The project PRECIOUS has received funding from the European Union s Seventh Framework Programme under Grant Agreement nº 611366" MI MI and Shared MI MI and Shared and Shared Decision Making and Shared Decision Making Decision Making Decision Making in chronically ill patients: in chronically ill patients: is is mhealth mhealth key for adherence? key for adherence? PILAR LUSILLA PILAR LUSILLA 6th 6th PAMI Conference PAMI Conference Hotel Hotel Mercure Mercure Poznań Poznań Centrum Centrum 18 October 2015 18 October 2015
Index Index INTRODUCTION: INTRODUCTION: P Patient atient adherence adherence in in chronic chronic medical medical conditions conditions Principles of Principles Principles of Principles of patient of patient patient centered patient centered centered care centered care care care The link The link between between SDM and MI SDM and MI MI, SDM & MI, SDM & Mhealth Mhealth Take Take to to home home message message
Adherence to treatment Adherence to treatment & chronically ill patients & chronically ill patients Doctors are highly qualified experts. But Doctors are highly qualified experts. But a a very high very high percentage of patients do not follow their experts’ percentage of patients do not follow their experts’ percentage of patients do not follow their experts’ percentage of patients do not follow their experts’ recommendations. recommendations.
The challenge of poor The challenge of poor adherence adherence WHO WHO: : 30 30- -70 70% % of of chronically chronically ill ill patients patients are are non non- - adherent adherent to to medical medical treatments treatments and and medical medical recommendations recommendations recommendations recommendations F Few ew of of them them inform inform their their doctors, doctors, and and not not all all doctors doctors identify identify correctly correctly the the lack lack of of adherence adherence WHO: Adherence to long-term therapies: evidence for action. 2003.
Understanding poor compliance Understanding poor compliance 30% non-voluntary (forgetfulness) 70% VOLUNTARY VOLUNTARY (drop-out) Doubts about WORRIES NEEDS About side effects
Patient Patient C Centered entered Care Care (PCC) (PCC) ASSOCIATED WITH ASSOCIATED WITH : : IMPROVED PATIENT IMPROVED PATIENT OUTCOMES OUTCOMES IMPROVED SELF IMPROVED SELF- IMPROVED SELF IMPROVED SELF- - - MANAGEMENT MANAGEMENT PATIENT SATISFACTION PATIENT SATISFACTION MEDICATION ADHERENCE MEDICATION ADHERENCE
Ethical Ethical principles principles of of s sharing haring decision decision making making Self Self- -Determination Determination Theory Theory (SDT): (SDT): our our intrinsic intrinsic tendencies (motivation) is to tendencies (motivation) is to protect and preserve protect and preserve our well our well- our well- our well -being -being being. being. . . Relational autonomy Relational autonomy: : we are we are not entirely not entirely free free, our , our decisions will decisions will always relate to interpersonal always relate to interpersonal relationships and relationships and mutual dependencies mutual dependencies
SDM: Concept SDM: Concept ”An ”An approach where approach where clinicians and clinicians and patients share the patients share the best available evidence when best available evidence when faced with faced with the task of the task of making decisions, and where patients making decisions, and where patients are supported are supported to consider to consider options to consider to consider options options to achieve options to achieve to achieve informed to achieve informed informed informed preferences preferences” ” Elwyn G, Coulter A, Laitner S, Walker E, Watson P, Thomson R. Implementing shared decision making in the NHS. BMJ. 2010
A 3 A 3- -step model for step model for clinical practice clinical practice Support the work Make sure that of considering patients know that preferences and reasonable options deciding what is are available best provide more detailed information about options
SDM and SDM and MI: similarities MI: similarities P Patient atient- -centered centered orientation orientation Focus on engaging patients to explore their: Focus on engaging patients to explore their: Views and opinions, Views and opinions, Options for treatment Options for treatment Options for treatment Options for treatment Management approaches from the patients’ perspective Management approaches from the patients’ perspective Similar communication Similar communication skills: exchanging information, skills: exchanging information, reflective listening reflective listening , , developing developing trust. trust.
Two complementary Two complementary processes processes MI MI SDM SDM Addresses ambivalence Addresses ambivalence Strives to clarify Strives to clarify to change to change treatment options treatment options The The interviewer seeks The interviewer seeks The interviewer seeks interviewer seeks Help Help Help a patient to Help a patient to a patient to a patient to to explore and to explore and actively consider those actively consider those understand the understand the options before options before patient’s reasons to patient’s reasons to supporting a supporting a journey journey change before setting change before setting toward informed, well toward informed, well- - out a plan of action. out a plan of action. considered preferences considered preferences and confident decision and confident decision
Key issues about mHealth Key issues about mHealth mHealth mHealth solutions can solutions can empower citizens with empower citizens with information and motivation information and motivation to improve lifestyles and to improve lifestyles and reduce reduce chronic reduce chronic reduce chronic diseases chronic diseases diseases diseases Patients Patients can stay can stay healthier, healthier, resources resources can be better can be better utilised, utilised, lowering lowering the costs of the costs of care. care. Source: PWC, socioeconomic impact of mHealth 2013
Socioeconomic impact Socioeconomic impact
Future perspectives Future perspectives By 2017, 3,4 billion people worldwide will own a By 2017, 3,4 billion people worldwide will own a smartphone and 50% will use health apps smartphone and 50% will use health apps Source: PWC. Health’Research Institute. Top health Industry issues of 2015
Mobile health app Mobile health app mHealth mHealth app are becoming app are becoming a a regular regular part of care part of care 86% 86% of clinicians believe that mobile apps will become important to physicians for patient care management over the next 5 years
So… An opportunity An opportunity to MI and SDM?
Conclusions onclusions MI and SDM are two patient centered approach that can be MI and SDM are two patient centered approach that can be useful for increasing treatment adherence useful for increasing treatment adherence mhealth mhealth apps can play a relevant role to improve the health apps can play a relevant role to improve the health in the population as mobile devices are worldwide in the population as mobile devices are worldwide available. available. An attractive format and a patient An attractive format and a patient centered An attractive format and a patient centered An attractive format and a patient centered approach centered approach approach approach seems to be appropriate when a health app is designed seems to be appropriate when a health app is designed Although with limitation, MI principles and some MI Although with limitation, MI principles and some MI strategies as well as SDM model can be adapted to an strategies as well as SDM model can be adapted to an mhealth mhealth format format. . More research is needed in order to find evidence More research is needed in order to find evidence- -based based feasibility and efficacy. feasibility and efficacy.
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