Why You Should Use a Mobile App to Help Manage Your Chronically Ill Patients

Chronic diseases are a global epidemic. Three out of five Canadians over the age of 20 have at least one chronic disease and many others are at risk of developing one. Caring for this group poses a heavy burden not only on caregivers, but also on the patient themselves. Many organizations who care for patients with chronic diseases have implemented technologies that make it easier for everyone involved. Mobile apps can be used for various purposes. The entire care team can connect in one place which fosters better communication and information sharing. Some platforms can be integrated with home health devices that the patient can use to monitor their conditions. They can share this information with their care team in real-time. The ability to monitor a patient’s condition remotely means that care providers can track their health and intervene when necessary. When an intervention takes place before the condition has the chance to get worse, it can avoid an emergency room visit or a trip to the doctors office. In this blog, we will be highlighting four posts explaining the various benefits an organization can have from using a mobile app for chronic disease management.

Integrations with home health monitoring devices

As mentioned previously, some apps allow for health monitoring through bluetooth devices. This post details the impact that encouraging your patients to use these devices for monitoring their chronic conditions can have. aTouchAway by Aetonix is a platform that supports real-time updates using various home health monitoring devices. These consist of a step counter, a fall detection/wandering bracelet, a pulse oximeter, a weight scale, a blood glucose meter, and a blood pressure monitor. They are easy to set up and use from the comfort of the patient’s home. When they patient has used any of these devices to monitor themselves, their results will be available to whoever has been permitted to view them. Care providers also find it especially helpful when the results can be represented in a graph or chart format. This makes it easy to spot any sudden changes in the pattern and make changes to routines/prescriptions if necessary.

Ability to observe trends and intervene

This post features an interview we conducted with one of our clients. Laura Schauer, a registered nurse with the Thamesview Family Health Team, sat down with us to share her experiences with using a mobile app for her patient’s chronic disease management. One story she told us particularly stood out. Laura explains that she has a patient with congestive heart failure who uses a weight scale and blood pressure monitor at home to share their results with her daily through aTouchAway. She noticed this patient suddenly had very low blood pressure readings. When she called the patient to discuss, they reported they had been feeling dizzy. Based off this information, Laura was able to discuss with the patient’s physician and agree on giving them a lower dose of their blood pressure medication. The physician was able to remotely adjust the patient’s prescription and the patient was feeling back to normal two weeks later. This is just one of many examples where healthcare practitioners are able to observe their patient’s health information through an app and take action.

Care Plan Sharing

Care plans are essential for patients with multiple chronic illnesses. They provide individualized guidance for the patient and their care team. This post details how digital accessibility to a patient’s care plan can improve the way their team provides care to them. When the whole team is kept up-to-date and informed of progress in one place, it is much easier to stay on track with the patient’s goals. Getting the patient set up on a mobile app along with the rest of their care team will help to ensure that the patient is kept at the centre of their care.

Reducing Hospital Readmissions

It’s no secret that hospital readmissions are part of what is so costly to our healthcare system. Especially when they are avoidable or unnecessary. This post looks at how using a mobile app helps to reduce these hospital visits. Patients who deal with a condition like COPD may be likely to go straight to the emergency room when they’re experiencing breathlessness. This is not always the right call, especially when there are other options available. Patients like these may take comfort in being set up on an app that connects them to their family and professional caregivers. If they are having trouble breathing, they are able to call someone close to them who can get a visual representation of how they’re doing and coach them on next steps.

If you or your organization are considering using a mobile app for your patient’s chronic disease management, we hope these posts will help give you further insight into the benefits it can offer you. Please feel free to look at our blog page for more articles on caregiving for patients with chronic conditions.

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COPD Education – Onboarding

Objective

To complete a thorough needs assessment / initial evaluation for a COPD patient of an outpatient clinic

Actors
Patient, Educator (Nurse, RT, the Physician could also be the educator)

Timelines
One 60-90 min session with the Educator

Description
  • This protocol should be established for all COPD patients from a given clinic, independently of whether they are new patients or they are known to the clinic. This protocol is the basis to engage the patient into other protocols such as education, exacerbation follow-up, etc.
  • We need to identify patient goals/concerns to guide the interventions
  • A thorough evaluation is carried on, with the objective of understanding where the patient is on their disease journey and follow-up treatable traits: dyspnea, exacerbation or dyspnea and exacerbation.
  • It includes the use of objective questionnaires such as the mMRC, CAT, HADS, Frailty Scale, etc.
  • Identify if the patient needs to be referred to other resources (e.g. Physiotherapist, social worker, occupational therapist)
  • Once Onboarding is completed, the patient continues to the COPD Education workflow
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COPD Education – Continuous Maintenance

Objective 

To cover in depth all the necessary elements of self-management education as per the LWWCOPD, with priorities based on patient goals and identified treatable traits

Actors
Patient, Educator (Nurse, RT or Physician)

Timelines
A number of “Core” educational modules have been identified which cover the basic COPD education from the LWWCOPD program. Additionally, optional modules can be used to respond to patient needs. The timeline (frequency, number of modules to be covered at a given education session) is fully customizable, although we recommend to have education sessions every 2-weeks during the “active” phase of education. Once this is completed, the patient continues to the Maintenance Mode (see below).

Description
  • Launched at the onboarding protocol
  • Provide basic overview of COPD self-management based on LWWCOPD (medication adherence, inhaler techniques, PLB technique & energy conservation) up to the development of an Action plan for early exacerbation recognition and management.
  • Prioritize self-learning by the patient (e.g. watching videos, reading educational materials, completing homework) in addition to live sessions with the Educator. Educational materials are sent to the patient directly via the platform, and become the patient’s own library. The Educator can customize which “homework” the patient receives.
  • Educators have access to “User guides” to standardise their educational intervention. These user guides include: objectives, interventions, suggested questions, evaluation of self-efficacy, and learning contracts for each module.
  • Once the core education is completed, the patient can continue to the Respiratory Status Follow-up Workflow (run in parallel)

The Maintenance Mode
  • As soon as the maintenance mode is engaged, the frequency of visits Educator/Patient is reduced to once every 6 months.
  • During the Maintenance Mode sessions, the educator has access to all the education modules and can choose any piece of content that needs to covered with the patient. 
  • A streamlined evaluation (similar to the initial eval.) is done during each “maintenance” visit to identify any substantial changes on the patient’s needs that will require some adjustment. The patient could come back to an “active” education mode (more frequent education sessions, e.g. every 2 weeks).
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COPD Respiratory Status Follow-up

Objective

Monitoring of stable patients from a clinic in order to identify early any aggravation of symptoms (exacerbation) and implement an action plan

Actors
Patient, Educator (Nurse, RT or Physician)

Timelines
Scheduled regular automated follow-up to the patient symptoms. Intensity/Frequency can be adjusted by the Educator depending on patient needs (e.g. daily, every week, etc.). Ongoing through the year.

Description
  • Launch: Patients who have completed the Core Educational including setting-up an action plan.
  • Regular automated questions allow to identify any change in patient’s symptoms and severity.
  • If an exacerbation is detected the patient gets a reminder to engage their self-management strategies while waiting for the Educator to call back.
  • An alarm is generated for the Educator, so they immediately call back the patient. At this call they will evaluate any further intervention required and schedule additional follow-up.
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