1 Recommendation

Is patient-centric healthcare approach more applicable to developed countries than to developing and poor countries?

By Richard Pankomera | 04 Mar, 2015

In developed countries, there is an advocacy for health care services to be patient-centric in which the patient takes ownership of his own health. Information Technology has played a role as an enabler or catalyst for such an approach. Mobile health, telemedicine as well e-health in general have assisted for such patient-centric approach.

With many problems in developing countries where mobile technology and internet access penetration is low, can this approach be a viable option? why and why not?

Replies

 

A/Prof. Terry HANNAN Moderator Replied at 10:27 PM, 4 Mar 2015

Richard Pankomera-“With many problems in developing countries where mobile technology and internet access penetration is low, can this approach be a viable option? why and why not?”
Richard I believe your question is valid not only for Low and Middle income Countries but also for high income nations.
So how do I respond with some degree of preciseness?
1. Mobile technology availability:
The four attached documents provide an extensive up to date review of the status of mhealth projects for LMIC. From these there is a clear cut demonstration that the availability of the m-technologies is becoming less of a problem with figures in the high 90 precent ranges for adults around the world having a mobile device.
I feel one significant asset of the mHealth technologies is the facility for intermittent connectivity (to the Internet). This means that Standardised healthcare data can be stored on the device and used in real time with more complete database storage occurring when connectivity is available. (1)
An excellent example of these features can be seen in the short videos below.
1. Bangladesh: https://www.youtube.com/watch?v=mpkAvhd0mUg
2. Pakistan: MDRTB Pakistan: http://www.youtube.com/watch?v=1N8236ReWnM
3. IRDResearch Data visualization using Google Earth: http://www.youtube.com/watch?v=v-3lqG3hSYM
2. “can this approach be a viable option? why and why not?
There are many studies on the effects of the implementation of new technologies into a complex social structure and not all of these are positive. [ http://www.gartner.com/newsroom/id/2819918 ] The most crucial factor in success (with evaluation) is whether the system meets the needs of the end users. In the case of mHealth this means “clinically useful”. Here the term CLINICAN applies to all involved and in particular patients (clients). As Mamlin and Biondich noted “feedback to providers and caregivers is critical. If the system is NOT CLINICALLY USEFUL(Patients included) it will not be used. “

I hope this response adds some value to this discussion.
1. Mamlin BW, Biondich PG, Wolfe BA, Fraser H, Jazayeri D, Allen C, et al. Cooking up an open source EMR for developing countries: OpenMRS - a recipe for successful collaboration. AMIA Annu Symp Proc. 2006:529-33. Epub 2007/01/24.

Attached resources:

David Aylward Replied at 11:34 PM, 4 Mar 2015

Richard Pankomera-“With many problems in developing countries where mobile
technology and internet access penetration is low, can this approach be a
viable option? why and why not?” I think the responses of Terry Hannan are
right on point. One of the things to keep in mind is that we are at the
front end of this mHealth curve, so we should be designing for the future,
and not limiting ourselves because of such concerns. One of the greatest
hockey players of all time said that he succeeded by "skating to where the
puck will be, not where it is". The wireless industry is advancing in
coverage, device power and features, and lower costs at an an extraordinary
rate. The future is smart phones and tablets. yes, systems should
accommodate feature phones, but let us take advantage of the extraordinary
global trends in wireless technology.

Hilde Eugelink Replied at 4:18 AM, 5 Mar 2015

I have read with great interest the discussion on using mobile technology
and internet where internet penetration is low. There is one thing I am
missing though in this discussion.

Yes, I do agree that mobiles can make a big difference, even in countries
where internet penetration is low. But what is really needed in these
countries is the know-how to manage, implement and even design their own
mhealth solutions.

For nearly twenty years now we have been assisting local organisations in
LMIC with using ICT-based solutions to further improve access and quality
of services, not only in sector health, but also in education, agriculture
and water.

Though connectivity and devices are on obstacle, it is skills, ownership
and leadership that really make the difference.

Secondly, we have also come to notice that with regard to mhealth
applications the one thing that is still a challenge is to develop business
models that actually work in LMIC. Many of the mhealth programmes today
still rely on donor funding and hope government will eventually chip in,
but as far as I am concerned, the likelihood that this will succeed is not
very big. It is much better to look at models whereby the consumer will pay
or contribute at least to the use of the service. There are some
interesting programmes whereby mobile money is combined with health
services, but these still have to mature.

