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First study on mobile technology for chronic disease and its implications for healthcare practice in

Results from the study show clear evidence that well-designed mHealth app interventions can effectively change patient health-related behaviour, improve patient knowledge and confidence for self-management of health and lead to better health outcomes.

The ‘mHealth’ policy brief was written by Dr Jane Walsh and Dr Liam Glynn from the Whitaker Institute at NUI Galway, and contends that mHealth can play a key role in meeting HSE policy objectives to empower patients to self-manage their health, providing them with better access to personalised information and support for active involvement in self-management and lifestyle change.

Opportunities

Newer technologies such as mobile devices and the Internet are omnipresent in modern society. Health-related behaviour change, driven by such technologies, has grown exponentially in recent years, with downloads for health- and lifestyle-related mobile applications or ‘apps’ expected to exceed €25 billion in 2015 and €50 billion in 2017. This presents a unique opportunity for healthcare providers to harness these technologies to deliver a more efficient service for the prevention of chronic disease.

Mobile technologies and wearable technologies such as technology-driven watches represent the ideal forum to facilitate patient self-management. Among the world’s population of seven billion people, there are over five billion mobile devices and over 90 per cent of those users have their mobile device nearby 24 hours a day. The use of such devices allows for the provision of ongoing monitoring and support of both individuals and healthcare professionals, while improving services by giving patients convenient access to detailed, personalised feedback.

This presents a unique opportunity for healthcare providers to harness these technologies to deliver a more efficient service for the prevention of chronic disease.



Research findings

The Whitaker Institute research found that ‘one size fits all’ interventions to enhance self-management of lifestyle behaviour are undesirable. Rather, patients prefer a personalised programme via an app enabling them to prioritise their approach to self-management.

Trust was also highlighted as a key factor in relation to its potential effect on engagement with healthcare providers and motivation around self-management.

 The introduction of a new technology or platform for engagement requires concerted efforts to alleviate patient concerns and to create confidence in terms of quality and security.

Patients’ motivation to use mobile technology was influenced by the potential of technology to provide information, feedback, reward systems and automaticity that could embed new self-management habits.

The potential for technology to facilitate a personalised flow of communication between patient and healthcare provider was recognised as important, as was the ability of technology to facilitate tailored messaging and feedback for patients.

The flexibility and inherent motivational ability of newer technologies seems to have the potential to improve the ability of patients to engage in sustained behaviour change.

Recommendations

There are a number of recommendations from this research. First, interventions via mobile technology are best ‘prescribed’ by a ‘trusted source’ (eg, a doctor). Secondly, a profile of barriers to action should be identified for each patient. Thirdly, self-management programmes should be tailored according to individual patients’ needs. Finally, due to the novel nature of the technology, it is best used to provide a neutral space in which patient and healthcare provider can interact.

Co-author of the mHealth policy brief, Dr Walsh, said: “Due to the novel nature of the technology, it is best used to provide a neutral space in which patient and healthcare providers can discuss and negotiate a management plan around often challenging issues such as concordance, sub-optimal control and lifestyle change.”

For further information on the Policy Brief visit: http://whitakerinstitute.ie/read/policy-briefs/.

New cutting-edge health technology to enable older people with chronic illnesses to be treated in their own homes launched by new Minister of State for Older People

ProACT — major EU research led by Trinity to revolutionise digital healthcare for older people

First cloud-based digital solution of its kind in Ireland and Europe

€4.87 million in EU funding 

Facilitates home-based integrated care for older adults

A new, cutting-edge digital health technology project led by Trinity College Dublin will enable older people with multiple chronic diseases to self-manage their conditions and to be cared for in their own homes. Minister of State for Mental Health and Older People, Helen McEntee, launched the new digital health research programme ‘ProACT’ recently. It has been awarded €4.87 million under the European Union’s Horizon 2020 Research and Innovation programme. Led by the Trinity Centre for Practice and Healthcare Innovation (TCPHI), the project brings together an EU consortium of research institutions, SMEs, health service providers, EU networks and multinational ICT companies IBM and Philips.

