Technology: The Answer to Patient Self-Care
We spoke to two experts to find out how pharma can embrace the concept of self-care and utilize technology to empower patients.
The role of patients in the healthcare process is fast changing; patients no longer want to be passive recipients of doctor’s instructions. They want to be actively involved and take responsibility for their health-related decisions. Pharmaceutical companies that wish to keep up with patients’ needs are required to find ways to help them be autonomous in their self-care.
What are effective ways that pharma can help patients take care of themselves responsibly and safely? We discussed this with Dr Julian Spinks, Senior Partner at Court View Surgery, and Dr William Soller, Clinical Professor of Pharmacy at the University of California, and interestingly, they both agree that technology might be the answer.
Spinks shared, “What we have here is a 21st century paradigm for the doctor-patient relationship. For hundreds of years, the relationship was based on a patient as a passive recipient of care decided by the doctor as a paternalistic figure. Later in the 20th century, this shifted to a more partnership approach but with patient involvement limited by the fact that the doctor held the information and interpreted it for them.”
“The dawn of the internet improved things a little but it was still the case that patients could find out about diseases and treatments but not their disease or treatment. Patient control of their health was limited by this. The past few years, with the growth of patient-controlled/wearable measurement, a degree of patient autonomy was obtained, but this was hampered by the lack of access to interpretation of the results without going back to their doctor. Worse, ‘dumb’ targets led to false alarms which both increased the patient’s anxiety and the workload of the doctor.”
Before looking into ways that pharma can facilitate the 21st century patient self-care process, it is important to be clear what self-care is.
The far-reaching benefits of self-care
A society that can take care of minor ailments without going to their GP can save society millions. According to the 2010 campaign of Proprietary Association of Great Britain, UK GPs spend about an hour a day treating patients with minor ailments which could be easily self-treated. This means that 57 million consultations a year (39% of GP consultations) and £2.5 billion of the total cost to the NHS are spent on treating patients with self-treatable minor illnesses.
The desire for a more active and informed self-care goes both ways; in a research survey organized by the Department of Health in 2005, over 90 percent of participants indicated that they wanted to improve their self-care skills. The DH stated in the report that enhanced self-care systems would have many wide-ranging benefits to the NHS, such as fewer hospital admissions and GP visits, better consultation quality, and informed and adequate medicine use. Similar conclusions have been drawn by the Irish Government, which has recognized the willingness of the public to take a more active role in their self-care, which has the potential to significantly reduce healthcare expenditure.
Self-medication is currently the primary mode of health self-management and includes the use of non-prescription or over-the-counter (OTC) drugs that are generally safe with rare adverse reactions. The pharmaceutical industry recognizes the importance of responsible self-medication in improving quality of life when a medical condition doesn’t require a visit to the doctor. Responsible use of non-prescription medicines for self-medication is a safe, cheap and quick way of solving medical conditions.
Many OTCs are widely available throughout Europe for many ailments. However, the main problem is that the vast majority of users wrongly believe that OTCs are completely safe and can be used without moderation, resulting in thousands of OTC incidents every year. As William Soller, Clinical Professor of Pharmacy at the University of California tells us, “About 20% of medications are taken for unapproved uses. Of those, a high majority (upwards of 75%) have little to no data supporting their use.”
So, how might technology become the next big thing in self-management?
Technology and pharmacist synergy
The key three players all gain - the doctor has confidence that he can ‘let go’ and allow the patient to self-manage with the software acting as a safety net. Industry would benefit as, more often than not, effective management actually raises sales. Most importantly, the patient has the validated tools to be involved in their own care".
According to Spinks, in technology lies the answer to self-care. He says, “The latest developments in wearable technology linked to portable computing (smartphones, etc.) bring the possibility of apps that not only track the patient’s results but can use algorithms to advise the patient on the best plan of action. Thus, a patient with lung disease could record their peak flows and, rather than triggering an alert if this drops below a set point, the software monitors the trend and responds in light of this. This produces true empowerment of patients to carry out guided self-management.”
Spinks adds, “I feel that the pharma industry could move beyond a model where it provides passive information, such as websites and paper-based literature, to play a role in developing these smart systems. The key three players all gain - the doctor has confidence that he can ‘let go’ and allow the patient to self-manage with the software acting as a safety net. Industry would benefit as, more often than not, effective management actually raises sales. Most importantly, the patient has the validated tools to be involved in their own care.”
Soller expands on this, explaining, “Most physicians and nurses don’t have the time to be in regular contact with their patients, so technologies that can enable that interface (i.e. that can ‘connect the dots’) are needed to effectively empower the concept of ‘being under a physician’s supervision’ during the 99% of self-directed waking hours in a patient’s life".
The problem of medicine misuse can also be overcome through technology. “I am a great believer in self-care, either self-directed or with the assistance of pharmacists,” says Spinks.“However, the concern is patients not reading the instructions or ignoring them. A really simple app could count down to the earliest point that an analgesic could be taken (your next paracetamol can be taken in x-minutes) or might suggest suitable OTC medications. Importantly, if this links to the patient’s medical and drug history, this could add an interaction checker to prevent patients taking medication which clashes or isn’t suitable.”
If we want patients to be in control of their health, we need to give them the tools that allow them to understand the jumble of crude results.”
Spinks warns, however, that not all patients are as enthusiastic about self-care as the pioneers: “Doctors are very much aware of a spectrum of patients ranging from the self-motivated who wish to control their own destiny, right through to the disinterested who are happier for the doctor to make all their decisions for them. This doesn’t preclude the use of smart systems in these patients but does mean that the outcomes may not be as positive. Likewise, doctors come with a range of styles and skills and are notoriously nervous about handing control of patient care to others, let alone patients and their smartphones. Industry, by piloting new approaches, may be able to find the best way to inform the healthcare industry of how to satisfy both groups.”
Another important point to consider is not to assume that access to baseline information automatically makes the patient fully informed. Spinks notes, “If we want patients to be in control of their health, we need to give them the tools that allow them to understand the jumble of crude results.”
Many pharmaceutical companies recognize the importance of technology and are embracing it within patient care. There are around 250 mobile applications created by pharma for iOS and Android. They range from patient-aimed apps designed for managing chronic conditions to those serving as a medical reference for doctors. Eli Lilly's MDLinx app collects top research news from cancer journals. AstraZeneca's GRACE 2.0 helps to identify high-risk heart patients. The NHS’ My Medication Passport enables patients to keep track of doses and timings of their drugs. However, most of these apps haven’t managed to generate more than several thousand downloads; Sanofi-Aventis is the most active with over one million downloads.
In addition to being a tool of patient empowerment, the health mobile app market is looking to become a multi-billion dollar market. It is only a matter of time before the pharma industry will tap into the full potential of this technology.