Improving patient adherence to address the changing healthcare landscape
01 August 2020
Over the course of the last decade, the global healthcare sector has undergone a major transformation. As Alexander Vervuurt, Healthcare Business Innovation Specialist at manufacturer of electronic components, modules & devices, Murata explains, to reduce acute pressure on stretched hospital resources & enable cost reductions, greater emphasis is now being placed on administering treatments to patients in their own homes.
This article was originally featured in the August 2020 issue of EPDT magazine [read the digital issue]. Sign up to receive your own copy each month.
Being able to stay at home improves quality of life for patients with ongoing medical conditions. It means they don’t have to spend long periods of time in unfamiliar clinical settings, or in transit. This approach also enables elderly people to live independently for longer, rather than being admitted to residential care homes. It’s also beneficial at a time when many more people are carrying out their own health monitoring regimes and evaluating their own wellbeing (for instance, keeping track of heart rate, blood pressure and blood glucose levels).
There are numerous chronic conditions where there is a need for self-medication. Among the most common are asthma and diabetes. The administering of cancer drugs at home is another important example. To ensure that this happens in an appropriate and effective manner, the equipment involved must be intuitive to operate. Otherwise, there is potential for mistakes when it comes to delivering the full treatment dosage, taking accurate readings and so on.
Several healthcare industry studies have shown that patients don’t always follow the instructions they are given as well as they should. Referred to as ‘non-adherence’, this presents medical practitioners looking to rely more heavily on home-based treatment with a major obstacle.
The reasons for non-adherence are numerous. In some cases, especially with elderly patients, it could be down to pure forgetfulness or lack of organisation. Some may find the required procedure too intricate or time-consuming to incorporate into their daily routine, and so they get out of the habit. Others might struggle to understand the procedure, or simply misinterpret it, while in certain circumstances patients may distrust medical professionals and ignore the advice they have been given.
Modern healthcare systems themselves must take some of the blame. With an ever-growing number of patients to fit into the average day, medical consultations are now much shorter than in the past. Healthcare professionals therefore have limited time to explain fairly complex matters. It is perhaps not surprising that some patients fail to comprehend what they are told.
The figures on non-adherence are quite startling. According to numerous academic research papers published in the last few years, when asked about their recollection of the information received during consultations, patients don’t fare well. Based on these figures, it’s acknowledged that approximately 60% of what the physician has explained to a patient will be recalled inaccurately, and instructions they have been given are therefore unlikely to be carried out with complete success.
Patients may not have a full grasp of what an administering or monitoring process entails, and some of the details they think are correct may be erroneous. The problem is that, after the consultation has finished, there is no easy way of checking the patient is doing things correctly. It could be that any procedural mistake they have been making is not uncovered until they are admitted to hospital once the condition has escalated.
In principle, innovations in electronic engineering offer ways of tackling the serious issue of patient non-adherence. Essentially, this can be done in two ways: first, by making processes involving items of equipment more straightforward and natural for the patient, so they don’t get confused; second, by providing feedback to the healthcare professional on the equipment’s usage – which will enable them to take action if their instructions are not being followed and empower them to change a patient’s treatment plan to achieve a better outcome.
Functional enhancements in the human machine interfaces (HMIs) of medical equipment will be pivotal. Where applicable, designs should look to eliminate arrays of buttons and instead rely on something more intuitive. Through collaboration with scientists at Kansai University, Murata has developed a proprietary polylactic acid (PLA) based polymer. Using this, it is possible to create cutting-edge piezoelectric sensors capable of delivering user-friendly HMIs.
The resulting product, called Picoleaf, is an ultra-thin (50 µm or less) force-sensing organic film that can be adapted to an extensive range of specific functional requirements. It provides a bendable, transparent HMI that generates an electric charge (via the piezoelectric effect) when force is applied. Its sensitivity is such that even the subtlest micron-level distortions can be detected. Unlike other sensors, which normally rely on pyroelectric sensing mechanisms, Picoleaf is not affected by any fluctuations in the ambient temperature.
This sensor technology is not exposed to mechanical wear-and-tear (unlike buttons or switches), so longer operational lifespans are possible. Furthermore, there are no edged areas in which germs can congregate, making the equipment inherently cleaner to use. Its flexibility is key, as this means the sensor surface can fit whatever shape the equipment takes, without impacting the ergonomics. Figure 1 shows the Picoleaf sensor, plus its accompanying signal-conditioning electronics and wireless connectivity hardware, integrated into an insulin injector pen.
As well as the user experience element, there is also scope for a diagnostic aspect, as data on patient usage can be captured – which, as mentioned previously, would be of great benefit for healthcare professionals. In the first instance, it could be established if a patient was actually using the equipment at all. And if so, whether the frequency with which they used it was as expected; the length of time it was being used for on each occasion could also be determined.
Sensor data can be used to ascertain if the equipment was being used, and if so, whether it was used correctly. This will encourage interaction between the patient and the healthcare professionals to address any difficulties the patient might be having with the treatment itself and using the equipment, ultimately improving how they use the equipment.
In many cases, the equipment is disposed of after one use, but the cost of applying a sensor function to equipment is still justifiable if it can be outweighed by avoiding expensive hospital admittance or the risk of life-threatening situations arising.
Alongside the progress being made in sensor technology, advances in battery construction are responsible for a dramatic ramping up in energy storage capacity. Murata has made high-density micro-batteries available to complement its sensor products. These allow access to items of medical equipment that have more compact form factors, but are still able to support less frequent recharging – which equates to much greater convenience for the patient. Combined with an array of different connectivity options, the result is an all-encompassing solution for the next generation of medical design.
By augmenting the way in which patients interact with technology, home treatment and monitoring activities will be much more effective. Patients will be able to lead lives that are less impacted by their health conditions, and the strain currently being placed on clinical staff can be mitigated.
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