decide treatment - a new approach to better health
Post on 10-Feb-2017
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• Physician• Psychiatrist• Editor• Head of department• Researcher• Chief adviser• Software developer
So many people, so many with chronic disorders
Healthcare is about
health
I want to be
healthy!
SUBOPTIMAL HEALTH:
6 COMMON REASONS
1. Does not use the best main treatment2. Does not use the optimal dosages
3. Difficult to take treatment as agreed
4. Difficult to lead a healthy lifestyle
5. Does not get enough support from others
6. Is not happy with the decision-making
1.Does not use the best main treatment
2. Does not use the optimal dosages3. Difficult to take treatment as agreed
4. Difficult to lead a healthy lifestyle
5. Does not get enough support from others
6. Is not happy with the decision-making
1.Does not use the best main treatment
2.Does not use the optimal dosages
3. Difficult to take treatment as agreed4. Difficult to lead a healthy lifestyle
5. Does not get enough support from others
6. Is not happy with the decision-making
1.Does not use the best main treatment
2.Does not use the optimal dosages
3. Difficult to take treatment as agreed
4. Difficult to lead a healthy lifestyle5. Does not get enough support from others
6. Is not happy with the decision-making
1.Does not use the best main treatment
2.Does not use the optimal dosages
3. Difficult to take treatment as agreed
4. Difficult to lead a healthy lifestyle
5. Does not get enough support from others6. Is not happy with the decision-making
1.Does not use the best main treatment
2.Does not use the optimal dosages
3. Difficult to take treatment as agreed
4. Difficult to lead a healthy lifestyle
5. Does not get enough support from others6. Is not happy with the decision-making
HEALTH OPTIMISATION
1. Finds the best available treatment
2. Takes the optimal dosage
3. Uses the treatment as agreed
4. Leads a very healthy lifestyle
5. Takes part in decisions
6. Receives enough support
An approach from the UK calling for the use of
technology
Figure 1. Summary of the four principles of medicines optimization
Increasing the effectiveness of adherence interventions may have
a far greater impacton the health of the population
than any improvement in specific medical treatments
Bryan Haynes
Increasing the effectiveness of adherence interventions may have
a far greater impacton the health of the population
than any improvement in specific medical treatments
Bryan Haynes
And this is only problem #3 of the 6
6 STRATEGIES FOR OPTIMAL HEALTH
1. Finds the best available treatment
2. Takes the optimal dosage
3. Uses the treatment as agreed
4. Leads a very healthy lifestyle
5. Takes part in decisions6. Receives enough support
BACKGROUND
HVA ER BEST Å GJØRE?TEKNISK STØTTE:
• Systematisk monitorering av effekter• Monitorering av annen info, som søvn og labsvar• Optimalisering av compliance• Integrert kunnskap fra mange kilder• Rangering av behandlinger ut fra forskning og reelle
effekter• Hjelp til å formidle kunnskap til henne på en forståelig
måte• Hjelp til å involvere henne i valget
Contributors:
London, Sydney, Seoul, Chicago,Odessa, Dubai, Singapore
Professor Jack Dowie
Frameworks:
1. Multi-criteria decision analysis
2. Single subjects research designs
3. Shared decision-making
Multi-criteria decision analysisMathematics Behavioral decision theoryEconomics Computer technologySoftware engineering Information systems
Multi-criteria decision analysisMathematics Behavioral decision theoryEconomics Computer technologySoftware engineering Information systems
• Includes exactly what is needed for optimal decisions
• Enables valid and consistent integration of large amounts of data
• Takes knowledge and preferences as input for calculations of treatment values for the individual
Single subjects research designs
Time
Deve
lopm
ent V
aria
ble
• What works for groups of people generally does not work for you!
Time
Deve
lopm
ent V
aria
ble
• Measure treatment effects and find out: Right: With treatmentMiddle: Without treatmentLeft: With treatment
• Conclusion: Less symptoms with treatment!
Shared decision-making
Shared decision-making1. Get the decision on the table
Shared decision-making1. Get the decision on the table
2. Acknowledge that it´s not possible to find the best treatment without knowing what´s important to the patient
Shared decision-making1. Get the decision on the table
2. Acknowledge that it´s not possible to find the best treatment without knowing what´s important to the patient3. Get all available options on the table
Shared decision-making1. Get the decision on the table
2. Acknowledge that it´s not possible to find the best treatment without knowing what´s important to the patient3. Get all available options on the table
4. Ask what the patient wants the treatment to do for her
Shared decision-making1. Get the decision on the table
2. Acknowledge that it´s not possible to find the best treatment without knowing what´s important to the patient3. Get all available options on the table
4. Ask what the patient wants the treatment to do for her5. Tell what the patient can expect from the best and worst treatment, on all outcomes
Shared decision-making1. Get the decision on the table
2. Acknowledge that it´s not possible to find the best treatment without knowing what´s important to the patient3. Get all available options on the table
4. Ask what the patient wants the treatment to do for her5. Tell what the patient can expect from the best and worst treatment, on all outcomes
6. Find out which treatment fits her preferences most
Shared decision-making1. Get the decision on the table
2. Acknowledge that it´s not possible to find the best treatment without knowing what´s important to the patient3. Get all available options on the table
4. Ask what the patient wants the treatment to do for her5. Tell what the patient can expect from the best and worst treatment, on all outcomes
6. Find out which treatment fits her preferences most
7. Agree on what is the best treatment
Shared decision-making1. Get the decision on the table
2. Acknowledge that it´s not possible to find the best treatment without knowing what´s important to the patient3. Get all available options on the table
4. Ask what the patient wants the treatment to do for her5. Tell what the patient can expect from the best and worst treatment, on all outcomes
6. Find out which treatment fits her preferences most
7. Agree on what is the best treatment
8. Provide support and allow the patient to participate in the decision process to the extent and in the ways preferred
Pilot: Bipolar disorder
Pilot: Bipolar disorder
• A very complex disorder• Highly invididual course and
treatment results• Can be unpredictable• Serious consequences
very common• Fatal consequences not rare
New knowledge summary methods• Fast and frugal • Patient-oriented • Decision-focused
New knowledge summary methods• Fast and frugal • Patient-oriented • Decision-focused
