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Patients as Monitors of Their Own Health

Posted Jun 28 2012 12:00am

In a number of previous notes, I have made a case for having patients take ownership for their own health, particularly through preventive and predictive medicine . By this I have meant that they should improve their health through such measures as weight loss, exercise, less alcohol consumption, and smoking cessation. However, such "health ownership" can also entail observation and physiologic monitoring by individuals of their health status. A recent article addressed this topic (see: Patients becoming monitors of their own health ). Below is an excerpt from it:

In the future, patients will become even more involved in the observation and monitoring of their own health or illnesses. For example, blood pressure can be checked 24 hours a day using a blood pressure cuff at home. “This is the classic example,” notes Professor Dr. Thomas Kubiak. “As time goes on, we will have to increasingly integrate new health observation and monitoring techniques into our daily lives. This will influence the situations of both patients and doctors.” [Dr. Kubiak and a health psychologist colleague] believe that our everyday state of health and behavior is much more helpful in determining proper diagnoses and therapies than lab-only results or questionnaires in which patients are asked to provide retrospective information about their state of health over the last few weeks or months. For chronic headaches, for example, it helps to keep a regular diary that tracks when headaches occur and what might have triggered them. There are also many ways for diabetes patients to check their own blood sugar levels and continually keep track of the results through devices that then help determine the proper insulin dosage....

The dissemination process [of self health monitoring] is sure to speed up even more now thanks to the widespread use of new communication instruments, such as smartphones. For example, these devices can be used for documentation purposes such as in an activity study, where a phone call at specific times during the day prompts a patient to complete a questionnaire the results of which are then linked to GPS data. This kind of ‘electronic diary’ can be very useful as it can have preventive or therapeutic benefits for the patient. Pharmaceutical companies also benefit as these new instruments can be used effectively in clinical trials of their products.

Individual health monitoring is about to become much easier as devices and apps for smartphone and iPads facilitate such monitoring (see: Big Pharma Develops Smartphone Apps to Achieve Multiple GoalsThe iPhone Effect: Smartphones and Their App Ecosystems Have Changed Everything ). Such devices also have the capability to communicate abnormal results back to a physician office or health coach. A classic example of potential cost-savings associated with telehealth involve monitoring of patients with congestive health failure (see:  Reducing the cost of frequent hospital admissions for congestive heart failure: a randomized trial of a home telecare intervention. ) Here is a conclusion from this older article:

Substantial reductions in hospital readmissions, emergency visits, and cost of care for patients with CHF might be achieved by widespread deployment of distance technologies to provide post-hospitalization monitoring. 

To restate the obvious, our smartphones now function at the level of personal computers with the advantage that they are readily accessible and can be connected to other devices that measure blood pressure, for example, or even hematocrit or blood oxygen levels. "Lab-on-a-chip" devices with a far broader test menu will be available not too far in the future. If you can process a credit card transaction with an iPhone, you can certainly use it to monitor your health status. 

:: Update on 6/28/2012 at 10:30 a.m. ET

(see: Ahead of Regulatory Approval, iPhone ECG Is Saving Lives—Human and Animal )

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