Innovative, automated strategies to engage patients at home are key to improving health outcomes

June 20, 2012

In a Perspective piece published Online First this week in the New England Journal of Medicine, a group of researchers from the Perelman School of Medicine at the University of Pennsylvania propose a multi-pronged approach to the new practice of so-called "automated hovering" that aims to improve patients' compliance with medication and dietary regimens and other positive health behaviors. These approaches combine newly discovered principles of behavioral economics that offer better ways to motivate patients to improve and protect their own health, technologies such as cell phones and wireless devices, and new reimbursement strategies for health care providers that require them focus more closely on patients' health outside of office visits and hospitalizations.

To be most effective, the authors say automated hovering approaches must be not only cost-effective – inexpensive to provide, without costly personnel oversight on a daily basis – but also guided by the growing field of research, which provides clues about what motivates and helps patients to remain engaged in behaviors that improve their health. "Behavioral economics explains why people are predictably irrational and provides tools for redirecting their behavior with carefully deployed nudges and financial incentives," they write.

"Even patients with chronic diseases might spend no more than a few hours a year in front of a doctor or a nurse. But they spend over 5,000 waking hours a year doing everything else -- and that 'everything else' often has a big impact on their health." says lead author David A. Asch, MD, MBA, director of Penn's Leonard Davis Institute of Health Economics. "If we are to help patients improve their health, we need to find a way to engage them during those 5,000 hours."

The authors cite Penn research on an electronic pill box used to monitor patients taking the blood thinner warfarin as an example of an automated hovering approach that holds promise for management of other illnesses. The dispensers studied were electronically tied to a lottery system that offered patients a chance to win money each time they took their pill – but if they box recorded that they had skipped their warfarin the previous day, they were ineligible to collect the prize even when their number came up in the daily random drawing. The system, which the Penn team detailed in a 2008 paper, reduced the rate of incorrect doses from 22 percent to about 3 percent. The authors suggest that a similar system could be easily deployed to improve medication adherence among patients discharged from the hospital with congestive heart failure or after being treated for acute coronary syndromes.

Asch and his co-author, Kevin Volpp, MD, PhD, director of Penn's Center for Health Incentives and Behavioral Economics recently received a $4.8 million Health Care Innovation Award from the Centers for Medicare and Medicaid Services to test out an automated hovering approach to help patients maintain their prescribed medication regimen when they are discharged from the hospital after a heart attack.

To be most effective, the Penn authors note that these approaches should target specific patient populations – especially those who are at risk of preventable hospitalizations, an enormous driver of U.S. health care spending. Diabetic , for instance, who can keep their disease in check at home by following their recommended diet and exercise guidelines and taking the proper medications, are an optimal target for automated hovering, as are those with heart failure or other cardiac problems who are well enough to manage their disease at home. In those groups, hovering could focus on promoting adherence to the medication regimens that are necessary to prevent costly hospital admissions.

Explore further: Integrating medication regimens into daily routines can improve adherence

Related Stories

Integrating medication regimens into daily routines can improve adherence

September 19, 2011
For medications to be effective, they must be taken in the correct dosage at the right time, as prescribed by healthcare providers. The World Health Organization estimates that half of patients take their medications incorrectly, ...

Home monitoring may help manage and reduce costs for heart failure

January 3, 2012
(Medical Xpress) -- Heart failure affects 5.8 million people in the U.S. alone and is responsible for nearly 1 million hospitalizations each year, most resulting from a build-up of body fluid in the lungs and other organs ...

Researchers focus on secondary stroke prevention after study reveals room for improvement

September 12, 2011
A year after hospital discharge, the majority of stroke patients are listening to doctor's orders when it comes to taking their prescribed secondary stroke prevention medications, new data out of Wake Forest Baptist Medical ...

Concurrent treatment for type 2 diabetes and depression significantly improves both conditions

January 10, 2012
(Medical Xpress) -- Patients simultaneously treated for both Type 2 diabetes and depression improve medication compliance and significantly improve blood sugar and depression levels compared to patients receiving usual care, ...

Recommended for you

Researchers see popular herbicide affecting health across generations

September 20, 2017
First, the good news. Washington State University researchers have found that a rat exposed to a popular herbicide while in the womb developed no diseases and showed no apparent health effects aside from lower weight.

Higher levels of fluoride in pregnant woman linked to lower intelligence in their children

September 20, 2017
Fluoride in the urine of pregnant women shows a correlation with lower measures of intelligence in their children, according to University of Toronto researchers who conducted the first study of its kind and size to examine ...

India has avoided 1 million child deaths since 2005, new study concludes

September 19, 2017
India has avoided about 1 million deaths of children under age five since 2005, driven by significant reductions in mortality from pneumonia, diarrhea, tetanus and measles, according to new research published today.

Gulf spill oil dispersants associated with health symptoms in cleanup workers

September 19, 2017
Workers who were likely exposed to dispersants while cleaning up the 2010 Deepwater Horizon oil spill experienced a range of health symptoms including cough and wheeze, and skin and eye irritation, according to scientists ...

Study suggests link between youth football and later-life emotional, behavioral impairment

September 19, 2017
A new study has found an association between participation in youth tackle football before age 12 and impaired mood and behavior later in life. The study appears in Nature's Translational Psychiatry.

Self-confidence affected by teammates, study finds

September 19, 2017
A person's confidence in their own ability varies significantly depending on who is in their team, according to new research from the University of Stirling.

1 comment

Adjust slider to filter visible comments by rank

Display comments: newest first

Home Care Assistance
not rated yet Aug 01, 2012
In-home care can provide quality assistance to older adults who wish to age in the comfort of home. To learn more, please visit our Youtube channel at "homecareinfo" and watch our video "Changing the Way the World Ages."

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.