Worldwide, non-communicable diseases (NCDs) are responsible for approximately 70% of deaths, of which 75% occur in low- and middle-income countries (LMICs). Yet funding for tackling NCDs is low compared to other diseases, and governments are struggling to respond to this massive health threat.
In a new report on the promise of digital health to address NCDs, The Broadband Commission Working Group on Digital Health calls digital health a catalyst in transforming healthcare from disease silos to an integrated, resilient health system.
Three Digital Health Benefits for Addressing NCDs
The report outlines how digital health solutions fundamentally change the cost-quality equation of healthcare by allowing patients to manage their own health, medical providers to deliver better care, and governments to strengthen the underlying health system. The report showcases three key benefits to LMICs as they respond to the growing image of NCDs on their population:
1. Efficient and high-quality care delivery
- Innovative service-delivery models bringing healthcare from facilities into communities and remote places; matching of health workers’ skills with tasks and delegating where appropriate
- Robust clinical decision-making with the support of intelligent information systems
- Efficient communication and use of information across healthcare providers
- Provision of tailored and face-to-face training and technology to extend health workers’ skills, enabling them to handle a broader range of clinical situations
2. People-centered and continuous care
- Providing accessible healthcare solutions through physical, remote and virtual touchpoints
- Support along the care continuum for people living with NCDs, moving from episodic treatment to long-term health management
- Empowerment of patients by providing them with information and soliciting their active engagement in treatment plans that include self-monitoring
3. Proactive and preventive care
- Support for people living with NCDs and associated co-morbidities across the population, by promoting healthy lifestyles and preventive measures, and focusing on risk factors and patients in pre-disease stages
- Provision of timely and secure access to the kind of longitudinal, population-based and forward-looking data that can help prevent NCDs and improve delivery of care
- Precision profiling with algorithms embedded in information systems that can be used within communities and at primary-care clinics
Investing in digital health specifically to combat NCDs can have wider health system benefits, including radically expanding access and transforming healthcare, making it easier to reach universal coverage in LMICs.
Digital Health Solutions Demonstrating NCD Impact
Demonstrating the impact of a digital health solution is important for convincing health systems, providers, and patients to adopt new technologies. The report highlights six digital health programs deployed at scale that show demonstrable benefits for NCD prevention and management.
Vitality Health App – South Africa
Reduce risk factors – App-based activity tracking and rewards program used by insurance companies to incentivize members to lead healthier lifestyles. Users can earn rewards ranging from reduced premiums to gift cards and discounted flights by meeting activity goals and making healthy food choices.
- 6 million individual users
- Admission rates to the hospital were 7.4% lower for cardiovascular diseases, 13.2% lower for cancers, and 20.7% lower for endocrine and metabolic diseases
Be He@lthy, Be Mobile – India
Smoking cessation – World’s largest mobile-based smoking cessation program is helping people quit tobacco use through interactive support delivered by mobile phones.
- Over 2 million users enrolled
- 7.2% six-months quit rate
Novartis Foundation Telemedicine – Ghana
Telemedicine – Connects community health workers with specialists via a 24-hour teleconsultation center that saves $31 USD per avoided referral to a health practitioner.
- Reached 6 million patients
- 31% unnecessary referrals avoided through teleconsultation
- 50% of teleconsultations resolved directly by phone
AccuHealth – Chile
NCD risk prediction – Wearable sensors linked to remote monitoring center with data mining and predictive modeling to anticipate health deteriorations that would require Emergency Room visit or hospitalization.
- Monitored over 15,000 patients
- 42% decrease in emergency room visits.
CASALUD – Mexico
NCD prevention and disease management – Proactive prevention of NCD risk factors using MIDOTM and disease management through SIC (an NCD information system). Online training to health professionals and community workers. Medicine supply and lab test monitoring
- National rollout to +12,000 primary care clinics.
- 1 million individuals screened with MIDO, 1.8 million patients using NCDs Integrated Dashboard
- Increased A1c testing in diabetic patients from 10% in 2014 to 55% in 2018
AxisMed – Brazil
NCD remote monitoring – Tracking blood glucose levels and blood pressure biometric data from chronic patients by medical professionals who oversee patient treatment plans.
- 80% of patients monitored have adhered to their treatment plan
- 66% reduction in hospital emergency ward visits
Digital Health Improves Health System Resilience
As digital health solutions improve NCD management and help countries progress toward universal health coverage, they should be considered to be an essential aspect of the healthcare system, just like medical equipment and hospital beds are.
Ultimately, health systems enabled by digital health solutions will gain resilience and be able to deal more effectively with evolving health threats, whether they come from infectious diseases or NCDs.
One of the areas where digital health applications has not made much headway is in the adherence arena.
The effect of chronic diseases on the health and wellness of individuals is increasing in every region of the world. One in three adults worldwide has raised blood pressure and one in 10 adults have diabetes.
Globally, there are approximately 422 million adults with diabetes as compared to 108 million in 1980 (4.7%-8.5% in the adult population).
Treatment of chronic conditions such as Diabetes and Hyper tension often includes prescription medications. Non adherence to medication therapy can compound the increases in morbidity and mortality, and can further add to additional health care costs. It is estimated that increased prescription medication adherence could save the United States US $5 billion annually in health care costs, including decreasing expensive emergency department visits and hospitalizations.
Medication non adherence contributes significantly to the growing burden of disease and high costs associated with care. For patients living with HIV, Taking HIV medicines every day prevents HIV from multiplying, which reduces the risk that HIV will mutate and produce drug-resistant HIV strains.
Digital Health apps have struggled in this realm, solving the adherence hoodoo. This is mainly because most digital health apps are basic are not very useful. While developing an app for a health client, I scoped out existing apps and I was baffled but what I found on the market. One app I downloaded was developed on the premise that medication is taken once a day. What we did in developing a medical adherence app, we incorporated personalization and user awareness.
Consider someone living with diabetes. Patient Care plans for this illness vary from individual to individual and are riddled with complexity.
The patient has to regularly check their blood sugar levels (glucose), inject insulin and take pills, while following a strict diet and exercise plan. What’s more, these steps have to be coordinated with inch perfect precision; otherwise if they forget to check their blood sugar levels before exercising, they could suffer a hypoglycemic reaction mid-workout and end up in the ER. Or, if they mix up short- and long-acting insulin, they could overdose. In addition, stress levels, sleeping patterns, and other factors affect glucose balance.
Existing apps struggle to navigate this maze. User-aware apps are able to solve this mess by doing the following.
• The app knows the user’s historical health patterns and senses when they are driving to their local gym.
• The app prompts the user to check their glucose levels and/or to eat an apple before exercising (when the user needs it most).
• The app knows when the user is going to sleep versus waking up versus driving 30 minutes to work.
• It tells the user to take long-acting or short-acting insulin at appropriate times. It also sends accurate, perfectly timed pill reminders.
• The app knows key data about the user such as their sleeping patterns, exercise habits, average work hours each week, and much more.
• Based on this data, it creates an activity report that enables the app to share tailored insights with the user, helps users see where they need to change behaviors or reveals causes behind certain symptoms, and/or gives the user’s healthcare provider information that they can use to help the user better manage their condition.