By Catherine Bolgar
The explosion of chronic diseases threatens to be a major health issue in coming years, especially with the baby boomers entering old age. Getting patients to participate in, and assume responsibility for their own care, is key to keeping health care costs in line. In 2050, the number of people older than 60 is expected to reach 2 billion.
Indeed, health budgets are under pressure in all countries, causing a rethink of how to structure the way it’s delivered and paid for. For example, both the U.S. and U.K. are moving toward value-based or outcome-based care, with incentives for providers to coordinate care and improve quality of care, rather than payment based on the number of procedures done.
“The key word is going to be patient engagement,” says Felipe Lobelo, associate professor of global health at Emory University in Atlanta. “That means not just taking care of someone who’s sick, but also preventing someone from getting sick in the first place. The health-care system is going to be more proactive in working with people to make healthy choices.”
One study found that having a voice in decision-making led patients to better adhere to treatment, with better outcomes. Another found that patients who used online systems to see test results, manage their medication list and exchange secure messages with their providers felt more in control of their own care and were more satisfied.
“The bigger challenge is what to do to keep patients well,” says Phil Koczan, chief clinical information officer at UCL Partners, a health-science partnership linking higher education and National Health Service (NHS) members in the U.K.
The difficulty is how to identify those patients, many of whom don’t see a doctor on a regular basis, and how to change their behavior.”
Five key behaviors are related to avoiding chronic disease—never smoking, regular physical activity, no or moderate alcohol consumption, normal weight and enough sleep. In a recent study, only 6% of Americans do all five.
While physicians try to offer advice and support to people with risky behaviors, “it’s quite difficult and time-consuming, and resources are limited to offer that sort of support,” Dr. Koczan says. “But there’s a lot of benefit if we can get it right.”
Wearable devices and mobile applications can help—if patients stick with them. A device “doesn’t say how to change eating habits or how to change exercise habits. It’s not personalized enough,” says Vibhanshu Abhishek, assistant professor of information systems at Carnegie Mellon University in Pittsburgh. “Devices need to get more personalized and give specific recommendations based on current behavior. Just walking 10,000 steps isn’t enough. It has to give goals and specific instructions to individuals—if I ate a big lunch, then here’s how much more I need to work out today.”
Devices are most useful “when the intervention is tailored to the patient,” agrees Dr. Lobelo. For each patient, “it needs to be tweaked. It’s a never-ending series of projects and applications, not one universal solution.”
Another aspect of prevention involves keeping patients with diseases or chronic conditions from becoming sicker. Most patients with chronic conditions are at home, not hospitalized, so no doctor or health professional regularly observes whether they follow the recommendations they’ve been given, Dr. Abhishek says. “Mobile apps provide an opportunity to collect this information in a cost-effective manner on a continuous basis. Using algorithms or health-identification tools, a doctor can figure out whether a treatment is working. It hasn’t been possible to do this in a generalized way because data collection has been so expensive. In the future we can say treatment A works for this type of patient, and treatment B works for this other type of patient, based on the data from mobile devices.”
A number of online platforms offer information and support for self-care by patients with different diseases. The University of Pittsburgh developed iMHere, a mobile health platform to empower chronic-disease patients for self-care under a clinician’s guidance. For example, iMHere aims to help spina bifida patients avoid secondary complications, such as skin problems and urinary tract infections, through remote monitoring, with clinicians sending patients customized treatment plans. Other programs aim to help cancer patients manage their care, such as managing the accumulation of lymph fluid after breast cancer treatment.
Health systems are going to be more proactive in working with people to make healthy choices,” Dr. Lobelo says. “Including patients—that’s the center of the whole thing. We want to encourage people to self-measure and use the data to improve their health. An active dialog needs to happen.”
Catherine Bolgar is a former managing editor of The Wall Street Journal Europe, now working as a freelance writer and editor with WSJ. Custom Studios in EMEA. For more from Catherine Bolgar, along with other industry experts, join the Future Realities discussion on LinkedIn.
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