ProACT, when complete, will be the first cloud-based digital solution of its kind in Ireland and Europe to specifically support home-based integrated care and management for older adults (aged 65 years and older) with multiple chronic health conditions. The technologies will be focused on facilitating behavioural and lifestyle changes for older people living at home and will link with their care support network. It aims to enable older individuals to live independently in their community for as long as possible.

Commenting on its significance, Minister McEntee said:  “Supporting older people and the challenges they face in later years is a priority for us in Government. ProACT is just one  example of how this can be achieved by providing a unified approach to integrated care, centred on the patient at home with support from caregivers, social care workers, community-based GPs, pharmacists and hospital-based clinicians. “I am delighted to be launching this project today, as it clearly will help people to remain in their own homes in the community as they grow older.”

Provost and President Dr Patrick Prendergast of Trinity College said: “Addressing the challenges of ageing is a priority for Trinity researchers. ProACT is a prime example of how important this research is for the benefit of all in society. It brings together clinical and health research, data solutions and ICT that will lead to the development of new technologies, with the overall aim of improving older people’s lives.”

The first phase of the research programme will target integrated care for diabetes, chronic heart disease, congestive heart failure, chronic obstructive pulmonary disease and age-related cognitive decline. It has the potential to be further developed to address all chronic disease conditions, across all age groups.

Through the new ProACT system, a range of new and existing care applications, sensors and healthcare technology devices will be linked. Customised interfaces will allow patients and their network of carers, GPs, pharmacists and hospital-based clinicians to access the system via their tablet, smartphone or computer, in order to input and access relevant information from one centralised location for the support of home-based, digital integrated healthcare.

 Currently, 50 million patients in Europe suffer from two or more chronic conditions. More than 70 per cent of healthcare costs are spent on the management of chronic diseases, with an overall expenditure in the EU of €700 billion annually. In Ireland, there are approximately 16,000 people aged 65 and over with multimorbidity. 

 Dr John Dinsmore, lead academic and co-ordinator of the ProACT project, said: “Care for patients with two or more chronic diseases is frequently repetitive and inefficient, involving multiple appointments that are often inconvenient and burdensome. Patients sometimes receive confusing and conflicting advice that could also be potentially unsafe, for example due to medication interactions. “This poorly-integrated and co-ordinated care has a range of negative consequences for the health and quality of life of patients and their carers, but also at a broader societal level in terms of healthcare resources.

“With ProACT, we will aim to improve patient engagement by empowering the patient to proactively manage their conditions and to promote a sense of ownership over their health and their care. The system will also seek to improve training and support, particularly for informal caregivers within the home, in order to help reinforce positive health management and lifestyle changes for patients aged over 65.”

By developing new proactive, home-based healthcare models that use digital technologies, it is possible to challenge the single disease framework of chronic disease management and provide new flexible, patient-centred solutions to support the management of multiple conditions. To achieve this, ProACT will develop a new cloud-based, open application programming interface (API) to integrate new and existing technologies to support individuals with multiple chronic conditions. Technologies the system will support include home-based sensors and wearable technology to track and provide personalised clinical and non-clinical feedback to patients.

The ProACT research programme will take place across two primary trial sites in Ireland and Belgium, with a system transferability trial planned in Italy in 2018. It will take over three years to complete and from 2019, future development work could see the system rolled out across a range of disease conditions and age groups.

Commenting on their involvement in ProACT, Lab Director, IBM Research Ireland, Dr Eleni Pratsini, said: “We welcome ProACT as a unique opportunity to tap into the multidisciplinary expertise of service providers, industry players and academic partners. The team at IBM Research Ireland will investigate how cognitive, cloud-based analytics can be extended to provide a consolidated view of the individual helping to drive behavioural change and enable better outcomes.”

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