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mHealth Equally Effective as Manual Chronic Care Management

mHealth developers must consult clinicians to create more meaningful tools for chronic care management.

mHealth is just as effective as paper-based chronic care management strategies.

Source: Thinkstock

By Sara Heath

- mHealth apps are useful for supporting chronic care management, but no more so than manual, paper-based self-management strategies, according to a study published in the Journal of Medical Internet Research.

mHealth apps can specifically benefit efforts for medication adherence, symptom recording, and self-management action plan monitoring.

“Mobile technology interventions (MTI) can provide an external source of self-management support, allow for accurate real-time symptom and medication monitoring, and use built-in reminders to adhere to treatment, as well as can store and activate action plans,” the researchers explained.

During a literature review of nine mHealth studies conducted since June 2016, the researchers looked at clinical outcomes, medication adherence, and use of behavior change techniques in developing an mHealth strategy in asthma care.

“Studies suggest that over 80% of people with asthma are willing to use MTI, and quantitative studies suggest that it is an acceptable medium for assisting asthma self-management,” the team noted. “This might be facilitated by MTI providing a feeling of support that positively influences individuals’ ability to cope with their asthma.”

The literature analysis showed that mHealth had a substantially positive effect on clinical outcomes, quality of life, and medication adherence compared to normal care. Normal care was categorized as care during which the patient participated in no self-directed chronic care management activities.

“The current review found that mHealth had a moderate effect on improving medication adherence when compared with standard treatment,” the researchers said. “Further, the current review suggests that MIT indeed do have a large effect on improving [quality of life] and a moderate effect on individuals achieving well-controlled asthma and fewer unscheduled visits.”

However, mHealth performed similarly when compared to paper-based and manual management interventions, the researchers found.

These findings show that simply offering medication adherence and self-management instruction is not enough to improve patient care. Patients need a mechanism – whether that be digital or manual – to engage with those instructions, keep track of their own efforts, and take ownership of their own care.

“Given that there was no difference between MTI and paper-based monitoring, it could suggest improvements in medication adherence and clinical outcomes can be made by providing some feature to monitor medication or symptoms in either electronic or conventional paper form,” the researchers explained.

Researchers should investigate further improvements that could make MTI and mHealth even more effective, helping to drive digitization in patient engagement.

Additionally, researchers should dedicate more effort into understanding how health behavior change affects mHealth use and outcomes.

“Internet and mobile-based interventions for promoting health-behavior change have been found to be more efficacious when incorporating more extensive use of theory, [behavior change techniques], and using text messages as mode of delivery,” the researchers pointed out.

Many of the studies investigated in this literature review did not incorporate behavior change theory, opening a door for future research. Assessing how behavior change can affect a patient’s mHealth use, as well as the efficacy of that technology, will help developers create more meaningful tools, the researchers noted.

Ultimately, the researchers contended that clinicians must enlist mHealth and other self-management interventions to ensure meaningful chronic disease management. However, the team also acknowledged some limitations.

“Implementation of mobile technology interventions poses a challenge: Physicians’ concerns regarding increased time and resource demands, accuracy of information, physician liability, and patient confidentiality must be addressed,” the researchers noted.

Additionally, clinicians and hospital leaders must test technologies for accuracy and efficacy before prescribing technology to patients. mHealth security should be another consideration for providers.

“Increased involvement of the physician in the development and testing phases of the MTI as well as assessment of privacy issues, and improvements in regulation and safety checks by regulatory bodies and the development of a risk assessment framework for medical mobile app is warranted,” the researchers concluded.

Technology professionals can create more effective tools that facilitate stronger engagement in chronic care management by involving clinicians, and potentially patients, in mHealth tool development.

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