Introduction
Pump therapy is becoming standard practice around the world. But it has failed to win support in the UK. There it remains an uncommon method of controlling diabetes. I shall propose some reasons for this.
Diabetes care is good in Britain
Britain has a very high standard of diabetes healthcare. Diabetic complications in the UK are rarer than in the US and similar countries. This is partly because of the emphasis on primary healthcare. This is inherent in a state funded system. Doctors are rewarded for pursuing people with diabetes throughout their lives, and offering continuing help and advice in controlling their diabetes. Paradoxically, the old US fee-for-service system rewarded doctors more for treating complications than preventing them. The advent of the HMO system in the US may ultimately reverse this.
Low spending on experimental treatment
In the meantime, in Britain there is little incentive to pursue innovative forms of treatment. Within tight budgets it is safer to spend money on well known treatment schemes.
Pumps were trialled in the 1980's
Trials of the new insulin pumps were conducted in Britain in the mid 1980's. The technology was primitive compared with today, and it was concluded that there were so many problems with pump therapy it offered no advantage over conventional treatment. At its outset pump therapy was rejected. The centralised system did not allow individual health authorities to experiment further.
Progress abroad and ignorance in Britain
This decision was at the time probably correct. However, the diverse and well funded healthcare systems of America and continental Europe provided the means to steadily improve the technology. This advance has occurred step by step, to reach the point today where pump therapy appears to offer people a clearly better life style and outlook. This advance has not been observed by the British medical profession, who are now widely ignorant of the possible benefits.
Pumps not advocated
This leads to a chicken-and-egg situation where doctors do not advocate pump therapy to their patients because they no little about it, and they know little about it because they have no patients using it!
No funding
There is now the further problem of funding. Users often describe the difference between the injection system and pump therapy as the difference between feeling OK and feeling fantastic. The NHS places no value on this difference. Provided the patient is OK, they have fulfilled their obligations. However many patients will clearly place great value on this difference. It is therefore necessary for patients to fund their pumps themselves, costing around £2000. At present about 60% of pump users are able to have the infusion sets and cartridges paid for by their hospital (rather than doctor, or on prescription). The remainder must pay for them themselves in full. This amounts to around £600 per year.
Patient ignorance
The belief that the NHS will provide all necessary healthcare free of charge often discourages patients from taking the initiative to purchase even better treatment. Combine this with doctors' ignorance of the treatment and you have today's situation: of the 250 000 people in Britain with insulin dependent diabetes, fewer than 150 use a pump.
Pump use may increase
There remains hope that in Britain pump therapy will continue to increase in popularity until it is firmly established as yet another conventional method of controlling diabetes.
by John Neale
Last update: 31-Oct-04.
Reproduced with permission.
|
|
|
