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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project, an initiative that promotes the writing of medical students, residents, and new physicians as they explore ideas for transforming American health care delivery.  I recently had the opportunity to interview three of the writing fellows about how to help patients take control of their health. Dr. Marissa Camilon (MC) is an emergency medicine resident at LA County USC Medical Center, Dr. Craig Chen (CC) is an anesthesiology resident at Stanford Hospitals and Clinics, and Dr. Elaine Khoong (EK) is a resident in internal medicine at San Francisco General Hospital. Here’s what they had to say:

1. How would you characterize the patients who are most successful at “taking charge of their health?”

MC: They are usually the the patients who aren’t afraid to ask questions about everything- possible treatments, pathology, risk factors.

EK: I think there are several traits that make patients successful at modifying their health: 1) Understanding of their disease: patients need to understand how their actions impact their health and be able to clearly identify the steps they need to take to achieve their desired health. 2) Possessing an internal locus of control: patients need to feel that their health is actually in their control. Oftentimes, patients who come from families that have a history of chronic diseases simply assume certain diseases may be their fate. But in reality, there are things that can be done to manage their disease. 3) Living in a supportive, nurturing environment: behavior changes are difficult. It is often not easy to the right thing for your health. Patients that take control of their health have a support system that helps ensure they take the steps they need. 4) Having realistic expectations: improving your health takes time and thus it requires patience. Individuals must be able to identify the baby steps that they’ve taken towards improving their health.

CC: Patients must collaborate with their physician – the best patients come in motivated, knowledgeable, and educated so they can have a meaningful dialogue with their doctor. Medical decision making is a conversation; patients who are invested in their health but also open to their doctor’s suggestions often have the best experiences.

2. What do you see as the main causes of non-adherence to medical advice/plans?

MC: Not fully understanding his or her own disease process, denial/shock, inability to pay for appointments/rides/medications.

EK: I think there are several reasons that patients may be non-adherent. These reasons can largely be grouped into three main categories — knowledge, attitude, and environmental factors. Some patients simply don’t understand the instructions provided to them. Providers haven’t made it clear the steps that need to be taken for patients to adhere. In other cases, patients may simply not believe that the advice provided will make an impact on their health. Probably most frequently, there are environmental factors that prevent patients from adhering to plans. Following medical advice often requires daily vigilance and strong will power. The challenges of daily life can make adherence difficulty.

CC: In my mind, non-adherence is not a problem with a patient, but instead a problem with the system. Modern medicine is a complex endeavor, and patients can be on a dozen different medications for as many medical problems. It’s unreasonable to expect someone to keep up with that kind of regimen. Socioeconomic factors also play a big role with adherence. Patients who are poor struggle to maintain housing, feed their children, hold a job; how can we expect them to be perfectly medically compliant? Tackling the issue of non-adherence requires engagement into the medical and social factors that pose challenges for patients.

3. Could mobile health apps help your patients? Do you think “there’s an app for that” could revolutionize patient engagement or your interaction with your patients now or in the future?

MC: Apps, not necessarily. Most of patient population has limited knowledge of their mobile phones (if they even have mobile phones). If they do have a phone, its usually an older model that doesn’t allow apps.

EK: I absolutely think that mobile health apps could help my patients. I work at a clinic for an urban underserved population. For patients that work multiple part-time jobs to make ends meet, it is difficult to ask them to come into see a healthcare provider (particularly if the commute to see us requires 2+ bus rides). Unfortunately the patients who are working multiple jobs are often patients in their 40′s and 50′s when they start manifesting the early signs and symptoms of our most common chronic diseases (hypertension, diabetes, and cardiovascular disease). Mobile applications have great potential to simplify the way through which patients can receive medical guidance especially helping the patients who don’t have the luxury to seek medical advice during normal work hours.

CC: I think there is a role for technology in the delivery of modern medical care. However, we have to keep in mind that not everyone has access to smartphones, and often the most medically disadvantaged populations are those who need support the most. Although initially, technology seemed to put a barrier between the clinician and the patient, I think as devices become more prevalent and we become better at using them, we’ll be able to use these collaboratively. The main advantage of an “app” or device is giving the patient more control over their health; they can track their sleep, diet, exercise, medication adherence, and other aspects of their health and work with their doctor to optimize it.

