Empowering patients with digital technology

Empowering patients with digital technology

by | Jan 5, 2016 | mHealth, Patient Engagement

On the previous blog post, “Transforming health and social care with digital technology” connected health or technology-enabled care (TEC) was defined as the collective term used for telecare, telehealth, telemedicine, mHealth, digital health, and eHealth services. This type of technology can empower patients and carers by giving them more control over their health and social care needs. It can also help individuals to obtain more information regarding their health.

In broad terms, TEC can:

  • Improve self-management through remote monitoring, education, and treatment adherence
  • Tackle areas of unmet needs that traditional treatment struggles to address, such as mental health
  • Supports the development of online patient portals and patient communities
  • Transforms the relationship between patients, carers and healthcare providers to focus on co-creation

Enables self-management

Nowadays, patients and their carers use technology to research information online, identify treatment options, rate providers, and share their experiences. Healthcare needs to acknowledge that emerging technologies offer a tremendous opportunity to transform the way people engage with their health.

Besides connecting patients and providers, digital technology leads to better outcomes and a more personalised service by educating patients in regards to their health-related issues, enabling remote monitoring, and supporting treatment adherence.

Informs and educates patients and carers

It is estimated that 75% of the UK population goes online for health information. Websites, apps, videos, texts and free online courses are being used to educate and provide information to patients and their family caregivers [1].

Figure 1 displays the most common category of mobile apps: fitness, medical reference and wellness apps, which provide information with other very limited functionalities.

Figure 1. Digital health app category, percentage share in 2014.


Figure 1

The use of digital technology to educate patients and carers is a crucial driver of patient engagement. Surveys suggest that patients are more likely to make better choices and be engaged in their health if they can access information quickly.

Digital technology connects patients and providers, leading to better health outcomes and a more convenient and personalised service, through informing/educating, two-way remote monitoring, and supporting treatment adherence [2].

TEC can help carers understand and support those they care for by:

  • Providing psychological reassurance
  • Enabling carers to co-ordinate their work-life-care balance through supporting flexible hours and remote working patterns (approximately 2.3 million people have had to give up work to become carers and three million have reduced their hours)
  • Delivering peer-to-peer support

Facilitates remote patient monitoring (RPM)

Remote monitoring uses technology to monitor changes in patients’ health status outside conventional clinical settings.

Historically, it allows a patient to use a device to perform a routine test and send the test data to a healthcare provider. Initially, it depended on a healthcare provider recommending its use to patients. However, digital technology has increased the potential for remote monitoring and, with the advent of apps and wearables, patients are increasingly bringing the innovation to doctors [3].

New advances in the development of biosensing wearables are spreading their capability beyond simply tracking activity. New devices can monitor a broad range of physiology (from posture to brain activity) and convert this information into outputs, through advanced connectivity and computing power.

Biosensing wearables can support people with chronic conditions, automating monitoring and detecting real time changes in an individual’s health status. Data from biosensing wearables can be uploaded to an Electronic Patient Record (EPR) and this information can be used to display an overview of a patient’s medical history in real-time, supporting early diagnoses and early intervention.

If a negative change occurs, patients, family caregivers and healthcare providers can be alerted quickly, preventing emergency admissions.

Increases treatment adherence

In bad cases, failure to follow treatment can cause a patient’s condition to deteriorate, leading to an increased likelihood of hospital admission, permanent disability, or death. Electronic reminders and alerts, via text SMS or apps, can remind patients to follow their treatment regimens, thus improving health outcomes.

The World Health Organisation has calculated that adherence to long-term therapies in developed countries is around 50%, and is even lower in developing countries [4].

In the UK, between one-third and half of all medicines prescribed for long-term conditions are not taken as recommended. It is estimated that the cost of unused or unwanted medicine is around 100 million GBP per annum [5].

Improved adherence allows healthcare providers and pharmaceutical companies to obtain a better understanding of the impact of drugs, including any complications or drug interactions, providing useful data for research. An increasing number of pharmaceutical companies are investing in digital TEC projects to increase patient adherence to the drugs they produce. Likewise, patients and carers are increasingly using digital health software to register and monitor medication intake [6].

References:

[1] Valuing Carers 2011: calculating the value of carers’ support, Carers UK and academics at the University of Leeds, May 2011.
http://circle.leeds.ac.uk/files/2012/08/110512-circle-carers-uk-valuing-carers.pdf

[2] Putting patients first. The NHS England business plan for 2013/14 and 2015/16. https://www.england.nhs.uk/wp-content/uploads/2013/04/ppf-1314-1516.pdf

[3] Primary care working differently: Telehealth and telecare –a game changer for health and social care, Deloitte UK Centre for Health Solutions, December 2012. http://www2.deloitte.com/content/dam/Deloitte/uk/Documents/life-sciences-health-care/deloitte-uk-telehealth-telecare.pdf

[4] Medication Adherence: WHO Cares? Mayo Clinic 2011. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068890/

[5] Aston Medication Adherence Study, Aston University. See also: http://www.aston.ac.uk/lhs/research/health/pharmacy/adherence/

