and worried that he wouldn’t keep up with his medications or come back for follow-up appointments. She suggested that David enroll in the Patient Support Program.

WELCOME PHONE CALL

David’s Treatment Experience Nurse called to welcome him to the program and completed a barrier assessment, which was entered in the SmartCARE Platform and reported to David’s clinician through the Clinician Feedback Loop.

Clinician Feedback Loop: Barriers identified

  • Self-care and offloading
  • Emotional concerns
  • Medication routine and logistics

SUPPORT OFFERED

The Treatment Experience Nurse listened to David’s concerns and answered his questions. She gave him tips on how to care for his grafts, encouraged him to use his removable cast walker and to offload as much as possible. She helped him build a medication routine and suggested he make a list of family and friends who could take him to appointments.

Clinician Feedback Loop: Barriers discussed

  • Self-care and offloading
  • Medication routine and logistics

Communication preferences

  • Patient interested in receiving more information by email

Content Delivery: Email

  • “Care After Graft Treatment” reminded David to stay off his feet, keep his grafts clean, and gave instructions on how and when to change the dressing
  • “Finding Support” suggested reaching out to friends and family to help with specific tasks such as cooking meals and grocery shopping
  • “Build Your Routine” gave more information, motivational tips, and activities to help him stay on track with his multiple medications

BARRIERS REASSESSED

During the next scheduled call with his Treatment Experience Nurse, David said he was feeling isolated and frustrated that he couldn’t be as active as he used to be while his grafts healed. The Treatment Experience Nurse empathized with David and suggested he talk about his feelings with his clinician, a friend/family member, or a support group. They also reviewed David’s list of family and friends and worked together to plan when David would call them and what he could ask them to do.

Clinician Feedback Loop: Barrier discussed

  • Emotional concerns
  • Medication routine and logistics

Content Delivery: Email

  • “Connect With Others” offered suggestions on staying connected while offloading at home, such as asking a friend to come over for a card game or a movie
  • “Ask for Help” recommended asking a friend or family member to drive to and/or attend appointments and help keep track of prescription refills

TEXT MESSAGES

Once David opted to receive text messages, he got reminders about upcoming appointments, along with motivational tips such as:

  • Ask for help if you need it, and be specific. Friends and family may be unsure about what they can do to help.
  • Focus on what is in your control, like offloading, taking your medicine, and keeping up with monitoring appointments. It can help to know that you are taking positive steps for your health.
  • Set small goals and focus on your progress to avoid frustration during treatment. Take it one day at a time, and celebrate your achievements.

ONGOING SUPPORT

During subsequent scheduled calls, the Treatment Experience Nurse continued to monitor David’s progress, reassess his barriers, and update his record for the SmartCARE Platform and Clinician Feedback Loop.

 
A Clinician’s Experience

SETTING EXPECTATIONS ABOUT SELF-CARE

Dr. Landers told David that he should stay off his feet as much as possible and explained how to care for his grafts. She was concerned that David was overwhelmed by all the information and wouldn’t follow through without additional support.

LIMITED TIME AND RESOURCES

Dr. Landers didn’t have the time or resources to address David’s psychosocial needs.

SOLUTIONS

The Patient Support Program provided additional personalized support that complemented Dr. Lander’s care of her patients and helped her monitor their progress between appointments, including the:

  • Treatment Experience Nurse, who educated David on how to care for his grafts, addressed his emotional needs, and offered support and advice throughout treatment
  • Clinician Feedback Loop, which shared information collected by the Nurse Case Manager between appointments, including reported side effects, missed doses and refills, and barriers addressed

MORE SUPPORT, BETTER OUTCOMES

As a result of being enrolled in the Patient Support Program, patients like David were more likely to complete their full course of treatment and therefore have better outcomes. Clinicians were able to provide better care for their patients because the program helped clinicians set expectations for self-care, strengthened patient–clinician communication, and provided data between follow-up appointments.

*Illustrative, not an actual patient/clinician

Channels of Support

TREATMENT EXPERIENCE NURSES

Nurses identify and address each patient’s treatment barriers during scheduled outbound calls and are available via a 24/7 hotline to answer questions and offer support

SUPPORT MAILERS & EMAILS

Information, tips, activities, and motivational messages are sent to patients throughout treatment based on patient barrier assessments and Nurse Case Manager conversations

TEXT MESSAGES

Personalized text messages remind patients to take their medications and keep them informed about their upcoming appointments

CLINICIAN FEEDBACK LOOP

Reports real-time data on patient status and engagement with the program via a portal, push email, or fax

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