decide treatment - a new approach to better health

• Physician• Psychiatrist• Editor• Head of department• Researcher• Chief adviser• Software developer

So many people, so many with chronic disorders

Healthcare is about

health

I want to be

healthy!

SUBOPTIMAL HEALTH:

6 COMMON REASONS

1. Does not use the best main treatment2. Does not use the optimal dosages

3. Difficult to take treatment as agreed

4. Difficult to lead a healthy lifestyle

5. Does not get enough support from others

6. Is not happy with the decision-making

1.Does not use the best main treatment

2. Does not use the optimal dosages3. Difficult to take treatment as agreed





2.Does not use the optimal dosages

3. Difficult to take treatment as agreed4. Difficult to lead a healthy lifestyle






4. Difficult to lead a healthy lifestyle5. Does not get enough support from others






5. Does not get enough support from others6. Is not happy with the decision-making

HEALTH OPTIMISATION

1. Finds the best available treatment

2. Takes the optimal dosage

3. Uses the treatment as agreed

4. Leads a very healthy lifestyle

5. Takes part in decisions

6. Receives enough support

An approach from the UK calling for the use of

technology

Figure 1. Summary of the four principles of medicines optimization

Increasing the effectiveness of adherence interventions may have

a far greater impacton the health of the population

than any improvement in specific medical treatments

Bryan Haynes

Increasing the effectiveness of adherence interventions may have

a far greater impacton the health of the population

than any improvement in specific medical treatments

Bryan Haynes

And this is only problem #3 of the 6

6 STRATEGIES FOR OPTIMAL HEALTH





5. Takes part in decisions6. Receives enough support

BACKGROUND

HVA ER BEST Å GJØRE?TEKNISK STØTTE:

• Systematisk monitorering av effekter• Monitorering av annen info, som søvn og labsvar• Optimalisering av compliance• Integrert kunnskap fra mange kilder• Rangering av behandlinger ut fra forskning og reelle

effekter• Hjelp til å formidle kunnskap til henne på en forståelig

måte• Hjelp til å involvere henne i valget

Contributors:

London, Sydney, Seoul, Chicago,Odessa, Dubai, Singapore

Professor Jack Dowie

Frameworks:

1. Multi-criteria decision analysis

2. Single subjects research designs

3. Shared decision-making

Multi-criteria decision analysisMathematics Behavioral decision theoryEconomics Computer technologySoftware engineering Information systems

Multi-criteria decision analysisMathematics Behavioral decision theoryEconomics Computer technologySoftware engineering Information systems

• Includes exactly what is needed for optimal decisions

• Enables valid and consistent integration of large amounts of data

• Takes knowledge and preferences as input for calculations of treatment values for the individual

Single subjects research designs

Time

Deve

lopm

ent V

aria

ble

• What works for groups of people generally does not work for you!

Time

Deve

lopm

ent V

aria

ble

• Measure treatment effects and find out: Right: With treatmentMiddle: Without treatmentLeft: With treatment

• Conclusion: Less symptoms with treatment!

Shared decision-making

Shared decision-making1. Get the decision on the table


2. Acknowledge that it´s not possible to find the best treatment without knowing what´s important to the patient


2. Acknowledge that it´s not possible to find the best treatment without knowing what´s important to the patient3. Get all available options on the table



4. Ask what the patient wants the treatment to do for her



4. Ask what the patient wants the treatment to do for her5. Tell what the patient can expect from the best and worst treatment, on all outcomes




6. Find out which treatment fits her preferences most





7. Agree on what is the best treatment





7. Agree on what is the best treatment

8. Provide support and allow the patient to participate in the decision process to the extent and in the ways preferred

Pilot: Bipolar disorder

Pilot: Bipolar disorder

• A very complex disorder• Highly invididual course and

treatment results• Can be unpredictable• Serious consequences

very common• Fatal consequences not rare

New knowledge summary methods• Fast and frugal • Patient-oriented • Decision-focused

New knowledge summary methods• Fast and frugal • Patient-oriented • Decision-focused

Addresses all patient-important outcomes

DECIDE TREATMENT: 18 FEATURES TAILORED TO SOLVE THE 6 PROBLEMS

1. Does not use the best main treatment

1. Does not use the best main treatmentLet´s integrate all available knowledge!

Best research results





+ All earlier experiences

Best research results





+ All doctor´s experiences

Best research resultsAll earlier experiences

Best research resultsAll earlier experiencesAll doctor´s experiences+ Removes contraindicated and irrelevant options and outcomes

Best research resultsAll earlier experiencesAll doctor´s experiencesRemoves contraindicated and irrelevant options and outcomes

+ Measured treatment results

Best research resultsAll earlier experiencesAll doctor´s experiencesRemoves contraindicated and irrelevant options and outcomesMeasured treatment results

= a fully populated decision matrix

Ranking and expected value of available treatments

Ranking and expected value of available treatmentsNo action is evidence-based in this world. All human behaviour is knowledge- and preference-based

What health is to her

Her personal trade-off

Ranking based on trade-off + all evidence

Personalised ranking, rather than the recommendations for an “average patient” in clinical guidelines

Click at the bottom left to start the movie!

Let´s pick one of the best!

Let´s find out how they compare


2. Does not use the optimal dosages


2. Can find the best dosage


2. Can find the best dosage3. Difficult to take treatment as agreed


2. Can find the best dosage3. Reminded of, signs off, look at together



4. Decides on, reminded about, inspect




5. Decides on support and receives it





6. Decides on decision quality and measures it

The patient´s treatment plan• Main treatment• Additional ones• Lifestyle measures

New side effectsLife eventsTreatment changesAppointments

Objective data• From the mobile• From the watch• From EMR

Text, video, graphics reached with one click from the panels

12 panels condensing huge amounts of data= Solid ground for shared decisions

Where is shared decision-making?

Where is shared decision-making?






here here

here

here

here

here

Integration in DIPS

Coordinated with and reflected in government whitepapers and

initiatives

Systems in the making for people with:

• Heart disease• Asthma• Stroke• Hypertension• MS• COPD• Diabetes

• Bipolar disorder• Palliative care • Lung cancer• Schizophrenia• Pregnancy• HIV• Psoriasis/eczema

5 studies as per 16.11.16 5 PhDs

Results:

SUS score 78

Tested with 88 potential usersNorway, UK, Ukraine

Above 68 is good

I don´t want to stop using this

Patients:

I feel safer having this system

I see the big picture very fast

Doctors:

We quickly get to the main issues

Results:

System modules

24 interconnected modules enriching each other

Modules in patient decision aids

Modules in clinical practice guidelines

You could be an author of a Health Helper!

THE ALTERNATIVE?

Take this and come back in a month

Take this and come back in a month

We can continue with business as usual:• No systematic measurement

of treatment effects

• Trust that our brains can process all necessary data

• No digital support outside of the encounter

CONCLUSION

Finding out what works for you should be as systematic as finding out what works for groups (= research)

Optimisation of health for each and every one of us1. Finds the best available treatment



