Is your medication enough? Adding a digital zing to chronic diseases!

Is medication enough?

Imagine a tall sturdy tree; the tree of ‘chronic disease’ that is growing at an alarming rate. More often than not, at the roots of this tree are the choices we all make. These choices define our lifestyle (the way we live!) and are influenced by a myriad different factor. Prescriptions of medication that have proven efficacy against these diseases are clearly not enough for our patients. Digital interventions like mobile applications aim for these deep-seated roots of lifestyle choices so that they can stunt the tree of chronic disease. Sounds morbid? Well, let’s look at the means by which lifestyle management complements the medications you take, in battling chronic diseases. 

What are ‘chronic diseases’? 

The Centers for Disease Control and Prevention, USA, defines chronic disease  as conditions that last one year or more and require ongoing medical attention or limit activities of daily living or both[1]. Patients with chronic diseases like Ischemic Heart Disease, Hypertension, Asthma, Congestive Heart Failure, Type II Diabetes mellitus and Cancer have to undertake long arduous journeys of care to prevent complications and/or exacerbations leading to hospitalization. The human population has a huge burden of these chronic diseases and the numbers continue to increase rapidly[2].

 

What are the lifestyle choices that will help improve health outcomes in chronic diseases?

Our lifestyle choices have the power to either prevent disease or if already suffering from a chronic disease, then to minimize ill effects. An interaction between lifestyle choices and genetic factors results in a wide array of chronic diseases. Lifestyle medicine is shown to dramatically help achieve better outcomes among patients[3,4].

So what are these choices?

  • Let’s consider the case of Mr. Raman. He suffers from asthma. He knows that increased particulate matter in the air, owing either to weather conditions/ festivals like Diwali; will trigger an asthma attack. Mr. Raman will benefit greatly from technology that can update him with real time Air Quality Index (AQI); enabling him to change his work timings or commute route if feasible. This technology enables Mr. Raman to make a lifestyle decision that will prevent his exacerbation. And just so you know, such a technology exists and can be offered to many patients like him. 
  • A healthy diet like DASH (dietary approaches to stop hypertension)[4] is key to keep blood pressure under control. Bite sized-lessons and calorie-counters on mobile apps in addition to the health coach’s advice on food choices make it easy for patients to adhere to healthier diet options.
  • Having a healthy body mass index and staying active: at least 150 minutes of moderate to intense physical activity a week![5]; are shown to improve control of blood glucose level in Type II Diabetes. Daily digital log of self-reported meals and activity are a great way of steering the patient towards conscious progress in these areas of lifestyle management. In addition to self-empowerment, the patient has access to guidance from trained health coaches who help them create roadmaps and reach many milestones along the way based on these daily logs.

What is the status quo like?

  • People usually discover by chance or late that they suffer from Hypertension, Heart disease, Type II Diabetes, or Asthma
  • They then go to a physician or specialist
  • A management plan is made, which generally includes medicines primarily with little or no advice on lifestyle change
  • Patient may take medicines regularly; but is very unlikely to follow lifestyle advice as there is inadequate reinforcement and minimal scope for behavior change
  • Patient follows up with the physician specialist once in a fixed time-period or earlier if he/she has had a complication or exacerbation
  • This cycle repeats. 

What is glaring in this cycle is that there is little space or time for the lifestyle component of chronic diseases, which is the key ingredient in successful chronic disease management.

Is the status quo enough??

  • Medicines with the best efficacy taken regularly without modifying lifestyle are proven to be suboptimal. Let’s analyze why. In clinical trials, the participants are under strict vigil and a lot is invested into achieving the ‘ideal’, whether it is adherence to the medicine or the lifestyle component. However, once the drugs are out in the market, the same level of ideal conditions are hard to achieve among all patients taking them, leading to suboptimal effectiveness!
  • Change in lifestyle like measuring water and salt intake in patients with congestive heart failure or checking the AQI before stepping outdoors in patients with asthma or weighing the pros and cons of ordering that extra sweet dish for dinner requires a change in behavior. It also requires guidance, understanding of the disease mechanism and credible information that is easily accessible     
  • Status quo doesn’t address the complex mechanisms of human behavior change, nor does it provide adequate guidance and/or appropriate credible information

Hence the status quo is definitely not enough!

Do our consistent healthy lifestyle choices matter? Yes!

  • There is a boost in drug effectiveness when complemented with consistent better lifestyle choices
  • There is absolutely no doubt that our daily choices affect short-term and long-term health outcomes. This is backed by thousands of research articles and evidence-based guidelines for the treatment of chronic disease. For instance, a recent document by the World Health Organization states that regular physical activity helps in reducing blood pressure by 7.4 and 5.8 mmHg (systolic and diastolic respectively). It reduces stroke risk by 30-40% and cardiovascular risk by 20-25%6

Why then are healthy behaviors difficult to adopt?

  • Behavior change is a complex process and is influenced by multiple internal and external factors
  • The behavior change cycle explains that a person passes through many stages when he/she decides to change a certain behavior7. A key to maintaining a positive behavior change is continuous patient engagement.

The way healthcare is structured today, this is hard to achieve. 

How do digital interventions act as enablers of positive behavior change?

  • Digital interventions like mobile applications with colorful, interesting and peppy interfaces may improve self-driven learning among patients
  • Apps that allow daily log of physical activities, meals, blood pressure etc. enable patients to check trends over time and progress since measuring successes is a key component for behavior change! 
  •      AI/ML based digital health interventions empower users to take their lifestyle into their own hands (literally!) and personalize their learning journey. Consistent credible information is delivered with timely triggers 
  • Features that remind patients to make healthier choices or take their medicines on time are great lifestyle boosters

The iterative process of comprehensive learning powers behavior changes and helps patients achieve the desired change 

Conclusion: This blogpost makes a strong case of why it would be great if medications are complemented with digital health applications. The benefits would be seen not just in patients and healthcare providers, but would extend to all other sectors like pharma, devices and insurance companies! So, go ahead, add that digital zing to chronic disease management!

Reference
  1. Mathur P, Mascarenhas L. LIFESTYLE DISEASES: Keeping fit for a better tomorrow. Indian J Med Res. 2019 Jan;149(Suppl 1):S129–35. 
  2. GBD 2017 Study Highlights: Causes of Death [Internet]. Institute for Health Metrics and Evaluation. 2018 [cited 2020 Jul 17]. Available from: http://www.healthdata.org/infographic/gbd-2017-study-highlights-causes-death
  3. Rippe JM. Lifestyle Medicine: The Health Promoting Power of Daily Habits and Practices. Am J Lifestyle Med. 2018 Jul 20;12(6):499–512. 
  4. Kushner RF, Sorensen KW. Lifestyle medicine: the future of chronic disease management. Curr Opin Endocrinol Diabetes Obes. 2013 Oct;20(5):389–95. 
  5. Physical activity [Internet]. [cited 2020 Jul 17]. Available from: https://www.who.int/news-room/fact-sheets/detail/physical-activity
  6. Physical activity for patients with hypertension A noncommunicable disease education manual for primary health care professionals and patients. World Health Organization 2017; 2017.
  7. Understanding behaviour change | Supporting behaviour change | Royal College of Nursing [Internet]. The Royal College of Nursing. [cited 2020 Jul 17]. Available from: /clinical-topics/supporting-behaviour-change/understanding-behaviour-change