Going beyond the pill — mhealth programme improves outcomes for COPD
Mark Brincat, Director of Product Strategy, Exco InTouch
11 August 2014
mHealth offers pharmaceutical companies the opportunity to go ‘beyond the
pill’ and deliver personalised health support to patients outside of a healthcare
setting. Digital health platforms can keep patients involved
in managing their care and adherent to their therapy and medication regimes.
solutions not only benefit the patients and improve their quality of
life; improved health outcomes also provide clear return on
investment for health payers and address the rising costs of
Facing the chronic disease crisis
The rise in the number of patients suffering from chronic
conditions worldwide, and the associated treatment costs are putting
increasing pressure on healthcare systems around the world. To take
diabetes as an example, in America alone only 18 million out of the
estimated 24 million sufferers are diagnosed, while as little as 15
million of them get treated. Of that number, only 6 million patients
are well controlled .
Similarly, treating diabetes in the UK consumes around 15% of the
national healthcare budget. However, as much as 80% of this is spent
dealing with the downstream consequences of poor control .
According to the WHO Report (2003), eliminating under-diagnosis and
under-treatment of patients suffering from chronic conditions and
improving the effectiveness of adherence interventions could not
only have a greater impact on the health of the population than any
improvement in specific medical treatments, it could also almost
double savings in medical care expenses .
It is estimated that increased adherence could decrease care
costs of the US diabetes patients from as much as $8,867 to $4,570
per year, resulting in $4,297 savings .
It is the widespread recognition of these pressures and the advent of mHealth
technologies that has offered pharmaceutical companies the
opportunity to go ‘beyond the pill’ and deliver better care or
patients and better solutions for care providers.
The importance of going ‘beyond the pill’
Advances in mobile technology and the rise of mHealth have an
enormous potential to make a real difference in healthcare, not just
for individuals, but of whole nations. AstraZeneca are leading the
way through designing mHealth programmes to address the inability to
manage treatment for individual patients suffering from chronic
conditions, their caregivers, and their healthcare providers (HCPs)
through their Intelligent Pharmaceuticals initiative. In 2013
AstraZeneca announced their collaboration with Exco InTouch to
develop a ground-breaking programme using interactive mobile phone and
internet-based health tools to help patients, caregivers and their
healthcare providers track and manage chronic conditions.
The main benefits of leveraging digital technology to support
patients come from remote monitoring, long term control, proactive
condition management and data collection. The initial focus for this
collaboration has been on patients suffering from chronic
obstructive pulmonary disease (COPD), through the AstraZeneca’s
Me&MyCOPD programme. The programme is set to give the enrolled patients
the opportunity to access personalised coaching and real-time
information about their disease and treatment via their mobile
phones or other web enabled devices, and to use digital technology
to securely collect, transmit and review their own clinical data.
As a result the programme ultimately leads to patients being able
to better control their conditions and HCPs able to make more
informed decisions and tailor care pathways to personalise each
patient’s disease management, optimising health outcomes. This
translates into improving patient welfare and quality of life by
reducing the number of unplanned hospital admissions and the
frequency and severity of exacerbations, decreasing the overall cost
of treatment at the same time.
Building scalable solutions
One of the most important considerations when designing truly
engaging mHealth services is to tailor each programme to the primary
issues and challenges facing that patient population. Figure 1
illustrates a typical range of patient and health provider
components from the Exco InTouch platform, which can be utilised in
order to create a seamless multi-level programme. Each programme is
uniquely adapted to each patient population, integrating effectively
into defined care pathways and providing a personalised level of
support. Figure 2 shows how the modules could be adapted for a COPD
Figure 1. mHealth Interventions Wheel developed by Exco InTouch
Case study: The AstraZeneca’s Me&MyCOPD programme
The Me&MyCOPD programme has been developed using the modular
approach shown in Figure 1. The treatment module is especially
relevant in COPD management as improper use of medications is a
common problem among COPD sufferers. For this reason AstraZeneca has
incorporated tracking of medication use and addresses any issues
through patient training, managing their clinic visits, supporting
pulmonary rehabilitation and providing the patients with advice on
how to manage their lifestyle to limit the negative outcomes of
Assessment is another important element, therefore the programme
captures a broad range of patient information; whether it’s
understanding patients’ needs and preferences, identifying changes
in their condition or providing personal goals management tools.
This element is supported by providing information and educational
content to patients, mapping it into the system through a care
In addition, the modular platform developed by Exco
InTouch feeds through a rules engine and is fully adaptable
according to specific requirements and amendable to consider
different stages of patient journey.
Figure 2. Example platform adapted for the needs of COPD Patients
Furthermore, this modular approach proves sustainable for mHealth
providers in that different interventions and functionality can be
added over time, creating new products that can be used in markets
with different clinical pathways.
There are three principle parts of the Me&MyCOPD system: a portal,
through which different stakeholders can be engaged to work with the
patients (Figure 3); a mobile element, which works with the patients
in real time and responds to their immediate needs; and the server,
where information is processed offline and messages are scheduled.
All three parts of the system work together on multiple levels to
deliver personalised support to patients’ real needs.
Figure 3. The patient portal
Patients suitable for the programme are identified by trained HCPs and
enrolled to individualised self-management plans, which can be
tailored towards individual needs and goals according to each
patient’s disease progression (Figure 4). The programme uses
clinically validated assessments to support patients to reduce the
probability of exacerbations occurring, and ultimately to reduce
Figure 4. A self-management plan can be
designed in a smartphone app, here showing personalised goals for
Real-time access to patient data
Information provided to the programme’s participants can be accessed
in a variety of ways, whether through internet portals or mobile
devices. Real-time access to patients’ data not only guarantees the
ability to monitor their adherence to treatment regimes, but also to
identify the sudden deterioration of their conditions. This allows
for a timely intervention when necessary and referral to HCP for
further support and assistance.
If their condition continues to worsen, the patients could be
signposted to see their HCP based on the outcome of their
assessment. The breakdown of events is not only shared with the
patients, their HCP(s) can also be provided information on when the
exacerbation took place, the form of intervention, how the patients
reacted and how they moved through to becoming well again.
The overall outcomes of the programme are measured through
questionnaires and assessments on the use of rescue medications and
adherence to standard medications by participants, as well as
through an assessment of the impact on the patients’ management of
their condition. In addition, payers can monitor the impact on
exacerbations and hospital admissions for these patients.
Tomorrow’s approach - today
The Me&MyCOPD programme rolled out by AstraZeneca and Exco InTouch not
only improves the long-term engagement and the pro-active management
of COPD among individual patients, it provides a comprehensive
system to all of the stakeholders within the healthcare system,
including caregivers, HCPs and healthcare payers. The programme is the
first to employ a personalised, truly mobile approach to monitor,
support and empower patients to take control of their condition,
utilising their own communication devices.
Moreover, the programme ultimately allows AstraZeneca to focus their
efforts to deliver new medicines that will address unmet needs by
expanding their understanding of how patients use and respond to
various treatment options. This underpins the ‘Intelligent
Pharmaceuticals’ strategy adopted by AstraZeneca and is a leading
example of how optimised treatment can improve patients’ quality of
life and health outcomes.
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