What if my blood sugar's too high today? Is it time for my blood-pressure pill? Researchers are trying to harness the power of cell phones to help fight chronic diseases with nagging text messages or more-customized two-way interactions.
"I call it medical minutes," said Dr. Richard Katz of George Washington University Hospital in the nation's capital.
He's testing whether inner-city diabetics, an especially difficult-to-treat population, might better control their blood sugar - thus saving Medicaid money - by tracking their disease using Internet-ready cell phones, which are provided with reduced monthly rates as long as the patients regularly comply.
Consider Tyrone Harvey, 43, whose diabetes was diagnosed seven years ago only after he got so sick that he was hospitalized for a week. He has struggled to lower his blood sugar since. In May, through a study that Katz began with nearby Howard University Hospital's diabetes clinic, Harvey received a Web-based personal health record where he records his daily blood-sugar measurements via cell phone.
If Harvey enters a reading higher or lower than preset danger thresholds, a text message automatically tells him what to do. And at checkups, doctors will use the personal health record, created by Indiana-based NoMoreClipboard.com, to track all his fluctuations and decide what next steps to advise.
"Hopefully, you're paying more attention to your numbers, too," said Howard's Dr. Gail Nunlee-Bland, whose clinic uses an electronic health record - a person's official medical history - that can automatically link to NoMoreClipboard's consumer version and update it with such data as medication changes.
The trend is called mHealth, or mobile health. If you're a savvy smart-phone user, you've probably seen lots of apps that claim to help your health or fitness goals - using your phone like a pedometer or as an alarm clock to signal when it's time to take your medicine.
Katz and other researchers are going a step further, scientifically testing whether more-personalized cell-phone-based programs can link patients' care with their doctors' disease-management efforts in ways that might provide lasting health improvement.
"Mobile phones provide that opportunity for persons to get the feedback they need when they need it," said Charlene Quinn, an assistant professor at the University of Maryland medical school. She is testing a competing cell-phone diabetes system from Welldoc Inc.
After all, most Americans carry a cell phone. Accessing the Internet with them is on the rise, too: Nearly 40 percent of cell callers do, the Pew Internet & American Life Project reported this month. That allows more-sophisticated digital health contact.
On the other hand, older adults are less likely to use smart phones. So are people who are sicker, with multiple chronic diseases, said Dr. Joseph Kvedar, director of the Center for Connected Health, a division of Boston's Partners Healthcare.
Kvedar notes that nearly any phone can handle simpler text-messaging programs. Among the biggest is the free text4baby, which sends weekly government-vetted health tips timed to pregnant women's due dates to about 50,000 participants.
Do these kinds of technologies work? There's some short-term evidence, although no one knows whether people stick with it once the novelty wears off:
- In a study of 70 Boston residents to improve cancer-preventing use of sunscreen, Kvedar found that six weeks of daily texts with reminders hooked to the weather forecast increased sunscreen use by 40 percent.
- Researchers at New York City's Mount Sinai Medical Center found that episodes of liver-transplant rejection dropped when they texted take-your-medicine reminders to 41 pediatric recipients or their caregivers, and sent another a text reminder to the parent if teen patients didn't quickly respond that they had taken their dose.
- The University of California, San Diego, went a step further, designing a text-message program to encourage weight loss in which participants texted back answers to such questions as "Did you buy fresh raw vegetables to snack on this week?" Answering allowed more-customized texts of diet tips. In a pilot study of 75 people, text-message recipients lost about 4 more pounds in four months than those given printed dieting advice.
"What systems work best with patients has yet to be figured out," said George Washington's Katz, who is testing a cell-phone program, too - and worries about more than affordability. "Otherwise, they find it's a nice toy to start with and forget about it."
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Autor(en)/Author(s): Lauran Neergaard
Quelle/Source: The Columbus Dispatch, 26.07.2010
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