A group of Finnish researchers have reported disappointing results in a randomized study looking the impact of giving patients remotely monitored connected health devices, like wireless blood pressure monitors & weight scales, as well as follow up from a trained health coach.
Interest in the use of wearables and connected health devices has exploded in recent years and with good reason. The burden of chronic disease is rising worldwide. Successful management hinges on the decisions that patients make every day, like whether to take their medicines or what they eat for breakfast. A visit with their doctor every few months for 15 minutes doesn’t seem like the best way to handle diseases that our patients have to live with and manage every single day.
In this study, researchers randomized about 500 patients, half with diabetes and half with high blood pressure, to either a remote monitoring system with a health coach or usual care. In the former, they were given a toolkit with a connected blood pressure monitor, weight scale, glucometer, and activity tracker. Health coaches contacted them for follow up on a monthly basis, reviewing data and offering feedback on improvement. They followed a self-reported metric of health-related quality of life as well as secondary endpoints including blood pressure, glucose control, and lipid levels.
Their patient population was notable in that participants were mostly in their late 60’s, overweight, and majority male (~65%). Over the course of this one-year study, they found no difference in their primary outcome of health-related quality of life or in the secondary clinical outcomes like blood pressure, hemoglobin A1c, lipid panels, or weight.
There are two other key points worth noting about the study. The first is adherence to self-monitoring, which was fair. Among hypertensive patients, participants sent in 57 blood pressure reports (median, IQR 36-89). Among diabetics, they sent in 47 blood glucose reports (median, IQR 20 – 89). That’s getting pretty close to weekly reports which is actually pretty good. The second point worth noting is the intensity of the intervention or lack thereof. On average, patients received about 9 calls lasting 20 minutes each over the course of the study. While that’s certainly better than 4 15-minute clinic visits in a year, I’d argue that chronic diseases like these require much higher frequency patient contact.
This study comes on the heels of another trial from Scripps finding that just giving patients these devices didn’t make a difference in outcomes, specifically utilization. In that that study, a big limitation however was the complete lack of a feedback loop for acting on the data being collected. The ball was entirely in the patient’s court.
In contrast, we’ve seen other studies that have shown that monitoring paired with high frequency, automated feedback of some kind can be effective. For example, the mActive study was able to get people moving more by paired an adaptive SMS program to step counts collected by a pedometer. Similarly, another study using only a standard text messaging program that sent daily messages & reminders about healthy lifestyles seemed to have a positive impact on outcomes like blood pressure control.
Chronic diseases are something that require active management by our patients every single day. Connected health devices can be useful tools in gathering objective data but only if they are paired with feedback loops of some kind to empower patients to act on that data. That could be giving patients a pre-defined medication titration plan, as was done in one positive study, or delivering text messages in response to the data collected. Both this study and the Scripps study show us that just giving patients these devices without the tools to act on the data collected or even what we may have traditionally considered more “intensive” follow up isn’t going to cut it.