“Even patients with chronic diseases might spend no more than a few hours a year in front of a doctor or a nurse. But they spend over 5,000 waking hours a year doing everything else — and that ‘everything else’ often has a big impact on their health.” says lead author David A. Asch, MD, MBA, director of Penn’s Leonard Davis Institute of Health Economics. “If we are to help patients improve their health, we need to find a way to engage them during those 5,000 hours.”
The authors cite Penn research on an electronic pill box used to monitor patients taking the blood thinner warfarin as an example of an automated hovering approach that holds promise for management of other illnesses. The dispensers studied were electronically tied to a lottery system that offered patients a chance to win money each time they took their pill – but if they box recorded that they had skipped their warfarin the previous day, they were ineligible to collect the prize even when their number came up in the daily random drawing. The system, which the Penn team detailed in a 2008 paper, reduced the rate of incorrect doses from 22 percent to about 3 percent. The authors suggest that a similar system could be easily deployed to improve medication adherence among patients discharged from the hospital with congestive heart failure or after being treated for acute coronary syndromes.
To be most effective, the Penn authors note that these approaches should target specific patient populations – especially those who are at risk of preventable hospitalizations, an enormous driver of U.S. health care spending. Diabetic patients, for instance, who can keep their disease in check at home by following their recommended diet and exercise guidelines and taking the proper medications, are an optimal target for automated hovering, as are those with heart failure or other cardiac problems who are well enough to manage their disease at home. In those groups, hovering could focus on promoting adherence to the medication regimens that are necessary to prevent costly hospital admissions.
Ralph W. Muller, CEO of the University of Pennsylvania Health System, is also an author of the paper.