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A global rise in the prevalence of chronic disease has led to an increase in the demand for primary healthcare services and a shortage of primary care physicians. Addressing these challenges calls for innovations in the healthcare delivery model including greater use of healthcare technology tools. We have previously described the feasibility of using an automated healthcare kiosk (Self-empowering and enabling kiosk - SEEK® MyHealthKiosk) in the management of patients with stable chronic disease in the primary care setting.
The aim of this follow-up study is to evaluate the health outcomes of patients with stable chronic disease who are on kiosk management compared to patients who are on routine management by nurse clinicians.
The study will be a 2-armed randomized controlled trial of 120 patients with stable chronic disease on 4-monthly follow-up visits over a 12-month period. Patients will be assigned randomly to intervention or control groups to receive kiosk or nurse management respectively. The primary outcome measures to be evaluated are the blood pressure and hemoglobin A1c levels of the patients. Secondary outcome measures to be examined are the proportion of patients whose disease control deteriorates over the course of the study, duration of visit, patient satisfaction with the management process, health-related quality of life, and the occurrence of any adverse events. Data will be captured longitudinally at baseline, 4 months, 8 months, and 12 months.
In summary, this study will assess the maintenance of stable chronic disease for patients using a healthcare kiosk for disease management. These patients are empowered to monitor and manage their own health conditions with reduced dependence on healthcare professionals. The adoption of the kiosk into routine clinical practice will facilitate the appropriate stratification of patient care needs, thereby allowing for the optimal utilization of the limited medical manpower resource.
The burden of chronic diseases is increasing worldwide leading to a rise in the demand for primary healthcare services that is coupled with a shortage of primary care physicians. The Association of American Medical Colleges has projected that for the period 2013 to 2025, the demand for physicians will continue to grow faster than supply, with population aging and growth accounting for most of the rise. For primary healthcare alone, physician shortage is estimated to be between 12000 and 31000. Addressing this shortage requires a multi-prong approach including innovations in care delivery, greater use of healthcare technology, and more efficient use of all healthcare professionals on the care team.
In Singapore, primary healthcare is provided by government polyclinics and private medical clinics. About 20% of primary healthcare is provided by 18 polyclinics, while the remaining 80% is provided by around 2000 private medical clinics. The chronic disease burden is however not distributed in corresponding proportions, with almost half (or 45%) of patients with chronic diseases being managed by the polyclinics. The polyclinics are therefore responsible for a significant proportion of chronic disease care in Singapore, and are in critical need of a transformation in the practice and delivery of primary care, so as to cope with the increasing patient load.
Primary care providers realize that not all patients require the same amount of time and resources; patients with poorly controlled disease or those with complex social issues require more time and attention. It would therefore be useful if patient care needs could be stratified so that more time can be given to those who need it.
At present, patients with chronic disease make routine follow-up visits to their primary care provider for assessment of their chronic disease status and for changes to their medications as necessary. Patients with well-controlled stable chronic disease may go through several visits to their primary care provider in 3 or 4-monthly intervals with little or no change to their medication regimen. These patients have to routinely wait in line with the rest of the polyclinic crowd for a doctor's consultation before getting their regular supply of medications.
We saw the potential of replacing some of these physician visits with an automated healthcare kiosk so that if the disease condition of such patients remained stable, they can continue on their current medications without having to see a doctor.
We previously designed and developed an interactive self-service healthcare kiosk (Self-empowering and enabling kiosk - SEEK) that allows patients to measure their physiological parameters such as blood pressure, height and weight in a sequential manner. The kiosk combines the patients' physiological parameters and their recent laboratory results to classify patients into good, sub-optimal, or poorly controlled groups. The kiosk produces a result slip for the patient with instructions to continue on their current medications (for patients with good disease control), or to see a nurse or doctor for further management (for patients with sub-optimal or poor disease control).
We performed a feasibility study at a polyclinic (SingHealth Polyclinics (SHP) - Bedok) using SEEK. Feedback surveys obtained from patients and healthcare providers showed high levels of acceptance and satisfaction with the use of SEEK in the management of stable chronic disease. We refined and verified the accuracy of the kiosk in terms of triage decisions and physiological measurements; and optimized independent kiosk usage with the provision of multi-language translations in audio and visual forms.
We propose a follow-up study to show non-inferiority of health outcomes for patients managed with SEEK compared to the current standard of care.
The potential benefits from the use of SEEK are as follows:
1. Appropriate stratification of patient care needs so that more time and resources can be channeled to patients with complex or acute needs;
2. Patient empowerment with regards to the management of their chronic health conditions, with flexibility of self-care and monitoring and decreased dependency on healthcare professionals;
3. Substitution of nurse clinicians for the management of stable chronic disease;
4. Reduction in the number of doctor visits per year for patients with stable chronic disease.
Kiosk intervention group
Not yet recruiting
Published on BioPortfolio: 2017-09-06T22:23:21-0400
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