患者最需要的5种移动医疗服务

目前所有的医疗计划均注重让患者积极参与到自身治疗中来。传统上，主要通过面对面地与医生或护士进行讨论或通过第三方、预先印好的书面材料来实现患者教育。Pew互联网研究项目进行的一项调查显示，目前70%的患者从医生或护士获得医疗信息。但该调查也发现，越来越多的患者正在通过网络途径寻求医疗信息——60%的美国成人在去年都这么做。

患者和看护人员目前越来越依赖于移动资源。移动医疗数字服务有多种形式，如应用程序、视频多媒体产品、可打印的患者指示、疾病状态教育和随访预约提醒等。通过专有的第三方平台、SAAS（软件即服务）或门户网站可实现此类移动患者教育。对患者而言至关重要并且也是最佳的5个数字医疗服务切入点包括：

1. 在患者因新的临床问题就诊的过程中，会有大量的新信息被传递给患者，包括诊断的定义和描述；疾病的严重程度；对预期寿命、职业和生活方式的影响；以及对其他方面的影响等。患者通常只关注后面的问题而不关注治疗目的、治疗方案和效果等医疗方面的问题。并且很多在讨论中传递给患者的信息会被患者遗忘。如果能够在技术上实现数字重放就诊过程并提供与诊断或所推荐的检查/操作相关的教育材料，将会可带来极大的便利性。一家名为Liberate Health的公司就有这样的技术能力。当然，不是所有患者的学习方式都一样。美国国立卫生研究院已更新相关指南，指导如何选择最有效的患者教育材料。

2. 患者到新的诊所就诊通常会感到不是很自在，因为在就诊过程中需要从头开始了解新医生的个性。患者最关心的问题是医生的治疗理念是否与其契合。要建立良好的医患关系的话，医生需要在沟通和支持患者方面下很大的功夫。向患者介绍一些数字工具，如应用程序和可靠网站的链接地址，可使患者感到医生真正站在患者角度为其着想，这对于促使患者积极参与治疗至关重要。

3. 患者在与医生就检查或操作进行讨论后通常会忘记有关检查本身的一些细节。借助通俗易懂的数字解释和图形说明会方便患者记住检查的内容。

4.在出院过程中，通常需在几分钟内快速向患者进行解释、说明和随访预约等。一项研究显示，仅42%的出院患者能够说出自己的诊断，并且仅37%的患者能够说出其带回家服用的所有药物的治疗目的[Mayo Clin. Proc. 2005;80:991-4]。另一项较大型的研究显示，患者对书面说明的理解存在偏差[JAMA Intern. Med. 2013;173:1715-22]。在这种情况下，数字形式的说明将有助于患者理解。

5. 看护者是卫生保健利益相关者中“沉默的大多数人”。当家庭中有深爱之人被诊断出疾病时，其他人需要转变成看护者的角色。这些看护人员是推行移动医疗技术的关键，因为他们比老年患者更懂得操作移动医疗工具，而且他们也需要准确的信息来使自己成为优秀的看护者。

不难预见，数字技术工具将使患者更积极地参与到治疗中，从而改善医患关系。尽管这些工具的推行不会一蹴而就，但最终会有广泛应用的一天。

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All current health care initiatives, whether overseen by providers, insurers, Pharma, or other industries, are focused on patient engagement. This overused but important term implies the active participation of patients in their own care. It implies that patients have the best means and educational resources available to them. Traditionally, patient education is achieve via face-to-face discussions with the physician or nurse or via third-party, preprinted written materials. Even now, 70% of patients report getting their medical information from physicians or nurses, according to a survey by the Pew Internet Research Project.

That said, more and more patients are seeking health information online – 60% of U.S. adults reported doing so within the past year, the Pew survey found.

Patients and caregivers are now becoming mobile. Baby boomers are becoming “seniors” at the rate of 8,000 per day. Mobile health digital tools can take the form of apps, multimedia offerings of videos, printable patient instructions, disease state education, and follow-up appointment reminders. These can be done with proprietary third-party platforms, or SAAS (software as a service), or practice developed and available via a portal on a website. The reason for this lies in its relevancy and the critical need for education at that corner the patient and caregiver are turning. I will discuss five touch points that are important to the patient and optimal for delivering digital health tools.

Office encounter for a new medical problem. When a patient is seen for a new clinical problem, there is a seemingly overwhelming amount of new information transmitted. This involves the definition and description of the diagnosis; the level of severity; implications for life expectancy, occupation, and lifestyle; and the impact on others. Often patients focus on the latter issues and not the medical aspects including treatment purpose, options, and impact. Much of what was discussed with them at the encounter is forgotten. After all, how much can patients learn in a 15-minute visit? The ability to furnish patients with a digital replay of their encounter, along with educational materials pertinent to a diagnosis or recommended testing/procedure, is appealing. A company with the technology to do that is Liberate Health. (Ed. note: This publication’s parent company has a relationship with Liberate Health. Dr. Scher leads Liberate’s Digital Clinician Advisory group.) Of course, not all patients learn the same way. Guidelines on how to choose the most effective patient education material have been updated by the National Institutes of Health.

Seeing a new health care provider. Walking into a new physician’s office is always intimidating. The encounter includes exploring personalities while discussing the clinical aspects of the visit. Compatibility with regards to treatment philosophy should be of paramount concern to the patient. Discussion surrounding how the physician communicates with and supports the patient experience goes a long way in creating a good physician-patient relationship. The mention of digital tools to recommend (apps, links to reliable website) conveys empathy, which is critical to patient engagement.

Recommendation for new therapy, test, or procedure. While a patient’s head is swimming thinking about what will be found and recommended after a test or procedure is discussed, specifics about the test itself can be lost. Support provided via easy-to-understand digital explanation and visuals, viewed at a patient’s convenience and shared with a caregiver, seem like a no-brainer.

Hospital discharge. The hospital discharge process is a whirlwind of explanations, instructions, and hopefully, follow-up appointments. It is usually crammed into a few minutes. In one study, only 42% of patients being discharged were able to state their diagnosis or diagnoses and even fewer (37%) were able to identify the purpose of all the medications they were going home on (Mayo Clin. Proc. 2005;80:991-4). Another larger study describes the mismatch between thoroughness of written instructions and patient understanding (JAMA Intern. Med. 2013;173:1715-22). Again, digital instructions reviewed at a convenient time and place would facilitate understanding.

 Becoming a caregiver. No one teaches a family member how to become a caregiver. It’s even harder than becoming a parent which is often facilitated by observation while growing up. Caregiving is often thrust upon someone with an untimely diagnosis of a loved one. There is upheaval on emotional, physical, and logistical levels. Caregivers are critical in the adoption of mobile health technologies. They need to be included in the delivery of these tools for a couple of reasons: They will likely be more digital savvy than the elderly patient is, and they need to have accurate information to be a better caregiver. They are the “silent majority” of health care stakeholders and probably the most critical.

It is not difficult to see how digital technology tools can help the physician-patient relationship by making the patient a better partner in care. While adoption of these tools will not happen overnight, it will happen.

Dr. Scher is an electrophysiologist with the Heart Group of Lancaster (Pa.) General Health. He is also director of DLS Healthcare Consulting, Harrisburg, Pa., and clinical associate professor of medicine at the Pennsylvania State University, Hershey.

 

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