We spoke with Stephanie Caddell, a registered nurse with years of experience working with patients in a remote care setting. In this interview, she discusses how the use of PGHD in remote care programs can help patients and providers to address mental health issues that arise when a patient is dealing with managing a chronic condition.
How have you seen chronic conditions impact other parts of a patient’s life and health?
Chronic conditions create a new life for an individual. For example, if a patient is diagnosed with chronic hypertension, they may begin to investigate their mortality for the first time. The suggestions to consistently monitor and make what may be difficult lifestyle changes may cause stress that was not an issue before. The patient may be placed on medication that is important to remember to take once, twice, sometimes three times a day, and this wasn’t a thought before the diagnosis.
Sometimes, the diagnosis or resulting treatment may cause changes in other aspects of life, such as their schedule and personality, which affects friends and family. This may result in continued negative feelings which could ultimately impact their mental health, even leading to anxiety and depression secondary to the original diagnosis. Clinicians should begin monitoring and addressing this potential issue at the start of any chronic condition diagnosis, and be cognizant to symptoms. Along with that, educating the patient on symptoms of situational or chronic depression is important as well.
What are the risks of chronic condition management when mental health is not considered?
Mental health must be addressed as a primary condition if a confirmed psychiatric diagnosis has been made. In my previous blog, I mentioned the three aspects of good health: medication management, physician involvement, and self-management. Of these three, self-management is the most important. Without it, the other two aspects will eventually be null and void.
A patient must at some point be willing and able to manage the tasks placed on them by their healthcare management team; from medication compliance, to diet, exercise, sleep, and communication, to name a few. If a psychiatric diagnosis is present, the patient may not have the drive to perform these tasks on a regular basis. Mental health must be stabilized in order for the patient to be successful in self-management. The risk, simply put, is a negative outcome – worsening conditions over time leading to additional comorbidities, hospitalizations, and ultimately, death.
How can data improve your ability as a provider to see the signs of mental illness?
I believe the lack of data may be a first sign of an issue. If a clinician begins seeing less, or no data being produced from an individual who may have previously been very involved with managing their information, an investigation needs to be completed to understand the patient’s reasoning for ceasing to gather information.
If a provider is receiving regular data from their patient, changes in general trends could be an indicator of a larger issue. From a vital signs standpoint, an increase in heart rate, respirations, and blood pressure may indicate stress. An increase in blood sugar and/or weight may also indicate either a lack of attention to an issue or a forthcoming mental health need. These signs must be monitored closely and investigated quickly in order to assist the patient to get back on track. If a mental health need is not found through questioning by conversation or a validated tool such as the PHQ2/9, then heavier coaching and/or medication changes may be necessary.
What role does technology play in remote monitoring, in terms of monitoring mental illness and other non-physical side effects of chronic disease?
Technology plays a significant role in monitoring non-physical side effects of chronic disease. Again, the lack of data from remote monitoring may indicate that a patient may be challenged mentally, emotionally, or financially, which can lead to additional conversations from the clinician supporting them. Specifically for mental health, there are now apps available to patients that can help them plot trends in their behaviors.
Varying symptoms may have a noteworthy correlation between physical and mental health. For example: a patient with hypertension may notice that days when they are more anxious, their blood pressure skyrockets. Being able to note triggers and evaluate them can lead to a reduction their numbers. Another example may be a patient with diabetes who may have emotional triggers that leads to indulging in processed sugars during an episode. Being able to prepare for this time of day, week, month, or other emotional trigger can help to steer the patient from a negative path.
What challenges do you face as a clinician when you don’t have access to information about a patient’s health status or activity outside of the hospital?
Data is factual. Patient recollection is not. A patient may simply not accurately recall events over a day, week, or month, and there’s the chance the patient may not feel comfortable telling their clinician information about themselves for a multitude of reasons (embarrassment, vulnerability, or lack of trust). If a clinician has real-time data, or a pattern of data over a period of time, trends can be visible enough to gently guide a patient toward better choices, compliance, and outcomes.
Another major issue is that comorbidities such as hypertension and diabetes are considered “silent killers,” and the negative trending of these conditions is much more likely to be unseen without clinician access to PGHD. An elevation in blood pressure or blood sugar goes largely unnoticed to a patient until the heart or kidneys begin to fail them. If a clinician has access to accurate information before these issues occur, interventions can take place to prevent detriment. Helping a patient become empowered with their own tools and information ahead of time allows for destination control.
How can patient-generated health data help you to intervene and improve a patient’s mental health and quality of life?
There is such a stigma surrounding mental health, and there is no need for it. Patients tend to think it is something that they can control. However, the fact is, mental health is no different than the physical conditions that most likely took them to seek their physician’s advice in the first place. A person can no more control the chemical changes in the brain with depression than he or she can control their pancreas not generating insulin. However, having a clinician that understands how mental health will impact a patient’s outcome can do amazing things in teaching a patient about better choices, better coping mechanisms, and a greater quality of life in their day to day. We must begin addressing emotional well being in treating comorbidities. Rule number one of behavior change is that an individual has to see the value of change for themselves. Because of this, all the effort that a clinician performs on the other end will mean nothing if mental health is not first evaluated and addressed.