Thanks to COVID-19 and numerous other factors, the adoption of digital health technologies used by patients in the home has skyrocketed. Accenture reported in 2021, for example, that remote patient monitoring technology adoption tripled among patients. Whether it is streaming video telehealth appointments with a provider, a remote patient monitoring platform, or a prescribed digital therapeutic to manage a chronic condition, the emphasis must be on the patient and caregiver experience.
That’s because even with the most advanced technology if patients and/or their caregivers do not enjoy using it, adherence to the care plan will drop. A poor patient experience can be detrimental to any digital health technology adoption, but for tools that help patients manage a chronic condition, a lack of engagement due to a negative user experience will likely result in a lack of adherence or abandonment of the treatment.
Mild cognitive impairment (MCI), for example, is a growing chronic condition. Approximately 12% to 18% of individuals aged 60 years or older (approximately 9 million to 13.5 million Americans) live with MCI, which is manifested in early memory loss or other cognitive ability loss (such as language or visual/spatial perception) in individuals who are still able to live independently, according to the Alzheimer’s Association. While a challenging condition in itself, MCI is also an early indicator of potential Alzheimer’s Disease or other types of dementia. Alzheimer’s disease also has no effective pharmaceutical clinical pathway and is exceedingly difficult for patients and their caregivers to manage in the home.
Digital therapeutics are stepping up to help fill that treatment gap given the evidence showing that elements such as games, photos and music can slow cognitive decline. Digital platforms on a mobile tablet or smartphone can be an ideal format to access such novel treatments. As global consulting firm EY wrote in 2019: “Efforts to develop new drugs to treat Alzheimer’s disease have failed. However, we can use technology in employing methods that are effective at slowing or counteracting the effects of the disease.”
As with any chronic condition, though, those digital therapies for Alzheimer’s disease need to be accessed consistently as recommended by patients’ providers, or the clinical benefit will be lost. To improve adherence, experience is everything.
Personalization Drives Engagement
In their survey, Accenture explored how negative experiences influenced patient behavior. The most common response—44%–was that the negative experience caused the patient stress or upset, which can certainly impact adherence to a care plan. More pertinent to treatment, 34% of patients reported that the negative experience made them less likely to receive care, while 34% switched medical providers.
An important consideration for improving the patient experience is personalization. “Digital medicine products offer the opportunity to become more patient-centric, influence patient adherence and outcomes, better understand the patient experience of disease and generate real-world data that is relevant to customers,” according to Deloitte. “…Digital medicine products present an opportunity to move beyond the pill, better understand patient needs and patient journey, and enhance patient experience and outcomes while on a therapy.”
Likewise, consulting firm McKinsey wrote that bringing a successful healthcare ecosystem to life requires a robust “engagement layer” to “deliver a personalized and integrated experience to consumers, enhance provider productivity, engage formal and informal caregivers, and improve outcomes and affordability.”
A digital therapy for managing MCI, for example, could use gamification to create a positive personalized experience for patients by adjusting gameplay to patients’ capabilities so they continue to find the activities challenging, but not so difficult that they are abandoned. Delivering a compelling user experience that adjusts to patients’ needs will drive continued access, especially when the therapy is prescribed by a trusted provider, which is also important to digital health engagement.
Caregivers’ Experience Crucial
Another user experience consideration with digital health tools is the caregiver. For many chronic conditions, the patient alone can access and operate the various technologies necessary to help manage their health. More often with neurodegenerative disease, however, one or more family caregivers are crucial to successful management and helping the patient adhere to the care plan. In fact, more than twice as many older adults with dementia have multiple unpaid caregivers compared to those without dementia.
MCI, in particular, can be particularly challenging for caregivers due to the newness and uncertainty about their loved one’s condition versus Alzheimer’s Disease or other forms of dementia where the prognosis is better understood. Yet these millions of caregivers are even more crucial to the patient’s outcome because MCI represents the early onset of neurodegenerative disease, a time when consistent treatment is critical to slow the progress of the condition.
Unfortunately, between 21.1% and 29.5% of caregivers for patients with MCI reported a clinically significant level of burden, more so if they had other health and social determinants of health challenges. Specifically, caregivers reported: an increased need for social support (51.2%); mental health concerns (37.9%) such as anger, frustration, anxiety and a need for patience in the caregiving role; and concerns about physical health (10%). Caregivers compared to non-caregivers are also more likely to be absent from work or have worse performance, are less physically active, more likely to visit the emergency department, and more often have depression, insomnia, anxiety and pain.
Easing the Burden Long-Term
Digital tools can ease the burden on these caregivers and slow the progression of the disease. A meta-analysis of studies of older adults using computerized cognitive training revealed small to moderate positive effects on global cognitive function, memory, working memory and executive function. Importantly, an even earlier study of patients with memory-related MCI found that playing a specific game on a tablet over four weeks improved memory, and researchers concluded the gamification aspect “maximizes engagement with cognitive training by increasing motivation.”
To personalize the therapy, artificial intelligence, machine learning and novel biomarkers can constantly monitor the patient’s cognitive performance through a tablet or smartphone-based activities to tailor elements for maximum benefit. For example, adjustments could be made to the number and type of tasks and games that are offered, based on the speed of the patient’s finger movements, time to complete games or tasks, and their facial expression identified through the device camera. A virtual care team specializing in neurodegenerative disease can also remotely monitor patients’ cognitive function and intervene as needed using cognitive rehabilitation techniques specifically selected for that patient for maximum efficacy.
To protect caregivers’ mental and physical health and maximize their engagement, the technology needs to be as intuitive to operate for them as it is for the patient. Ease-of-use is particularly important when multiple family members are caring for a loved one. These indispensable members of the care team need to be able to quickly understand how to support their family members with digital therapy. At the same time, the digital health tool should also offer educational content and self-care techniques that help caregivers manage their family members with neurodegenerative conditions.
Connecting Experience to Improved Quality of Life
An engaging digital health platform for managing MCI can improve the experience of the patient and caregiver, while also creating a ripple effect in other areas of their lives. In a Harvard Health Publishing blog, Andrew Budson, MD, writes that if these non-pharmacologic strategies to manage MCI could save just one hour each week of a caregiver’s time across 2 million patients, they could save 104 million hours valued at $1.7 billion each year. The caregiver could then devote that time to their other family or career obligations while the patient would be free to pursue other activities associated with slowing neurodegenerative disease such as social interactions, healthy eating, or meditation.
With numerous promising medications being developed to manage the neurodegenerative disease, it is clear that slowing the progress of these devastating conditions will require a diverse approach. Regardless of the method, however, it will be the experience of the patient and the caregiver that will matter most to success and cannot be underappreciated as new therapies of any kind are studied and released to the market.
About Aniket Singh Rajput
Aniket Singh Rajput is founder and CEO of Neuroglee, which builds personalized evidence-based virtual care and prescription digital therapies for neurodegenerative diseases.