Secondary effects of COVID-19 on the healthcare system and patients

This is a guest article and does not necessarily reflect the views and values of Digi-Bridges. The original article was created by Natalie Yeadon from Impetus Digital.

By now, your social media feeds are probably full of COVID-19-related news articles, opinion pieces, and memes (not to mention conspiracy theories involving 5G or Bill Gates). Reminders of the impact of the pandemic on our healthcare system, economy, and day-to-day lives are everywhere. To date, most of the focus has understandably been on the immediate effects of the virus and the efforts to enforce physical distancing and develop a vaccine. However, we are getting to the point where we need to start considering the long-term effects on the healthcare system when making decisions.

Long-term physical effects of COVID-19

Delays and cancellations of elective procedures are already resulting in backlogs that could take years to clear. Delaying surgeries such as joint replacements, along with complementary services such as physiotherapy, could result in the patients’ conditions deteriorating to the point where they will require substantially more medical resources in the future than if they had undergone the surgery and received physical rehabilitation in a timely manner. Further, some “semi-elective” surgeries, including for hematological and thoracic cancers, are being delayed on a case-to-case-basis, with potentially disastrous results.

There are also delays in routine cancer screenings such as pap smears, mammograms, and colonoscopies. This is likely to result in higher rates of late-stage cancer diagnoses post-COVID-19. Since early detection of cancer is by far the best way to beat it, we have to prepare for higher numbers of cancer-related hospitalizations and deaths in the medium-term future. 

In general, family doctors and pediatricians are seeing fewer patients right now, and even if patients have access to a doctor right now, many choose to stay home unless there is an emergency. As a result, worrying declines in routine vaccinations have been reported in the US and elsewhere. Even before this pandemic, we were seeing clusters of measles cases in certain countries where vaccination rates were low. With COVID-19, I predict the rates will dip below the threshold for herd immunity in many parts of the world. Even after there is a vaccine for COVID-19, we may be fighting polio again. It’s a scary thought, but advanced planning will be key to stay on top of these secondary effects of the pandemic.

Mental health aspects

In addition to the above, we are already seeing the acute effects of COVID-19 on the mental health of both healthcare providers and other frontline workers, and on the general population. The rates of PTSD, anxiety, and depression are likely to keep rising the longer lockdowns are enforced. Related stressors such as fear of becoming sick, sudden unemployment, or having to homeschool young children will only add fuel to the fire. Although we may never know the true rates, we can assume that domestic violence is increasing during quarantine, causing further emotional trauma. 

There may also be a risk of healthcare providers lumping all mental health disorders under a “post-COVID-19” umbrella. Underlying or co-morbid conditions could become harder to diagnose. Whether or not there will be a second wave of COVID-19 itself, there will be a second wave of physical and mental health issues, and we need to start preparing for this now.

What can we do?

It is clear that all stakeholders, including governments and hospital administrators, need to work together to minimize any adverse long-term effects on the healthcare system and patients. One can argued that, when relaxing physical distancing guidelines or lockdowns, we should prioritize reopening medical and allied health practices well before restaurants and beauty salons. Getting a mammogram or going to the dentist for a checkup might not be ‘essential’ in the same way as undergoing emergency surgery for an aneurysm. However, not doing those things for years can cause life-threatening conditions to go undiagnosed until it is too late.

For pharmaceutical companies that want to help their customers here and now, there are multiple ways. The appetite for medical education on how to adapt clinical practice to COVID-19 and treat patients “virtually” remains high. Contrary to what many Pharma representatives think, most healthcare providers (except those working directly with COVID-19 patients such as intensive care specialists) are actually less busy than pre-COVID-19. They welcome the opportunity to attend webinars or other types of online medical education events from home, and to be able to network and share best practices with colleagues from across the country.

The needs of healthcare providers and their patients during this time will vary greatly based on their conditions and the available treatments and resources. Therefore, to determine other ways that Pharma can help, close (virtual) collaboration with not just expert KOLs but also community physicians, nurses, allied health professionals, and patients/caregivers is critical.

Lessons learned from the pandemic so far

Being a glass-half-full-person, I think it’s important that we don’t lose sight of the positives and the lessons learned in the last few months. The pandemic has shown that a lot of jobs can be done successfully (and often more effectively) on a remote basis. This will hopefully translate to more flexibility for workers in the future. Especially, this will benefit those with physical disabilities or other health conditions, who have long advocated for work-from-home policies.

