By Shelby Unger, ARCH Research Intern
Patient burden in the self-management of chronic conditions is widely discussed in conjunction with the hope of innovative technology alleviating some of this burden. Chronic conditions require much day-to-day planning and decision-making, which can be particularly burdensome for patients, as the responsibility of self-management is not a linear one. The self-management of a chronic condition completely reconstructs the ways in which a patient once interacted with their health care professional and management of their condition becomes a collaborative effort (Health Service Executive, 2016). While the idea of providing support to empower patients with chronic conditions in their self-management journey is not a new one, the role of technology in self-management and the balance between patient support and potential patient hindrance is worth further unpacking.
In Ireland the efforts towards greater support for self-management for chronic conditions is prevalent and growing. For example, the HSE has created an implementation plan for four chronic conditions that are currently on the rise in Ireland (O’Reilly et al., 2016). Namely; Chronic Obstructive Pulmonary Disease, Diabetes, Asthma, and Cardiovascular disease (Ibid). The HSE describes self-management support as a system that provides education and intervention to increase skills and confidence in managing a chronic condition (O’Reilly et al., 2016). When thinking of support in health care as a patient, my mind immediately goes to medical professionals. For many people that have a chronic condition, these professionals play a vital role in how an individual may understand and interact with their self-management routine. Patients are exposed to an abundance of resources in terms of specialists, support groups, and as time moves forwards, technological support.
As technology becomes more prominent for the aiding of self-management for chronic conditions, the question arises; how much is too much? Often with chronic conditions, the care routine comes with a slew of medications, breathing machines, blood sugar monitors, heart rate monitors, blood pressure machines, and activity trackers, to name but a few. The list of required technology just to live a normal day for patients with any chronic condition is quite extensive. Much of this mandatory regime involves technology, which involves a learning curve that can be daunting for someone. For instance, consider introducing a new piece of technology or app that requires an individual to record their key health indicators (i.e. insulin intake, diet tracker, medication schedule, etc.), this becomes an added step in an already extensive routine and learning how to use this new piece of technology may be a deterrent from the get go for a person who is already engaging in a tech heavy self-management environment. This concept of navigating a new device or piece of technology may seem disheartening to a potential user.
Along with learning to operate a new piece of technology, many devices exist as supplementary pieces to a routine. Rather than a device that streamlines the self-management process, many pieces of technology exist as something to use in addition to the other self-management tasks. For someone that is spending much of their day performing tasks that are already felt as burdensome, is adding an extra responsibility truly improving quality of life and reducing stress and burden?
Technology is commonly created to replace existing manual methods of management. For example, if someone with diabetes keeps a handwritten log of their blood sugar levels and insulin intake, does replacing that with an electronic way of logging these metrics manually really add value to the user? If this log is a feature of a device that is also connected to a blood sugar monitor and insulin pen and logs a history of an individual’s data automatically, this could potentially become meaningful to the user as all of their information would be stored in one place while eliminating the step of self-reporting their data every time they complete their self-management routine. There is a notion of a saturated market of connected health technologies and leads into understanding where the motivation for the end user to embrace another step or a new piece of technology in an already exhaustive routine lies (Hughes, 2009).
The number of people living with chronic conditions is growing and the burden of self-management is becoming more amplified (O’Reilly et al., 2016). Therefore, technologies that can adequately and effectively reduce patient burden may be advantageous in the connected health market. Of course much of this involves understanding the individual user experience and needs, but just because a piece of technology may be clinically better, does not necessarily mean it is better in theory or in practice. Often companies become engrossed with reinventing the wheel when the optimization of something that already exists may be a better solution in terms of acceptance and adoption (Hughes, 2009). With all of this in mind, it is reasonable to consider that patient experience within chronic conditions is a valuable resource, and while health technology is on the rise, taking a step back to critically think about where a specific device may play a role to the long term benefit or burden for patients is worth the brainstorm.