eHealth 2010, Barcelona


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eHealth 2010, Barcelona

  1. 1. Personal health systems formental health management, early intervention and treatment Ilkka Korhonen Technology Manager VTT Technical Research Centre of Finland
  2. 2. Mental health - costs• Mental health problems costs 3-4% GDP in OECD countries (ILO 2000) • Finland: 49% of all disability pensions, 30% of absenteism, 13% direct healthcare costs (2007) • Germany: 74% increase from 1995 to 2002 in long- term sick-leaves due to mental health problems (Knapp et al 2007)• Depression 6% of all DALYs (WHO 2005) – most common mental disorder • Prevalence ~6-7%, ~20% of all people at some point of ther life
  3. 3. Depression - challenges• Depression is under-diagnosed or diagnosed with a delay • Treatmens more effective when applied in time  Tools to improve early diagnosis needed• Efficient treatments of depression exist (medication + therapy) but: • In Europe, 90% of people with mental health problems said they had received no care in the previous 12 months, and only 2.5% of them had seen a therapist (Knapp et al 2007) • Only 1/3 of people with anxiety and depressive disorders have mental health treatment, of which half occurs in primary care and lacks expert consultation (Katon 2003) • Main reason: access block = lack of resources for treatment (esp. scarcity of therapists/experts) • Also, fear of stigma, lack of expertise and tools in primary care  Tools for efficient treatment needed
  4. 4. Computerised Cognitive BehavioralTherapy (CCBT)• Treatment of affective disorders: medication + therapy (esp. CBT)• CCBT = “generic term for delivering CBT via an interactive computer interface delivered by a personal computer, internet or interactive voice response system"• CCBT has been shown to be effective • Outcomes comparable to traditional care • Up to 75% less therapist time needed  Opportunity to ease the access block!• Current CCBT tools • Based on simple technologies • Not widely deployed
  5. 5. Personal Health Systems New wearable devices Advanced analysis tools - easy, affordable, accurate and psychophysiological models - from data to information and feedbacComputing and connectivity + New service models- pervasive + New delivery and business models + New peer and social networks Easy, available, affordable, efficient, personalised, trusted, standard-based, interoperable, citizen-driven
  6. 6. Personal Health
  7. 7. 7Mobile Wellness Diary
  8. 8. Matching of intervention and PHS Theme Structure Technology NUADU I NUADU II •Goal of Interventions •Healt binder •Scale 1. Analysis of good •Analysis of Good life •Self observation •Pedometer life and actions to •Self awereness exercise form •Wellness Diary promote it •Home assignments •Scale •Nuadu-portalACT •Self Observations •Nuadu-portal 2. Analysis of •Analysis of health- and wellbeing •Self observation -Wellness Diary health- and •Self awereness and observer form -Nutritioncode wellbeing exercise (food diary) •Home assignments •Self Observations 3. Own work ability •Rapatti-learning game •Self observation •Mobile Coach and lifestyle •Problem solving method form •Home assigments 4. Solutions to •Speed relaxationRaPatti •Feedback from Rapatti-learning problematic •Self observation game •SelfRelax situations •Finding solutions to problematic form situations •Stages of change •Firstbeat 5. Plans for the •Experiences from problem solving •Self observation HEALTH + future •Plans for the future form borrowing HR- •Feedback from interventions belt
  9. 9. RCT – impact of PHS? Health Questionnaire City of Espoo Employees Replied n=4134 (n ~10 900) (38%), willing to participate Fulfilled Inclusion criteria (n=782) n= 3401 (31%)Randomization Subjects (n=352) Intervention Group 1 Intervention Group 2 + technology Control Group (n= 116) (n= 118) (n= 118) BASELINE: Measurements, NUADU-Questionnaire and personal feedback (n=352) Drop-out: other reasonsIntervention I Intervention II (n=3)Results from measurements Results from measurementsPersonal health goal Personal health goalHealth binder Health binderSelf-observation equipment Group meetingsGroup meetings (5 x 1.5h) (5 x 1.5h + 30min) ICT-toolsDrop-out: other reasons (n=1)Non-compliance (n=1) Non-compliance (n=4) Drop-out: other reasons (n=1) Personal support (n=117, Personal support, ICT, borrowing 99%) HR-belt (n=114, 97%) 6 MONTHS: NUADU-Questionnaire (n=347, 99%) Drop-out: other reasons Drop-out: other reasons Drop-out: other reasons (n=3), health (n=3) (n=3), health (n=1) (n=4) Intervention Group 1 Intervention Group 2 Control Group (n= 112, 97%) (n=111, 94%) (n=110, 93%) 12 MONTHS: NUADU-Questionnaire (n=318, 90%), Measurements (n=317, 90%) and personal feedback (n=333, 95%)
  10. 10. Preliminary results• PHS usage • At the beginning, >80% at least tried some PHS • Usage dropped during study – after 12mths, ~30% active users • Different PHS had different users and each PHS gained an active and committed group of users• Benefits (own assessment) • Increased exercising • Better understanding of own health • Better understanding of own fitness • Improved motivation towards better lifestyle • Improved stress management • Feedback more positive after the end of the study (experiences) than prior to study (expectations)• Note: analysis of true health benefits not completed
  11. 11. Cardiac rehabilitation, QLD, AustraliaPersonal devices at home Service Provider Web-portal access Web portal Other Health PC via internet Information Measurement Health Systems Diary data data Reports Data display for self management Educational Discussion, material messaging Diary, data & photo Server Health Database Health Database Motivational synchronisation Records Records SMS & Video Server Relaxation audio via 3G Internet Measurement Bluetooth and manual entry Treatment & Community Care Team Devices Health mentoring feedback via Information Mobile Phone phone 3G Data to server: • Diary entries • Measurement data • Photos Movement activity Feedback Tools: Heart Rate • Videoconference Blood Pressure • Teleconference Weight Web portal GUI • Multimedia & SMSIn collaboration with AEHRC, CSIRO
  12. 12. Home-based rehabilitationprogramme Home Program Overview Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7-> Getting Activity Anxiety Smoking Medications Sleep Themes started Relaxation Panic Overweight Cholesterol Family Motivation Worries Phobias Diet High blood Sex Heart Attack Emotions Low mood pressure Angina Stress Depression Diabetes Tele & Video- conference (Mentor) Goals & Plan WellnessDiary Entries twice/day StepCounter Continuous use SMS (text messages) 2/day Video clips 2/week Relaxation Audio Every day
  13. 13. P4Well: Technology Toolkit forSupported Self-Management of Stressand Mild Depression• PHS toolkit + psychological intervention programme • 3 group intervention meetings  cost-efficiency of a group intervention • PHS to empower self- management  personalisation through use of PHS and eConsultation
  14. 14. Depresssion 9 8 7 6 5 Test 4 Control 3 2 1 0 Pre Post
  15. 15. PHS and mental health• Main challenge in mental health problems is to provide treatments to all in need – especially depression • Early access – empowerment – efficient use of expert’s time• PHS may significantly improve CCBT • Better access • Continuous monitoring • Contextuality – treatment opportunity• Our experiences • PHS are accepted and used (~30-90% active users in long-term) when applied in combination with a proper intervention model (support / service) • Mobility is the ”killer application” • Toolkit approach seems to work • PHS and intervention programme need to be designed in parallel • PHS alone will not work • PHS glued on top of existing treatment models will not work • Stepped care models
  16. 16. Thank you!