The rise in telehealth is another interesting side effect of the pandemic. Here in Canada, many provinces are introducing new billing codes for telehealth, and we are quickly learning about the pros and cons of telemedicine for different types of patients. From a physician’s perspective, there may be substantially lower rates of no-shows. A follow-up appointment that might take 30 minutes in person can be done in <10 minutes over the phone. From the patients’ perspective, being able to refill a prescription in 5 minutes without having to leave the house might mean that they don’t have to take several hours off of work, find a babysitter, or skip lunch. 

Finally, the development of fully virtual congresses is another interesting outcome. Born out of necessity, many of these have actually been more successful than their in-person counterparts in terms of attendance and engagement. I predict that, as the technology keeps improving, we will see more virtual congresses, conferences, and other learning and training events, even after we are able to safely meet in person again. 

About Impetus Digital

Through their cutting-edge online collaboration tools, Impetus Digital helps life science organizations  virtualize  their in-person meetings and seamlessly gather insights from, and collaborate with, internal and external key stakeholders.  Visit www.impetusdigital.com to find out how Impetus Digital can help transform your events into the digital sphere.

Clinicians’ Role in the Adoption of mHealth and Its Implications for Organizational Practices

This original research paper was published in the Journal of Medical Internet Research (JMIR) mHealth and uHealth; the full text can be accessed in this link https://mhealth.jmir.org/2019/5/e13555/

Background: Despite the existence of adequate technological infrastructure and clearer policies, there are situations where users, mainly physicians, resist mobile health (mHealth) solutions. This is of particular concern, bearing in mind that several studies, both in developed and developing countries, showed that clinicians’ adoption is the most influential factor in such solutions’ success.

Objective: The aim of this study was to focus on understanding clinicians’ roles in the adoption of an oncology decision support app, the factors impacting this adoption, and its implications for organizational and social practices.

Methods: A qualitative case study of a decision support app in oncology, called ONCOassist, was conducted. The data were collected through 17 in-depth interviews with clinicians and nurses in the United Kingdom, Ireland, France, Italy, Spain, and Portugal.

Results: This case demonstrates the affordances and constraints of mHealth technology at the workplace, its implications for the organization of work, and clinicians’ role in its constant development and adoption. The research findings confirmed that factors such as app operation and stability, ease of use, usefulness, cost, and portability play a major role in the adoption decision; however, other social factors such as endorsement, neutrality of the content, attitude toward technology, existing workload, and internal organizational politics are also reported as key determinants of clinicians’ adoption. Interoperability and cultural views of mobile usage at work are the key workflow disadvantages, whereas higher efficiency and performance, sharpened practice, and location flexibility are the main workflow advantages.

Conclusions: Several organizational implications emerged, suggesting the need for some actions such as fostering a work culture that embraces new technologies and the creation of new digital roles for clinicians both on the hospitals or clinics and on the development sides but also more collaboration between health care organizations and digital health providers to enable electronic medical record integration and solving of any interoperability issues. From a theoretical perspective, we also suggest the addition of a fourth step to Leonardi’s methodological guidance that accounts for user engagement; embedding the users in the continuous design and development processes ensures the understanding of user-specific affordances that can then be made more obvious to other users and increase the potential of such tools to go beyond their technological features and have a higher impact on workflow and the organizing process.

Please cite as:

Jacob C, Sanchez-Vazquez A, Ivory C

Clinicians’ Role in the Adoption of an Oncology Decision Support App in Europe and Its Implications for Organizational Practices: Qualitative Case Study

JMIR Mhealth Uhealth 2019;7(5):e13555

DOI: 10.2196/13555

Would your doctor prescribe a mobile health solution?

This article was originally published in the Journal of mHealth; you can access the full issue here.

Despite their potential, until recently, many reports pointed out that Mobile Health solutions are still lacking scientific evidence supporting their effectiveness; however, this is fortunately slowly changing now.

There is growing evidence that mHealth solutions are moving from fitness trackers and quantified self to more impactful tools that truly empower healthcare professionals and patients. Such tools have the potential of revolutionizing Healthcare.

In April 2017, the remarkable results of a randomized trial comparing a mobile health follow-up with regular examination in Lung Cancer patients showed that the median survival was 19 months for patients who used the app, compared to only 12 months for those who received routine checkups1. The study also reported a better quality of life among the app users. “Through personalized follow-up using this convenient and simple online application, we can detect complications and signs of relapse and offer appropriate care earlier,” said lead study author Dr. Fabrice Denis, MD, Ph.D., a researcher at the Institut Inter-regional de Cancérologie Jean-Bernard in Le Mans, France. “This approach introduces a new era of follow-up in which patients can give and receive continuous feedback between visits to their oncologist.” Which makes this solution one of the first Evidence-Based Medicine Applications showing significant overall survival improvement in a clinical trial, paving the way for more evidence-based mobile solutions to come.

