Consumer Health Informatics by Thomas Wetter

Author:Thomas Wetter
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

9.5.3 Tight Medical Guidance and Behavioral Coaching

An investigation from Korea resembles [11] in Sect. 9.5.2 in various respects. Kim and coworkers [8] also target obese diabetics – where notably obesity starts at BMI > 23 in Korea – and offer weekly advice provided through a nurse who specializes in diabetes mellitus 2 . Here as well the medical history and risk factor s are taken into account, partially from patient reporting, partially from the EHR of the tertiary care hospital where the study is affiliated. They are visible and made use of by the provider who is one of the researchers as well. When advice consists of medication changes the patient’s primary care provider is notified. Patients in the intervention arm receive their advice once per week through the Internet and can read them on mobile phones or at land-line Internet access points. The control arm just keeps going and measurements of various labs pertinent to diabetes are collected equally in control and intervention arm.

Two major differences should be noted compared to [11]: First, the advice to the patient can relate to insulin or other medication dosage but it can equally be behavioral such as that bad glucose control can result from lack of exercise. Second, the patients in the experimental arm have to record blood glucose readings several times per day, fasting in the morning and postprandial i.e. after every meal.

Although the sample was smaller here (18 intervention and 16 control out of 40 enrolled finished the half year study period) significant improvements materialize in the intervention arm alone. The control remains unaffected. The major point of concern, however, is that the effect is by far stronger after the first 3 months than after half a year. HbA1c arm average falls from 8.16 % to 6.94 % and then rebounds to 7.07 %. There is no medical explanation for that in the data such that an explanation that lends itself is that the researchers are just demanding too much of a good thing: while in [11] experimental arm participants were requested to note the fasting glucose once per day and to report every 2 weeks participants here do several measurements and data transmissions every day. They may just get tired of the effort, despite convenience of using ubiquitous cell phone technology.

In summary we find a Level 1 service which can turn Level 2 when offered through a 3rd party that has existing personal treatment relation with the patient. Legal procedures for medication changes must, however, be found. The service does not have Level 0 or Level 3 elements. Human effort is not reduced – it may even increase – but workload balancing can be a benefit. To avoid wearing and reduced adherence an adaptive data capture scheme with longer intervals when glucose is in good control and tightening when control fades could be considered (cf. Sect. 4.​5.​2 for a similar strategy in COPD management).

Take Home

Compared to regular care Consumer Health Informatics services achieve better control of HbA1c throughout.

Perseverance increases with patient empowerment

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