What element do you think most influences a patient’s health? Social circumstances? Genetics? Treatments? Environment?
All of these have an impact of course, but by far the leading element affecting patient health is behavioural patterns . In fact, behavioural patterns account for 40% of patient health, according to The New England Journal of Medicine. [1]
Below both genetic predisposition and social circumstances, lies treatment. Treatments themselves represent only 10% of what influences a patient’s overall health.
It is clear that if Doctors acted on behavioural patterns, which have a 40% influence on health, they could have a much greater impact than by proposing only a treatment and a consultation every 6 months. The simple solution would be to suggest doing this systematically, but changing behaviour has never been this simple.
This was more evident than ever in the lockdown stage of the fight against the coronavirus epidemic with the changes in behaviour that were asked of us. Many had a hard time changing their way of life despite the risk involved. Developing new habits takes time – whether that’s keeping two metres apart in supermarkets or removing the packaging before putting groceries away and washing their hands immediately after arriving home.
Changing our habits and behaviours requires daily discipline and monitoring.
In a pandemic situation such as the one we are only now escaping from, messages are sent to us every day to remind us of the actions to take. Information is continuously disseminated, as well as testimonies, and expert guidance to help us change our behaviour.
This is not usually the case. When we are ill or at risk of developing a disease, our doctor is not constantly sending us messages to help us change our behaviour, nor does he or she put us in touch with other patients who can give us tips on how to change our lifestyle and avoid becoming ill.
By way of example – to reduce the risk of developing cardiovascular disease and/or having a heart attack, all we need to do is change 7 behaviours in our daily lives: not smoking, regular physical activity, eating a healthy diet, maintaining a normal weight, and regular checks of cholesterol, blood pressure and blood sugar.
In this case, we know exactly what to do! We just don’t get reminded of it every day, and this is where the problem lies.
Firstly, doctors have never been trained to change their patients’ behaviour. Secondly, to integrate this type of change requires time. It is difficult to achieve results by spending only a few minutes a year with a patient. Yet 90% of doctors spend less than 28 minutes per year with their patients. [2]
During the pandemic, changes to routine were enforced with fines and punishment. But for this daily monitoring style system to work going forward, this will need to change to a reward system.
The question to ask is what can be proposed to enable patients to adopt new behaviours?
The added value of digital health solutions
Some digital applications offer close monitoring of patients and help them to change their behaviour. Some of them have obtained the CE mark and have set up clinical trials proving their effectiveness – they are defined as digital therapies.
Generally speaking, to qualify as a digital therapy, two conditions must be met
- The solution must act to prevent, manage symptoms or even cure the disease.
- There must be clinical evidence of its effectiveness.
According to the Digital Therapeutic Alliance, there are about 200 companies worldwide identified as providers of digital therapies, 75% of which are from the US.
In more than 80% of cases, digital therapies use cognitive-behavioural therapies (CBT) and physical exercises to influence the course of illnesses, but they can also use other means such as virtual reality or remote monitoring.
These digital therapies can be divided into several categories:
- Remote monitoring
- Health pathway coordination
- Coaching/therapeutic education
- Compliance/ adherence
- Cognitive behavioural therapy (CBT) techniques
- Experiential therapies (VR)
Who develops these applications?
These digital therapies are often originally developed by health professionals in partnership with software developers or editors. It is an alliance of complementary skills between scientists and engineers.
[1] https://www.nejm.org/doi/pdf/10.1056/NEJMsa073350?articleTools=true
