Utilising Real Time Disease Management to Augment Current COPD Pathways
Matthew Bonam, Pharmaceutical Projects Director at AstraZeneca and Tim Davis, chief executive of Exco InTouch discuss their collaboration and the virtues of mHealth in combatting chronic obstructive pulmonary disease.
It is widely recognized that non-adherence to health programs has a major impact on overall population health. In the US alone, the cost to the health care system is an estimated $290bn1. As a result patients incur the risk of less-effective treatment and greater likelihood of hospital stays, whilst health services suffer the effects of poor outcomes, wasted healthcare expenditure and the draining downstream impact of poor control. The pharmaceutical industry itself faces challenges associated with lower prescription sales and less evidence demonstrating a drug’s efficacy profile.
Only around 30-40 per cent of non-adherence is attributed to forgetfulness, therefore successful programs must extend well beyond simple reminder systems. mHealth solutions are tailored to each population, delivering support, education and motivation to patients, carers and health care professionals. These programs are designed to empower patients and carers to better manage their condition, with health care providers able to improve their decision-making through accurate, relevant content for each patient.
Chronic obstructive pulmonary disease (COPD) is the sixth leading cause of death in the world, and this is expected to worsen to become the fourth leading cause of death worldwide by 2030, due to an increase in smoking rates and demographic changes in many countries2. Globally, as of 2010, COPD affected approximately 329 million people (4.8% of the population)3. It is just this type of rapidly growing condition that can benefit from the long term patient management support that mHealth affords.
In the continuing drive to improve patient adherence, many organisations are seeking to implement patient facing solutions and address the need to manage resources committed to long term condition support. Two such companies are AstraZeneca and Exco InTouch, who recently announced a partnership to develop and launch interactive mobile phone and internet-based health tools. Health care providers, they say, are under increasing pressure to maximise efficiencies in order that more can be done to prevent hospitalizations and other costly disease exacerbations. Improving outcomes is the raison d'être of everyone fighting the growth of COPD, including Tim Davis, chief executive of Exco InTouch, who is a strong advocate of introducing mobile and web-based innovations to improve outcomes. He says: “Putting the patient at the centre of healthcare is being made easier by utilising everyday technologies to help patients and healthcare providers improve health outcomes. These programs, I believe, will lead the way in moving the pharmaceutical industry beyond the pill and into providing on-going support to patients through personalised health solutions and intelligent pharmaceuticals.”
The mHealth program introduced by AstraZeneca and Exco InTouch will allow COPD patients enrolled to have the opportunity to access personalised coaching and information about their disease and treatment via their mobile phones and other web enabled devices. Patients will also use digital technology to collect, transmit and review their own clinical data. Furthermore, patients and their health care providers will be able to use this real-time information to make informed decisions and tailor care pathways to personalise each patient’s disease management and optimise health outcomes. For Matthew Bonam, Pharmaceutical Projects Director at AstraZeneca, real time disease management has three main functions: to provide healthcare professionals with the information they need to deliver the best care to individual patients when they need that support; to learn and develop mHealth solutions for the future; and most importantly, to try to make a meaningful difference for patients.
Bonam says: “COPD is a difficult disease to live with. Symptoms can be frightening for individuals, and can impact on activities that we take for granted; when the patients’ symptoms worsen, especially to the point where they are hospitalised there is an added risk that their lung function will further worsen. Real time disease management can help patients to manage their condition and maintain their health for as long as possible. Using new technology, healthcare providers can intervene before the patient’s condition worsens to the point where they need to be treated in hospital.
“There is still more to be done to further improve care to patients. We’re not looking to re-engineer whole processes and programs but to build on what is already there”
“There are a lot of resources already spent very effectively on COPD by health care providers (HCPs), and many examples of excellent practice and innovation that have, and continue to improve outcomes for patients. However, there is still more to be done to further improve care to patients. We’re not looking to re-engineer whole processes and programs but to build on what is already there.”