[6] Mobile apps, fighting for patient adherence, Mobile health global, December 2014. See also http://www.mobilehealthglobal.com/in-the-news/news/109/mobile-apps-fighting-for-patient-adherence

[7] Psychological Therapies, Annual Report on the use of IAPT services: England – 2013/14 Experimental Statistics, Health and Social Care Information Centre, September 2014. http://www.hscic.gov.uk/catalogue/PUB14899/psyc-ther-ann-rep-2013-14.pdf

The importance of early intervention in the recovery process

The importance of early intervention in the recovery process

by | Dec 8, 2015 | mHealth

Early intervention is critical to treating mental illness before it can cause tragic results such as serious impairment, unemployment, homelessness, poverty, and suicide [1].

The identification of mental illness and its treatment, as early as possible, represents a high priority. The early detection and treatment of mental illness promote recovery, independence, and self-sufficiency, as well as facilitating social activities and employment opportunities [2].

It is estimated that 100,000 adolescents and young adults in the United States alone experience a first episode of psychosis every year. The early phase of psychotic illness is widely viewed as a critical opportunity for indicated prevention, and a chance to alter the downward trajectory and poor outcomes associated with serious mental disorders such as schizophrenia. The timing of treatment is critical; short and long-term outcomes are better when individuals begin treatment close to the onset of psychosis. Numerous studies find a substantial delay between the onset of psychotic symptoms and the initiation of treatment. In the U.S., treatment is typically delayed between one and three years, suggesting that many people experiencing first episodes of psychosis are missing a critical opportunity to benefit from early intervention [3].

Early identification and rapid referral are essential to shortening the duration of untreated psychosis and pre-empting functional deterioration. The World Health Organization advocates reducing the duration of untreated psychosis to three months or less by addressing “bottlenecks” in the pathway from early psychosis identification to initiation of specialty care [3].

To support early intervention, in 2009, the National Institute of Mental Health (NIMH), implemented a research project to change the prognosis of schizophrenia through aggressive treatment in the earliest stages of illness.Recovery After an Initial Schizophrenia Episode (RAISE) is designed to reduce the likelihood of long-term disability that people with schizophrenia often experience. It aims to help people with the disorder lead productive, independent lives. At the same time, it aims to reduce the financial impact on the public systems often tapped to pay for the care of people with schizophrenia [4].

In 2011, RAISE began conducting a full-scale, randomized controlled trial comparing two different ways of providing treatment to people experiencing the early stages of schizophrenia and related disorders. Both types of treatment emphasize early intervention but feature different approaches for initiating and coordinating care. Treatment may include personalized medication treatment, individual resiliency training, and supportive services, such as family psychoeducation and education or employment assistance [5]. The RAISE study, expected to be completed by August 2016, aims to emphasize the importance of early intervention.

The Monsenso mHealth solution can help healthcare providers to closely monitor patients who have experienced a first episode of mental illness.

After experiencing a first episode, the healthcare provider can encourage the patient to use the Monsenso mHealth solution. This will enable the clinician to monitor the individual on a continuous basis, and react if symptoms arise.

With the Monsenso user app, patients can fill in self-assessments on a daily basis. These self-assessments include information on the patient’s behaviour and symptoms related to his mental health. Furthermore, the solution collects sensor data through sensors in the patient’s smartphone, and this combined with the self-assessment will help the healthcare provider to continuously monitor the patient, and support intervention at a very early stage. Early warning signs and automatic triggers can be set to indicate to the health care provider that proactive intervention is needed, if for example a patient sleeps too little or feels too distressed.

Early intervention and continuous monitoring can maximize a person’s chances of a fast recovery, self-sufficiency, and living a high-quality life including the possibility to pursue and education and maintain a stable job.

References:

[1] Directors Blog: SAMHSA and NIMH partner to support early intervention for serious mental illness. P. Hyde and T. Insel. National Institute of Mental Health Blog (2014, June 17) http://www.nimh.nih.gov/about/director/2014/samhsa-and-nimh-partner-to-support-early-intervention-for-serious-mental-illness.shtml

[2] Early intervention and recovery for young people with early psychosis: consensus statement. J. Bertolote and P. McGorry. British Journal of Psychiatry (2005). http://bjp.rcpsych.org/content/bjprcpsych/187/48/s116.full.pdf

[3] Evidence based treatment for first episode of psychosis: Components of coordinated specialty care. PHD R. K. Heinssen. RAISE NIMH (2014, April 14). http://www.nimh.nih.gov/health/topics/schizophrenia/raise/nimh-white-paper-csc-for-fep_147096.pdf

[4] Raise Project Overview. National Institute of Mental Health. (2009)http://www.nimh.nih.gov/health/topics/schizophrenia/raise/index.shtml

[5] NIMH RAISE Project makes progress as team refines research approach. National Institute of Mental Health. (2011, August 9) http://www.nimh.nih.gov/news/science-news/2011/nimh-raise-project-makes-progress-as-teams-refine-research-approaches.shtml