Comment les soins de santé numériques favorisent-ils l'adhésion?

Comment les soins de santé numériques favorisent-ils l'adhésion?

août 11, 2019 0 Par admin

Translating…

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With a career in health care that’s had me work on basic and translational research, clinical care, technology development, large and small company leadership, and health care policy, I have heard just about every aspect of the enterprise assert its primacy.  « It all starts with basic research! » « Nothing matters unless it is translated to the bedside! » « Without aligned incentives, the system will never work! »

It seems like an interdependent Gordian knot where nothing can change without something else changing first, and no one thing is more important than anything else.

But maybe there is a simpler way to view it.

With deference to Henry Russell (Red) Sanders and a nod to Vince Lombardi, I want to focus on the most important thing, the everything, the only thing that matters in health care. Perhaps it’s a fool’s errand, but with a few important assumptions, I propose (with copious humility) that adherence is the only thing that matters in health care.

Before I attempt to argue that adherence to medical advice is health care’s everything, I should acknowledge one assumption — the assumption of expertise.

Assumption (E): Expert medical advice is more beneficial than not, and in particular, following medical advice is more beneficial than suffering the natural history of disease or following the ad hoc advice from non-expert sources.

And this assumption comes with one messy observation (caveat) — that being that medical advice is not one thing.  Medical experts can and do disagree and, at worst case, propose diametrically opposed advice.

To allow us to continue, I will ask the reader to believe that for any health care condition or circumstance, there is or could be one path of care, one set of recommendations, that the majority of medical experts would agree is sound medical advice. This somewhat idealized view of medical advice is what medical guidelines committees and artificial intelligence approaches hope to distill from our integrated research and clinical experience. I humbly ask the reader to assume its existence.

With the assumption and caveat listed above, it should be then obvious that the only thing that stands between each patient and a better outcome is their adherence to medical advice. The complete value of the entire health care enterprise rests with the patient following the expert advice of their trusted and knowledgeable clinician, whether it be to have a specific procedure, take a specific medicine, perform or avoid certain behaviors, etc.

With adherence being so central, why then do we so poorly manage and infrequently measure this final and most critical common pathway in health care? The answer, of course, is complex.

Health care professionals struggle to convince people to do something they do not want to do or stop doing something they otherwise choose to do (think weight loss, exercise, smoking cessation). Sometimes it’s a matter of communication or education, where there is a genuine absence of understanding or belief on the patient’s part in the value of a specific recommendation (think vaccinations for serious communicable diseases). Sometimes it’s a matter of cost, where the patient simply cannot afford to comply with the recommendations and its attendant costs (too often the case with prescription drugs). And sometimes it’s a matter of distraction, such that even a well-intended patient fails to comply with their best intentions because other aspects of their life intervene (think about the minority of patients who complete a full course of outpatient antibiotic therapy).

If, as I have argued, adherence is the only thing in health care, I would further posit that adherence is the value proposition for digital health care.

Prior to the advent of the near-ubiquitous and persistent sensing and communication that constitutes digital health care approaches, adherence has largely gone unmeasured and unmanaged, leaving the entire value of the health care enterprise to be jeopardized by the patient’s adherence, which itself is influenced by a plethora of unmanaged and uncontrolled influences.

But now, the emerging tools of digital health care — sensors, chatbots, avatars, AI-engines and ML approaches — allow for continuous measuring and monitoring of health care behaviors and persistent, context-specific messaging that can serve to educate, nudge or otherwise help to coerce a subject (patient or clinician) to perform (or discontinue) a specific activity. Finally, there will be both measurement and management of the linchpin of health care — adherence.

At two companies I help to manage, we provide patients smart tools to help them recover from physical (RH) or mental (TLC) injury. We carefully measure their adherence to prescribed therapeutic activity and link this adherence to outcomes and present all this information to both the patient and their clinician. Combining specifically relevant educational materials with engaging tools, careful measuring and monitoring (and an awareness of being measured and monitored), together with audio-visual feedback, drives both engagement and adherence.

Another excellent example is CPAP treatment for sleep apnea. Similar to the case of physical therapy, for patients with sleep apnea, no one gets better from CPAP they don’t use. ResMed, a leader in the space, makes connected sensors for its CPAP machines (read: digital health), and in addition to seamless documentation of compliance, ResMed has demonstrated that remote monitoring enables a host of strategies that effectively increase adherence.

For some, the promise of digital health care being used to track adherence will seem unwanted and overly intrusive, and they may choose to opt out (as many currently opt out of following best medical advice). But for those interested in obtaining the best medical outcomes, the tools of digital health care will help to ensure adherence and help them to avoid the many otherwise broken links between best advice and best outcomes.