Mobile health solutions also proved to be a noteworthy tool in enabling health researchers to recruit big numbers of patients and monitor them in real time.  A research published in “Nature Biotechnology” showed how an app to study asthma triggers enabled the research team to recruit about 9,000 participants with asthma, who used a mobile health app daily to register their symptoms and triggers. The research team wanted to investigate the impact of the wildfires in the area on asthma patients, and thanks to the real-time data reported through the app, they concluded that when fires flared up, so did asthma symptoms2. “In the past, stuff like this was just logistically impossible to do,” says Chan, director of digital health at the Icahn Institute for Genomics and Multiscale Biology at Mount Sinai in New York City. “It opens up a brand-new area of research.” Such contribution in rigorous research shows the undeniable value of real-time monitoring and reporting enabled by mobile health solutions.

The instrumental role of healthcare professionals

The growing evidence around the effectiveness and impact of mobile health is, however, not enough for its success; healthcare providers’ adoption is key in making mobile health solutions a standard of care in healthcare when it makes sense.

Notably, healthcare professionals have a tendency to be late in adopting new technologies in general; this could be due to their critical nature and their professional concern about any risk or uncertainty that could be related to novel technologies, which pushes them to adopt such solutions relatively late when they have proven to be more mature and safe to use3.

Another noteworthy observation in the specific case of mobile health solutions compared to other healthcare technologies is that they are mostly patient-centered and patient-driven.

A survey conducted by MedPanel about the crucial role that healthcare professionals can play in the success of mobile health solutions points that physicians can play a much more effective role in such tools’ adoption if they are involved more actively. “As long as tech companies view wearables and apps as consumer-driven markets, these products will remain a fad,” says MedPanel President Jason LaBonte, “But if they engage physicians to recommend these products, wearables and apps will be viewed as part of healthcare and become permanent fixtures.” This shows the critical role that Healthcare Professionals (HCPs) can play and the importance of involving renowned physicians and scientists in the development as well as the endorsement of the apps in order to make them a success.

Factors impacting HCP adoption

Knowing that a successful integration of mobile health solutions in the healthcare system is largely relying on HCPs and whether they would choose to adopt such solutions, many researchers investigated the topic, including systematic reviews that analyzed and condensed much of what has been published about the topic, for example the work by Gagnon et al 4. These studies showed that there are emerging themes pointing to the main factors impacting the decision of healthcare professionals when they are considering whether or not to integrate a mobile health solution into their daily practice.

The usefulness and ease of use of the mobile health solution in question, as well as its impact on clinical outcomes, are the top factors mentioned by healthcare practitioners when asked about elements impacting their decision to adopt an mHealth solution.

Legal compliance issues, such as privacy and security matters, are generally perceived as a major barrier to adoption as the use of mobile health tools could generate risks to patients’ data privacy.

Training and access to support came up in various discussions, with HCPs stating that the availability of training material and easy access to support are key, and many mentioned that they stopped using some mHealth solutions due to the lack of these elements.

Interoperability and system reliability also emerged repeatedly, and mHealth is still sometimes perceived as an additional workload when it is not integrated with other technologies used such as Electronic Health Records (EHRs).

Other factors such as cost issues are still perceived as a barrier, especially in the absence of a clear reimbursement scheme for such solutions. On the other hand, HCPs confirmed that mHealth undoubtedly empowers patients and positively impacts their relationship with them.

Ensuring a successful adoption and integration of mHealth in healthcare practice requires app developers and providers to take into account the different factors impacting this adoption, and the fact that these factors go far beyond technology and the app itself to include other important social factors such as training, support and legal compliance aspects. These are elements that should not be underestimated.

References:

1.    Denis F, Lethrosne C, Pourel N, et al. Randomized Trial Comparing a Web-Mediated Follow-up With Routine Surveillance in Lung Cancer Patients. J Natl Cancer Inst. 2017;109(9). doi:10.1093/jnci/djx029.

2.    Chan Y-FY, Wang P, Rogers L, et al. The Asthma Mobile Health Study, a large-scale clinical observational study using ResearchKit. Nat Biotechnol. 2017;35(4):354-362. doi:10.1038/nbt.3826.

3.    Wu I-L, Li J-Y, Fu C-Y. The adoption of mobile healthcare by hospital’s professionals: An integrative perspective. Decision Support Systems. 2011;51(3):587-596. doi:10.1016/j.dss.2011.03.003.

4.    Gagnon M-P, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. J Am Med Inform Assoc. 2016;23(1):212-220. doi:10.1093/jamia/ocv052.