Patient Perspectives - Online strategies for hypertension management
Khinlei Myint-U Corporate Manager Center for Connected Health Partners HealthCare
Meet Tom
• Sixty-two years old • Diagnosed with hypertension seven years ago • Struggles with diet and exercise, doesn’t like taking medication
Hypertension
• 65 million Americans have hypertension.
• 90% of middle aged Americans will develop hypertension in their lifetime.
• Despite effective treatments, only an estimated 23% of people with hypertension have their blood pressure adequately controlled.
What is the opportunity for connected health?
• Despite growing use of the Internet for health information, little is known about patient perspectives on the use of this medium for hypertension clinical management and self-care
• Goal: Assess patient perspectives on remote monitoring and the use of online technologies as components in their hypertension care
Focus Groups
• Focus groups held to examine beliefs and perspectives of individuals with hypertension
• Effort was made to recruit an equal number of male and female subjects and a range of ages and ethnicities • Focus group moderated by a professional moderator; discussion guidelines were developed by research team
• Research team, with backgrounds in market research and business, psychology, public health, nursing, and medicine observed the focus groups and engaged in thematic classification of the transcripts.
Perspectives on current condition
• Frustration in blood pressure fluctuations, lack of control.
– “I had to be on medication and many different medications, I’m having a lot of trouble…For a few years it’ll be fine and then all of a sudden it goes up again. Nobody really knows why.” (Female, 54)
– “I feel like I can bring it down with diet and exercise, which I’m trying…but then, certain times, it goes up, you know, if I eat maybe to much salt or different factors, stress or whatever” (Female, 41)
• Use of medication as a reflection of a failure of will
– “I feel I’m doing myself an injustice because I’m not being as careful as I should, and I’m relying upon the medication to do what I personally should be being better at” (Male, 64)
Two concepts
• Self-monitoring of blood pressure with data transmission PLUS
• Online Office Visits – Regularly scheduled online office visits with their health care provider – Concept centered around the idea of online office visits that replaced inperson visits • Online personalized portal – An Internet-based feedback portal, designed for self-care
Online Office Visit
• Participants understood potential value of online office visits
– “Yeah, I wouldn’t have to wait in the waiting room for twenty minutes…for a five minute visit” (Male, 58)
• But had preconceived concerns over how the process would work.
– “I think it would be great but I just don’t know if they’re, my practice is very busy…I just don’t know how quickly they’d get back to you.” (Female, 41) – “You know, my fantasy says they’ll let it sit around for a month before they look at it, so I say, I want to speak to a real person…If you speak to a real person you can hold that person responsible” (Male, 58) – “Would this be with my doctor? Or is it going to be his nurse? I want to be sure I’m talking to my doctor. How do I know? Who’s going to prove that to me?”(Female, 54)
Online Office Visit
• Concern over their ability to sufficiently communicate their medical status, and lack of confidence in ability to self-monitor
– “I definitely would not feel comfortable with the online office visit. Not because I’m afraid of the computer or security but the aspect is maybe there’s something other, related, and I might not be adequately describing it to my doctor” (Male, 64) – “You’re monitoring your symptoms and describing them to the doctor and he’s supposed to interpret what you said, but maybe you can’t selfmonitor that well.” (Male, 58)
• Concern over privacy
– “Lots of people make money off people who are sick. Some insurance company might suddenly double or triple my rates if they picked it up” (Female, 64)
Second concept: Online feedback portal
• Remote monitoring of blood pressure linked to an online hypertension portal. Participants were shown mockups of a prototype
• Online portal included: – Visual representation of their blood pressure data – Targeted automated messaging around blood pressure data, medications, and other self-reported information – Ability to email or download data – Educational content • No link between this portal and their physician
My Blood Pressure Readings
140/90
Take blood pressure reading at least twice a week Read this month’s module on “Healthy eating” Complete the “Healthy eating” quiz Read new information on hypertension risk factors
Ongoing Complete Not Complete Not Complete
View all messages
+ 4.05.06 11:23 AM ET. Your blood pressure tends to be higher on weekends. Make sure you keep up with your diet, exercise and diet on weekends. If you keep noticing this trend, it may be worth discussing with your physician. + 4.01.06 10:15 AM ET. Since you’ve started your new medication, your average blood pressure reading was 135/86, compared to 138/88 before. + 3.14.06 4:06 PM ET. Here are some things you may have noticed since you started taking your new medication. Side effects of beta blockers
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Delete message
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Online feedback portal
• Participants liked the idea of an online-based tracking system as a way to gain insight into their actions
– “The idea of being able to keep track of your blood pressure, you know, record it without having to get a paper and write it down, that you’ll probably lose, which I do all the time. I would go there, I would see, ok, last month it was good, this month its not good, what am I doing differently…” (Female, 41) – “It’s a valuable tool to measure blood pressure there’s no doubt about it. You can actually do research on your own positive behavior, exercise, including your diet, fruits and vegetables instead of Reese’s peanut butter cups.” (Male, 47)
Online feedback portal
• Targeted messaging – providing dynamic feedback based on blood pressure data and self-reported information was appealing
– “I like the computer generated messages just because it gives you pointers. It’s not telling you, you have to do this, but you know, it notices like on the weekend, you got out a little bit more…”
• Subjects felt strongly that coordination with their healthcare provider would greatly enhance the appeal of this program.
Factors to encourage adoption
• Online portal that presents blood pressure data must also offer rich features for active self-management.
• Decision support rules to produce accessible, relevant targeted feedback would be seen as highly valuable
• Physician participation would increase perceived usefulness and establish trust
• Clear communications around the process for physician involvement is important
Conclusions
• More to learn about how to use available technologies to – Educate, motivate patients
– Encourage a richer conversation using everyday data between patient and physician
Acknowledgements
• Vinod Nambudiri, Harvard Medical School • Alice Watson, MD, Center for Connected Health
• Joseph C. Kvedar, MD, Center for Connected Health