4 mistakes your patients should avoid with wearables – American Medical Association

4 mistakes your patients should avoid with wearables – American Medical Association
22 Mar

Evidence on the impact of wearable digital health-monitoring devices is still emerging, as clinicians and researchers work to find out what these gadgets can and cannot do. In the meantime, however, there is a growing idea about the potential medical missteps patients should be aware of when donning wearables. 

To help ensure that mobile-health applications are safe, effective and trusted among patients and physicians, the AMA has collaborated with other industry partners through the Xcertia nonprofit to develop guidelines for privacy, security, operability, usability and content. 

While physicians are still digesting recent news from the American College of Cardiology’s annual meeting regarding the capability of Apple Watch to detect atrial fibrillation(AFib) in a small group of its users, in the meantime they are tasked with helping patients properly engage with wearable devices in a way that improves health instead of upping anxiety.

Here are four things your patients should watch out for when it comes to wearables’ health impact. 

Disengaging before the benefit can be realized. The first mistake that patients make with wearables is too give up on them prematurely. As with many interventions, there is often an initial period when patients are enthusiastic about the wearables’ role in improving their health.  

But that can drop off quickly if patients find the wearables inconvenient because of too-frequent recharging needs, or because meaningful benefits are not being seen, said Steven Steinhubl, MD, the director of digital medicine at the Scripps Research Translational Institute. 

To address this, patients need adequate instruction and available contacts for continued technology support, said Virginia Sun, PhD, RN, an associate professor with the Department of Population Sciences at City of Hope, a comprehensive cancer center in Duarte, California.

‚ÄúWe set up the device for¬†patients¬†instead of just handing them a box and asking them to open¬†it¬†at home,‚ÄĚ she said. ‚ÄúThere should be designated staff whose primary responsibility is to provide technology support.‚ÄĚ

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For wristband devices,¬†patients need to understand that it is better if they wear the device on their nondominant hand, and the devices¬†preferably¬†should be¬†waterproof and have a long battery life‚ÄĒat least¬†one year is preferred, said Sun. She¬†co-wrote¬†a¬†JAMA Surgery¬†report¬†on how a wristband pedometer helped identify patients who may need more support to regain function after major abdominal cancer surgery.¬†

‚ÄúPatients should keep their device on as much as possible,‚ÄĚ she said. ‚ÄúThis helped with adherence, which is important because we will have no data if patients aren‚Äôt wearing the device.‚Ä̬†

Ignoring the body’s messages and relying solely on the device. There is something worse that can happen, according to Dr. Steinhubl, lead author of a JAMA study on how the use of wearable electrocardiogram (ECG) patch resulted in earlier detection of AFib in high-risk individuals. 

Patients may experience discomfort and rely on the device for a diagnosis. 

‚ÄúThey think ‚Äėno news is good news,‚Äô‚ÄĚ Dr.¬†Steinhubl¬†said.¬†¬†

He added that patients will wrongly¬†conclude that¬†‚Äúif they‚Äôre having chest pain, it can‚Äôt be their heart‚Ä̬†because their ECG¬†device is showing a normal reading.¬†

Getting fixated on the data, a recipe for high anxiety. The opposite is also true. Instead of reassuring that all is well, wearables can increase patient anxiety, Dr. Steinhubl said.  

He recalled how a colleague became concerned because his wearable device was indicating a rapid heartbeat while he was sitting still. The man called his doctor, but his doctor was not available, which caused his anxiety to escalate. 

Gregory M. Marcus, MD, a professor of medicine at the University of California, San Francisco, noted how concern over a high heart rate increases adrenaline, causing it to beat faster.  

Heart-rate readings are an almost universal feature of wearable devices and are commonly misunderstood, said Dr. Marcus, who co-authored a JAMA Cardiology study on smartwatches and passive detection of AFib. 

‚ÄúA normal, healthy heart rate is by its nature variable, and what determines whether a heart rate is too fast or too slow is rarely the number,‚ÄĚ he said. ‚ÄúIn general, when we need to worry about heart rate is based on symptoms‚ÄĒsuch as¬†when¬†feeling faint or¬†inappropriately¬†fatigued¬†with no or minimal exertion.‚Ä̬†

Similarly, patients can become fixated on the data. Patients can get stuck on one number such as daily steps and ignore other health variables such as diet or sleep, according to a recent report from The Doctors Co., a medical liability insurer.  

Interpreting the data without physician help.¬†Home ECG monitoring with wearable adhesive patches transmitting data to a physician trained to interpret the readout is a digital-health success story, Dr. Marcus said. But the direct-to-consumer variety used by people who are not at risk for¬†AFib¬†tend to yield false positives that may lead to health care¬†use¬†that is unnecessary, wasteful and possibly dangerous‚ÄĒsuch as blood thinners being unwarrantedly prescribed.¬†

‚ÄúWearables do have¬†a¬†terrific capacity to be extremely helpful, but we shouldn‚Äôt be naive about the potential downsides,‚ÄĚ Dr. Marcus¬†said. ‚ÄúThis is a new frontier in medicine: Private, for-profit companies marketing devices that diagnose disease in a way that bypasses physicians and¬†thus far have¬†circumvented¬†the scientific rigor that would normally be required to change clinical practice.‚Ä̬†

The AMA is committed to¬†making technology an asset¬†rather than a¬†burden, and¬†preparing physicians and patients to use these tools for improved health outcomes. The AMA‚ÄĮDigital Health Implementation Playbook‚ÄĮpackages‚ÄĮkey steps, best practices and resources to‚ÄĮextend care beyond the exam room.‚ÄĮ¬†

Source: https://www.ama-assn.org/practice-management/digital/4-mistakes-your-patients-should-avoid-wearables

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