4. Do you know of any programs to improve health literacy that have been particularly successful or innovative? If so, describe. If not, what kind of initiative do you think could make a difference for your patients?

MC: I know that some of the primary care clinics in the county have started using texting for appointments reminders. Texting seems to be more accessible to our county population.

EK: Unfortunately, off the top of my head, I cannot think of any great programs that have increased health literacy. Part of the reason for this is that we really don’t have a great sense of what levers increase literacy. Any initiative that will work best honestly depends on the individual patient — each patient has different barriers that limit their health literacy. For some patients, their limited English proficiency is the greatest barrier. For other patients, there are cultural beliefs that must be considered in delivering health content. And for some patients, numeracy or general literacy is an issue. Unfortunately, I think there is no one size fits all solution for addressing health literacy.

CC: I don’t think there’s any magic bullet for health literacy. Different communities, patient populations, and clinical settings merit different interventions. For example, tackling child obesity in a neighborhood with lots of fast food requires a different program than ensuring prenatal health in an immigrant community.

5. Are there generational differences in how your patients interact with the healthcare system? Describe.

MC: I tend to see older patients since they usually have more medical problems. They are more likely to have a primary care doctor; whereas younger patients don’t come in as often, but don’t usually have access to primary care.

EK: I think more than a generational difference there is actually a cultural and socioeconomic difference. Traditionally, we are taught or somehow led to believe that older patients are more likely to simply adhere to medical advice whereas younger patients question. But in my limited experience, I have seen affluent patients more engaged with providers (bringing in their own resources, asking about health advice they’ve heard or read about). Some of my less wealthy patients seem more passive about their health and during visits. Furthermore, patients from certain cultural backgrounds are more or less likely to view healthcare providers as an authoritative figure rather than a partner in shared decision making.

6. Do you use digital systems (EMR/Social Media/Mobile) to interact with your patients in any way? Do you think you should do more of that, or that there is a desire for more on the part of your patients?

MC: We do have an EMR but don’t really use it to interact with patients. As I mentioned before, mobile texting may encourage patient interaction.

EK: The main way that I currently use digital systems to interact with patients is via email. Our clinic has a somewhat difficult-to-navigate telephone prompt system, so some patients email me directly re: changing their appointments, medical advice, or medication refills. Unfortunately our EMR doesn’t currently have a patient portal (although it will be rolling this out soon). I think a patient portal is a great tool for helping patients stay more engaged in their healthcare.

I think there is a role for SMS messaging to remind patients about appointments, important medications, or other healthcare related notices. For the right patient population, I think this could make a big difference.

In general, I am a big proponent of technology. I don’t think it’s going to be a panacea for our many problems in the healthcare system, but I think there are very specific shortcomings that technology can help us address.

7. What would your patients say they needed in order to be better educated about their health and have more successful healthcare experiences?

MC: More time with their physicians, mainly.

EK: Almost certainly simply more time with healthcare providers to better explain their health issues as well as more time to explore shared decision making.

CC: There is a lot of information out there about common illnesses and diseases, but not all of it is accurate or up-to-date. One challenge for patients is identifying appropriate resources written in a manner that can be easily read and understood with content that has been reviewed by a physician or other health care expert.

8. If you could pick only 1 intervention that could improve the compliance of your patients with their care/meds, what would it be?

MC: Increase the amount of time physicians have to answer questions with patients and discuss medical treatment options with them.

EK: Wow, that’s a hard one. I struggle to answer questions like this because I strongly believe that each patient is so different. Any non-adherent patient has his or her own barrier to adherence. But I suppose if I had to pick something, it might be some form of weekly check-in with a health coach / community health worker / health group class that intimately knew what the most important steps would be to helping that one patient ensure better health.

CC: I think that social interventions make the most difference in the health of underserved populations. For example, stable housing, healthy meals, job security, and reduction in violent crime will improve health including medical compliance far more than any medicine- or technology-based intervention.

Combining Telehealth And Mobile Technology To Improve The Quality Of Health Care

Bill Crounse, MD, Senior Director, Worldwide Health, Worldwide Public Sector Microsoft Corporation shares his insights and describes four leading trends and technologies that will transform health and health care in 2012 and beyond.

These leading technologies include:  cloud computing, health gaming, telehealth services and remote monitoring/mobile health.

