Gnanagurudasan Prakasam, M.D. a pediatric endocrinologist based in Sacramento, Calif., is dealing with a critical, fragile patient population the same way most people connect with their long lost friend.
He is doing it through social media.
As the medical director for the Pediatric Endocrinology, Diabetes and Healthy Life Style program for children at the Sutter Medical Center and the founder and president of the Center of Excellence in Diabetes and Endocrinology (both based in Sacramento), Prakasam has young patients whose lives are measured by the number of insulin shots they take. As he notes, if they miss one day of doses, the results could be severe.
Prakasam's vast life experiences--he is board certified in three countries: India, Canada, and the U.S.--have allowed him to think in a more nontraditional way. He has developed a social media program which connects his pediatric patients to each other for support.
The program has been a hit and Prakasam, who will be a featured panelist at the Institute for Health Technology Transformation's (iHT2) San Francisco Health IT Summit, shared details of his success with Healthcare Informatics Senior Editor Gabriel Perna. Below are excerpts from their conversation.
What are you doing to connect with patients through social media?
I run one of the biggest Type 1 diabetes practices in the country. We have more than 1500 children coming as far as six hours away. Kids ranging from less than one years old up to 21 years of age. They have to live with diabetes. They have to take five shots of insulin per day. They have to check their blood sugar eight to ten times [per day]. That’s the population they are. They are intensely monitoring it all the time. They live and breathe diabetes all of the time. If they missed insulin, even for a day, they can go into severe dehydration and up to a coma.
It's a unique patient population, it affects their day-to-day life from sports to school to their day care providers. Having them interconnected and supporting each other creates a better standard of living for them. With that in mind, about 15 years I started a listserv connecting these patients. About seven years ago, I switched over to using multiple channels. I have YouTube videos, I tweet, I blog. The most important thing I do is I interconnect these patients so they can talk to each other on a regular basis. They talk about how they deal with this on a daily basis. They are supporting each other. For instance, when the parents are out of town and the kid is staying at the grandparents, they are on the phone supporting the grandparents. I'm the link between all these guys meeting each other on a consistent basis. They have developed relationships. As far I know, this is the only physician-run support group [connecting through social media].
What are the benefits of connecting with patients directly through this kind of platform?
It improves the quality of care significantly. These patients and their parents live under constant stress. Their life is occupied with diabetes. They are under constant pressure about managing their diabetes better. Any kind of support they get from the next family makes their life easy. If you go to the Facebook group, you'll see the kind of interaction we have going on. I have a paper coming out...it reveals that 78 percent of my patients said I take better care of them because of social media. Seventy eight percent. They think a physician takes better care of them because he is available on social media. They don’t feel alone. They feel I'm with them all the time.
Why is it ideal for patients with pediatric diabetes?
The management is intense. Type 2 diabetes patients, if they forget to take their medicine, they're not going to land in the hospital. If they don't take care of it over a period of time, their health will deteriorate. Whereas, these patients, if they miss insulin, even for a single day, they can go as far as getting in a coma. It occupies their life. It drags on the family to have to live with that. They have to live and breathe every single day of their life. That's why it's important.
At Sutter, you are doing some unique things with telehealth and connecting with patients directly. You, yourself are doing social media. What's the philosophy behind this? It seems like you are involved with a lot of nontraditional methods of healthcare.
I come from India, I am board certified in the U.S., England, and India. I have seen different healthcare delivery systems, different kind of social economy groups, culture everywhere I have managed exists. The one constant is the privilege these families give me to take care of them. I am not doing them a favor. These families are doing me a favor by helping me to help them. They are giving me an opportunity to take care of their child. I feel by being available to them in different modes, a part from the traditional way of managing diabetes, makes me more human. It makes them feel I’m part of their life. It makes them feel I am not away from them.
What are some of the challenges you face in this nontraditional environment?
I do not charge any money for this, I'm not providing any medical advice. When a regular physician does something like this, it has to be on his or her own time. There is no compensation for this in today's healthcare environment. To really do something, like this it becomes extremely difficult. We’re all tied down for time. Where is a physician or a nurse going to find the time? If the patient satisfaction is better, if they get better, if there is incentives built in, more people will think like this. It will enable the patient to take better care of their diabetes.
As an example, my readmissions rate in the hospital for diabetes is about five percent. The average nationally is 9-to-15 percent. I don't have an answering service in my practice. They can call me 24/7. I have 1500 children with diabetes. However, they don’t call me that often. By giving them more access, they are using it more appropriately. The answering service gives them more incentive to call. They know they don’t have to call necessarily because they can call whenever. That's the difference.
Register here for the Health IT Summit in San Francisco to hear more from Dr. Prakasam on using social media to improve care for pediatric diabetics