番茄社区app

I am a huge fan of remote patient monitoring.

As I've written about before, patients spend a tiny fraction of their lives in the office with us, in those direct face-to-face interactions between a patient and a provider. Their doctors' visits are 20 minutes long, which works out to about 1/500th of a week, so for the vast majority of their life, they're on their own. And rightly so. Those brief appointments with us are opportunities for us to inspire, to educate, and to reaffirm the importance of different health interventions and sticking with them, in the hope that our patients will carry on healthy lifestyles for the bulk of their lives when they're not with us.

Assessing Effectiveness

Remote patient monitoring gives patients an opportunity to see the effects of the things they are doing, as well as the effects of the things they're not doing, on their short- and long-term health. When a patient takes their blood pressure medicine every day, tracks their pressure at home, and then sees that their numbers come down and stay down, this can help them stick with the plan of daily compliance. And if they're willing to check their blood pressure when they're not taking the medication and they see that it's high, this may give them some feedback to help them move towards positive change.

For high blood pressure, they can't see the effects of controlling the blood pressure on their long-term health, such as an increased risk of heart attack or stroke, the development of left ventricular hypertrophy, or worsening kidney function, but it's our job to link those things together in their heads and their hearts so that they will continue the efforts to stay compliant. For a great many of our patients, this continuous or intermittent tracking is probably very empowering, and makes them see the benefit of doing these things for their health.

Of course, there is always the concern that too much data becomes unactionable -- that if our patients send us reams and reams of data that we feel compelled to respond to, and for which they often wait for a response, this can add an undue burden onto the healthcare system and contribute to provider burnout. As we move forward, hopefully we can find ways to use smarter systems to analyze these patient reports, spot trends, suggest interventions, and even find a way to correlate compliance with medication and positive or negative changes in blood pressure to suggest more tailored messaging and treatment. "Last week you took your blood pressure medication less than 50% of days, and the trend in your systolic readings reflects this; let's see what happens next week if you can try and get that compliance closer to 100%."

The Sheepish CPAP Non-User

Another example is our patient's sleep, where they spend up to a third of their lives, and we know has huge impacts on their health and well-being. Far too often, my conversations with patients about their obstructive sleep apnea and compliance with its treatment ends up with them sheepishly letting me know that they are "just not wearing it". It's uncomfortable, it's noisy, they feel claustrophobic when they wear it and find they can't breathe, if they're the least bit congested they can't use it at all, and it's certainly not very conducive to nighttime snuggling.

There has been enormous growth lately in the home technology sector to increase the monitoring of sleep at home. Today, even formal sleep studies can be done with home set-up devices that track respiratory rates, oxygenation, pulse, and body movements at night while patients sleep, to help get a picture of their overall sleep architecture. And the devices that our patients are wearing, from Apple watches to Fitbits to Oura rings, are being upgraded to include more and more data that is generated and collected once we turn out the lights and go to sleep.

But in the end, if generating all of this macro- and microscopic data doesn't lead to a change, doesn't lead to a pattern that a patient and a provider can recognize as something that they can and will intervene on, then is it really serving a purpose? If they're not going to wear their CPAP, then maybe we can hope that seeing data on how bad their sleep really was from a data standpoint, combined with how they feel in the morning, could be the things that move them toward making a big change.

Consumer-Driven Data

These days it seems that people without sleep apnea are wearing sleep devices, people without high blood pressure are tracking their blood pressure at home, and people without diabetes are using continuous glucose monitors to assess their overall glycemic control. Most of these consumer-driven choices are meant to inspire them to make positive changes.

But our patients have already generally not responded that well to the message of "Get more sleep, eat less salt, eat fewer carbs, and exercise more," which for the most part would be the same advice we give to those without hypertension, sleep apnea, and diabetes who are collecting this data on their own. So truth be told, we really only want to collect data that can lead to patient change -- either in their lifestyle or in compliance with their treatment regimen.

Figuring out the sweet spot, this middle ground that we can use to get them to take their medicines or wear their CPAP device, or make those healthy lifestyle changes like exercise and moderation of caloric intake, will be the key to implementing effective programs of home monitoring. Massive downloads of data from our patients will only be useful if we can help them move towards change, guided by systems that are smart enough to spot trends and patterns and offer useful advice that can make a difference.

If we're just getting a report that says that a patient only got 4 hours of sleep last night, and our message back to them is, "Sleep more," then no one's doing their job right. But if the patient notes that their sleep data is terrible and they have a morning headache and feel exhausted on arising, then maybe a good clinical trial of wearing their CPAP every night and noting the difference can lead to long-term change and better outcomes.

Let's sleep on it and see what happens.

Comment