Los Angeles clinic shows flaws in diabetes care

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LOS ANGELES, Oct 8 (Reuters) Two years ago, Mike Metcalfe awoke from a five-day coma ago to discover he was diabetic, a new statistic in a disease that has reached epidemic proportions in the United States and other rich countries.

But unlike some other sufferers of diabetes, which cost the United States an estimated 132 billion dollars per year, Metcalfe has his condition under control and hasn't darkened a hospital door in the intervening two years.

That is thanks to a program designed at the University of Southern California's School of Pharmacy that puts pharmacists into community clinics serving the poor.

In addition to filling prescriptions, they give check-ups, order tests and help high-risk patients manage the complex drug regimens that come with diabetes, high cholesterol and heart disease.

Such intervention helps rein in the costs of treating chronic diseases, which are taking an ever-increasing chunk out of U S health care spending, by paring unneeded drugs and tapping programs that provide common, or even the latest, medicines free of charge or at steep discounts.

''If you give the right medicines, you will save in the long run,'' said Steven Chen, the program's pharmacist supervisor, who oversees five pharmacists and five residents working at seven Los Angeles safety-net clinics and a mobile asthma van in Orange County.

Metcalfe, 53, takes his medicine religiously, has adopted a healthy diet, and has moved on from his tiny room on Los Angeles' Skid Row - one of the poorest areas of Los Angeles and a home to many indigent people.

''Dr. Chen saved my life,'' said Metcalfe, who still attends the same clinic in Skid Row.

''I do not want to live a nightmare,'' said Metcalfe, who saw diabetes ravage a relative's health and is determined to stay clear of its expensive and devastating consequences, which can include heart disease, kidney failure, amputation and blindness.

TAKE TWO PILLS, SEE ME IN THE MORNING A new study from the Milken Institute found that common chronic diseases -- including cancer, diabetes, heart disease, stroke, lung problems and mental illness - cost the United States at least 7 billion in medical treatment and more than 1.05 trillion dollars in lost productivity in 2003.

It goes on to suggest that the bill for chronic illness could hit trillion by the middle of the century, and emphasizes that much of that additional cost is avoidable.

Public health officials are particularly concerned with the fast rise in diabetes, which affects at least 194 million people worldwide and is expected to top 300 million people by 2025, according to the World Health Organization.

It cost the United States 92 billion dollars in medical costs and billion in indirect costs in 2002, according to the Centers for Disease Control.

''Diabetes is like an accelerant'' for other health problems, said Dr. Alan Marcus, medical affairs director at device maker Medtronic Inc .

Countries in Western Europe and Scandinavia use databases kept by their national healthcare system to track patients and coordinate care.

Such national efforts, which may reduce waste and prevent life-threatening emergencies, are not in place in many poor countries or in the United States, where 47 million people were uninsured last year.

The United States is also burdened with a shortages of doctors specializing in endocrinology and geriatric medicine. At the same time, pharmacists who could help ease the burden often are not reimbursed for patient care.

The federal government has taken steps to raise the profile of pharmacists.

A federal agency provided seed money for the University of Southern California program and several others like it. And in some cases, Medicare will pay pharmacists to consult with elderly and disabled patients who have a lot of prescriptions.

Still, doctors say the current U S system offers private insurers little incentive to invest in intensive disease management.

''It requires up-front expenditures for future benefit, which an insurer won't necessarily realize. It's contrary to their financial interests in a way,'' said Howard Wolpert, an endocrinologist who teaches at Harvard Medical School.

In the cases where people are not improving despite all efforts, Chen employs the old-fashioned house call.

In one recent case, he tracked down the ''address'' of a man who lived in a camper shell on the corner of an abandoned lot.

Chen said the mystery was solved when he found the man's insulin. It was stored as recommended in a refrigerator. But the refrigerator had no door and was sitting in the center of the lot, far from any source of power.


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