A quiet revolution has taken place in patient healthcare in the past decade or so. The patient is no longer the passive recipient of healthcare, but rather an active and informed participant. The paternalistic “Yes doctor” model of medicine is dead and, enabled and empowered by developments in data and technology, the patient is now firmly in the driving seat when it comes to their own care.
But who is the informed patient and what do they want? Pharmaceutical giant Pfizer recently published the results of its Health Index, an annual survey that aims to provide a snapshot of Irish people's behaviours and attitudes in relation to health. Now in its 13th year, the data gathered has allowed several trends to emerge as time passes.
Pfizer managing director Paul Reid explains that data obtained from the Health Index allows Pfizer and other stakeholders respond to changing needs. "The fact we've been doing the Health Index for 13 years shows us the challenges for health policy development, as people's lifestyles, finances and health change. Overall, Irish people remain very positive in relation to rating their own health – seven out of 10 rated their health at seven out of 10 or higher."
What this year’s results have shown once again is that Irish people believe health should be the top priority when it comes to Government spending – “that’s something that has been incredibly consistent year on year”.
"This year's Index also illustrated how health priorities shift with age – the younger age group are more concerned with appearance and thus diet and fitness, for the 40-60 year age bracket, reducing alcohol consumption is their top priority, while for those aged 60-plus, disease-prevention is the number one concern."
Personalised medicine
As healthcare needs shift, Reid says the movement towards personalised medicine is a positive one. "The Health Index helps us as a pharmaceutical company look ahead to see what we will need to provide, and it is more targeted drugs for specific populations or rare diseases. We are now focused on developing first-in-class medicines and that's something that is going to be seen more and more globally."
Overall, the findings of the Index point to a high awareness of health across all demographics. Dr Caroline Whelan, chief operating officer of the Mater Private, couldn't agree more. "Health now has the patient at the centre, and it is a patient who knows what they want, who is demanding, and well-informed."
Technology is a significant catalyst for change within healthcare at the moment, continues Whelan; she cites Google and Apple’s recent forays into health as prime examples of how the tech and health sectors are merging.
“The Mater Private is known as a high-tech hospital so for us it is important that we are innovative across a number of strands.”
Indeed, the hospital has been at the forefront of technological advances in clinical care. The leading hospital for robotics in the country, more than 2,300 procedures have been carried out since the hospital first obtained the da Vinci robot in 2010 – thousands more than any other centre. Initially used solely for prostatectomy and hysterectomy, the past two years has seen the robot employed for cardio-thoracic, hepato-biliary, and gastrointestinal procedures.
What this means for patients is shorter operations and dramatically reduced recovery times. “For the patient, this impacts how much time they have to take off work, their risk of infection and complications goes down, all because it is more efficient and non-invasive.” The Mater Private also recently spent more than €500,000 on a 3-D mammography machine, and is the only hospital where this is available. “There are concerns over screening programmes at the moment, and we decided that this investment in the most up-to-date equipment was worth it.”
Online booking systems
On a more practical level, online booking systems now mean appointments are chosen to suit patients, rather than the other way around. And fresh from an historically paper-based system, eReferrals have just been introduced in the past month, says Dr Whelan.
“Access to healthcare is such an area of concern and demand. GPs can now send referrals via email rather than fax for any consultant in the hospital,” she explains, adding that the GP can then log back in for the patient’s results. “This is faster and better coordinated care, with better traceability for patients.”
Kelan Daly, director at KPMG’s management consulting practice, believes these changes in how patients receive healthcare are long overdue. “If you look at the majority of health system delivery models across the world, they are a 19th-century concept – people rock up to a physical building, wait in line, have their appointment and off they go again. The information and the power lies with the medical expert.”
In 2018, patient expectations are dramatically different, he says. “This is in keeping with what we see in other industries – for example, banking. People expect to do so much online, they are starting to expect the same from healthcare and not be tied to this archaic model. Wearables allow for remote monitoring – patients are asking why can’t these be used instead of them having to attend a hospital.”
Meeting these enhanced patient expectations presents challenges for healthcare systems across the world, admits Daly. “Yet at the end of the day, these advances have positive cost and practical benefits for health systems – more physical buildings are not needed, and waiting lists reduce.”
He gives the example of the services that US health insurer Kaiser Permanente provides; in addition to a hospital network, the insurer offers telehealth and telemedicine services, and aims to provide a majority of care in the community. “Even going back as far 2012, 50 per cent of their consultations were done electronically.”
Daly says Ireland is still starting to put the building blocks in place that will enable these types of offerings become the norm. “Progress is not as quick as everyone would probably like, but they are not alien concepts, which is very encouraging. If you put an accountant’s hat on it, it makes sense. Making interventions before they become ill, in their own home setting, this saves all the expense of entering hospital. It does require investment earlier on in the chain, but all the evidence would suggest that from a finance perspective, it is a more efficient use of resources, while being better for the patient.”
Five health trends to watch out for:
Data: The data tsunami is coming for healthcare and a patient's own data will soon not only be able to offer them personalised healthcare, it will become a valuable commodity, with companies willing to cough up for your vitals.
Wearables: Whether it's the new-fangled fitness watch of your preference, or the Apple health app you can't delete, we are now able to measure our health and fitness status with a simple flick of our wrist. As wearables become more widespread, clinical trials are using them to conveniently collect data without the patient having to attend trial sites for monitoring.
Telemedicine: If you do everything online, this is for you. It is the subject of some debate among doctors, who say nothing can replace the face-to-face experience of an appointment with your GP or specialist, but as waiting lists grow ever longer, online consultations look set to take off.
Personalised medicine: Don't feel you fit into a textbook? Patients are increasingly being offered tailored medication regimes based on their genetic profile – clinicians now realise that not all bodies process drugs in the same way and what works for some may not work for others. Identifying the right treatment for the right patient will mean no more trial and error.
Robots: The robots are coming, and there's no need to be afraid. Robots allow for cutting-edge surgery, but may also have a significant role to play in rehabilitation and monitoring, as well as revolutionising end-of-life care.