Is your patient a good candidate for remote patient monitoring?

According to a report by the Australian Institute of Health and Welfare (AIHW)¹, in 2016-2017 alone there were 715,000 potentially preventable hospitalisations in Australia.

Almost half of these hospitalisations (47%) were due to chronic conditions. Since the 1980s, the number of people in Australia with multiple coexisting chronic conditions, known as multi-morbidity, has increased four-fold.² Current estimates suggest that 40% of Australian adults have three or more chronic conditions³

While older patients are more likely to have multiple chronic conditions, they’re also generally considered more likely to struggle with adopting new technology. This perception, as well as other barriers such as cost and inferior or cumbersome technology, has resulted in the reluctance of clinicians to think patients can manage with the use of technology to monitor their own health. Recent research on tech adoption in older adults in the US by the Pew Research Center⁴ found that while many seniors remain digitally disconnected, two-thirds of those aged 65 and older go online and 42% now own smartphones (up from just 18% in 2013).

How remote patient monitoring can help

Remote Patient Monitoring (RPM) can help to reduce unnecessary hospital admissions whilst empowering patients with chronic conditions to be more proactive in managing their health.

Research by the CSIRO⁵ has shown that RPM provides cost savings for the healthcare system and improves patients’ quality of life and understanding of their own medical conditions. It enables patients to stay connected with health professionals outside of formal care delivery settings (such as hospitals and GP clinics) and can allow older patients to receive care in their own homes for longer.

With remote monitoring, deterioration in a patient’s health status can be brought to a provider’s attention early enough to allow for proactive intervention to help avoid hospitalisation. It also involves patients more in the management of their own care; for example, by teaching them how and when to integrate taking medication into their daily activities. Hospitals that manage patients with RPM can experience efficiency gains with better patient flow and reduced emergency room admissions.

Assessing patients for RPM

Research literature identifies a wide range of conditions that are known to benefit from vital sign monitoring and routine collection of health survey data including (but not limited to) asthma, diabetes, chronic obstructive pulmonary disease (COPD), heart failure, coronary artery disease, cardiac arrhythmias, mental health, and wound care.⁶

RPM is best deployed in populations where the goal is to improve health literacy and self-management, support patients with unstable and poorly controlled chronic conditions, and help people stay at home and out of hospital where that might be appropriate.

Factors to consider

When contemplating who could benefit from the use of RPM, health professionals should consider the patient’s type of health condition, personal attributes and technological capability.

Technical literacy: It’s important that a patient has the ability to use the technology required to facilitate RPM. However, a recent study⁷of telemonitoring older patients with multi-morbidity found that their belief in their own ability to use technology was not linked to prior experience. This suggests it’s important that appropriate on boarding processes are followed so a patient’s confidence in RPM is established early.

Health literacy: RPM may aid improving health literacy which is important as low health literacy is associated with poor health outcomes and reduced effectiveness of chronic disease management programs in general. This is because health literacy impacts on the ability of people to understand the advice and recommendations from healthcare providers.

Readiness to engage: An individual’s adherence to prescribed medicine regimens and lifestyle changes have been shown to impact on the effectiveness of health interventions. Self-motivation to participate in an RPM program is in itself a good indicator of patient suitability.

Removing barriers to technology adoption

A 2017 review⁹ of the factors influencing patients’ acceptance of smartphone health technology for chronic disease management showed that perceived ease of use was affected by patients’ smartphone usage experience, their relationship with their doctor, the perceived health threat, and self-efficacy. When people use their own mobile device, they are more likely to add an application for a specific use than if they are required to use new and unfamiliar devices in their home.

Improving care through technology

MyCareManager is a software solution from Telstra Health that helps healthcare professionals monitor, connect with, and guide multiple patients remotely, using a comprehensive dashboard that provides at-a-glance visibility of any matters requiring attention. Clinicians can also use the built-in video conferencing feature to contact their patients both for assessment and support and if they identify clinical issues.

The solution actively involves patients in their health and wellbeing. Using the MyCareManager Client App, patients build a healthcare plan, including a list of daily tasks to action, and receive scheduled reminders, notifications and appropriate monitoring from their clinician.

The team at MyCareManager have the technical and clinical expertise to work with clinicians to define patient eligibility based on their medical needs, technological compatibility and user competency. This includes providing an assessment tool that helps clinicians determine a patient’s mobile device competency level, and therefore their individual suitability to this solution.

UPDATE:

MyCareManager has now been replaced by Virtual Health Platform, Telstra Health’s next generation virtual care solution. Virtual Health Platform is a secure, scalable and interoperable virtual care solution, which draws on over a decade of experience in implementing and scaling virtual care solutions like MyCareManager.

Built with FHIR at the forefront, Virtual Health Platform removes the intermediate step of translating data to a standard format and simplifies healthcare interoperability. This helps to significantly reduce implementation time and enhance overall clinical efficiency.

The platform provides a digital, automated and streamlined process for creating improved and more transparent remote healthcare delivery. The platform can be easily adopted by healthcare services of all sizes and locations and can be customised to support a variety of use cases.

Sources:
1 https://www.aihw.gov.au/reports/hpf/36/mhc-potentially-preventable-hospitalisations/contents/summary

2 Australian Bureau of Statistics (ABS), National Health Survey: Summary of Results, 1983 Cat No 4311.0 Commonwealth of Australia, Canberra, 1985.

3 Australian Bureau of Statistics (ABS), National Health Survey: Summary of Results, 2007-2008 (Reissue) Cat No 4364.0 Commonwealth of Australia, Canberra, 2009.

4 http://www.pewinternet.org/2017/05/17/tech-adoption-climbs-among-older-adults/ 

5 https://www.csiro.au/en/Research/BF/Areas/Digital-health/Improving-access/Home-monitoring

6 Stachura ME, Khasanshina, E.V. Telehomecare and remote monitoring: An Outcomes Review. 2007

7 https://sapc.ac.uk/conference/2016/abstract/perceptions-and-experiences-of-telemonitoring-older-patients-multimorbidity

8 Haynes RB, Ackloo E, Sahota N, et al. Interventions for enhancing medication adherence. Cochrane Database Syst Rev 2008:CD000011.

9 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5738544/