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Mobile technology rewires health care delivery

Case Study

With his father on dialysis, and his mother recently having a kidney transplant at MUSC, Juan Aguayo knows the risks he faces. The 25-year-old has high blood pressure already.

Aguayo admits he has been frustrated staying on his medications, knowing that will help him avoid ending up with heart and kidney problems. It's one of the reasons he volunteered for a mobile technology study targeted to help hypertensive patients be more compliant.

It's a common problem. The World Health Organization reports that only about 50 percent of people typically follow their doctors' orders when it comes to taking prescription drugs. That rate can be higher with chronic conditions, such as hypertension, known as a silent killer because many patients have no symptoms.

Brenda M. Brunner-Jackson, program manager, wraps a blood pressure cuff around his arm at a checkup at the Franklin C. Fetter Family Health Center on John's Island. She helps track and counsel patients enrolled in SMASH or Smartphone Medication Adherence Stops Hypertension.

Brenda Brunner-Jackson, program manager in the College of Nursing, takes Juan Aguayo's blood pressure.

"So have you been taking your medications?" she asks.

She really doesn't have to since she has readouts from his MedMinder, a computerized, medication dispenser, and his Bluetooth-enabled blood pressure monitor that he uses.

This time, though, Aguayo smiles, happy to discuss it. "It makes it easier to take. I open the right one and the flashing light will stop. It helps a lot," he said. "Now it's stuck to me. Now it's a habit of doing it already."

Aguayo knows if he doesn't respond to the light, a beeping will start, and then he'll get a call from a medical professional "coach" who helps him troubleshoot problems. It's strong incentive to take the medicine on time. Aguayo said he actually got to the point he was standing over the MedMinder before the light started flashing. With the study ending, Brunner-Jackson set Aguayo up with a timer system on his cellphone so he can continue to get reminders.

Aguayo hopes to spread the news in his community about the dangers of high blood pressure. "If you can get help, get help. It can lead to dialysis and kidney failure. It's simple to take control of it if you take the steps to train yourself."
His parents are proud of him. "They don't want to see me go down the same road. It's a wake-up call for me."

Case Study

When the call went out to teachers at Jerry Zucker Middle School of Science about a "tension tamer" study for teachers who might qualify, Jack Sanders thought he would give it a try.

As an 8th grade resource teacher and tennis coach, Sanders experiences many times where he could use some tension taming by the end of the day. To qualify for the study, though, a person had to be pre-hypertensive. Sanders figured he wouldn't make it through the screening since he's young, slim and good about doing what he can to stay in shape.

Volunteering to be screened, he was shocked to find out that he did qualify for MUSC's Tension Tamer proof of concept study. He and two other teachers took part in the study.

Participants were asked to do something Sanders, 27, didn't know much about – breathing awareness meditation. Sanders said he liked the technological approach of the study in that he would be using a smartphone with a Tension Tamer app. The app tracks heart rate through photoplethysmography using the camera lens on the phone to get a pulse from a person's finger while the participant does an audio-delivered breathing meditation.

TeacherTeacher Jack Sanders learns he loves to meditate through a study using mobile health technology.

Sanders' favorite part, though, was how the app transmitted time-stamped heart rates from the session back to the servers for real-time analysis. He loved the direct physiological feedback that showed him that something as simple as breathing exercises could have such a dramatic impact on his heart rate and tension level. The app also included inspirational, coaching texts to encourage participants to be compliant in practicing.

An auditory kinesthetic learner, the approach was ideal for him. "A book wouldn't have worked as well, if at all. That hands' on experience where you can have it is much better for me than a book."

Sanders said it has been life changing for him. Instead of the 15 minutes he was supposed to spend doing the app, he found himself doing it for 20 or 30 minutes.

"I had done no meditation before so it was an all new experience. I was very skeptical at the beginning because I thought how is a telephone going to monitor my blood pressure and tell me I'm 'relaxing.' This is just nuts. It doesn't make sense."

But work it did.

It opened his eyes to the dangers of high blood pressure, a condition he didn't think applied to him. "That was my attitude. When I started going through this, I realized I may be young, but it can happen at any age. You have to be ready for it."

The best part is that Sanders now is into the habit of using the breathing meditation whenever he needs it. He especially likes doing it when he gets home to disconnect from the day. Now that he knows how to do the breathing meditation, he doesn't need the app. Instead, he did his own research and found an app with soothing ambient noise.

"I was able to take what I learned, apply it and even grow with it. I typically would have a stressful day and go home and stew on my stress, which adds more frustration to my next day and I don't sleep well at night.

"Now I realize I have to take time to disconnect. If I don't do that disconnect, my day never ends."




Friday, April 6, 2012

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