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With a career in health care that’s had me work on basic and translational research, clinical care, technology development, large and small company leadership, and health care policy, I have heard just about every aspect of the enterprise assert its primacy.  « It all starts with basic research! » « Nothing matters unless it is translated to the bedside! » « Without aligned incentives, the system will never work! »

It seems like an interdependent Gordian knot where nothing can change without something else changing first, and no one thing is more important than anything else.

But maybe there is a simpler way to view it.

With deference to Henry Russell (Red) Sanders and a nod to Vince Lombardi, I want to focus on the most important thing, the everything, the only thing that matters in health care. Perhaps it’s a fool’s errand, but with a few important assumptions, I propose (with copious humility) that adherence is the only thing that matters in health care.

Before I attempt to argue that adherence to medical advice is health care’s everything, I should acknowledge one assumption — the assumption of expertise.

Assumption (E): Expert medical advice is more beneficial than not, and in particular, following medical advice is more beneficial than suffering the natural history of disease or following the ad hoc advice from non-expert sources.

And this assumption comes with one messy observation (caveat) — that being that medical advice is not one thing.  Medical experts can and do disagree and, at worst case, propose diametrically opposed advice.

To allow us to continue, I will ask the reader to believe that for any health care condition or circumstance, there is or could be one path of care, one set of recommendations, that the majority of medical experts would agree is sound medical advice. This somewhat idealized view of medical advice is what medical guidelines committees and artificial intelligence approaches hope to distill from our integrated research and clinical experience. I humbly ask the reader to assume its existence.

With the assumption and caveat listed above, it should be then obvious that the only thing that stands between each patient and a better outcome is their adherence to medical advice. The complete value of the entire health care enterprise rests with the patient following the expert advice of their trusted and knowledgeable clinician, whether it be to have a specific procedure, take a specific medicine, perform or avoid certain behaviors, etc.

With adherence being so central, why then do we so poorly manage and infrequently measure this final and most critical common pathway in health care? The answer, of course, is complex.

Health care professionals struggle to convince people to do something they do not want to do or stop doing something they otherwise choose to do (think weight loss, exercise, smoking cessation). Sometimes it’s a matter of communication or education, where there is a genuine absence of understanding or belief on the patient’s part in the value of a specific recommendation (think vaccinations for serious communicable diseases). Sometimes it’s a matter of cost, where the patient simply cannot afford to comply with the recommendations and its attendant costs (too often the case with prescription drugs). And sometimes it’s a matter of distraction, such that even a well-intended patient fails to comply with their best intentions because other aspects of their life intervene (think about the minority of patients who complete a full course of outpatient antibiotic therapy).

If, as I have argued, adherence is the only thing in health care, I would further posit that adherence is the value proposition for digital health care.

Prior to the advent of the near-ubiquitous and persistent sensing and communication that constitutes digital health care approaches, adherence has largely gone unmeasured and unmanaged, leaving the entire value of the health care enterprise to be jeopardized by the patient’s adherence, which itself is influenced by a plethora of unmanaged and uncontrolled influences.

But now, the emerging tools of digital health care — sensors, chatbots, avatars, AI-engines and ML approaches — allow for continuous measuring and monitoring of health care behaviors and persistent, context-specific messaging that can serve to educate, nudge or otherwise help to coerce a subject (patient or clinician) to perform (or discontinue) a specific activity. Finally, there will be both measurement and management of the linchpin of health care — adherence.

At two companies I help to manage, we provide patients smart tools to help them recover from physical (RH) or mental (TLC) injury. We carefully measure their adherence to prescribed therapeutic activity and link this adherence to outcomes and present all this information to both the patient and their clinician. Combining specifically relevant educational materials with engaging tools, careful measuring and monitoring (and an awareness of being measured and monitored), together with audio-visual feedback, drives both engagement and adherence.

Another excellent example is CPAP treatment for sleep apnea. Similar to the case of physical therapy, for patients with sleep apnea, no one gets better from CPAP they don’t use. ResMed, a leader in the space, makes connected sensors for its CPAP machines (read: digital health), and in addition to seamless documentation of compliance, ResMed has demonstrated that remote monitoring enables a host of strategies that effectively increase adherence.

For some, the promise of digital health care being used to track adherence will seem unwanted and overly intrusive, and they may choose to opt out (as many currently opt out of following best medical advice). But for those interested in obtaining the best medical outcomes, the tools of digital health care will help to ensure adherence and help them to avoid the many otherwise broken links between best advice and best outcomes.


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