Journal of Aging and Health — January 2017 —
Objective: To examine the outcomes of a Medicare population who participated in a program combining digital health with human coaching for diabetes risk reduction.
Method: People at risk for diabetes enrolled in a program combining digital health with human coaching. Participation and health outcomes were examined at 16 weeks and 6 and 12 months.
Results: A total of 501 participants enrolled; 92% completed at least nine of 16 core lessons. Participants averaged 19 of 31 possible opportunities for weekly program engagement. At 12 months, participants lost 7.5% (SD = 7.8%) of initial body weight; among participants with clinical data, glucose control improved (glycosylated hemoglobin [HbA1c] change = −0.14%, p = .001) and total cholesterol decreased (−7.08 mg/dL, p = .008). Self-reported well-being, depression, and self-care improved (p < .0001).
Discussion: This Medicare population demonstrated sustained program engagement and improved weight, health, and well-being. The findings support digital programs with human coaching for reducing chronic disease risk among older adults.
Read the full paper.
Harvard Business Review (by Alexander L. Fogel and Joseph C. Kvedar) — Businesses that are serious about reducing health care costs — and improving the health and well-being of their employees — should take a serious look at digital therapeutics, which have the potential to provide effective, low-cost ways to prevent and treat chronic diseases and their consequences. Digital therapeutics are technology-based solutions that have a clinical impact on disease comparable to that of a drug. They primarily use consumer-grade technology such as mobile devices, wearable sensors, big data analytics, and behavioral science and can be delivered through web browsers, apps, or in conjunction with medical devices. They can also be deployed in real time and at scale, which is critical for intervention in chronic diseases.
Journal of Medical Internet Research — October 2016 —
Background: Digital health tools are increasingly recognized as effective in improving asthma clinical outcomes such as control and adherence; however, few studies have evaluated patient perspectives on the usability and value of these tools in supporting asthma self-management. Patient perceptions of digital health tools, including usability and satisfaction, will determine the success of these digital health interventions and the durability of their effects.
Objective: We aimed to assess patients’ usability feedback and satisfaction with an asthma digital health platform after 12 months of use.
Methods: We administered surveys to participants of a randomized controlled clinical study designed to measure the clinical effectiveness of the Propeller Health Asthma Platform. The electronic surveys evaluated patients’ feedback on the usability of the sensor and the perceived value of the platform and information provided after 12 months of use. The clinical study had enrolled patients (N=495) in parallel arms from specialty and primary care clinics. Intervention group patients (n=250) used electronic inhaler sensors to track the date, time and geographic location of medication use. Patients received access to a digital health platform including smartphone and Web-based applications that provided information about their asthma medication use trends, real-time asthma control, guidelines-based education, and personalized support for 12 months. Physicians could monitor the status of their patients and receive notifications about short-acting beta agonist (SABA) overuse. Survey results reported here represent adult participants from the intervention group who completed the exit survey at 12 months.
Results: Respondents (n=89) reported being very satisfied (79%) or somewhat satisfied (20%) with the inhaler sensor, stating that the sensor was “small,” “unobtrusive,” and “easy to use” and carry. A total of 90% of respondents found the information they received via the platform useful, with 93% expressing satisfaction with the information. In open-ended responses, participants cited valuing how the platform increased awareness about their asthma control status and medication use, provided “relevant” and “timely” information, and identified potential environmental triggers that exacerbated their symptoms, with 65% of respondents identifying 1-7 new triggers as result of the information. Respondents described improved communication with their doctors: 46% of the respondents had talked with their doctor about the information they received, and 22% stated that their doctor recommended or changed a specific aspect of their asthma management as a result of the information. Over 50% of respondents said that they felt their asthma was more controlled as a result of the information they received, which is supported by the clinical results demonstrating 63% of uncontrolled patients achieved control during the program.
Conclusions: Patients reported positive usability of a digital health platform for asthma self-management, citing that it was easy to use and fit into their lives unobtrusively. Almost all patients perceived value from the digital health platform in contributing to their self-management, finding value in increasing self-awareness, identifying asthma triggers, offering actionable information, and improving communication with their doctors.
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mHealth Intelligence (by Eric Wicklund) — A relatively new mHealth platform known as digital therapeutics is poised to take healthcare by storm.
Also commonly known as software-as-a-drug, the industry currently consists of a few dozen startups and about $500 million in business, but Psilos Group Managing Partner Joseph Riley says the market stands to blossom to a few hundred companies and some $6 billion in business in five years.
“The potential is tremendous,” he says.
Riley describes the software platform as “the equivalent of having a health coach in your pocket 24/7.” It’s driven by healthcare providers and payers looking to cut healthcare costs and improve outcomes by pushing targeted health and wellness messages when and where needed – most often through an app on a patient’s smartphone.
Journal of Diabetes Research — September 2016 —
Background: The feasibility of digital health programs to prevent and manage diabetes in low-income patients has not been adequately explored.
Methods: Researchers collaborated with a digital health company to adapt a diabetes prevention program for low-income prediabetes patients at a large safety net clinic. We conducted focus groups to assess patient perspectives, revised lessons for improved readability and cultural relevance to low-income and Hispanic patients, conducted a feasibility study of the adapted program in English and Spanish speaking cohorts, and implemented real-time adaptations to the program for commercial use and for a larger trial of in multiple safety net clinics.
Results: The majority of focus group participants were receptive to the program. We modified the curriculum to a 5th-grade reading level and adapted content based on patient feedback. In the feasibility study, 54% of eligible contacted patients expressed interest in enrolling (). Although some participants’ computer access and literacy made registration challenging, they were highly satisfied and engaged (80% logged in at least once/week).
