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Saving time and reducing hospitalisation risk with digital long-term condition platform.

Case study with

Asynchronous education and risk stratification

Potential 332.3 hours and £19.2k saved per 1,000 asthma patients via asynchronous education.

As few as 25% of people typically demonstrate correct inhaler technique.¹ Aide delivered conversation-based education on inhaler technique to 31 patients who needed it in Suffolk Primary Care, saving 10.3 clinical hours (based on the current 20 minutes it takes to educate one patient via a practice nurse).

An illustration of an inhaler, a sheet of paper and a mobile phone

An illustration of a woman sat at a table on her mobile phone

Reducing the risk of potential hospitalisation by uncovering hidden medicine behaviours.

Aide identified that 50% of patients did not have an asthma action plan (AAP), which patients overuse their reliever inhaler (>2 times per week) and for what reason, and provided education on reliever and preventer inhaler use.AAP use is associated with a 70% reduction in mortality.² Reliever inhaler overuse puts people at increased risk of hospitalisation³ and is indicative of poor asthma control. Identifying these patients and providing an intervention could save £1516 to £2473 per patient.⁴

Klijn, Sven L et al. “Effectiveness and success factors of educational inhaler technique interventions in asthma & COPD patients: a systematic review.” NPJ primary care respiratory medicine vol. 27,1 24. 13 Apr. 2017, doi:10.1038/s41533-017-0022-1
Kouri, Andrew, et al. "An Evidence-Based, Point-of-Care Tool to Guide Completion of Asthma Action Plans in Practice." European Respiratory Journal, vol. 49, no. 5, May 2017, Art. 1602238. PubMed Central, doi:10.1183/13993003.02238-2016.
One million people in UK at risk of asthma attack because they could be relying on 'wrong inhaler' (Asthma + Lung)
Respiratory High Impact Interventions (NHS)

Medicine optimisation and patient activation

Raising adherence to avg. 73.3% for ICS prescriptions, paving the way for a potential 10% reduction in severe exacerbations.

Inhaled corticosteroids (ICS) adherence in adults (using the Medication Possession Rate), ranges between 15% and 54%. Increasing adherence by 25% has been associated with an approximately 10% reduction in severe exacerbations.¹

An illustration of a woman doing yoga in the morning

Increasing patient confidence and activation as a foundation for fewer GP visits, A&E visits and hospital admissions.

Aide increased patient confidence in skills to manage a condition (+7.4%), medicine understanding and ability to take them as prescribed (+8.4%), feeling fully involved in treatment decisions (+4.2%), and knowing what to do if a condition changes in the future (+4.2%).

Connections have been made between self-management capability of the patient and reduced utilisation across the entire health economy by the Patient Activation Measure (PAM).²

Engelkes, Marjolein, et al. "Medication Adherence and the Risk of Severe Asthma Exacerbations: A Systematic Review." European Respiratory Journal, vol. 45, no. 2, Feb. 2015, pp. 396-407. European Respiratory Society, doi:10.1183/09031936.00075614.
Barker, Isaac, et al. "Self-Management Capability in Patients with Long-Term Conditions is Associated with Reduced Healthcare Utilisation across a Whole Health Economy: Cross-Sectional Analysis of Electronic Health Records." BMJ Quality & Safety, vol. 27, 2018, pp. 989-999.

Dr Neil Macey

The initial aim of our project with Aide was to identify our asthmatic patients who were overusing reliever inhalers to see if we could educate and increase their adherence to preventer therapy, so improving their overall asthma control. We quickly expanded the remit to offer Aide to our whole population of patients with asthma.

We were pleased with the high initial uptake of Aide and high retention rates, which we feel are a testament to its usability and use of natural language. We were pleasantly surprised by the frequency with which some patients were engaging with Aide to log their medication use and symptoms. The apparent increase in medication adherence rates in users was obviously a huge positive too.

The early but useful insights into which educational modules users found most useful (e.g. inhaler technique) are valuable. The opportunities for asynchronous patient education with the ability to revise and repeat have great potential for this and many other areas of clinical medicine.

Dr Neil Macey, Lead GP at Stowhealth

Engagement

Enabling continuous daily patient touchpoints at scale with an avg. 4 conversations per patient/day.

Aide can enagage in the conversations that clinicians and patients want (and need) to have, but resources today don’t enable. These interactions have been with patients in area classifications including ‘hard pressed aging workers’, ‘challenged diversity’, ‘rural tenants’, ‘outer city hardship’ and ‘urban professionals and families’.

Engagement
4 conversations per patient per day completed on average
For the 75th and 90th percentiles (our most engaged patients):
90th → 7 conversations per day
75th → 5 conversations per day

UI elements showing a variety of conversations via Aide's chat functionality

Symptom data

Real-time and historic symptom severity data, most-problematic symptoms and atypical findings.

Every 28 days, Aide engages in a conversation to uncover the patient’s most-problematic symptom, including at what time of day it is most-noticed.

This is combined with patient-initiated symptom logging defined by condition, for example ‘coughing’, ‘wheezing’ and ‘breathlessness’ for asthma. It also enables the patient to state their own symptom observations.

E.g. One patient reported a symptom of “Upper back pain at level of the sternum with mild chest tightness.” This is stored for the clinician, reducing the need for patient recall ability.

Most-problematic symptom: Morning
Chest tightness → 9%
Coughing → 39%
‍Breathlessness → 42%

Most-problematic symptom: Evening
Chest tightness → 45%
Coughing → 21%
‍Breathlessness → 14%

Summary

Our partnership with Suffolk Primary Care demonstrates Aide’s ability to stratify risk, improve adherence and uncover insights to help clinicians enhance patient care.

Led by Dr Neil Macey, Lead GP at Stowhealth, this initiative offered Aide to patients aged 18+ on the asthma register across seven GP practices to help manage their condition. No other new asthma intervention has been run in tandem.