iPods in the Exam Room: A Pilot Study and a Discussion of Technology’s Role in Patient-Centered Care and the Treatment of Chronic Illness Danielle King, PsyD Behavioral Health Consultant, Tampa Family Health Centers Sally Schwer Canning, PhD Behavioral Health Consultant, Lawndale Christian Health Center Professor of Psychology, Wheaton College Collaborative Family Healthcare Association 15 th Annual Conference October 10-12, 2013 Broomfield, Colorado U.S.A. Session # B3b Friday, October 11, 2013

Faculty Disclosure We have not had any relevant financial relationships during the past 12 months.

Objectives Define the role of patient education and self management in the patient- centered treatment of depression and other chronic illnesses in primary care Identify ways in which the use of phone, tablet and iPod-based technologies can help address current limitations in traditional patient education modalities Describe the use of podcasts in providing patient education in primary care and identify the outcomes of a pilot study testing the acceptability and impact of this modality. Discuss future opportunities to integrate interactive technology with current patient education, self management, and behavior change strategies

Patient Education (PE) and Self Management in the Patient-Centered Medical Home “Supporting patients in improving their health is a key expectation for the medical home.” Patient support includes helping chronic disease patients: (1)develop and follow self-care guidelines about diet, exercise, medication adherence, and symptom recognition; (2)deal with risk factors such as obesity and undertake efforts to reduce their risks. Positive effects on patient outcomes, knowledge, and self-efficacy. “These efforts include computer-based programs that combine health information with online peer support, decision support, or help with behavior change.” (Murray et al., 2005) Scholle SH, Torda P, Peikes D, Han E, Genevro J. Engaging Patients and Families in the Medical Home. (Prepared by Mathematica Policy Research under Contract No. HHSA I TO2.) AHRQ Publication No EF. Rockville, MD: Agency for Healthcare Research and Quality. June 2010

Challenges to Patient Education and Self Management Efforts in the Patient- Centered Medical Home Provider Time Patient Engagement Patient/Provider Relationship Patient Literacy

Using Technology to Address Challenges Provider Time Patient Engagement Patient/Provider Relationship Patient Literacy Current use of technology in patient education Pilot study – using podcasts to deliver patient education in primary care for the treatment of depression

Purpose of the Study: To evaluate the acceptability and potential impact of iPod use on patient education in the treatment of depression in primary care. To gather initial feasibility perceptions from Behavioral Health Consultant users.

Podcast Sample Developers: Neftali Serrano, PsyD and Hunter Hanson, PsyD

Hypotheses Recall of Treatment Recommendations Intent to Implement Treatment Recommendations Patient Satisfaction

Participant Demographics N = 52 Gender: – 69% (F) 31% (M) Language: – Spanish: 46% – English: 52% Age: 45 (mean) PHQ-9 Score: 17 (mean) Education

Technology use - 42% of patients had never used an iPod prior to study. -33% of patients reported sometimes using an iPod prior to study

Podcast Accessibility Ability to see the video and words and hear the script “well” or “very well”? 98 – 96%

Response to Treatment Recommendations Ability to accurately recall 1 or more of treatment recommendations (TR)? 98% Mean # of TRs generated? M=2.65(1.29) Percentage of patients stating intention to implement one or more TRs? 92% Mean # of intended TRs? M = 1.55(.77)

Patient Satisfaction with Podcast

Podcast Just as Good as Provider

Preferred Hearing from Provider

Provider Perceptions of Feasibility Efficiency – Streamlined, Multitasking – Emotional benefit – Outliers Clinical Usefulness – More effective, standardized – Visual, tangible, more interactive than a handout Impact on Patients – “Made sense” – Reinforcing, more than one source Possible Barriers and Future Use – Technical (paperwork, theft, battery) – Already in Use

What does this mean? The results of this preliminary study lend support to the notion that podcasts delivered through iPods or other handheld devices appear to be acceptable and helpful patient education tools for the treatment of depression within an underserved primary care setting.

Limitations Research Limitations – Sampling (Clinics, Providers, Participants) – Single Group Design (No comparisons) – Limited Assessment (Implementation, Outcomes) Clinical Limitations – Type of Technology Used iPods vs. Smart Phones Interactive (Stages of Change, Sense of Self Efficacy, Peer Support) – Single Clinical Application

Expanding the Discussion Other Chronic Illnesses and Health Behaviors – Diabetes, Obesity, Smoking Cessation Interactive Technology – Apps for diaphragmatic breathing and guided imagery – Text reminders for self management behaviors – Interactive apps based on readiness for change and sense of self efficacy – Apps for self-monitoring (mood, self management behaviors) – Online peer support

Learning Assessment Audience Question & Answer

Session Evaluation Please complete and return the evaluation form to the classroom monitor before leaving this session. Thank you!