Communications of the ACM
Physicians See Mobile Phones as Tools to Aid Non-Compliant Patients
A Mobile-Phone-based Patient Compliance System would positively influence patients' compliance behaviors, including mobile-delivered contextual reminders based on association theory.
When it comes time to take their medicine, an estimated 50 percent of patients in developed countries who suffer from chronic diseases either forget or choose not to comply. In the United States, for example, where over 100 million Americans live with at least one chronic health condition—and where chronic diseases account for more than 75 percent of the nation's $2.3-trillion healthcare system—non-compliance with treatment regimens can take a devastating toll.
Which is why researchers are using technology to not only deliver medication reminders—like the personal health medication compliance monitoring system that an Australian team is testing for cardiovascular sufferers—but also to positively influence patients' compliance behaviors.
"In the very near future, we want to use smartphones as influencers—to reward or penalize a patient if their behavior doesn't conform to certain instructions, like taking a pill or exercising," says Dr. Guanling Chen, assistant professor of computer science at the University of Massachusetts Lowell. "But, to do that, we need to recognize why they aren't taking their medication. Because they forget? Because the pill is too hard to swallow? Because they always jog at 8 a.m. when it's time to take their medication?"
Chen is lead author of a position paper that describes the team's approach to what they call a "mobile-phone-based patient compliance system" or MPCS.
"The GPS sensor in the smartphone might tell us the patient is always out walking their dog when it's time for their pill, and so the program might adapt to reminding the patient an hour later," Chen says. "Or if the patient doesn't take their medicine on time, a drop-down menu might query them as to what's going on. We are trying to understand the reasons behind the patient's behaviors and then personalize the reminders the smartphone sends them."
Co-author Dr. Ethan Berke, assistant professor of community and family medicine at Dartmouth Medical School and a practicing family physician, says smartphones can help physicians understand patient behavior.
"If the mobile device can collect data—either from the user directly through querying them or through some other method—if we know why compliance is an issue at the time we were hoping an activity would take place, then it really helps the clinician modify the recommendation or work with the patient on how to make the compliance issue go away," he says. "As opposed to just hammering away at the patient with 'you really need to take your medicine, you really need to take your medicine.' "
Both co-authors are currently working on early prototypes of the MPCS and Chen estimates it will take another year or two before the software can go through the "real-world validation stage and we're ready to start looking for a manufacturing partner."
As a practicing family physician at a rural community health center, Dr. David Nelson is keenly aware of the problem of patient non-compliance. At Ammonoosuc Community Health Services in Littleton, NH, his team treats approximately 10,000 patients and he estimates that only "50 percent of recommended medical interventions are actually followed."
A self-described "early adopter," he confesses to being "very much excited about the MPCS project" and he plans to "seek grant funding to get enough of these devices to pilot them with the 60 patients out of our 10,000 who we have identified as our sickest."
"According to a recent article in The New England Journal of Medicine, 10 percent of patients in this country account for 64 percent of healthcare costs. That means that if you have something you think might improve health outcomes . . . and if you could pilot it with a small number of your patients—your sickest—you could potentially see a huge impact on health resource expenditures. And, to me, that is a very exciting prospect indeed."
Paul Hyman was editor-in-chief of several hi-tech publications at CMP Media, including Electronic Buyers' News.
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