Tag Archives: patient adherence

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February 2019

Bob Kocher and Bryan Roberts, health care investors and partners at the venture capital firm Venrock, predict “Telemedicine Takes Off,” in their Fortune article, “10 Health Care Predictions for 2019 From a Pair of Venture Gurus” (December 10, 2018).  They note that payers are finally realizing it’s better to “embrace and encourage telemedicine usage as opposed to burying it in their unengaging member portals and clunky mobile apps.”    

The time for telemedicine is now!   Patients, as consumers, are demanding this.  It’s been well established that patients of all ages and socioeconomic backgrounds are using mobile technology in their lives – from all the conveniences of retail or travel, to simply sharing photos and stories with family and friends.  According to a recent global survey by Cisco, 74 percent of patients prioritize access to health care services over in-person interactions with health care providers, and 70 percent said they were comfortable communicating with providers via text, email, or video, in lieu of an in-office visit.

Yet some clinicians still ask or protest: “My elderly or low income patients won’t use mobile health technology.” Smartphone adoption continues to grow rapidly in the US market:  Pew Research in 2018 reports 77% of Americans own a smartphone vs. just 35% in 2011, and 53% own a mobile tablet device (e.g., iPad or Android). 

In our experience, patients over age 65 using our Trusted Patient Coach mobile solution on their smartphones or mobile tablets are just as, if not more compliant than other demographic groups.

Some providers protest, “They can use our electronic medical record (EMR) portal.”  But those are also clunky to use.  Many are web based or supported by clunky mobile apps and are used for episodic tasks such as viewing diagnostic test results, refilling a prescription, or scheduling an appointment.  Sara Heath, in Patient Data Access News, reports that even among patients registering to use EMR portals (and many patients do not), their utilization is only 20-35% of the time. 

Clinical evidence shows that patients who track themselves do a better job of managing their health and have better clinical outcomes – e.g., managing a chronic condition or recovering after surgery.

At Health Helm we focus on Patient Reported Outcomes and self-tracking, providing clinical teams and their patients with a secure, reliable way to track and report meaningful information about their progress on a daily or routine basis . Clinicians know that when communications with patients are better, they can identify complications or problems earlier and then intervene to address them earlier. 

Kocher and Roberts note that even medicare is adding codes to reimburse telemedicine. Other insurers are, also – recognizing that meaningful, sustained connection using telehealth results in better outcomes at lower costs, with a better patient experience.  Bottom line:  Kocher and Roberts, “Expect telemedicine usage to more than double in 2019, while making substantive inroads beyond flu and cold into areas such as chronic disease management.” 

Sources:


https://www.healthaffairs.org/do/10.1377/hblog20150723.049490/full/

https://newsroom.cisco.com/press-release-content?type=webcontent&articleId=1148539

Heath, Sara, “Patient Access to Health Data, Patient Portal use Increases.” Patient Data Access News, Patient Engagement HIT, October 12, 2017.

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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.