Tag Archives: digital health

Monitoring COVID-19 Patients at Home During Recovery

Over 85% of COVID patients (diagnosed and presumptive or symptomatic) will be directed to recover at home.   Recovering at home is scary for patients and their families, given the potential severity of the disease and its varied course in different patients. In some patients the path is more mild, in others more severe, and difficult to predict. 

Telehealth solutions like Trusted Patient Coach™ (TPC) enable patients to report their symptoms and progress daily.  TPC reduces the burden on clinics and call centers, and enables objective triaging for intervention if a patient’s recovery deteriorates.  Patients self-report daily, using Patient Reported Outcomes Measures (PROMs) questionnaires, using CDC or other protocols designated by the public health organization or provider.   These questionnaires can be reconfigured rapidly, in most cases in a day, as symptoms tracking and contact tracing evolve.

“The precise line between a mild versus a moderate case of COVID-19 is uncertain, and the terms themselves are nonspecific,” says Dr. Richard Martinello, Associate Professor of Medicine (Infectious Diseases) and Pediatrics and Medical Director, Infection Prevention, Yale New Haven Hospital (ref.  https://health.usnews.com/conditions/articles/coronavirus-recovery-what-to-know  ).

Patients can begin reporting daily from the onset of symptoms using TPC. They continue reporting during the course of those symptoms, and for another 3-5 days following the end of symptoms. Additionally, they can connect with and be cleared by a health provider before discontinuing home isolation. 

As Contact Tracing grows to mitigate and ultimately contain the further spread of COVID-19 , TPC is a weapon in the arsenal of public health [and military organizations]. Contact tracers need to quickly locate and talk with the patients, assist in arranging for patients to isolate themselves, and work with patients to identify people with whom the patients have been in close contact so the contact tracer can locate them, gather data on activities, symptoms and potential for spread. TPC can rapidly remotely register and capture patient consent, provide patient education to patients on their own mobile devices – and do so securely, assuring patient privacy and mitigating scam risks.  TPC sends standardized questionnaires at registration, enabling rapid initial baseline data collection and direct electronic capture, for follow up by tracers on TPC’s web-based dashboard and with reporting extracts for tracer follow up and public health analyses.  TPC augments the specialized interviewing by tracers, speeding the patient and disease mitigation follow up.

The benefits TPC provides Public Health Agencies and providers in support of remote monitoring of patients recovering at home and in contact tracing are:

  • High patient compliance, clinicians can rely on.
  • Easy to configure for clinician monitoring of COVID, rapidly adaptable as protocols evolve. At discharge, complex recovery protocols can easily be implemented for close monitoring.
  • Clinically validated in post-surgery and substance use recovery contexts.
  • HIPAA compliant, TPC enables secure data collection to better manage each patient’s recovery and gather important pandemic public health data.
  • Ready to deploy now: 2 hours for configuration and 2 days for platform set-up. TPC is operational today supporting patients and clinicians.

Trusted Patient Coach provides patients and families peace of mind by staying connected, is easy to use and remotely install from the App Store on a patient’s (or family caregiver’s) mobile device. TPC is ready to deploy now in Canada and the US.

The American Medical Association notes, “Medication adherence is a growing concern for physicians and health care systems. There is increasing evidence of noncompliance among patients and correlated adverse outcomes that follow.”  (January 29, 2020).  Marie T. Brown, MD, a geriatric and internal medicine specialist at Rush University Medical Center, in Chicago has been studying this. She has been listening to patients and her fellow clinicians to get to the root cause of why patients don’t adhere.  Reference Building patient trust to support medication adherence (American Medical Association) for more information.

Poor communications between clinicians and patients combined with poor or inconsistent education about medications are key factors contributing to non-adherence.  When coupled with other patient barriers and concerns, adherence is driven lower.  Among those barriers are that patients: 

  • Don’t think they need the medications anymore – especially true for “silent killers” such as hypertension and kidney disease;
  • Fear side effects from taking the medication;
  • Cannot afford the medications
  • Distrust medicine and/or pharmaceutical companies

Non-adherence to other care plan tasks can be attributed to similar factors, for example, important tasks assigned to patients following surgery, such as tracking symptoms of infection or other clinical complications and maintaining physical activity and physical therapy.

Patient Reported Outcomes Measures (PROMs) can play a role in overcoming these barriers, particularly PROMs that are easily accessible to patients through their mobile devices.  Mobile apps like Trusted Patient Coach™ (TPC) are clinically proven, intuitive, reliable ways to collect standardized, consistent PROMs data directly from patients about medication and care plan adherence and patients’ clinical status and progress. 

