How mobile health kept patients in treatment during a hurricane
by Sebastian Seiguer, JD, MBA

Severe weather makes preserving public health even more challenging. Limited staff availability, obstructed roadways, unsafe conditions and long travel times make important practices such as home and clinic visits nearly impossible. Ensuring medication adherence for certain patients is critical, and severe weather can turn this already challenging situation into an outbreak.

In August and September of 2017, public health departments across Texas faced these challenges in the wake of Hurricane Harvey as they continued treatment for patients with tuberculosis (TB). Health departments across the U.S. are responsible for treating patients with TB. Given that the disease is highly contagious and costly if not contained, it’s imperative that every dose of medication is taken.

To help ensure high medication adherence, patients receiving treatment for active TB take every dose of medication in front of a health care provider, a practice known as Directly Observed Therapy (DOT). DOT works because the relationship between the patient and provider keeps the patient engaged. Additionally, people tend to perform better when they know that they are being observed, a phenomenon known as the “observer effect.”

According to a recently released report published by the U.S. Centers for Disease Control and Prevention, 282 patients with tuberculosis across 17 local or regional health departments needed to continue treatment during Hurricane Harvey. Sixty-one of these patients used a mobile health platform so that their DOT could take place virtually. Through video DOT, Texas public health officials were able to confirm that 59 of these 61 patients took every single dose of medication as prescribed, according to the report. In other words, those patients achieved 100 percent medication adherence. The technology used is asynchronous, allowing patients to video record themselves taking medication and report side effects without the provider having to be online at the same time.

This success demonstrates the power of technology to improve health and save costs. Crises such as Hurricane Harvey bring technology’s benefits into sharp focus. However, the need to take every dose of medication as prescribed extends far beyond rare infectious diseases and hurricanes.

A Multi-Billion Dollar Problem

Medication nonadherence is a multi-billion dollar problem in the United States. Approximately half of medications are not taken as prescribed, which leads to more than $100 billion in avoidable hospitalizations.

When a patient needs to take medicine in a hospital, the standard of care is that a nurse or other health care provider will bring the person the medications and watch as he or she takes it. But what happens when the patient leaves the inpatient setting and returns home? Continuing DOT in-person is not practical given the high burden and cost of the technique.

Technology can remove the barriers that stand in the way of supporting patients as they take every dose. It can also give providers a daily insight into a patient’s progress where data was previously unavailable. These insights, and the ability to improve medication adherence, have the potential to dramatically reduce health care costs, while improving utilization of the more than $400 billion spent on medications annually in the U.S.

The potential is strongest for chronic diseases. More than half of all patients with Medicaid have a chronic condition, which represents a significant portion of costs to the program. For example, congestive heart failure is one of the most expensive chronic conditions to treat, with total costs to Medicaid ranging between $29,271 to $51,937 per patient. In a study of Medicaid patients with congestive heart failure, patients who were adherent to medications had fewer hospitalizations and ER visits and had overall costs that were 23 percent lower than nonadherent patients.

The same is true for other chronic conditions. The range between the most and least adherent patients with Type 2 diabetes are from $4,570 per year to $8,867 per year—a two-fold increase. Similarly, for patients with high cholesterol, the most adherent patients cost approximately $3,924 per year whereas the least adherent patient cost $6,888 per year.

Technology must be considered as a part of the solution to close the gaps in medication adherence rates and the costs of nonadherence. Mobile health tools, such as the one used in Texas, can prevent adverse outcomes that could lead to more costly treatment. The need for these tools will become more imperative as the healthcare delivery model shifts to value-based care.

Particularly for patients who are treated in their home and often take medications without the supervision of a provider, technology can provide critical data between in-person visits. Mobile health can facilitate and improve the patient-provider relationship, which increases medication adherence and could ultimately lead to healthier patients and lower costs.

Read the full February cover series here.