By Anne Federwisch, OTR
January 20, 2000
Photos: Courtesy of DiabetesWell

Before certified diabetes educators Michelle Perrot, RN, and Penelope Mayes, RN, began providing diabetes disease management online, they were a bit apprehensive about using a computer to interact with patients instead of dealing with them in person. But they’re firm believers in Internet nursing now.

“I love patient bedside care. I did not think this would be for me at all,” said Mayes, unit director of nursing for the Atherton, Calif.-based Web site DiabetesWell. Previously, she and Perrot worked in the more conventional clinic setting of the diabetes wellness center set up by endocrinologist and DiabetesWell founder Joe Prendergast, MD.

Although Perrot, manager of e-health communications for DiabetesWell, does miss meeting people in the clinic, her online role has far exceeded her expectations. “We still feel that we have that human interaction, that human contact,” she said. “It may not be face to face, but we’re still able to connect with people.”

Broad reach

Prendergast began a diabetes news service via the Internet in 1998, but the online disease management program didn’t launch until October 1999. Currently, 620 people subscribe to the diabetes management component, while the site itself (with general information about the condition) logs 31,500 hits per day, Perrot said.

The numbers reflect the growing consumer trend to seek medical information online. Diabetes Web sites in particular are proliferating, said Rick Mendosa, a freelance writer with Type 2 diabetes. Mendosa writes a column called “About the Internet” for the American Diabetes Association Web site. Since he started tracking diabetes sites in 1995, the number has grown from six to about 800.

Despite the plethora of diabetes sites, DiabetesWell is in a class of its own because of the interactive role of the health professionals with subscribers, Mendosa said. “It is a unique approach.”

Personalized plans

Patient education is the key part of the new service, the nurses said. “We’re empowering them with knowledge,” Perrot said.

Once patients enroll, they fill out an extensive intake summary and send in information about their blood-glucose levels. The medical operations manager then contacts clients for administrative purposes, much like a front office staff member would in a clinic. Patients receive a personalized treatment plan; a secure, personal Web site for their medical information; a LifeScan glucose meter and starter kit; and a daily dose of “Dr. Joe’s E-news.”

The nurses review subscribers’ information and contact them based on their glucose profiles and to address any questions, problems, or concerns. Currently, nurses e-mail patients as needed, though a system for continual follow-up care and support is being developed.

Internet communication allows the nurses to divide their time among patients in increments as small as a few minutes, allowing them to effectively interact with about 25 to 30 patients a day. Though subscribers frequently e-mail the nurses when they’re first enrolled in the program, the rate tapers off as the clients gain knowledge, Mayes said.

Patients eventually will pay $19.95 per month for the service, but it’s currently free. Plans are under way to contract with health insurers to cover the cost as a preventive measure. LifeScan manufacturer Johnson & Johnson and entrepreneur Regis McKenna are key investors in DiabetesWell.

Freedom to ask

The online format has benefits the nurses did not originally foresee. E-mail offers subscribers an uninhibited way to ask questions without feeling like they’re bothering the health professionals. “What we’ve seen on the Web with patients is that once we develop a rapport with them, they talk about things and share things with us that we feel might [otherwise] never get to the ears of a physician,” Mayes said.

Perrot agreed. “What we’ve found is that instead of the Internet being impersonal, it’s become really personal,” she said. “We were shocked by that.” They’re finding that people reveal potentially embarrassing information more often on the Internet than in person because someone isn’t sitting across from them and judging them. So, the nurses now field a lot more questions about erectile dysfunction and recreational drug use than they ever did in the clinic.

Because the program is so new, it’s too soon to evaluate outcomes, Perrot said. But they are collecting data such as lab results, patient satisfaction surveys, number of emergency room visits, and specialist consultations to eventually gauge effectiveness, Mayes said. But Mendosa already lauds the site. “Even as conscious as I am about diabetes, it got me to watch what I was doing a lot better,” he said.

Despite their enthusiasm for their new positions, the nurses admit the job does have its downside. Because the Internet is available 24 hours a day, there is no formal end to their day. With long days and some weekend work, they often put in 60 hours a week. And the site is only effective for patients who can use e-mail and read the information provided.

But Perrot and Mayes aren’t willing to relinquish their cyber-roles for the clinic. “We’re blazing a trail,” Perrot said. “It’s exciting.”