[This is a preview of some of the exciting mHealth research being presented at this week’s Medicine 2.0 Congress on September 15-16. This abstract and others are candidates for the iMedicalApps-Medicine 2.0 mHealth Research Award]
Joshua Richardson, PhD, Cary Reid, MD
iMedicalApps-Medicine 2.0 mHealth Research Award Finalist
Chronic pain (CP) is a highly common, costly, and frequently disabling disorder among older adults. In fact, the Institute of Medicine in its 2011 seminal report called pain a major public health problem in the U.S. and noted that older adults constituted a particularly vulnerable population because of established disparities in pain management.
Although analgesic medications like opioids remain the most commonly prescribed therapy for treating older adults for chronic pain, concerns about side effects by both patients and providers constitute a major barrier to their appropriate use.
Mobile health (mHealth) technology is flexible, adaptable, and increasingly affordable, and therefore is a potentially powerful tool for supporting provider and older patient management of opioids to treat chronic pain.
Patients may not take sufficient dosages due to side effects, either real or perceived. Adult children may not provide sufficient dosages to their parents out of concern for potential addiction. Providers may not prescribe sufficient dosages out of concern for medical malpractice suits should a medication happen to hurt an older patient. These concerns, some more based in fact than others, constitute barriers to effective treatment of pain for older adults.
One cause for these barriers is the inconsistent ways in which data is collected or, as is often the case, not collected. Providers who prescribe the potent pain medications rely heavily on their patients’ abilities to reliably collect accurate data about pain status and quality of life. Yet patient data that inform opioid medication management are traditionally recorded during patient visits, not while the patient is away from the office, and therefore offer providers an incomplete view of a medication’s potential effectiveness and/or harm.
This increases the chances of prescribing errors or may result in adverse events such as patient falls. Overcoming provider and patient barriers to analgesic medication use requires novel means for accurately and reliably communicating information and coordinating care to help providers and patients better monitor opioids in the management of CP.
mHealth Approach to Pain Management
mHealth may provide new opportunities to collect clinical, patient lifestyle, and patient behavior data that could foster enhanced provider-patient communication and care coordination. However, few mHealth technologies exist that support communication and coordination to meet the needs of older patients with CP and providers alike. This represents a wide area of potential study for which there is great need yet for which little is known.
As part of the Medicine 2.0 Congress in September 2012, we will describe various needs assessments we have been performing. First, we will present CP’s debilitating impact on the general population as a whole and on the older population in particular. Second, we will describe the needs that both older patients with CP and providers have for effectively communicating and coordinating care with one another. Third, based on these defined needs, we will describe potential mHealth solutions such as mHealth applications or ubiquitous computing that could improve communication and care coordination in this setting.
Our research team, headed by Dr. Reid, has already begun investigating patient and provider needs in multiple ways. We are reviewing the literature to understand what specific opportunities and concerns exist as they relate to older adults using mHealth in pain management. In addition, we are investigating the ways that patients and providers perceive mHealth’s potential usefulness and understand perceived barriers in the management of CP. Although in its early stages, our research is beginning to demonstrate the needs for, and the interest in having, innovative mHealth applications that improve the treatment for CP among older adults by bettering patient-provider communication and care coordination. mHealth holds substantial promise as a tool to overcome communication and coordination barriers associated with the care of older patients with CP. We are looking forward to the Medicine 2.0 Conference so that we can share insights into our work and identify the areas where research and technological innovation can, and are beginning to, optimally address the need for improved CP care.
Joshua Richardson, PhD, is a faculty member with The Center for Healthcare Informatics and Policy (CHiP) and a member of the Health Information Technology Evaluation Collaborative (HITEC) based at Weill Cornell Medical College, NY, NY. He evaluates the design, implementation, and adoption of clinical informatics applications and health information technologies, and focuses on mHealth’s potential impacts on the delivery of health care.
Dr. Reid is an Associate Professor of Medicine at Weill Cornell Medical College where he directs Cornell’s Edward R. Roybal Center for Translational Research on Aging. This NIH-funded center seeks to translate the findings of basic behavioral, medical, public health, and social science research into treatments, intervention programs, and policies that improve the health and well-being of older adults who suffer from or are at increased risk for pain.