Digital Technology improves hospital-community transition and helps patients with rehabilitation and mobility independence
Modern technology (e.g. smart phones/tablets, information technologies, web-based applications, apps, social media, etc.) has changed all aspects of our lives including communication, education and entertainment. For the health care industry, advances in technology has impacted in the way health professionals, clinics, hospitals and health authorities deliver innovative health services to patients. From telehealth to m-health, on Bloom this month we will explore how technology is impacting health in general and health care at PHC.
As part of our eHealth focus, we spoke with CHÉOS Scientist Dr. Linda Li about her and her team’s efforts to develop and test methods to optimize mobility independence in older adults using digital media. This study is a one-year project funded by CIHR. Dr. Li and colleagues will explore interventions developed with the use of social networking sites, mobile applications, and health tracking devices such as pedometers and accelerometers.
Q: Where do you think health care is going with regards to online and mobile tools?
Linda Li: The use of online and mobile tools is common in the general population – around 83% of Canadian have access to the internet at home and the majority use it for health and wellness purposes. Mobile devices and wearable technologies are also becoming more affordable. This offers great opportunities to provide health services for people at a time and in a place they prefer. In the near future, we can expect to see even more digital tools developed for health professionals and patients. The challenge is how to implement them in clinical practice and patient self-management.
Q: What does past research say about using technology to help patients with rehabilitation? With mobility independence?
Li: Several systematic reviews have found modest to moderate effect in using technology for rehabilitation and health promotion. Online clinical decision support systems (e.g., automatic alerts/reminders, drug-dosage calculators), have been found effective in providing preventive services, ordering appropriate tests and prescribing treatments. Consumer health informatics (e.g., patient education websites, online patient decision aids) are useful at various stages of chronic disease management. Also, mobile technologies and wearable monitoring tools are useful for improving cardiovascular fitness and physical activity, and for weight management. The use of technology for health services delivery is relatively new. Unfortunately, some of the early studies have methodological pitfalls, making it challenging to offer recommendations at this point. There are tremendous needs and opportunities for research in this field.
Q: What types of online tools do you hope to develop/test?
Li: We have recently completed a study on an online patient decision aid called ANSWER for patients with rheumatoid arthritis who are considering methotrexate. ANSWER-2, which is a patient decision aid on biologic therapy for rheumatoid arthritis is currently being developed. We are completing an RCT on an online physical activity coach for patient with knee osteoarthritis. We are also working with computer science colleagues at SFU to develop an intervention using a commercially available physical activity tracker to motivate and monitor physical activity in patients with various types of arthritis.
We are excited about the new CIHR-funded network, ICON, because this will allow researchers, patients and health professionals to co-create and test new tools and interventions. We have combined the expertise of 9 research and training programs in brain health, joint health, digital media and knowledge translation in BC, Alberta, Ontario and Quebec. A key component of the ICON is the training opportunity for students to develop skills in both health research and digital media. We welcome anyone who is interested to explore opportunities to collaborate.
We also spoke with Dr. Scott Lear from PHC’s Division of Cardiology and the Pfizer/Heart and Stroke Foundation Chair in Cardiovascular Prevention Research at St. Paul’s Hospital on his research on the use of text messaging to improve the hospital-community transition that also aims to prevent readmission in patients with cardiovascular disease. Dr. Lear and colleagues, including CHÉOS Scientist Dr. Martha Mackay, have received one-year funding to develop a program that will help heart disease patients recover after being discharged from hospital.
In this study, patients will receive text messages within the first 60 days after discharge from hospital using the Txt2Prevent program. These messages will prompt the patient on follow-up care, medication use and maintaining healthy lifestyle behaviours.
Q: What are you hoping to find with your study?
Scott Lear: We hope that the Txt2Prevent program will provide patients with self-management support, enhance medication adherence and improve social support, which in turn will lead to a lower number of re-admissions and a better quality of life for the patients.
Q: What does past research say about using technology to help patients in hospital-community transition?
Lear: Very little research to date has been done in this area but there is some indication that the use of automated technology (IVR) can improve medication adherence.
Q: How important is follow-up and structured care post-hospital?
Lear: This is very important but there are not too many formal programs to provide this care. We do know that as many as 30% of patients are not taking their medications prescribed during their hospital stay even 30 days from discharge. In addition, patients have questions on when to resume their activities and when to seek care.
Q: What types of online tools will you research? Apps? Questionnaires?
Lear: For this one we will be using text messaging so patients who have a device capable of receiving text messages can participate. We also have other research using web-based models of care.
Tiko Kerr, Vancouver Artist and patient of Dr. Julio Montaner