--
with kind regards / met vriendelijke groet, Hilde Eugelink Sector
Developer Health / Community Relations International Institute for
Communication and Development (IICD) P.O. Box 11586, 2502 AN The Hague, The
Netherlands Visitors: Raamweg 5, 2596 HL, The Hague, The Netherlands Phone:
+31 (0)70 311 7311 Fax: +31 (0)70 311 7322 Skype: Heugelink Follow us:
www.iicd.org - facebook.com/iicd.org - twitter.com/iicd

*People - ICT - Development*

Working on Mo, Tue, Thu, Fri

A/Prof. Terry HANNAN Moderator Replied at 4:42 AM, 5 Mar 2015

Hilde, all you say is correct. Many projects in LMIC need and REQUIRE donor or philanthropic funding-as did happen in Kenya with MMRS going to AMPATH then OpenMRS.
What is a GAME CHANGER is "effective information management at the clinical interfaces".
This is how the Moi-IU collaboration changed the game plan and outlook for eHealth in Kenya then elsewhere.
I am attaching a Poster I am to deliver in 2 weeks to show how "effective information management at the clinical interfaces" changed the management of HIV and other diseases in Kenya then elsewhere.[Personal use only until the end of March 2015]
Also the video link shows the SAME project 14 years after we started.
AMPATH SUMMARY 2014 (11mins): http://www.youtube.com/watch?v=zkoWdqqHUs4&feature=youtu.be
"When there appears to be no way out there is always hope"

Attached resource:

Maggie Sullivan Replied at 11:59 AM, 5 Mar 2015

I feel the least prepared to speak on mhealth given my lack of experience in and exposure to this field. I will say that all of my experience in LMICs (at least in the past 5 years) involves Facebook on both flip phones and smart phones. I am skeptical of mhealth's potential in LMICs where there is such a collosal lack of health infrastructure - how much can a decision tree on a phone do in areas where local public health centers have no medications, very little equipment for testing/screening and staff that go on strikes a few times a year? This lack of effective public health/community health infrastructure subsequently spawns an unregulated private market. In a setting like this, what does "patient-centered" mean?

Paul Gonza Replied at 12:39 AM, 6 Mar 2015

Hello Maggie,

I agree with your thoughts on the state of healthcare in LMIC, particularly
in sub-Saharan Africa, it is true infrastructure is inadequate. However,
we've got to step forward and do our part as public healthcare
professionals together with the contribution of the IT specialists with
what we have wherever we are. We can't just curse the darkness, but we've
got to light a candle. Health workers in Uganda are innovative, always
working with the little they have despite the government's low funding of
the healthcare sector. It's a fact that we've had several outbreaks of
Ebola & Marburg here, but methods of information sharing through use of
mHealth and fm radios helped a lot in containing these epidemics in our
country. In addition, there was a study which was conducted to determine
whether SMS reminders would improve TB treatment outcomes and as well
minimise loss to follow-up (treatment defaulting) here; the results were
positive. I believe the IT community can help to revolutionize healthcare
delivery in LMIC and also improve on quality of healthcare of our people.

--

Gonza K. Paul

"Stretch your limits: You'll never really know how good you are until you
step a bit outside of what you know."

A/Prof. Terry HANNAN Moderator Replied at 1:06 AM, 6 Mar 2015

Paul, I am away from my PC and working on my iPad that does not allow me to upload a PPT to this site. When Bill Tierney and I with others began the integration of patient-centred data and create outputs for health care measurment and assessment we produced a report that "lit a candle in the darkness of Africa [HIV/AIDS]" and chnaged the way the governement of Kenya chnaged their whole collaborative approach to HIT [eHealth] in Africa. If you would like a copy please send your email to
If anyone else would like a copy please email me.

A/Prof. Terry HANNAN Moderator Replied at 1:07 AM, 6 Mar 2015

Ooops
error in my typing

Richard Pankomera Replied at 6:03 AM, 6 Mar 2015

Maggie,
"There is such a collosal lack of health infrastructure - how much can a decision tree on a phone do in areas where local public health centers have no medications, very little equipment for testing/screening and staff that go on strikes a few times a year?"

Your statement is a true reflection of what is there on the ground. LMICs face a lot of problems especially in the public healthcare sector. The root cause of these problems lies in the term 'LMIC'. These are countries whose funding to all sectors remain the lowest including the healthcare sector. I am talking from Malawi perspective

But still the question arises, cant something be done amid these problems just to improve slightly the lives of the poor people. Cant we maximise the usage of these little resources to make a difference for the disadvantaged? I think , this is where the patient-centricity comes in. This approach aims at not only treating a disease as an episodic measure but also looks at preventive measures. "What does patient centred mean in LMIC?" I think it is relevant in LMICs as it has a number of benefits. Some patients die from preventable diseases? Some patients get sick because they did not know who to prevent it. A simple healthy message on the feature phone can do wonders on ones life? A simple reminder message on the feature phone can save a life and make a difference in LMIC despite poor road network. Research has shown that an advocacy of basic hand washing has prevented some of the infectious diseases. http://www.cdc.gov/handhygiene/Basics.html . So if such messages are even relayed on the feature phones, that may make a difference. I think there is a paradigm shift from episodic provider centric approach to preventive and collaborative approach of managing our health systems. I think that is where patient-centricity is relevant to both high income and LMICs.

