CASE STUDY:

Insulin Pump and CGM Adherence

CHALLENGE

Our client wanted more patients to have a strong start with their insulin pump therapy so they would have more success with treatment. Once on the pump, only 80% of patients stayed on the pump for 6 months, resulting in high A1c levels for patients who dropped off.

HCS SOLUTION

We developed and delivered an omnichannel patient support program designed to support both initiation and long-term adherence to insulin pump therapy.

IMPACT

Our support program for new Insulin Pump users reduced 6 month A1c levels by 24% compared to a control group of new Insulin Pump users not receiving HCS program support.

A Patient's Experience

MEET JOE

Joe*, a 52-year-old security guard, had type 2 diabetes. His daily injections were not keeping his A1C below 8 consistently, so his clinician recommended an insulin pump to maintain a more stable blood glucose level.

STRUGGLING WITH TREATMENT

Joe was nervous about using a new device. When it arrived in the mail, he was overwhelmed by the instructions and wasn’t sure he could learn to use the pump on his own. He worried that the pump wouldn’t fit under his uniform and was embarrassed that his coworkers might see it. Joe was also concerned about the ongoing cost of treatment.

ENROLLED IN THE PROGRAM

Joe’s clinician thought he would benefit from additional support, so he helped Joe enroll in the Patient Support Program. Joe’s clinician wanted him to get a good start on treatment so he would be more likely to use the pump consistently.

FIELD CLINICIAN TRAINING

As part of the Patient Support Program, Joe’s clinician invited him to participate in an in-office group training session for patients starting on the insulin pump. Along with other patients, Joe learned more about the benefits of using an insulin pump and gained confidence in his ability to fill, apply, and replace his device.

WELCOME PHONE CALL

Joe’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 Joe’s clinician through the Clinician Feedback Loop.

Clinician Feedback Loop: Barriers identified

  • Lack of education/training
  • Lifestyle changes
  • Medication routine and logistics
  • Financial concerns

SUPPORT OFFERED

The Treatment Experience Nurse listened to Joe’s concerns and answered his questions. She reassured him that the pump would be discreet and that it would not interfere with his job. She also suggested resources for reimbursement/benefits support and signed him up with co-pay assistance to help with his out of pocket cost.

Clinician Feedback Loop: Barriers discussed

  • Lack of education/training
  • Lifestyle changes
  • Financial concerns

Communication preferences

  • Patient interested in receiving more information by email

Content Delivery: Email

  • “Living With an Insulin Pump” shared patients’ success stories about using a pump to better control diabetes
  • “Talking About Your Diabetes” offered advice on talking to friends, family, and co-workers
  • “Affording Your Device” outlined potential resources for financial support

BARRIERS REASSESSED

During the next scheduled call with his Treatment Experience Nurse, Joe admitted that he was having a hard time keeping track of his food intake and managing his insulin dosage. He was frustrated and feeling down. The Treatment Experience Nurse empathized with Joe, helped him establish a system to count carbs, and reviewed how to calculate his carb-to-insulin ratio. She suggested that he log on to the Patient Web App to learn more.

Clinician Feedback Loop: Barrier discussed

  • Medication routine and logistics

Content Delivery: Email

  • “Build Your Routine” gave more information, motivational tips, and activities to help remember when to replace the pump and refill a prescription
  • “Set Yourself Up for Success” provided tips on having a positive mindset throughout treatment

PATIENT WEB APP

Joe logged on to read information about diabetes and how to calculate his carb-to-insulin ratio. He also used worksheets from the Patient Web App to keep track of when to replace his pump and refill his prescription.

ONGOING SUPPORT

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

 
A Clinician’s Experience

LIMITED TIME AND RESOURCES

Dr. Morrison* didn’t have the time or resources to address her patients’ psychosocial needs and set expectations about self-care, but she knew her diabetes patients could benefit from additional support to help manage their treatment.

DATA DUMPS

Before Joe enrolled in the Patient Support Program, data points captured by his insulin pump were delivered as a data dump, which Dr. Morrison and her staff didn’t have time to analyze.

SOLUTIONS

The Patient Support Program’s Treatment Experience Nurse and Field Clinician Training provided additional personalized support that complemented Dr. Morrison’s care of her patients. The program also provided tools that helped Dr. Morrison improve her communication with patients and monitor their progress between appointments, including the:

  • Monitoring App for Clinicians, which analyzed data from Joe’s pump and reported actionable information, such as an alert if Joe wasn’t using his pump
  • 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 Joe were more likely to initiate treatment and stay on their insulin pump and therefore have better outcomes. Clinicians were able to provide better care for their patients because the program strengthened patient–clinician communication, helped clinicians set expectations for therapy, and provided data between follow-up appointments.

*Illustrative, not an actual patient/clinician

Channels of Support

TREATMENT EXPERIENCE NURSE

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

FIELD CLINICIAN TRAINING

Provide field clinicians with training and materials to help patients better overcome barriers to initiation of treatment

PATIENT WEB APP

App that keeps tracks of a patient’s insulin pump, reminds patients of their prescription refill schedule, and indicates when the pump needs to be replaced

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

MONITORING APP FOR CLINICIANS

App that allows the clinician to track the status of their patient’s insulin pump, including missed doses

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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