Could apps mean patients in Wales take more control of their treatment?

Doctors and scientists are looking at ways for drugs and conditions to be better monitored by patients themselves.

The BBC reports Dr Chris Subbe, consultant in acute medicine at Ysbyty Gwynedd in Bangor, said “When I see patients they often have half a dozen conditions, be on 20 lots of medication and we will do dozens of tests on them. It’s much more difficult then to engage on whether something is good, bad, dangerous or safe. The person who probably knows best – what might have changed from previously – is the patient themselves or someone close to them, a relative or good friend.”

He said the amount of information made it ripe for mistakes, but new technology could help filter out the most important parts and feed it back to patients so they have more control.

Chris Subbe already has a reputation as an innovator. He developed a scoring system for hospital staff on a simple plastic card to help flag up changing conditions of patients. It’s now in use hospitals around the UK and has been developed into an electronic early warning monitoring system at Ysbyty Gwynedd.

Chris Subbe believes patients could also benefit from the scoring system themselves, particularly those with heart disease or chronic obstructive pulmonary disease. He said “They’ve often got slightly abnormal vital signs but they will know what they are so a lot of patients buy their own saturation probe and know what their normal saturations are – so they know ‘that’s normal for me’ and ‘if it’s not normal me’, please do something.”

He said they were exploring how patients could hold their own early warning score, at hospital or at home. He said “You will carry something around with you, saying this is my normal score – and if I’m not around this area, I’m sick. We believe it will allow patients to be more active in the conversation about their own safety. But it might also encourage health professionals to do the right thing, to remind them. If the patient is able to remind them of any abnormality – that’s very powerful.”

He said it was a challenge for the NHS to keep up with technology, but he believes working more closely with patients was the future and Wales could be ahead of the curve. He said “By playing patients into this, we believe we are creating a system which is much more stable and is being driven by the person who has the most interest that it will be run reliably and safely.”

Aparito, set up four years ago in Wrexham, developed an app to help patients take their medicines properly, as well as wearable technology for children with rare diseases, to help track how new drugs are performing.

Chief executive Dr Elin Haf Davies, chief executive of Aparito, said “We know 50% of prescriptions are not taken as they’re meant to be – the wrong dose, regime or even the wrong drug – so we provide the technology on the patient’s own phone, so they have the right support to engage with the right mediation at the right time.”

The app is linked to the mediation prescribed for the patient and gives alerts and notifications of when to take it, but also asks them why they haven’t taken if they’ve missed a dose.

Elin Haf Davies, who is a former children’s nurse, said “Patients choose not to take their medication for lots of different reasons even though they’ve been prescribed it by their doctor. To try to understand that reason – whether it’s side effects or perceived poor efficacy – and it’s an important indicator in managing safety.”

The app isn’t currently available in Wales, but Aparito hopes discussions with the NHS will lead to this changing.

At Ysbyty Gwynedd, doctors are testing another app as part of a clinical trial to help patients stay as safe as possible during their chemotherapy treatment.

Health in Wales reports the app, designed by Caernarfon based Galactig and funded by Tenovus, sets a reminder every day to ask patients how they are.

Patients who have been invited to take part in the “Keep Me Safe” trial are using the app to help them take the right steps if any complications occur during their treatment. The bilingual app can be shared with the patient’s partner, carer or friend who can actively support their safety as they undergo treatment.

Glynnis Gaines, from Llandudno, who is currently undergoing chemotherapy after being diagnosed with cancer is using the app. She said “When I was asked if I wanted to take part in the trial I wasn’t too sure at first as I’m not very good with technology! I was pleasantly surprised with how easy the app is to use and it’s great that my husband can also have the app on his phone. He can make sure I’m using it every day to log how I’m feeling which really gives me reassurance during my treatment.”

Patients are required to answer a set amount of questions through the app each day, such as if they are experiencing shortness of breath or have any chest pains, and an alert goes to their chosen “buddy” to notify them that this has been logged.

Derick Murdoch, from Galactig, developed the app to help his mother who was undergoing chemotherapy. He said “Shortly after my mother was diagnosed with cancer, we began working on the app. During the development I was able to utilise one of its core concepts – that ‘patient safety is a network’. Remotely doing checklists enabled me to take part in my mothers’ care despite her being hundreds of miles away.”

Dr Anna Mullard, A Consultant Medical Oncologist at Ysbyty Gwynedd, said “Here in Alaw [Ward] we take part in numerous clinical trials, some of which are implemented into general practice and some are not depending on the outcome of the study results. So far this trial currently offers the app to 50 patients and we have received positive feedback from those who are using it. This app helps to identify whether patients need to seek help if they experience any complications with chemotherapy, which many patients do. Friends and family are often able to identify when their loved one may be not themselves and this app can help them know when to call for help and come into hospital. The Keep Me Safe study gives us an opportunity to explore whether this kind of technology will benefit patients and their carers.”

Chris Subbe, the Principal Investigator of the study, said “Cancer treatments can be scary and many will have some side effects. It is already common practice for doctors and nurses to check side effects of cancer treatment with patients but researchers at the Alaw Unit are now expanding this to allow patients and their carers to be more aware of the possible side effects when they are at home. Technology plays an increasing role in healthcare and this app is helping us work together with patients to try and keep them safer during their treatment.”

Dr Tim Banks, Tenovus Cancer Care Head of Research, said “Through the research we fund we aim to find new ways to diagnose cancer, better ways to treat it, and to make life easier for people living with cancer today. We are very pleased to hear such positive early feedback for the ‘Keep Me Safe’ app and look forward to the full results following the completion of the research.”

Bangor University health lecturer Dr David Evans said it was important technology was used wisely and not as a substitute for dealing with doctors face to face. He said “I’ve been a huge supporter of how we can use technology in the delivery of care, but it has to be done in the context of a social interaction. The more we see if we can deliver healthcare through an app, it will miss out on the needs of real human beings. But certainly technology can aid our ability to engage more accurately with professionals.”

He said it would not mean doctors or nurses were replaced, only that the technology would help them make more informed decisions at a time when they are stretched, and enable them to “spend more quality time with the right patients at the right time.”

Chris Subbe said it was important “we don’t leave people who are not digitally connected behind.”

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