The empowered patient
Professor Walter Van Dyck
Historically, the physician was always the best informed about both the patient’s health condition and potential treatment options – this ensured that he/she was the dominant party in this asymmetric doctor-patient relationship. Now, with patients becoming more proactive in the management of their health, the centre of gravity is moving from the healthcare provider to the more knowledgeable patient, and this is raising expectations exponentially. Patients take for granted that their preferences and concerns are listened to, as more and more they want to be involved in a shared medical decision making process. There is clearly a shift from physician-controlled to patient-empowered medicine, and this is making the relationship more symmetrical, for ’No longer is the patient willing to be patient.’
|EMPOWERING PATIENTS, ONE STEP AT A TIME
One new development is Zora the robot. With infinite patience, it leads physical re-education for people in need (epileptics, old folks homes) in a fun and original way. Able to stand-up, bend over, sit down and move by itself, it can be programmed by physiotherapists to help practice individual movements or collective stretching.
Of course, for acute interventions in catastrophic situations, like cardiac arrests or bone injuries, the traditional ‘diagnose-and-treat’ paradigm will continue to prevail. But, in the case of chronic illnesses like diabetes or hypertension – and these make up the lion’s share of healthcare budgets – the patient expects to be more engaged in his/her treatment. Physicians in general however, don’t have or make the time for it, nor do they have the relational proficiency to help patients manage their disease, let alone help them change their life style i.e. stop smoking, lose weight, eat better and so on. Today’s new ‘empowered patients’ take control of their disease by continuously informing themselves about their health condition and by being more engaged, in an interactive way, with healthcare service providers and peer communities. They often share personal information and ask open questions, and ultimately consider alternative options for taking control of their wellness and sickness. In the wellness field, mobile e-health technology, (e.g. a device worn like a watch or even seamlessly integrated into the body), enables both real-time biomarkers and navigational data acquisition, and this data can be instantly analysed using specialized software apps. But they also allow the individual to post personal health data to a self-selected community resulting in voluntary peer pressure to improve sporting performance or lose weight, say. As an example, sports shoes fitted with an accelerometer chip to measure movement and integrated with a sports watch measuring heart rate, are elements of a body area network delivering real-time data to the person targeting an improved body condition. It gets even more stimulating if the captured human data is posted on social media for friends to compare.
The challenge is for medical technology companies to use emerging nano-, bio-, and information technologies to build and provide market access for cross-industry health solutions geared to personalized health data acquisition and coaching. This will require close collaboration between biopharmaceutical and medtech companies. On the healthcare provider side, physicians, next to curing, will also need to become proficient in preventing their empowered patients becoming chronically ill, and, if they do get sick, coaching them with a co-developed therapy.
|MANAGING CHRONIC DISEASES USING MOBILE HEALTH TECHNOLOGY
A recent Vlerick Healthcare Management Centre project on cardiovascular disease management involved a health ecosystem simulation in which we studied the effect of sponsoring cardiovascular exercise. It included physician point of care diagnostic technology and nursing call centre-supported telemonitoring adherence tools for those patients that were being treated after a heart attack and who were on medication . The results showed that the largest incremental net benefit was measured only when all three interventions were applied simultaneously, indicating the need for a total health system view when making individual intervention decisions. Interestingly, the study also showed the positive effect of funding wellness rather than sickness, with the upstream sponsoring of preventive cardio-vascular exercise paid for by reduced treatment and medication costs downstream.