Technology should therefore be used to link the three partners (patient, pharmacist, GP), with each having different responsibilities. In such an approach the patient will be responsible for managing their medicines according to an agreed schedule, carrying
out the home monitoring and providing feedback on symptom control through the connected health equipment. The results of this engagement will then be relayed (wirelessly or via landline linkage) to a central (web-based) data platform, which will automatically send back a positive, supportive message to the patient if control is being achieved. When disease management markers become out of control, they will automatically trigger an alert message to be sent to the patient and also to the GP or pharmacist (or both) for appropriate action to be taken. Having reviewed see more the findings, the GP or pharmacist
could then send a text message to the home base unit or telephone the patient to give advice. This type of approach could also be delivered from a hospital base (hospital doctor and clinical pharmacist), for example, during the first month (highest risk period for readmission) after a patient has been hospitalised, before ‘discharging’ the patient to the primary care providers when the patient is deemed to be stabilised. This ‘ward in the community’ concept could be a useful approach to addressing high readmission rates. Continued support could be provided from the hospital pharmacy team if community pharmacists do not wish to become engaged. There are some examples of pharmacist ABT199 engagement in
‘connected health’ in published studies to date, however, these have been the exception. Although a recent study in the New England Journal of Medicine (evaluating a telemonitoring programme for heart failure patients) provided no evidence of benefit, further research is urgently required within this ‘space’ as isothipendyl monitoring equipment becomes more sophisticated and user friendly. It is clear that not all patients will have the required self-efficacy to fully participate in this type of programme, or may have issues around privacy, and a test of suitability may need to be developed, in much the same way as a genomics test is used in personalised medicine. This would allow alternate approaches to care provision to be considered and help prevent unnecessary spend on equipment that will remain unused. It is clear that further rapid developments will be made in the connected health world in the near future. Pharmacists must become engaged or find themselves further excluded from the care of patients with chronic illness and pharmacy practice researchers must assist by providing the evidence base for this new paradigm in chronic disease management.