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How technology is shaping patient education

Technology plays a crucial role in patient education and its importance is only likely to increase
History:

Patient education is at the core of modern healthcare and its importance has been demonstrated in many diverse disease and treatment areas, in particular hormone replacement therapy,[1] diabetes,[2] asthma[3] and erectile dysfunction.[4] Providing quality information and education will ultimately give patients greater control over their disease, increasing compliance and empowering the patient, all of which can lead to improved outcomes and reduced healthcare burden. Health policy analysis in the mid-nineties demonstrated the effectiveness of patient education, showing that for every $1 spent, between $3 and 4 were saved.[5] A focus on the value of informing patients about their own condition can be approximately traced back to the 1950s, in particular to the discharge of American veterans from hospital.[6] 


Changing landscape:


During the past 50 or 60 years, patient education has changed markedly but the biggest change is without doubt the move from a healthcare professional deciding and telling the patient what is best for their health, to a process of patient empowerment where treatment decisions are made jointly. Part of this is equipping them to care about their own health and so move from a focus on curing to an emphasis on preventing or managing disease. For instance, a patient who may have been diagnosed with type 2 diabetes must be encouraged to care about their health and not just believe they have a progressive disease which may eventually kill them. If the patient cares about and invests in their health, they may modify their disease and will inevitably have a higher quality of life, as well as fewer complications, leading to a reduced healthcare burden.

Innovation:

One of the biggest changes in patient education is the acceptance that it is no longer appropriate to just give a leaflet to a patient and send them away. The use of technology has revolutionised the way patients are educated about health. Last year, a major pharmaceutical company working in diabetes launched an innovative first person simulation using 3D headsets for patients, healthcare professionals and the general public. The simulation showed the high impact of mild hypoglycaemia (low blood sugar) on a patient; it made the viewer ‘feel’ the symptoms of hypoglycaemia in various scenarios through a typical day for a person with type 2 diabetes. While this also increased empathy in healthcare professionals, for newly diagnosed patients it acted as an effective tool to give them greater understanding of symptoms to be aware of which allows them to take action earlier to address low blood sugar. No amount of written text could realistically give the same level of impact or information as this 3D simulation. It has since been translated into nine languages and used in 26 countries across the world, demonstrating how effective patient education tools can be used globally.

Automated delivery of patient education can be both efficient for the patient and free up physician time. In 2008 Northeastern University developed a virtual nurse (‘Louise’), which provides an interactive discussion with the patient about home care, this takes place before the patient is discharged and the conversation is composed based on the patients’ medical records. The aim of this initiative is to free physician time and any unanswered questions are included in a report which can be progressed by a human nurse. The reduced physician time was calculated to save the hospital $145 per patient, interestingly 74% of interviewed hospital patients preferred to get the information from ‘Louise’ rather than the doctor.[7]
Not all technology has to be completely revolutionary; the simple use of ipads has also been shown to enhance conversations between patients and clinicians through quick access to illustrations and videos.[8]    

It has been estimated that over 48% of the UK population own smartphones[9], which has opened a route for patient education to be used as and when a patient requires. This was very successfully demonstrated by the UK’s largest men’s health charity, the Men’s Health Forum. During Men’s Health Week 2011 they launched the smartphone app ‘Bloke Noises’ which allowed men to play a simple game and be directed to trusted information on the internet where they could become informed about health issues they may previously have been reluctant to discuss. In fact, apps are almost ubiquitous, with many disease-specific apps available on both iPhone and android devices. The relative simplicity of producing an app has been demonstrated by a recent study by Bournemouth University showing how people with type 1 diabetes can participate effectively in the design of an app for their use.[10]
Interactive technology has also proved particularly effective in general communication with patients, with a report showing a 42% increase in patient satisfaction with hospital educational materials when interactive technology was used.[11] An interesting trend in measuring whether patient education is effective is remote monitoring. For instance, in cardiology, this allows doctors to monitor the heart rhythm and any potential problems.[12]  Such remote monitoring of specific or general health has the potential to allow doctors to see if a patient has been implementing the education they’ve received.     

The future:

Innovation can always help to advance a field, however while cutting edge methods can provide a fantastic resource, in this case, it is very likely the future of patient education will feature even more extensive use of apps, in particular these will focus on helping patients manage complex ‘lifestyle diseases’ such as type 2 diabetes. While there is concern that the field of medical apps is somewhat unregulated[13] there can be no doubt that apps provide a fantastic opportunity to provide information, conveniently to patients. With the expanding use of the internet, e-learning will also provide an increasingly useful resource for patients. While cutting edge innovation is more likely to be driven by the private sector, the pharmaceutical industry often competes in a very crowded market; as such they are always seeking a new way to stand out from their competitors. Use of technology and innovation should seek to drive enhanced patient experience and improve outcomes both on an individual and an economic level.

References:
[1] Sturdee Climacteric. 2000 Dec;3 Suppl 2:9-13.
[2] Funnell et al., Diabetes Care 2009 32 1 S87-S94
[3] Wilson et al., Patient Education and Counseling 80, 3, 2010,  393–398
[4]
Hackett et al., Clinical Cornerstone 7, 1, 2005, 57–64

[5]
Bartlett E, Patient Education and Counseling 26, 1–3,  1995, Pages 87–91

[6] Beauchamp, G.E. Patient education and the hospital program. U.S. Veterans Admin. Bull. 10-88: 3, 27, 1953.
[7] Jack, B.W et al.. A reengineered hospital discharge program to decrease rehospitalization: A randomized trial. Ann Intern Med, 2009 150(3), 178-187.
[8] Patient Education Management “Don't get left behind: iPads making strong inroads with patient education” 2011
[9] New Media Trend Watch http://www.newmediatrendwatch.com/markets-by-country/18-uk/154-mobile-devices
[10] Pulman, A., Hill, J. and Masding, M. G., 2013. The development of an innovative mobile phone app for type 1 diabetes alcohol education. In: Diabetes UK Professional Conference, 13--15 March 2013, Manchester, England.
[11] The Beryl Institute “Enhancing the Patient Experience Through the Use of Interactive Technology” 2011
[12] Acosta-Lobos et al., Future Cardiology 2012, Vol. 8, No. 3, 425-43
[13]
Buijink et al., Evid Based Med. 2013 Jun;18(3):90-2




25th October 2013

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