Daily PROMs demonstrate higher adherence reinforced by both daily routines for patients and the regular connection with and monitoring by their clinical teams.  As patients report taking their medication, indications of infection or other clinical issues, their clinical team can intervene early, before an issue festers into a more serious problem.

In using daily or routine mobile tools like Trusted Patient Coach, the physician and patient now have a stronger connection showing the patient that the physician really cares about adherence and therefore their overall outcomes and well-being. 

Patient education about medications are extremely important, which can be reinforced with PROMs tools.  For example, one of the clinician and patient groups using Trusted Patient Coach prescribed aspirin post-surgery as an anticoagulant; reported adherence was dropping.  Clinicians followed up the non-adherence and learned that patients thought aspirin was for pain and had stopped taking it as pain subsided.  Up front patient education and providing education through the TPC mobile app helped to correct this gap, leading to higher anticoagulant adherence.

The easy to use connection and timely responses between the patient and his/her clinical team help to re-enforce essential patient-clinician communications.  Use of Trusted Patient Coach by patients in post-surgery recovery and supporting chronic diseases such as Substance Use Disorders, has demonstrated steady adherence and enabled the human touch and trust with clinical teams.

 

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Interview with Nurse Practitioner About Patient Reported Outcomes

Health Helm’s CEO, Pamela McNamara, sat down with a Nurse Practitioner in a pain management practice in New England, to discuss patient centered care, patient reported outcomes, and how these could enable her patients to receive a more holistic approach to care.

close-up-doctor-health-42273-300x300 The Importance of Patient Reported Outcomes from the Perspective of an NP

What does patient centered care mean to you and your practice?

We follow the CDC guidelines and apply judgment given the risk factors. For example, we ask patients how long they have been on pain medications — opioid or others. We treat each patient holistically, considering her/his situation: How functional are they, are they working or disabled? What activities do they want to be doing with or without medication? What are they doing to avoid pain? What other medical considerations, such as social and mental health ailments are they affected by?

We consider and encourage trying alternatives to opioids for each patient, such as aquatic therapy for an osteoarthritis patient, chiropractic care for a younger patient, acupuncture, massage and/or yoga.We also attempt to use other pain management options including non-opioid prescription including over-the-counter aspirin, ibuprofen and acetaminophen, pain creams and patches. Medical cannabis including CBD creams and oils can be beneficial for chronic pain helping patients with anxiety, sleep and muscle spasms. We offer surgical procedures high-tech treatments using radio waves and electrical signals or implantable spinal cord stimulation. Unfortunately not all patients have access to these alternative therapies. Many of these therapies are not covered by insurance or these patients have access to care issues causing barriers to receiving this type of care.

How would a mobile patient reported outcomes tool fit in to your practice: supporting you as a clinician, while aiding in the treatment and management of your patients, as well as enabling them to better manage themselves?

A top priority for our patients is to gauge the extent to which they are trying to manage themselves and deal with their pain, and pain-related issues, rather than solely seeking more pain medications. If we know a patient is trying, we can work with them to utilize alternative approaches to opioids.

One benefit of patient reported outcome data will be to see evidence of how the patient is trying to manage their pain and with what result.

This patient reported outcome data can provide me, as a clinician, with a better basis for building an ongoing relationship with my patients to manage their pain and make progress.
Patient reporting would enable me to track their pain and other medication, track the extent and circumstances in which pain meds including what doses, numbers, and pills are being taken.

How would the PRO tracking work in your practice?

Typically we see a patient on chronic opiate therapy monthly. Patients on non opioids therapy are followed every three to six months.

During that four week period, we monitor their pain using pain scale tools. The use of a pain scale can help guide the clinician in creating a treatment plan as well as measure the effectiveness of the treatment. Indications a treatment plan may be ineffective include if a patient scores a 10 consistently (on the traditional pain scale of one to 10), the patient also reporting that they’re repeatedly out of medication early? The mobile tracking would help us monitor that more closely.

A mobile tool to monitor patient reported outcomes would be useful during the middle of that two month period, to alert us if problems are occurring. For other patients, patient reported outcome data is useful just before or during the four week follow-up visit to assess clinical status, progress, or problems, and to focus the patient visit on key issues. In preparation for this type of patient, the data would be scanned for sleep pattern variations, increased or decreased activity levels, issues related to ambulation, and responses to questions such as “ Do the current medication you are keep you functional and able to perform the daily tasks you need to do?”

The clinician would look at a snapshot for that patient over the prior month and be better prepared for a discussion about what’s going on, what can be changed in the pain management regimen, and what may need to change in other related activities.