Telehealth, Remote Monitoring, Mobile Health

I’d like to focus on telehealth and remote monitoring/mobile health since I feel telehealth is the nucleus of patient care, and telehealth can help reduce health care costs, and improve quality health care for patients. Telehealth technology combined mobile technology such as smartphones will make monitoring patients conditions easier and more efficient, and “cheaper and more scalable.

Patient Quality Health Care

Through the Accountable Care Organizational Model (ACO), the core concept is to Read more »

*This blog post was originally published at Health in 30*

Interview With Ocra Health CEO: The Future Of The Company’s Interactive Health Apps

Post image for Orca Health crafts new level of sophistication in patient education apps, interview with CEO Matt Berry #mHS11

Orca Health has had quite a year. Launching their first app in in 2010, they now have a suite of ten apps with–we are promised–even more on the way. By combining stellar art work, three-dimensional interactive graphics and high-end native programming for the iPad, they have created and may well be en route to cornering the market for perioperative patient education apps.

Recent milestones for the company include winning the startup competition at Health 2.0 Europe, having two apps, EyeDecide & FootDecide, included in the iTunes App Store’s Apps for Healthcare Professionals. Until recently, Orca Health’s EyeDecide was ranked as the #1 downloaded free medical app on the App Store, and three other other apps (FaceDecide, BreastDecide & ENTDecide) are in the Top 25. To top it off, the iTunes App Store just included EyeDecide among the best the iPad / iPhone apps in its App Store Rewind 2011. It is interesting to think about the different places, and there are many, they could go from here.

Orca Health was among those selected for the StartUp Mobile Health Pavilion at the recent mHealth Summit (check out our full coverage), along with about two dozen other great mobile healthcare companies. There, I got to meet CEO & founder Matt Berry and publicist whiz Jake Lybbert (follow on Twitter). I talked with Matt about the (short) history and future of Orca Health, and his thoughts on the potential for tablets to improve the patient experience.

First, I have to ask – why the name Orca? Read more »

*This blog post was originally published at iMedicalApps*

Company Introduces Platform For Wirelessly Connecting Medical Devices

Post image for Qualcomm announces major breakthrough for connected medical devices #mHS11

One of the major announcements at last week’s mHealth Summit was made by Qualcomm who introduced a new platform for wirelessly connecting medical devices. The 2net platform abstracts away the details of connecting a sensor to a cloud-based server.

Right now, if a company develops a great  lightweight sensor to measure, say, walking speed, it will also have to engineer a way for that information to be transferred wirelessly, sometimes across a couple of stops, to its eventual destination somewhere on a server. Although these same challenges repeat for every device, each company has to “reinvent the wheel”.

Additionally, once it arrives at the company’s servers that rich collection of data would still be isolated – in a “data silo”. If another company comes along with a terrific heart rate sensor and suggests, “why don’t we combine the two data streams and make a useful new app”, not only would they have to recreate the entire chain of communication for themselves, the two companies would have to agree to methods for their two servers to talk and share information.

2Net makes almost all of the above problems Read more »

*This blog post was originally published at iMedicalApps*

mHealth News: Grandma Wins “Apps Against Abuse” Tech Challenge

There aren’t too many grandmothers developing mobile health apps these days, but I met a charming one (Jill Campbell) at the mHealth Summit yesterday. Jill is a 60 year-old woman from Texas who has been actively concerned for the safety of herself and her daughter over the years.

“My daughter took a self-defense class,” Jill explained, “And she was taught the ‘fight or flight’ response to escape harm. I’m 60 years old. I’m not good at fighting and not very fast at fleeing. So what’s my third option?” Jill created the WatchMe 911 app to provide the solution.

“I first started thinking about a personal alarm system before smart phones even existed. I saw that there were car alarms and house alarms, and wondered why there weren’t personal alarms. At the time I imagined that the personal alarm would go through an answering service system, but since smart phones were created, it can all be tied together in an app format.”

Jill demonstrated the WatchMe 911 app to me during our interview. It contains features such as a panic button that can be armed in advance. Two taps on the smart phone screen and a circle of friends and 9-1-1 are contacted immediately with your GPS location and an alert message. The panic button is a favorite for women who are concerned for their safety when walking late at night or in dimly lit parking lots or alleys. Read more »

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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