Digital Chronic Care. Does It Work?

Digital health solutions improve patient outcomes with chronic conditions mainly in three areas including symptom self-management, HCP-patient communication and mental and physical wellbeing. Positive clinical evidence on patient outcomes is available for all three domains, however the quality and maturity of clinical evidence varies significantly depending on the chronic condition type.

Understanding the patient experience is crucial in chronic condition care, as disease and long-lasting treatment have significant negative effects on a patient’s physical, emotional, and social well-being. Therefore digital solutions have been concentrated on improving patient outcomes in three major areas:

Providing better self-management of symptoms:

Designing digital solutions around the different dynamics of each chronic condition, lifestyle, and patient need is critical for providing better symptom self-management capabilities and reducing unscheduled clinical visits. Especially for chronic conditions with severe side effects due to medication and treatment (e.g., cancer), managing severe symptoms (such as nausea, fatigue, diarrhea, and pain) may be successfully eased with the help of self-management features within the digital tools.

For example, successful solutions in oncology are consistently collecting e-PROMs (electronic patient-reported outcomes) and using evidence-based algorithms to evaluate every piece of information and provide real-time personalized recommendations (e.g., nutrition tips, physical exercises, etc.). Personalized recommendations, health/symptom dashboards, reminders on medication, appointments, nutrition, and exercise along with extensive information within digital tools help patients understand their disease and how to manage it better and have the potential to increase their level of engagement and stay with the medication for a longer period (increased medication adherence).

Does it work, is there evidence?: Increased mental and physical wellness and overall QoL, medication adherence, symptom control, patient knowledge, communication and involvement of patients emerge as a common endpoint for all chronic illnesses. For example, in diabetes, there is strong evidence especially on better self-management of symptoms due to device integrations, whereas in conditions such as cancer, MS and epilepsy there is medium-low evidence maturity from the available digital solutions.

Rating: Overall the quantity and quality of clinical evidence is medium.

Improving HCP-patient communication & insights:

Providing enhanced HCP-patient communication mechanisms are crucial in managing and helping patients suffering from chronic conditions which must be monitored regularly and efficiently by the care teams. Chronic condition digital health tools, which contain a patient app and a web portal for HCPs improve communication and collaboration between patients and their care team due to their interoperability. In addition to many features (e.g., direct chat, video consultation, report sharing etc.) that directly connect patients and HCPs virtually, e-PROMs enhance communication between patients and care providers and improve patient involvement in care planning and decision-making. Smart features within digital tools automatically analyze the reported symptom data and prioritize according to severity level based on algorithms adapted to each drug and each patient profile to help HCPs plan their actions. Improved management of treatment-emerging symptoms can help maximize treatment and medication adherence while helping HCPs identify symptoms and intervene as early as possible to mitigate potential complications.

Does it work, is there evidence?: Common endpoints from clinical studies include enhanced patient-provider communication, improved symptom management, less frequent hospitalization, and longer continuation of therapy. Depending on the chronic condition, leading solutions already have meaningful evidence for the use of e-PROMs as a part of routine clinical care. For example, in chronic mental illnesses, there is high evidence of improved real time HCP-patient communication due to intensive telehealth features within digital tools.

Rating: Overall the quantity and quality of clinical evidence is still low-medium.

Supporting mental & physical wellbeing of patients:

Depression, deteriorated mental and physical health, and poor overall wellbeing often coexist with other chronic conditions, contributing to poor self-management and subsequent poor health outcomes and poor quality of life. Successful digital solutions are already improving patient outcomes by enabling them to self-report their moods, physical activity, and nutritional intake and receive tips and exercises for improving symptoms, anxiety, stress, nutrition, and physical activity tailored to their specific conditions and severity levels. Additionally, community and peer support features in digital platforms actively enable interaction, anonymous information sharing, and private talks about issues specific to their circumstance with other community members.

Does it work, is there evidence?: Improved mental and physical wellbeing of patients has strong clinical evidence among all types of chronic diseases, with common endpoints of improved connection, positive mood, coping behaviours, as well as lower depressive symptoms, anxiety, stress, reduction in pain scores, and increased physical activity.

Rating: Overall the quantity and quality of clinical evidence is high.

There is positive clinical evidence on the use and acceptance of digital tools among patients across all types of chronic conditions, whereas the level of clinical evidence on symptom management, communication, and patient outcomes varies depending on the dynamics of each disease.

Digital solutions in managing chronic conditions have proven to improve patient outcomes with varying levels of clinical evidence maturity based on several therapeutic areas. The three main improvement areas have prominence in many provided services and offerings currently available in the digital health market. For designing successful digital health solutions, healthcare companies must start by integrating the three major areas into their service offerings, which serve patient and chronic disease-specific needs.

(If you would like to learn about “Eight services that digital health solutions must have to support patients with chronic diseases”, read R2G’s market insight here)