Remote patient monitoring: assessing risk beyond the clinic

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A demographic shift

We’re living in an era which has undergone a dramatic change in age demographics. In the US in 2019, for the first time in human history, the number of people aged over 65 is greater than the proportion who are younger than five. As life expectancy continues to increase, so does the proportion of people living with a variety of chronic conditions and functional impairments, such as dementia or diabetes. Because of the increasing need for long-term monitoring and treatment, this changing focus from acute to chronic illnesses is leading to a shift in the delivery of care.1,2

Over the past decade the healthcare and technology industries have attempted to keep abreast of this societal shift, by advancing both the sophistication and availability of their digital health offerings. One innovation which has become increasingly prevalent across a range of therapy areas in the hope of improving outcomes and reducing costs, is remote patient monitoring (RPM). With this technology physicians, patients and carers can be connected through a continuous stream of real-time, personal data, and individuals’ health can be monitored outside of the clinic.3

Monitoring those at risk

RPM can provide clinicians with a holistic view of a patient’s health over time, offer a deeper understanding of treatment adherence, and allow for more personalized care plans to be developed.4  Such technology is already beginning to transform the management of chronic conditions and there is also the potential for monitoring individuals who are at a high risk of health deterioration. For instance, in those who have recently undergone surgery. At present, hospital wards face an unmet need where the deterioration of high-risk patients is not always identified in a timely manner. This can contribute to preventable cardiopulmonary arrest, unscheduled admission to the intensive care unit (ICU), a rise in hospitalization costs, and a detrimental impact on quality of life. Remotely tracking high-risk patients’ vital signs could allow for proactive intervention, averting these subsequent negative outcomes and providing benefits for patients and healthcare systems alike.5

Can RPM truly address this unmet need? A recent study investigated the reliability of RPM in postoperative surgical patients wearing a wireless patch sensor after admittance to a ‘step-down’ unit because of high risk of complications. The sensor was found to accurately measure heart rate yet failed to accurately measure respiration rate (RR) with a deviation within 10% of the reference standard. However, the researchers caveated that this finding may be due to recurrent outliers and clinically implausible inconsistencies of RR values provided by the reference monitor. The researchers concluded that despite the result, RPM could have the potential to aid early recognition of physiological decline in high-risk patients.5

A positive future

While these results emphasize a need to analyze and improve the accuracy of RPM sensors before they can be routinely utilized in clinical practice to identify those at risk, the outlook for RPM remains positive. It has shown promise in an array of conditions, including Parkinson’s disease, hypertension, and obstructive pulmonary disease.6 Moving forward, if we can focus on alleviating any technical barriers to RPM, both patients and hospitals could reap the benefits.

References

  1. How is Technology Transforming Healthcare at Home. Available at: https://hackernoon.com/how-is-technology-transforming-healthcare-at-home-1ce827b355b9. Accessed: May 2019.
  2. ‘First time in human history’ 65 and older will outnumber children under 5. Available at: https://newbostonpost.com/2016/04/01/first-time-in-human-history-65-and-older-will-outnumber-children-under-5/. Accessed: May 2019.
  3. The technology, devices, and benefits of the growing remote patient monitoring market. Available at: https://www.businessinsider.com/remote-patient-monitoring-industry-explained/?r=AU&IR=T. Accessed: May 2019.
  4. American Heart Association. Using Remote Patient Monitoring Technologies for Better Cardiovascular Disease Outcomes Guidance. Available at: https://www.heart.org/-/media/files/about-us/policy-research/policy-positions/clinical-care/remote-patient-monitoring-guidance-2019.pdf?la=en&hash=A98793D5A043AB9940424B8FB91D2E8D5A5B6BEB/ Accessed: May 2019.
  5. Breteler MJM et al. BMJ Open 2018; 8(2): e020162.
  6. Noah B et al. NPJ Digital Medicine 2018; 1, Article number: 20172.

RESP-42001 November 2019

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