Here’s one of those ideas born out of a frustrating clinical scenario, one we’ve all been in.
You have a fragile diabetic, with insulin compliance a major issue, and you’re working towards getting glycemic control back in order. Calling the patient every few days to refine the regimen. Then suddenly one day, you call, and the number is no longer in service. Or the voicemail box is full. Days go by, weeks go by, finally they reappear, back to square one, sugars completely out of whack. They couldn’t afford their cell phone bill.
This is not an uncommon occurrence, and not only in diabetes, but in a number of chronic diseases that require regular follow-up.
My idea is simple, and patterned loosely after similar programs that exist in the United States, like Lifeline and SafeLink. The government partnering with mobile providers to supply a free phone (an inexpensive older model) with free unlimited local minutes (and unlimited voicemail capability), to individuals who are deemed by a health care professional to be medically fragile.
Certainly there would be the concern that this type of program could be easily abused, but I’ll throw in a few caveats. One, the application would have to be initiated by a physician who has personally had difficulty reaching that patient for medical reasons. I realize there is an inherent bias there that would favour those with access to regular primary care, but since the goal of the program is to increase medically-relevant communication, I think this is a fair criteria. Specialists, walk-in doctors, and ER physicians would also be able to file an application. Make the application non-billable to OHIP. If physicians think it will make their life easier to track down a patient, they’ll complete the application regardless of remuneration. A narrative would be included as part of the application providing the details of how communication has fallen apart in the past.
The argument could be made that all low-income families could benefit from mobile phone subsidies, but let’s focus on the low-hanging fruit that we can all agree on for now. Interrupted communication with our medically-fragile patients is a direct threat to their health, and costs the system huge sums in down-stream medical management.