MEDICINE&SCIENCE
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Moscucci said finding a program that works for patients can be a challenge. Studies have found home monitoring programs lacking when patients do not change their habits, take their medications properly or routinely report problems.
Other local hospitals are experimenting with home monitoring programs to better engage patients. For the past year and a half, some of the most difficult cases from MedStar Health’s Union Memorial and Good Samaritan hospitals and Washington Hospital Center have been going home from the hospital with a tablet that allows face-to-face time with a social worker and pharmacist who ensure that they are taking medication properly and coping with their disease.
Many patients find their situation depressing, and frequently other health issues or problems in their homes distract them from their own care, said Kathryn Walker, senior clinical director of palliative care for MedStar Health. She said the ability to talk live, at regular intervals, seems to build trust and gain cooperation in a way that phone calls don’t.
In the month before the first 31 patients were enrolled in MedStar’s program, there were about 10 hospitalizations and in the month after the number dropped to four. Dozens of medication errors were averted.
“We’re saying with this program that some patients need more,” she said. “It’s clear patients need a lot of education and someone to help walk them through some things.”
Janet Bettger, a health services researcher at the Duke Clinical Research Institute who helped craft Sinai’s program, agreed that patients need education and often intensive communication, at least at first.
“A lot of self-management is related to behavior change,” she said. “It needs to become routine and stick. In so many cases the patients don’t get to that point. We need to be involved and track them and empower them.”
Bettger said a technology-based method might not work for everyone. Some patients won’t take their vital signs daily and medications properly no matter the kind of remote prompting and will need to come to the doctor for regular monitoring, though that can be burdensome for heart failure patients who easily get out of breath.
Ambio Health, which donated the equipment and software costing up to $500 per patient for the first year, has been selling such monitoring systems since 2012 to medical groups and health systems that are managing patients with various chronic conditions. Ambio CEO Kevin Jones said he believes the technology works best when combined with a coaching element.
Scott said he needed the coaching support when he was first discharged from the hospital and contacted Howell at Sinai frequently with questions about medications and diet. Howell said Scott is now a “rock star” patient and they have much less interaction.
He checks his vitals and keeps tabs on them through a website he accesses on his cellphone. He goes to cardiac rehabilitation three times a week at Northwest Hospital. And the biggest change has been paying attention to what he eats.
Meals are made at home more frequently and include more fresh vegetables and fruit. Scott reads labels, checking for sodium that can worsen his condition. When the broad-shouldered, 6-foot-5-inch Scott goes to a fast-food restaurant, he eats one hamburger and not three. He has an implantable defibrillator to regulate his heartbeat if needed.
Scott said he has influenced the health habits of the rest of his family.
“My scare got their attention,” he said. “We’re all trying to get in better routines.”