EXECUTIVE SUMMARY

Technology, including smartphone apps, can help patients monitor their chronic conditions, prevent health crises, and give more information to case managers and others who are following these patient populations.

• Not all apps are evidence-based, but some have shown benefits in preventing pregnancy-related complications.

• Patients can receive education through the app, which provides hyperlinks to evidence-based educational videos and other information.

• Smartphone apps also can monitor patients’ vital signs and blood sugar levels, providing fast information to case managers.


Some healthcare providers have found that use of technology, such as a smartphone-based app, can help prevent postpregnancy medical crises. It is a tactic that could work for more patients, if healthcare providers would be open to adopting new ways of monitoring their patients.

“I found in my research there are not a lot of healthcare providers or professionals who are monitoring with the apps that are out there,” says Geronda Pulliam, RN, BSN, MS, CCM, assistant clinical director at Triad Healthcare Network Care Management program in Greensboro, NC.

“There are thousands of apps, and not all that are evidence-based,” Pulliam says. “For people who need more information or who need to follow a patient’s gestational diabetes or hypertension, anything related to medical problems, these apps are helpful.”

Apps are easy for patients to use as they can access them through their smartphones. For healthcare providers, the technology is a convenient way to serve their patient population, she adds. For example, there is an app available to help prevent pregnancy and postpregnancy complications related to gestational diabetes.

“Members sign up and are followed by a nurse case manager, who communicates with them by way of the internet portal, and through text messaging on their smartphone,” Pulliam explains. “Patients enter their weight, activity level, blood sugar level, and blood pressure within the portal.”

Patients receive evidence-based education through the app, which includes hyperlinks to educational videos and other medically sound information. This information can be sent to patients during and after pregnancy.

The app can monitor trends in whether patients checked their blood sugar levels at the provider’s advised times. It also can monitor blood sugar trends, including whether the levels are higher in the morning. By checking patients’ weight, the app can identify fluid retention.

Participation within the app was above 75%, and patient satisfaction was 90%, Pulliam adds.

“We’ve had cases where pre-eclampsia was avoided because of the monitoring,” she explains. “The app sent information about low-sodium meal plans, and explained hypertension.”

Patients complete a prenatal questionnaire when they sign up for the app, and potential pregnancy complications are identified through the questionnaire.

“We gave members the correct tool to manage at-risk pregnancies,” Pulliam says. “For some patients, that risk was decreased and they didn’t have to be admitted for pre-eclampsia, or their pre-eclampsia was managed better.”

A support team, consisting of nurse case managers and others, check the dashboard and monitor patients’ use of the apps, which can be time-consuming, she notes.

“You might have to look at your budgets and staffing, which is what population health is all about,” Pulliam says. “We look at nonconventional ways of patient care to make sure patients are able to self-manage their needs.”

Case managers usually are receptive to using the technology because the apps help them better manage their patient populations, she adds. This solution can work for people who are busy with their work and families. It is a way to enroll people in case management programs even if time and transportation are barriers because the apps can be accessed anywhere, and with little time commitment by patients.

“Most people cannot live without their phones — so many things are done electronically,” Pulliam says. “The ease of use and convenience of a health-monitoring app improves patient adherence because people are more likely to use it and participate in a program.”

These apps fit in well with patients’ life-work balance. They provide quick opportunities for case managers to reinforce patients’ health improvement actions.

“We can monitor and follow up with encouraging words and praise for the patient because they’re doing exactly what they should be doing, and are having good outcomes,” Pulliam says. “That’s definitely important for population health and case management.”