In a recent (2011) poll by the Pennsylvania Medical Society’s Institute for Good Medicine, 93% of adults said they were more responsible for their healthcare than their doctors were. However, 32% also said they exercised less than weekly, and 43% exercised two or more hours per week. The engagement of people in their own healthcare is a fundamental issue to healthcare reform on many levels. Chronic diseases account for the vast majority of the healthcare budget and most are preventable. Non-adherence to medications is estimated at 50% in patients with chronic diseases (http://davidleescher.com/2011/10/12/mobile-health-technology-solution-to-medication-non-adherence/). There is a physician shortage now, especially specialists. This shortage will grow. Office appointments, in case one hasn’t noticed, are harder and harder to come by in most traditional practices. Proponents and developers of wireless health technologies believe that they will improve patient outcomes and result in significant healthcare expenditure savings. Many wireless technologies involve sensors which operate without the patient even knowing they are in service. However, even a weight scale or blood pressure cuff that transmits data wirelessly requires a patient (or caregiver at the minimum) to firstly remember to use it, and secondly to actually perform the task. Medications need to be swallowed, even though an automated reminder may be sent. The motivation to lose weight or control one’s blood sugar with diet is the foundation for following through with a mobile health patient solution. The emotional GPS to go to McDonald’s needs to be rest. Both motivation and engagement need to occur for many mHealth technologies to achieve their stated goals.
Before asking how people can become more involved in their well-being and healthcare, it will help to examine what the potential barriers are to achieving this. Most patients as well as caregivers today have no idea what medical services cost. Studies have demonstrated that having the price of a test or procedure next to the physician’s automated order, money is saved by ordering less expensive or less of them. Perhaps patients should have a similar list on a mobile app, locally relevant. This idea is not a new one. Below is a copy of a procedural charge list furnished by Pennsylvania Blue Shield in February, 1948:
Certainly socioeconomic and cultural differences between providers and patients affect engagement. Differences among patients with regards to medical literacy will make engagement variable. Providers need to provide information in meaningful digestible ways. This is taught in medical school, but the real world is more diverse than those academic situations. There is great variance in family or caregiver support. This can make all the difference between good and poor outcomes. The provider-patient relationship, rooted in the mechanisms mentioned above, as well as specific interactions (especially the first one) and body language is a big determinant of engagement. Compounding this is the fact that many patients do not see the same provider every visit. Electronic health records provides potentially better continuity of information, but may in fact lead to discontinuity of personal relationships. The provider needs to be supportive, explain the reasons for directives as well as the outcomes without them, and alternatives to specific treatment recommendations. The treatment plan for a chronic disease should be discussed to give the patient and caregiver a broad overview of how much motivation and effort on the part of the patient is required. Supporting educational materials written or viewed in an understandable manner are necessary, as most patients forget most of the conversation that took place in the office. A companion or caregiver at the visit is a big help in this regard, as more information is retained in this manner. The provider needs to engage the patient from the outset in helping to determine treatment based on options and certainly the recommendation of the provider. Many providers give the necessary information and options and then ask “So what do you want to do, Mr. Smith?” I believe the provider should also provide his/her recommendation as well, based on both objective evidence and experience.
Educating patients and caregivers about the uses and roles of mHealth technology will be important to its success. Patients need to know its indications, and certainly limitations. There will be actionable alerts, but patients need to know they can speak to a real person and hold a provider’s hand if needed.
Though I write primarily about mHealth, we need to walk before we run, and not take for granted that patient engagement just doesn’t happen because we give someone a gadget that is easier than going to an office. wireless technologies will afford better care if patients are engaged, but there will ALWAYS be a need for the human factor in healthcare:http://www.theatlantic.com/life/archive/2011/10/are-doctors-becoming-obsolete/246439/