What do you get when your patients don’t take their medications or adhere to a treatment plan? Readmissions to the inpatient wards, $300 billion of healthcare utilization, and 125,000 needless deaths. The new PatientPartner mobile game aims to boost adherence by giving patients something to play for 15 minutes while waiting in the doctor’s waiting room.
The game unfolds by telling a fictional patient’s health story, like a clinical case. Reminiscent of a Choose Your Own Adventure book — in a more interactive, engaging form — the video game player decides at critical points what to do about the game character’s health.
In one clinical study, use of the app increased medication adherence by 37%.
CyberDoctor CEO & founder Akhila Satish, MS, who drew from her life sciences research experience at the National Institutes of Health, University of Pennsylvania, & University of Michigan, spearheaded the project.
The app draws on the experience of director Mantosh Dewan MD, a SUNY Distinguished Service Professor and former chair of SUNY Upstate Medical University’s Department of Psychiatry.
What’s fascinating is the app doesn’t tailor to any specific disease. An independent IRB-approved clinical trial demonstrated that — with 100 non-adherent patients with diabetes at Pinnacle Health Systems in Hershey, PA — PatientPartner boosted adherence. The trial resulted in an increase of medication adherence from 58% to 95%, diet adherence increased by 24%, exercise adherence increased by 14%, and — even more fascinating — HgbA1C decreased from 10.7% to 9.7%. (The trial has yet to be published and is in press.)
iMedicalApps sat down at the Health 2.0 Silicon Valley 2013 conference to interview Akhila Satish and Mantosh Dewan.
iMedicalApps: How did you two meet & design this? This is a fairly unique project.
Akhila Satish, MS: MyCyberDoctor started off as a research project when I was at the University of Michigan. I was interested in the gaps of communication between providers and patients. We started off with symptom tracking and as it evolved, we built this patient adherence tool to accompany it–PatientPartner.
Mantosh Dewan, MD: As healthcare providers, we have a particularly hard time with adherence. We recommend the right things and the patients don’t follow through. Then they end up in the inpatient unit. We struggle with figuring out how to get to patients, how to get them to understand what things are going on [with their health] and change [their] behavior so they play ball with us. We want to partner with them. We don’t want to dictate, and nagging them doesn’t work.
So [traditionally] we’ve tried reminders, like calling twice a day so you may take your meds. We’ve tried a $8000 [system] to call patients. It’s expensive. [Instead,] we want to use something easy to use, brief to use, and have an impact that we can be sure of. So when we created PatientPartner, we based it on principles of a broader better version of critical thinking.
Akhila Satish, MS: We wanted to give the patients feedback that they could actually use and learn from – just asking them if they’ve done x or y doesn’t teach them anything about why they haven’t or have done it. It doesn’t help drive a meaningful, lasting change. And we wanted to get to that level of cognition.
iMedicalApps: So does it affect even hard-to-reach folks, those who don’t follow up with appointments or don’t engage with their providers?
Akhila Satish, MS: [Well, the app is available] only for iOS now. We hope to expand to other mobile devices and possibly a web-based platform as well in the near future. When we clinically tested it, we tested it from 17-year-olds to 70-year-olds with a huge range of economic backgrounds, different groups, & different literacy levels. [And in the future,] working with an [underserved] population is something we feel strongly about.
Mantosh Dewan, MD: Because this app is a one-time 15-minute exercise, I would hope you [the provider] could whip [the application] out [and ask], “Mrs. Jones, can you do this at the moment?” Our hope is that the doctor would be involved but make it easily available to those who can download it. There are few [other treatments or interventions] where you can spend 15 minutes on a product and see results lasting out to 3 months.
iMedicalApps: And what about the study? Dr. Dewan, was this something you were able to test in your residency program or clinics?
Mantosh Dewan, MD: It was tested independently at outside sites in IRB-approved clinical trials. It’s very hard to find an IRB-clinically approved trial of any app. Because we were trying to get away from subjectivity, we wanted objective measures, so we looked at non-adherent measures for DM patients in a standard clinical practice and used HgbA1C.
Because PatientPartner works with general complexity theory, [we didn’t] target diabetes, cancer, or stroke. We wanted something brief and generic. There are many other apps that are targeted towards [specific] diseases.
Akhila Satish, MS: It’s easy to assume it’s just for diabetes, because we used that biological marker of Hgb A1C, but the principles scale out to everyone. [We could have] looked at something more universal like blood pressure, but there are so many other factors that could impact the blood pressure that day in the study. So we used Hgb A1C because we wanted a quantitative, objective marker to test our product out with, not because PatientPartner is a product only for diabetic patients.
iMedicalApps: Do you have any advice for healthcare professionals, researchers, and entrepreneurs who want to make an impact?
Mantosh Dewan, MD: If you have an interesting idea, it should be fun. It shouldn’t be work. But it’ll be work when you [work on] the nitty gritty [details]. You’ve got to do it. It’s the same as writing a book, you don’t do it for the money. It’s an enormous waste of time! So you don’t do it for that. You hope that others read it and learn something.
Akhila Satish, MS: For us, personally, it is about the patients. [I’m hoping] this could go live and millions of patients could be transformed from our work. To help a patient to start making better choices that could help them live a little longer and better…that’s the number one motivation [for me].
Mantosh Dewan, MD: In the [same way,] in psychiatry, [a patient visit is] an hour at a time. Now we’ve moved towards brief therapy. The idea is, “can I have more patients in this small amount of time?” This was a quantum jump from a 40-hour week where you can barely see 20 patients. This [app] was sort of a chance to move from psychoanalytic therapy to brief therapy to [help affect] lots of people with the same ideas.
The PatientPartner app is only available for iPhone & iPod Touch — no word yet on other iOS, Android, or Windows devices. Visit their website at www.mypatientpartner.com or get the application from the iTunes store.
About the conference
Health 2.0 recently held their annual conference in Silicon Valley, bringing together business leaders and entrepreneurs along with physicians, empowered patients, and nurses making headlines with their new apps and software. The Health 2.0 organization has, since 2007, held conventions throughout the world, established local grassroots chapters of health technology enthusiasts, and provided media coverage of emerging companies and products.
Steven Chan, M.D., M.B.A., is a resident physician at the University of California, Davis Health System, researching mobile technology, psychiatry & human behavior. Steve previously worked as a software & web engineer & designer at Microsoft & UC Berkeley. Reach him at @StevenChanMD or www.stevenchanMD.com.