Mobiles for Non-Communicable Diseases
Posted on October 13, 2015
Here’s a first post for the new website! An Oldie, but a Goldie!
Non communicable diseases (heart diseases, strokes, cancers, diabetes, and chronic lung disease) cause an estimated 36 million deaths every year, including 9 million people dying prematurely before the age of 60. mHealth solutions can provide solutions such as improving glycaemic control in type 2 diabetes as well as improving outcomes among patients with obesity and cardiovascular diseases. Furthermore, mHealth is a cost-effective solution that can improve the quality of care among underserved populations, in turn promoting equity in access to healthcare. For example, research by the Telenor Group showed that mHealth can reduce the costs of medical care among the elderly by 25 percent, double access to physicians by those living in rural areas, and improve chronic disease treatment compliance by 30-70%.
Here are some of the ways mHealth can achieve these results:
Medication Adherence: Only 50% patients with chronic diseases comply with their medication regimen with over 40% reporting intentional non-adherence in just 10 days of therapy. When additional drugs are added into the equation, adherence can be as low as just 10%. In addition to waste of costly drugs, non-adherence leads to more hospital visits, hospitalizations and re-admissions. Provider-patient mis-communication, forgetfulness, unwanted side effects, treatment anxiety have all been listed as reasons for lack of medication adherence. Several apps now exist to remind patients to take appropriate doses of their medication at the correct times, set up appointments and track compliance with medical instructions. Some examples of these apps include MedCoach, DoseCast, Pill-Reminder, On-Cue compliance, HealtheTrax, txtalert etc.
Supply chain management: mHealth apps can be used to reduce delays in medicine shipments by reporting shortages of medicine and other products. One such campaign, the Stop Stock-Outs campaign encouraged both consumers and pharmacists to use SMS through FrontlineSMS systems to report shortages and were able to monitor medicine availability, lobby for increasing national budgetary allocations for purchase of medicines and improve the supply/distribution chain. Additionally, mHealth can be used to authenticate that drugs purchased by consumers are not counterfeit. Furthermore, effective record management and patient updates allows for quicker and more accurate dispensing of medication.
Lifestyle Compliance: Lifestyle factors play a huge role in chronic diseases and apps can easily help patients regulate and monitor their diets, exercise, smoking and other behavioral factors that directly influence health outcomes. Apps for monitoring risk areas for persons with asthma, Crohn’s diaries, dietary guidance, fitness motivation etc. can all account for huge cost savings in the healthcare industry. Virtual coaching apps provide advice on a range of issues, tracking activity and making suggestions based on a person’s goals.
Education: mHealth can be successfully used to properly educate patients on their conditions, treatment regimens, follow-up instructions, long term prognosis etc. One such example was recently was evaluated where users in 60 central Ugandan villages to text questions on sexual and reproductive health to a server and receive pre-prepared responses from a database. There is a lot of room to re-design these mHealth systems for best results. Furthermore, several countries are now using games, quizzes, social media and similar non-traditional mechanisms to deliver vital health information. For example, Project Masiluleke, a collaboration between PraekeltFoundation, iTeach, PopTech and MTN in South Africa, has sent out 1 million messages/day since 2009 encouraging people to call HIV/AIDS and TB helplines for information.
Clinical Use and Decision Making: mHealth is advancing in providing low cost tools for diagnosis, monitoring and treatment. You can read about some of these advances in diagnosis here. Physicians are also able to use these tools for vital decision making in patient management. One such app used in Botswana aimed at residents in training and provided them with medical references and applications that allow them to consult with specialist supervisors on difficult cases.
Remote Monitoring: mHealth technology can be used to manage diseases and improve patient care by alerting healthcare workers on significant changes to patient health. This is particularly useful for reaching patients in underserved or hard to reach rural areas. One such application in China deployed an electrocardiogram sensing handset that records 30 seconds of heart data which is transmitted 24-hour care facility. The facility, staffed with over 40 physicians monitor this information from patients in underserved areas and provide real-time feedback to those with cardiovascular diseases. Another is example is LifeScan which created the OneTouch® Verio®Sync Blood Glucose Monitoring System, the first FDA approved meter to automatically send blood glucose results wirelessly via Bluetooth technology to an iPhone, iPad or iPod touch using a mobile app. The app produces reports, simple visual analytics on data collected and allows user to easily share their information with caregivers and healthcare providers. The app can store up to 2,500 blood glucose results and events and up to one year of results and events.
Financing options: Mobile technology can help reduce the overall cost of care in treating and managing chronic diseases by allowing easy deposition of funds to saving accounts, micro health insurance plans as well as using mobile money to pay for treatment and medication. For example, in Kenya, the Changamka Medical Smart Card allows people who have no access to medical plans or insurance cover to save money using mobile money transfers. Another project, also in Kenya, uses mobile banking, public information, and free treatment in order to give women access to fistula repair.
mHealth applications are growing at a rapid rate, creating a potential for major improvements to the healthcare sector in developing countries. At the same time, there is the issue of duplicative work, wasted efforts and funding as well as confused healthcare workers. Evaluations of existent programs with an eye on effective application design can create mHealth systems of value that can then be mainstreamed into health systems.
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