Addresses all patient-important outcomes
DECIDE TREATMENT: 18 FEATURES TAILORED TO SOLVE THE 6 PROBLEMS
1. Does not use the best main treatment
1. Does not use the best main treatmentLet´s integrate all available knowledge!
Best research results
3. Difficult to take treatment as agreed
4. Difficult to lead a healthy lifestyle
5. Does not get enough support from others
6. Is not happy with the decision-making
+ All earlier experiences
Best research results
3. Difficult to take treatment as agreed
4. Difficult to lead a healthy lifestyle
5. Does not get enough support from others
6. Is not happy with the decision-making
+ All doctor´s experiences
Best research resultsAll earlier experiences
Best research resultsAll earlier experiencesAll doctor´s experiences+ Removes contraindicated and irrelevant options and outcomes
Best research resultsAll earlier experiencesAll doctor´s experiencesRemoves contraindicated and irrelevant options and outcomes
+ Measured treatment results
Best research resultsAll earlier experiencesAll doctor´s experiencesRemoves contraindicated and irrelevant options and outcomesMeasured treatment results
= a fully populated decision matrix
Ranking and expected value of available treatments
Ranking and expected value of available treatments
Ranking and expected value of available treatmentsNo action is evidence-based in this world. All human behaviour is knowledge- and preference-based
What health is to her
Her personal trade-off
Ranking based on trade-off + all evidence
Personalised ranking, rather than the recommendations for an “average patient” in clinical guidelines
Click at the bottom left to start the movie!
Let´s pick one of the best!
Let´s find out how they compare
1. Does not use the best main treatment
2. Does not use the optimal dosages
1. Does not use the best main treatment
2. Can find the best dosage
1. Does not use the best main treatment
2. Can find the best dosage
1. Does not use the best main treatment
2. Can find the best dosage3. Difficult to take treatment as agreed
1. Does not use the best main treatment
2. Can find the best dosage3. Reminded of, signs off, look at together
1. Does not use the best main treatment
2. Can find the best dosage3. Reminded of, signs off, look at together
4. Difficult to lead a healthy lifestyle
1. Does not use the best main treatment
2. Can find the best dosage3. Reminded of, signs off, look at together
4. Decides on, reminded about, inspect
1. Does not use the best main treatment
2. Can find the best dosage3. Reminded of, signs off, look at together
4. Decides on, reminded about, inspect
5. Does not get enough support from others
1. Does not use the best main treatment
2. Can find the best dosage3. Reminded of, signs off, look at together
4. Decides on, reminded about, inspect
5. Decides on support and receives it
1. Does not use the best main treatment
2. Can find the best dosage3. Reminded of, signs off, look at together
4. Decides on, reminded about, inspect
5. Decides on support and receives it
6. Is not happy with the decision-making
1. Does not use the best main treatment
2. Can find the best dosage3. Reminded of, signs off, look at together
4. Decides on, reminded about, inspect
5. Decides on support and receives it
6. Decides on decision quality and measures it
The patient´s treatment plan• Main treatment• Additional ones• Lifestyle measures
New side effectsLife eventsTreatment changesAppointments
Objective data• From the mobile• From the watch• From EMR
Text, video, graphics reached with one click from the panels
12 panels condensing huge amounts of data= Solid ground for shared decisions
Where is shared decision-making?
Where is shared decision-making?
1. Finds the best available treatment
2. Takes the optimal dosage
3. Uses the treatment as agreed
4. Leads a very healthy lifestyle
5. Takes part in decisions6. Receives enough support
here here
here
here
here
here
Integration in DIPS
Coordinated with and reflected in government whitepapers and
initiatives
Systems in the making for people with:
• Heart disease• Asthma• Stroke• Hypertension• MS• COPD• Diabetes
• Bipolar disorder• Palliative care • Lung cancer• Schizophrenia• Pregnancy• HIV• Psoriasis/eczema
5 studies as per 16.11.16 5 PhDs
Results:
SUS score 78
Tested with 88 potential usersNorway, UK, Ukraine
Above 68 is good
I don´t want to stop using this
Patients:
I feel safer having this system
I see the big picture very fast
Doctors:
We quickly get to the main issues
Results:
System modules
24 interconnected modules enriching each other
Modules in patient decision aids
Modules in clinical practice guidelines
You could be an author of a Health Helper!
THE ALTERNATIVE?
Take this and come back in a month
Take this and come back in a month
We can continue with business as usual:• No systematic measurement
of treatment effects
• Trust that our brains can process all necessary data
• No digital support outside of the encounter
CONCLUSION
Finding out what works for you should be as systematic as finding out what works for groups (= research)
Optimisation of health for each and every one of us1. Finds the best available treatment
2. Takes the optimal dosage
3. Uses the treatment as agreed
4. Leads a very healthy lifestyle
5. Takes part in decisions6. Receives enough support
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