Technology: the missing link in true patient engagement?

Approximately 50% of patients do not take their medication as prescribed. This comes at a huge financial cost, and results in suboptimal patient outcomes. There is a wealth of research indicating a myriad of behavioural reasons for non-adherence and ways that we can help patients overcome these. The challenge we now face is successfully integrating these methods into patients' everyday lives, so that they do not add to the existing burden of disease.

While manual adherence programmes with assigned nurses have yielded positive outcomes, it isn't always possible to provide this widely due to financial and resource restraints. Therefore we should take advantage of devices already owned and commonly used by the majority of patients to filter the resources and attention of HCPs effectively.

More people than ever use smartphones. With the average person checking their phone 27 times per day, notification features are a strong resource to exploit. It's all about making it easier for patients and taking advantage of existing user behaviour. People are more likely to look at their smartphone and see the reminder notification to fill in their daily log, rather than use a printed diary that could get lost in a pile of paperwork.

Collating all information about their condition in one place gives patients better visibility on their condition and empowers them to make informed choices. It effectively highlights all aspects that need to be managed; medication, associated self-management behaviours, appointments and more. Technology-based platforms provide an obvious solution to house this information.

Research indicates patients are more likely to sign up to a technology-based programme than opt in to receive product-branded support materials. Therefore technology is well-positioned to provide a point of access. Use of technology in adherence programmes is not a revelation, but how do we use it to best improve patient engagement?

A number of key technology developments mean we are at an exciting stage where advances in patient tracking, combined with sophisticated algorithms, can work continuously to intelligently process real-time data and make ongoing adaptations to engagement programmes:

• Wearable technology: collecting data from daily life (heart rate, temperature) tracking improvements and signalling to HCPs when an intervention is required
  
• Smart-devices: sensor-enabled pills, smart inhalers and smart injection systems give detailed, accurate adherence data
  
• User journey analysis: by analysing trends in individuals' behaviour, we can accurately identify potential barriers to adherence and address these immediately. For example, when patients frequently visit a page about potential side effects we can infer that a fear of side effects is a potential barrier. Content that focuses on the management of side effects can then be presented to these users to address their concerns.
  

Combined with a wealth of real-world data, we are also able to use advances in machine learning to predict outcomes and apply appropriate interventions based on previous data trends.

Traditional adherence programmes often require patients to submit written questionnaires at set time-points, and the answers dictate the content delivered. A more modern approach of using tracking methods requires minimal patient input beyond initial sign-up, fitting seamlessly into their lives without additional disruption. This is key to the adoption and engagement of any programme.

Linear approaches dictated by preset timelines are dated. The future will see a constant cycle of processing data that will optimise support. By leaving technology to do the hard work, insight-driven approaches can deliver the most advanced bespoke solutions, ultimately relying less on patient input and providing a mutually convenient connection between HCPs and patients.

emotive uses many of these approaches to deliver technology-based engagement programmes in many chronic disease areas. One multiple award-winning insight-based global programme targeted 18-30-year-old asthmatics, a typically hard-to-reach group. Using behavioural science methodology, 'MyAsthma' used initial profiling questions supplemented by ongoing data to feed a complex algorithm that provided content tailored to the individual. The multiplatform intervention has demonstrated clinical improvement in ACT (Asthma Control Test) scores among users.

Traditionally, communication between HCPs and patients rapidly declines post-prescription, leaving patients feeling unsupported. Technology-based approaches can benefit both sides by facilitating deeper, two-way conversations during the consultation and even between visits. A key component of the technology-based patient engagement programmes that emotive has worked on allows the sharing of PROM data by patients with their HCP so that treatment pathways can be reviewed jointly with all information at hand.

Technology is continuing to evolve and has already proven its value in improving patient engagement. To continue to enhance the levels of engagement and deliver better outcomes, we must ensure any programme integrates fully with patients' lifestyles, while simultaneously allowing easy connections between HCPs and patients. It's a tall order, but one that technology, leveraged in the right hands, is capable of delivering.

Helen Moyes, behavioural psychologist at emotive, and Chris Edmonds, managing director at emotive