stevania krisma Replied at 12:27 PM, 6 Mar 2015

I am thinking about the idea of sharing the responsibility of health care, the same proportion for each medical professionals (physicians, nurses, pharmacists, laboratorists, etc), management and IT community. It means each has the same significance, and if one fails then the whole system will fail.

stevania krisma Replied at 12:51 PM, 6 Mar 2015

Richard Pankomera - I like your idea. That's true and has made me self-contemplating.

Zach Landis-Lewis Replied at 1:36 PM, 6 Mar 2015

Hi Richard,

Thank you for posting such a thought-provoking question.

"In developed countries, there is an advocacy for health care services to be patient-centric in which the patient takes ownership of his own health."

Another way to view patient-centered care is to start from the premise that the patient already owns his or her health, and that care which doesn't align with the patient's goals, ability, and context is likely to be ineffective. From this perspective, patient-centered care is not in opposition to public health approaches to care in low-resource settings. Instead it prevents waste of resources. For example, improving patient-provider communication (http://www.ncbi.nlm.nih.gov/pubmed/?term=14621334) might still improve the care received, even when decisions to be made are limited (eg choosing between 1 of 2 drug regimens for provision of ART).

So technology and systems that support patient-centered care, for example tools for shared decision-making, would seem to have increasing potential for impact, especially where the mHealth, eHealth and telemedicine infrastructure is already in place.

Richard Pankomera Replied at 2:59 PM, 6 Mar 2015

Zach,

"So technology and systems that support patient-centered care, for example tools for shared decision-making, would seem to have increasing potential for impact, especially where the mHealth, eHealth and telemedicine infrastructure is already in place."

The statement above is realistically true. Even in business setting, the more one invests , the more the benefits . But also it says that the more a business entity risks in its investments, the more potential the benefits. It is true that in LMICs, the infrastructure for mhealth, ehealth and even tele-medicine leaves a lot to desired. I agree with Terry that before we venture into any of these projects we need to find out if 1)the intervention is clinically useful, does it benefit both the health provider and health consumer? 2) so there is a need to collaborate between among all players in the project, as you are putting it that communication should be a mediator of success in our interventions. After all, a journey begins with a single step

Zach Landis-Lewis Replied at 4:17 PM, 6 Mar 2015

Yes, I completely agree that the ideal approach is to collaboratively develop tools that are clinically useful and benefit all players.

I also agree with what I hear you saying about why or why not to use health IT to support patient-centered care - and more generally in response to Maggie's question of what patient-centered care means in LMICs - that patient-centered care can improve the use of limited resources in LMICs, and that the small steps that we can take matter. For example, improved communication could help a provider to find the best match between available resources and the optimal treatment for an individual.

But more broadly I'm excited about patient-centered approaches that might be increasingly used in LMICs to involve patients in the uptake of clinical knowledge - such as including patient advisors in the development of clinical guidelines and the design of research studies, and sharing the findings of research studies with patients more directly, all of which contribute towards patient-centered care. I think the health informatics community has a lot of opportunities for impact in these areas and more generally in implementation science/knowledge translation in LMICs.

Perhaps I'm too optimistic about the pace of infrastructure improvement, and I recognize that there are many limitations currently. However I think there are many important challenges ahead that we can already work on to understand how health IT can best support patient-centered care in LMICs, and that by focusing on human experience we can already learn how to build better tools while the infrastructure continues to improve.

Ade Yahya Replied at 6:32 PM, 6 Mar 2015

I do not think the issue is about being more applicable or not my opinion is that most poor countries are in a stage where that is not the number one priority. The working conditions and culture need to be address first before they can really get the idea of patient centered service. They need to take one step at the time first try to rewrite the way their health system function and from there anything else can come.

Richard Pankomera Replied at 7:55 PM, 6 Mar 2015

Amirath Yaya,

I have liked Amirath Yaya contribution. Sometimes some projects fails is because we leap more leaps forward than necessary!! i like these realistic ideas!!

A journey begins with one step

Paul Gonza Replied at 3:07 AM, 8 Mar 2015

Dear Prof. Terry,

My email: for sending me the PPT of the report about
HIT(eHealth) in Africa as promised.

Thank you and regards,

--

Gonza K. Paul

"Stretch your limits: You'll never really know how good you are until you
step a bit outside of what you know."

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