MEDdesign

Making the Most of Medical Wearables: Addressing Patient Adherence Challenges

By Jiang Li, Ph.D.
November 28, 2023


• Categories: 01-Digital Health, 04-Product Design & Development, Care Delivery, Home Health, MEDdesign, Product Design, RC - Device Design & Manufacturing

Patient adherence has historically been a challenge. Patients may deviate from treatment plans due to a variety of factors, including lifestyle choices, technological complexity or just plain forgetfulness.

Studies have shown that 50-60% of patients with chronic illnesses miss medication doses, take the wrong doses or quit treatment within the first year. As a result, up to 69% of medication-related hospitalizations are caused by poor adherence. Patients experience these same adherence challenges when it comes to routinely using medical devices, including wearable technologies.

Wearable technologies can play a crucial role in managing patient conditions and collecting real-time data for remote patient monitoring (RPM) and decentralized clinical trials. But patient adherence challenges must be addresses to fully realize these benefits.

Adherence Dynamics in Clinical Trials vs. Healthcare Settings

In clinical trials, researchers assess adherence once the trial concludes. However, inaccurate or incomplete data can compromise trial results. To safeguard data integrity, researchers should implement strategies such as compliance monitoring and robust data analysis.

Continuous or real-time data monitoring is more commonly used in a healthcare setting, especially in acute situations that require active and ongoing monitoring. With real-time continuous monitoring, providers can promptly address adherence issues and adjust treatment plans.

To navigate the nuances of adherence effectively, providers, researchers and manufacturers must comprehend the distinctions in patient behavior between clinical trials and healthcare settings. For example, patients’ awareness of their participation in a study may motivate them to follow the protocol more closely than in a healthcare setting. While patients using a wearable device to manage a health concern—or proactively manage their well-being—are more likely to adhere to usage instructions and follow treatment plans when they can see how their actions are affecting their health.

Challenges Among Age Groups and Conditions

Age and disease states both play a crucial role in patient adherence. Chronic conditions such as diabetes and hypertension require continuous monitoring and data sharing. Patients with these conditions are more likely to embrace wearables that enable daily health tracking and seamless communication with healthcare providers. On the other hand, acute health issues from injuries or sudden illnesses may require short-term use of wearables for diagnostic or follow-up purposes, with varying levels of adherence.

Age presents unique challenges and preferences. Medical-grade wearables are predominantly used by older individuals who are managing chronic conditions such as cardiovascular issues, diabetes and respiratory ailments, or are undergoing post-surgical care. To assess the use of RPM device in cardiac rehabilitation settings, Vivalink surveyed 200 clinicians who work in the field. Roughly 44% of professionals identified patient adherence as the primary obstacle to implementing RPM in home-based cardiac rehabilitation.

Initially, older patients may face obstacles in adhering to wearables due to limited exposure to technology and apprehensions about the devices. In contrast, younger, tech-savvy patients tend to readily adopt wearables for health tracking and management.

However, it’s crucial to recognize that individual proficiency levels vary. To effectively meet the diverse needs of patients across all age groups and disease states, it is important to avoid making broad assumptions and instead offer tailored support and training to all patient demographics.

Root Causes of Poor Patient Adherence

Beyond age, disease state and whether wearables are used in clinical trials or healthcare, specific challenges significantly affect patient adherence to these devices. Effectively addressing these obstacles requires healthcare providers, researchers and developers to thoroughly understand the root causes, which include:

Technology complexity: The complexity of certain wearable devices can be a significant obstacle to patient adherence. Patients who are unfamiliar with mobile devices and wearables may feel overwhelmed by the technology, discouraging effective use. To tackle device complexity, it is imperative to prioritize user-friendly design.

Wearable manufacturers and developers should focus on creating intuitive and straightforward interfaces. For older or less tech-savvy users, incorporating larger font sizes and providing clear instructions are essential accessibility features. Streamlining the setup process by bundling cellular connections can reduce technical obstacles, ensuring users can activate their devices effortlessly.

Lifestyle compatibility: A patient’s lifestyle plays a pivotal role in their ability to adhere to wearables. For example, if a device is bulky and needs to be removed before activities like showering, patients may find it inconvenient and choose not to wear it. Active daily routines and physical activities can also pose lifestyle challenges.

Wearable technology must integrate with patients’ lifestyles. Vendors often offer a variety of devices, each one engineered to excel in its designated setting. The selection of the appropriate wearable, considering features such as water resistance, durability and comfort is crucial.

Vendors must customize their technologies, recognizing that a one-size-fits-all approach will not suffice. For example, apps can be tailored to individual customer needs and requests. The customization can vary based on the specific study or application, all with the primary aim of assisting patients in effectively using the device and ensuring adherence.

Physical limitations: Physical limitations, especially among older or chronically ill patients, can impede their effective use of wearables. Applying adhesive-based devices or maneuvering intricate wearables may prove challenging for individuals with limited dexterity or mobility. Patients with physical limitations may benefit from devices equipped with adhesive patches and adjustable straps.

Healthcare professionals can effectively address physical limitations, particularly in elderly or ill patients, by appropriately and comfortably applying wearable devices in a hospital or clinic setting. To assist with wearables in cases where physical limitations or remote locations are a problem, clinicians may offer home visits.

Forgetfulness and lack of motivation: Human behavior significantly impacts patient adherence. Even the best-intentioned patients can forget or neglect to wear their devices for various reasons. Patients may also overlook device usage if they don’t immediately perceive benefits or if using the device disrupts their routine.

Compliance dashboards and reminders play a pivotal role in promoting patient adherence. Dashboards allow clinicians to monitor device activity on specific days and assess the percentage of connected devices, enabling them to promptly intervene when instances of non-adherence are detected.

The integration of reminders, whether within wearable apps or through push notifications, encourages consistent device usage. In a study involving nearly 180 participants prescribed daily statin medication, the use of automated alerts was found to be highly effective in improving medication adherence.

Optimizing Patient Adherence to Medical Wearables

Patient adherence is critical to maximizing the benefits of medical wearables. Without strong adherence, these devices cannot contribute to clinical trials and RPM at their full potential. Manufacturers must innovate and tailor solutions to overcome adherence challenges. At the same time, researchers need to gain a deeper understanding of patient behavior and preferences.

As technology continues to advance, enhancing the user-friendliness and customization of wearable devices while incorporating alerts offers the potential for higher adherence rates and, in turn, improved healthcare outcomes. Medical wearables are a driving force behind healthcare advancements, but their impact relies on collaboration between healthcare providers, manufacturers and researchers.