Davis and Bonam believe that there is already an ongoing channel of communication between patients and HCPs, and that realtime disease management technology can augment that.
Davis adds: “We need to go beyond giving patients a paper diary to fill in, they’re not useful as they don’t get the data to the HCP in a usable format. We shouldn’t be taking up more and more of a HCP’s time in this way, and using new technology for data collection will cut this down.”
AstraZeneca and Exco’s program is starting in the UK, where COPD is the fifth biggest killer, and the number of people with the condition is increasing. It is estimated that 1 in 8 people over 35 remain undiagnosed. The Department of Health has made diagnosis and treatment of COPD a priority and due to the impact on the health of individuals and the overall costs to the health service, the treatment of COPD has attracted funding for the development of innovative solutions. There have been examples of very positive impacts both from increased HCP interventions and telehealth, but these are unlikely to be cost effective solutions for large populations, says Bonam.
According to Davis, one of the reasons that COPD was chosen for the Exco InTouch/AstraZeneca collaboration was that it affects so many other parts of the body; for example, muscles are weakened as your activity diminishes.
“There is no cure for COPD,” he says, “which estimates say affects around 3 million people in the UK, though by stopping smoking, taking medication as prescribed and maintaining muscle tone and physical activity the progression of the disease and its impact on the patients overall health can be reduced. We think interactive tools will provide a lighter touch and reduce the significant costs associated when a patient is hospitalised.”
But how will this work in practice? According to Bonam, a COPD patient in the UK may be asked by his or her physician to participate in the program. He continues: “The patient would access a disease management program via mobile phone and internet. Each patient will be asked to capture their symptoms weekly and track how often they have used their maintenance therapy via a simple form within the app. Patients will also receive a device that attaches to their rescue inhaler and tracks how often it is used.”
“Realtime disease management is quick and simple and a new patient can be up and running within 15 minutes”
But what about physicians and other HCPs, how will they use this new interactive technology, and will it add to their workload? Bonam doesn’t think so. He says: “We have to be wary of the promise of ‘jam tomorrow’, but realtime disease management is quick and simple and a new patient can be up and running within 15 minutes. It costs a huge amount of money every time a COPD patient is hospitalised, and this new way of treating patients is designed to reduce that. These new tools can also analyse the data, meaning the HCP will not have review all data but will be alerted when a patient’s condition is deteriorating, helping them to focus their efforts on the patients who need the most help.”
Meeting global privacy regulations is high on the agenda, and realtime disease management must be fully compliant. There’s no reason why it shouldn’t be, says Bonam: “The patient identifiable data should only ever be seen by the patient and their HCP, and the HCP will still make all of the decisions about treatment.” Real time disease management is all about providing as much help as possible to both the patient and the HCP, he adds: “Despite the large amount of resources spent on COPD disease management in the UK, we know there is significant unmet need and believe that more can be done to prevent hospitalizations and other costly disease exacerbations. Interactive or mobile-based care can be provided to patients who have medical need irrespective of what COPD medicine they have been prescribed, and this is absolutely critical; it’s about delivering the best care available.”
Real time disease management generally uses data from existing data sources such as electronic medical records, health insurance claims, patient registries and patient/healthcare provider surveys. They can show the impact of a medicine in ‘real world’ clinical practice. When combined with findings from rigorous clinical trial data analysis and clinical and economic modelling, can help to create a fuller picture of what is happening to a patient, build understanding of disease patterns and inform the best use of health resources. The data generated in this program is not designed to generate real world evidence of medication efficacy but will inform new approaches to improving healthcare outcomes for COPD patients.
With the increasing pressures on health care resources, organisational partnership work around health technology is helping maximise efficiency, whilst often improving the care of those with chronic conditions, especially in areas such as COPD. Helping patients with these conditions to better understand their illness, especially when they are exacerbating, appears to be key in improving outcomes.
mHealth programs must learn from this and provide patients with engaging content that grows over time to ensure tangible benefit in terms of education, support and condition management.
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