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Self-Management Tech Better for Wellness than Chronic Illness

While a self-management tool didn't improve COPD symptoms, it did boost overall patient wellness and reduce clinician visits.

Self-management technology may be useful for improving general wellness.

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- Tablet-based self-management tools might not be successful in improving specific chronic illnesses, but they do have an effect on overall patient wellness, according to a study published in the Journal of Medical Internet Research.

In a randomized control trial, researchers tested the “sElf-management anD support proGrammE,” or EDGE. This tablet-based and internet-connected device allows patients to tap into self-management resources and keep track of their symptoms.

The researchers introduced EDGE to 110 patients with moderate to severe chronic obstructive pulmonary disease (COPD) and tested clinical health outcomes against a control group.

Using the St. George’s Respiratory Questionnaire, the team tested both COPD-specific health outcomes and general health outcomes. The team also tested for health services utilization between both patient cohorts.

After a 12-month test period, the researchers found that EDGE had no effect on COPD self-management. While the tool had neither a positive nor negative effect on chronic disease-specific issues, it did improve overall wellness.

Patients using EDGE also visited their clinicians less often. Intervention patients saw general practice nurses an average of 1.5 times compared to 2.5 visits for patients receiving usual care. Intervention patients also visited general practice doctors less often, with four visits compared to 5.5 visits for usual care patients.

“The finding of a significant improvement in prespecified secondary outcomes supports a beneficial impact on broader measures of health status and number of visits to practice nurses,” the researchers noted.

The researchers also observed a better overall quality of life for intervention patients, including improved depression score, reductions in hospital admissions, and reduction in visits to a general practitioner.

These findings warrant further investigation, the researchers said.

“A digital health intervention used on its own may not replace a more intensive and personalized intervention for many patients,” the team pointed out. “However, other outcomes are also important, including broader measures of health status, psychological health measures, and use of hospital services.”

Other EDGE benefits include cost-effectiveness and ease-of-use. The tool is reportedly less-costly than telehealth and other self-management technologies, the researchers said.

EDGE also utilized icons for navigation rather than a keyboard, making it easier for all patients utilize, regardless of age or digital health literacy levels.

Although the tool is effective in improving overall wellness and the researchers expressed interest in further investigation in that area, more research may need to be done to find a solution for COPD-specific management tools.

Chronic disease is incredibly costly, the researchers said. Finding a solution that helps support patients in self-management of their condition could help reduce these costs by reducing COPD-related complications.

“There is a need to identify different forms of self-management that can improve outcomes and to develop and optimize ways of delivering available interventions to maximize effectiveness and safety,” the researchers noted.

Finding a solution will be key for future chronic disease management efforts, research finds. While most patients know that they need to engage in self-management for their chronic illness, a study from the American Heart Association found that very few patients actually have adequate information to do so.

For example, 82 percent of patients with heart disease concerns could identify and understand the link between high cholesterol and heart disease, and a majority were also aware of their history and risks for a cardiac event. Despite that knowledge, just under half (47 percent) of patients reported having their cholesterol checked within the past year.

Researchers suggest talking to patients about self-management techniques and leveraging strategies to ensure patients can engage in these techniques. Additionally, clinicians must address the risk factors associated with heart disease.

"Current guidelines call for lifestyle modifications as a first line treatment, but that's often not enough,” said the American Heart Association’s cholesterol advisory group member Mary Ann Bauman, MD. “We also need to talk to patients about other risk factors, including genetics and family history, to determine the most effective course of treatment for each individual."

Ultimately, it’s going to take better education and guidance to motivate patients to engage in chronic care self-management. Healthcare professionals may be able to do this by using communication skills to educate patients and technology to help guide patients outside of the office.