Tech could revolutionize the approach to long-term condition control.
Navigating the intricate world of primary care and chronic diseases, digital health technology promises to revolutionize the way specialists provide care. With approximately half of all U.S. adults battling chronic health issues such as heart disease, stroke, cancer, type 2 diabetes, obesity, and arthritis, these innovative tools could hold the key to better treatment and management.
Emerging technologies like remote monitoring, mobile health (mHealth) apps, and wearables flood the market, but are they suited for healthcare professionals' needs? To find out, we spoke with primary care and internal medicine specialists about their daily practices and their opinions on digital health's potential transformation.
A Beeping Heartbeat: Remote Monitoring's Early Success
Primary care providers (PCPs) mostly welcomed wireless remote monitoring of patients' vital signs and symptoms, as it enables early intervention for specific symptoms and encourages patient engagement. One prime example of this digital tool's success lies in managing heart failure cases, as noted by Suzanne Falck M.D., associate professor of internal medicine at the University of Illinois College of Medicine.
For heart failure patients, data from an implanted sensor is instantly transmitted to a healthcare professional, who can then offer advice on medication, lifestyle, scheduling additional visits, or suggestions for seeking emergency care. Clinical trials have demonstrated that remote monitoring significantly reduces hospitalizations in patients with cardiovascular implantable electronic devices, such as pacemakers and implantable defibrillators, and is more cost-effective than conventional management.
The Empowerment of Apps
Mobile technology, with 77 percent of U.S. adults owning smartphones and around half owning tablets, is poised to make a significant impact on chronic disease management. Judith Marcin M.D., a family practice specialist in Chicago, emphasized that patient-facing health apps can empower people to participate more actively in their healthcare journeys.
Around 259,000 mHealth apps are available in app stores, with a majority aimed at consumers with chronic conditions such as diabetes, hypertension, chronic heart disease, and depression. In clinical trials, patients with type 2 diabetes who used an app to monitor blood glucose showed a more-pronounced reduction in HbA1c than those who did not use an app.
While fewer patients receive support to manage their diabetes currently, a recent article in Diabetes Technology & Therapeutics suggest that apps could enable patients to better monitor their condition, improve their disease trajectory, lower rates of complications, and prevent comorbidities.
The Wearables Revolution: Potential or Fad?
Exiting advancements in digital health include wearable technology and devices, as per Dr. Marcin. These tools are being researched extensively, with potential applications like portable cardiac monitors, EKGs, sleep cycle analyzers, and glucose monitors on the horizon.
Activity trackers, such as FitBits, have gained popularity, although their impact on health outcomes is indistinct. In a 2016 survey, adoption rates were at 23 percent in the U.S, 19 percent in Australia, and 15 percent in the United Kingdom. However, the drop rate is high, with up to 30 percent of users abandoning their activity trackers due to lack of utility, boredom, or device failure.
One study, called TRIPPA, found that wearing an activity tracker increased physical activity but failed to produce improvements in blood pressure or weight. In another trial, called IDEA, participants who wore a multisensor activity tracker as part of a standard behavioral intervention actually lost less weight over 24 months than those who only received standard intervention.
Accessibility Concerns
All the physicians consulted by MNT expressed concern about technology access among underserved populations, particularly low-income families. "Those individuals in need of these services are least likely to have the resources to make the most of these programs," commented Dr. Marcin.
Older adults, who are the most likely demographic to have multiple chronic conditions, are another group being poorly served by digital health. A recent study by David M. Levine, M.D., a practicing PCP and primary care researcher at Brigham and Women's Hospital and Harvard Medical School, found that in the U.S, only around 20 percent of older adults have tablets in their home, and only around 40 percent are using email and the Internet.
Seniors' digital health use was low and barely increased between 2011 and 2014, Dr. Levine told MNT. Black or Latino seniors were approximately half as likely to use digital health as white seniors. Additionally, language can serve as another barrier to using digital health technology, as most apps are created and presented for English speakers.
Change Is Coming: A Gentle Approach to Digital Health
"Easy-to-use, easy-to-learn technology is essential for both providers and patients to adopt it," stressed Dr. Marcin. Setting reasonable expectations for new technology's capabilities is also vital; adding new technology could slow down a busy practice, necessitating clear communication with both patients and staff.
New technology must be easy to understand and use, and providers should set realistic expectations for how a new technology will work, Dr. Marcin advised. Framing change as a means to enhance patient care and long-term healthcare goals may help instill confidence in adopting technology to improve healthcare outcomes.
Upon being questioned about integrating new technology into their practice, one internal medicine specialist stated that it should only be utilized if it does not interfere with patient contact and does not generate additional work. It should streamline workflow and provide extended time for patient and physician interaction.
- Incorporating remote monitoring of patients' vital signs and symptoms proves beneficial for primary care providers as it enables early intervention and promotes patient engagement, particularly in managing heart failure cases.
- Mobile health apps, owned by a majority of U.S. adults, have the potential to empower individuals with chronic conditions like diabetes to be more involved in their health care journeys.
- Wearable technology, such as activity trackers, show promising applications like portable cardiac monitors and glucose monitors, but their impact on health outcomes remains under study.
- Access to technology, particularly among low-income families and older adults, is a concern for primary care providers, as these demographics are least likely to have the resources to make the most of digital health programs.
- Adopting technology within practices requires easy-to-use and easy-to-learn tools to ensure providers and patients are willing to adapt to new digital health solutions for better patient care.
- New technology should be integrated into practice with clear communication, reasonable expectations, and a focus on enhancing patient care and long-term healthcare goals.
- For technology to be accepted in practice, it should streamline workflow, provide extended time for patient and physician interaction, and not interfere with direct patient contact or generate additional work.