Conclusions: Underserved prediabetic patients displayed high engagement and satisfaction with a digital diabetes prevention program despite lower digital literacy skills. The collaboration between researchers and a digital health company enabled iterative improvements in technology implementation to address challenges in low-income populations.
Read full paper.
Respiratory Medicine — May 2016 —
Background: Overuse of short-acting beta-agonists (SABA) is described in asthma, but little is known about overuse of SABA in chronic obstructive pulmonary disease (COPD).
Methods: Prospective 3-month cohort study of patients with moderate-to-severe COPD who were provided a portable electronic inhaler sensor to monitor daily SABA use. Subjects wore a pedometer for 3 seven-day periods and were asked to complete a daily diary of symptoms and inhaler use. Overuse was defined as >8 actuations of their SABA per day while clinically stable.
Results: Among 32 participants, 15 overused their SABA inhaler at least once (mean 8.6 ± 5.0 puffs/day), and 6 overused their inhaler more than 50% of monitored days. Compared to those with no overuse, overusers had greater dyspnea (modified Medical Research Council Dyspnea Scale: 2.7 vs. 1.9, p ¼ 0.02), were more likely to use home oxygen (67% vs. 29%, p ¼ 0.04), and were more likely to be on maximal inhaled therapy (long-acting beta-agonist, long-acting antimuscarinic agent, and an inhaled steroid: 40% vs. 6%, p ¼ 0.03), and most had completed pulmonary rehabilitation (67% vs. 0%, p < 0.001). However, 27% of overusers of SABA were not on guideline-concordant COPD therapy.
Conclusions: Overuse of SABA was common and associated with increased disease severity and symptoms, even though overusers were on more COPD-related inhalers and more had completed pulmonary rehabilitation. More research is needed to understand factors associated with inhaler overuse and how to improve correct inhaler use.
Read full study.
Journal of Allergy and Clinical Immunology: In Practice — 2016 —
Background: Telehealth strategies for asthma have focused primarily on adherence to controller medications. Telemonitoring of short-acting b-agonist (SABA) focuses on patterns of use and may allow more timely action to avert exacerbations. Studies assessing this approach are lacking.
Objective: This pragmatic controlled study was designed to measure real-world effectiveness of the Propeller Health Asthma Platform to reduce use of SABA and improve asthma control.
Methods: A total of 495 patients were enrolled in parallel arms (1:1) for 12 months of monitoring SABA use. Intervention group (IG) patients received access to and feedback from the Propeller Health system. Routine care (RC) patients were outfitted with sensors but did not receive feedback. Physicians were able to monitor the status of their patients in the IG and receive proactive notifications.
Results: The daily mean number of SABA uses per person decreased by 0.41 for the IG and by 0.31 for RC between the first week and the remainder of the study period (P < .001 for the
difference between groups). Similarly, the proportion of SABA-free days increased 21% for the IG and 17% for RC (P < .01 for the difference between groups). Asthma Control Test (ACT) scores were not significantly different between arms in the entire study population, but adults with initially uncontrolled ACT scores showed a significantly larger improvement in the proportion with controlled asthma in IG versus RC (63% controlled in the study period vs 49%, respectively; P < .05 comparing the 2 improvements).
Conclusions: Compared with RC, the study arm monitoring SABA use with the Propeller Health system significantly decreased SABA use, increased SABA-free days, and improved ACT scores (the latter among adults initially lacking asthma control).
Read full study.
Forbes (by Todd Hixon) — Digital therapeutics have made surprising progress. This is good news, because digital therapeutics are typically cheap, and they have shown impressive ability to change behavior, one of the most important challenges in healthcare.
Dr. Joe Kvedar of Partners Healthcare and his co-authors recently published a very useful book, The Internet Of Healthy Things. Joe has led Partners’ efforts in connected health (using technology to connect Partners’ medical resources to patients outside the hospital) for 20 years, beginning before the era of smart phones and web-based services. Much of his material is familiar to me, however, I was quite impressed by the progress he describes on multiple fronts with digital therapeutics.
The term “digital therapeutics” refers to using a digital system to treat a medical condition, much as one might use a drug, a human counselor, or surgery. Digital therapeutics are used both stand-alone and in combination with conventional therapies.
Andreessen Horowitz (byVijay Pande): The other huge area of interest for us is “digital therapeutics”…The way I like to think of it is this: If the first phase of medicine was about small-molecule drugs delivered intravenously, and the second phase (then led by biotech companies like Genentech) was about protein biologics, then the third phase is about digital therapeutics.
It seems like the holy grail of medicine is to take a pill, wait a bit, and then get better — just like magic! But there are real limits to this, especially when it comes to depression, PTSD, smoking cessation, type II diabetes, insomnia, and other behavior-mediated conditions.
I’m confident that 10-20 years from now when we look back on this phase of medicine, it’s going to seem backwards and even barbaric that our solution to everything was just giving out pills.
Wired Innovation Insights (by Mike Payne) — Digital therapeutics is more than normal doctor visits done via phone or chat; this new field of medicine consists of immersive programs that act reliably and remotely to change individual’s behaviors in order to achieve positive clinical outcomes and “bend the curve” of future medical cost growth. These programs tie patients and health professionals together with web and phone interactions, run online educational curriculum, collect data using smart devices, and are based on the latest behavioral therapy science including group dynamics, game theory, and more.