The number of people diagnosed with chronic illnesses continues to increase exponentially with heart disease, stroke and diabetes being the most widespread and costly health problems. Billions of dollars are spent annually treating chronic diseases, yet most of them are preventable with better diet, stress reduction and increased physical activity. Healthcare leaders do their best to emphasize prevention, yet traditional methods fail to ensure patient adherence. While many individuals aim to improve their health, busy lifestyles make it difficult to increase exercise and eat healthier.
Often, when patients are diagnosed with a chronic disease, they don’t adhere to their physicians’ directives to keep the disease from progressing. Unfortunately, too many chronic conditions go untreated, creating an avoidable drain on an already overburdened healthcare system.
The Internet of Things (IoT), along with innovations within remote patient monitoring, is making possible the advent of a new generation of wearable devices that can help prevent chronic disease and/or assist with its management once a person is diagnosed. Unlike the mass produced wearable devices on the market today, the next generation of wearables, or Wearables 2.0, provide medically meaningful data to healthcare providers in order to help them understand their patients’ conditions and determine if they are adhering to medical directives.
This is particularly important because although technology already exists to help people help themselves, current methods for managing chronic illness are not making a dent in reducing overall healthcare costs, or in lowering the quality or loss of life. Why? One reason is patient non-adherence.
Patient non-adherence
The problem and cost of patient non-adherence is enormous, yet it has gone uncovered for decades and is a key issue in chronic disease management. Non-adherence manifests itself in patients who do not follow therapy orders, whether it’s drug, physical therapy, or lifestyle changes. While expense is a large part of the problem, even when a patient can afford therapies, fear, forgetfulness and lack of directions directly impact non-adherence.
James M. McKenney, PharmD, in an article entitled Patient Education and Adherence: How to Make it Cost-Effective offers four elements required when developing a program to enhance patient adherence which include enabling, reinforcing, prompting, and problem solving. It is interesting to note that IoT can help with each of these elements:
- Enabling: A wearable device enables a patient to adhere to treatments by providing reminders, instructions and feedback.
- Reinforcing: Feedback helps a patient know if he or she is following instructions correctly.
- Prompting: Reminders and suggestions can help a patient stay on track.
- Problem Solving: Instant feedback can help a patient make good decisions and take the right steps in following treatment protocols.
Identification and intervention: Two helpful factors
According to Neil Chesanow, two big factors help in non-adherence: identifying patients before they don’t comply and intervening once they get to that stage. Using powerful algorithms in predictive modeling has proven to be a useful technique to identify patients who are on the verge of not complying. Chesanow reports, “According to Walgreens’ Kristi Rudkin, predictive modeling has been instrumental in identifying ‘new-to-therapy’ patients, who are at significantly higher risk than existing or ongoing patients of deciding not to take their medication.”
Chesanow also reports amazing results for intervening with non-adherent patients. He cites an interventional approach used by Geisinger Health System in Danville, Pennsylvania who serves 2.6 million patients with an above average population of poor, elderly and sick people. Chesanow quotes Geisinger president and CEO, Glen D. Steele, Jr., MD, PhD as he testified before Congress prior to passage of the Affordable Care Act as saying “Admissions for our patients with multiple chronic diseases have been reduced by as much as 25 percent, and readmissions following discharges decreased by as much as 50 percent in community sites.”
To accomplish this, Geisinger uses predictive modeling to identify non-adherent patients and then intervenes with a care team of nurse practitioners. Most patients will receive a phone call. But patients who need extra help are referred to health coaches who specialize in disease-specific education for conditions like diabetes and chronic obstructive pulmonary disease. In these cases, care teams monitor the patient via phone, texting, email, videoconferencing, or the use of wireless devices that remotely send team members data on the patient’s vital signs.
Improving adherence using IoT
Patient adherence is often low because people just don’t have the appropriate feedback to let them know if they are doing the right things at home on their own. What is needed is a comprehensive tool that gives patients tangible, real time information about whether their condition is improving or getting worse. While many patients have access to email not all do which can be the case with patients who are economically disadvantaged. Today, the IoT and medical technology innovations have the potential to make these types of interventions accessible to doctors and patients who aren’t part of sophisticated integrated systems like Geisinger. In fact, when larger populations are able to utilize tools such as texting and wireless devices, perhaps then there will be better adherence and even greater outcomes. By incorporating metrics into wearables that directly measure clinical improvement, healthcare providers have an unprecedented opportunity to speed up the course of action and reduce the cumbersome cycle of disease management.
Take heart disease, for example. Let’s say a person survives a heart attack and is sent home with a list of medications to take. They are told to start walking, avoid stress, improve their diet and to follow up with their cardiologist. The patient does his best to follow doctor’s orders for about two or three weeks and even starts walking even though he wasn’t physically active before the heart attack. However, he doesn’t really notice any difference in his well-being, so he gradually reverts back to old lifestyle habits. The patient often becomes discouraged from taking care of himself because he doesn’t have the right tools to guide him and measure progress. This scenario is characteristic of the problem that drives patient non-adherence.
In fact, studies have found that people are willing to self-manage if they have the right tools that are easy to use. So what exactly is missing? What does healthcare need to do to help chronically ill patients stop the cycle of non-adherence and worsening symptoms? More and more health professionals are looking for easy-to-use tools that p clinical-grade feedback about their condition, and instructions on what to do next.
The right information in the right hands at the right time
What is desperately needed in disease management is the ability to take medically relevant, clinical-grade data and provide real time feedback to patients that includes a benchmark of their conditions and information about next steps. Clinically accurate patient monitoring devices have the potential to improve outcomes. In fact, a national survey of 1,000 respondents found that nearly 9 out of 10 consumers (88 percent) believe that working in partnership with their healthcare professional will help improve their overall health. The vast majority (78 percent) would also be more inclined to use a personal monitoring device if it were clinically accurate and easy to use.
With the right feedback at the right time, patients can engage in their care after the diagnosis of chronic illness. If wearables are going to aid in chronic disease management, their numbers must make medical sense. The optimal solution is to base the score from wearables on medical-grade data so that accurate and meaningful data is relayed to both the physician and the patient.
Innovations to close the gap
Innovations in medical technology devices and the IoT are poised to help people deal with their chronic illnesses on massive levels through the relay of clinical feedback. IoT technology that incorporates medically relevant, clinical grade data into wearables can help turn non-adherent patients into people who are actively engaged in managing their health. These devices can be seamlessly integrated into healthcare so that when a patient receives a text message reminder to take a medication, that can drive up adherence in drug therapy. When a patient needs to walk after heart surgery and is fearful of having another heart attack, knowing that he or she is being monitored and receiving information in real-time provides a comfort level, that, up until now has not been widely available.
As efforts continue in increasing prevention and patient engagement, a major goal should be to develop clinically-accurate monitoring devices for chronic disease management. This will ultimately lead to subsidized solutions, insurance-reimbursable medical-grade wearables that help encourage and promote patient adherence and support population health efforts.