Tools that help patients adhere to doctor’s recommendations improve patient outcomes—it’s simple math with a host of benefits. For patients with heart disease, tracking daily routines and ensuring compliance with recommended medications and behaviors can be a difficult, but necessary part post hospitalization. eTools are emerging to help physicians and patients deal with monitoring changes in condition and keeping abreast of medications and recommendations.
These tools can provide reminders and serve as a means to check patients in a place where physicians these days never, or rarely, go—at home.
But, what’s out there? And what are the costs and benefits associated with some of the more popular technologies? Several research groups have been exploring the options. Smartphone apps, web-connected devices, and web portals are all areas being tried out by physicians worldwide to help patients in addition to more traditional telephone reminders and patient engagement training. Some approaches combine old and new technologies, texts, phone messages and internet connectivity to create an approach that works best for patient and provider.
Here’s a look at some of the eTools currently being applied to better manage doctor’s orders when heart patients go home.
ETools can provide physicians a way to improve effectiveness across the board with their patients, including those who have been harder to engage in the past. Gautam Shah, MD, and his team from the Cleveland Clinic recently looked at the effectiveness of tablet-based telemonitoring intervention among high-risk, low-income patients with heart disease in reducing hospital readmissions (Circulation: Cardiovascular Quality and Outcomes. 2015; 8: A117).
Through the Cleveland Clinic network, his team works largely with low-income African American patients. “Just given the kind of the population we work with, we have a lot of problems with patient adherence to medications and we’re always trying to come up with different ways to improve it,” he says.
The tablet-based system assists in monitoring a patient’s heart rate, blood pressure, weight and other vital statistics while also providing the patient with reminders about taking medications and making health information available—all without the need for frequent office visits. It also provided patients the opportunity to interact with their physician without having to try to catch the doctor over the phone when they had questions. “Rather than having to call and leave a message, they can communicate with their healthcare provider, either the nurse or the primary care physician through the monitors.”
While the sample size was small, Shah says the findings are promising. Patients had little trouble adopting the technology once they had it. While there were some instances of needing to contact patients when data weren’t acquired on a given day, it was easier to weed out those who needed help from those who didn’t.
The biggest barrier to replicating the findings on a large scale, he notes, is in obtaining the tablets. “That would be expensive and we don’t know if that would be cost effective. We just did a feasibility study with this trial,” Shah says. “We would need more nurses and more healthcare providers in our team because we had to constantly remind patients to measure their weight or their blood pressure. There were very few who actually just did it.” They are looking into the question of cost, but Shah says “we’re not there just yet.”
Smart thinking with smartphones
Smartphones are everywhere. And for most people, these go-anywhere devices are a standard part of living. When the patient already has the device, it increases the simplicity of getting a monitor up and running when the patient leaves the hospital, especially when all a discharging physician needs to do upload an app.
During the initial phase of the trial, Aimee Layton, PhD, from Columbia University and NY Presbyterian in New York City utilized an app developed initially for the Apple iOS, which has since been broadened to include Android and a range of languages.
“One of the great things about a smartphone intervention is that it allows us to integrate the data directly into our computer as opposed to telephone surveys or paper surveys that are not real time,” says Layton. She notes that older methods of tracking patients outside the care setting also are more labor intensive, schedules may be hard to synchronize and that with the chance of vital