Should smartwatches be used in chronic disease management?

An important aspect of chronic disease management is for patients to take charge of their own health, whether that means checking their weight or tracking their physical activity, heart rate or blood sugar levels.

Smart watches, owned by about one in three Australianscan provide a convenient, continuous, and integrable monitoring platform that makes this process much easier. But they are not without their drawbacks.

Australian Pharmacist explores the pros, cons, and potential uses of smartwatches in healthcare, and how pharmacists can best help patients use them in chronic disease management.

There is an application for that

There are many smart watch apps in the market, which can track a variety of health measures such as:

• number of steps
• heartbeat
• sleep stage estimation
• peripheral oxygen saturation
• heart rate variability.

Some are even validated by the Administration of therapeutic productsincluding AppleWatch’s electrocardiogram algorithm, which alerts users if an irregular heart rhythm (atrial fibrillation) is identified.

With smartwatches capable of detecting how fast an individual is moving, studies have been conducted on its use, powered by machine learning, to early detection of parkinson’s disease.

These tracking and monitoring features can help manage a variety of chronic conditions, including:

• diabetes
• hypertension
• heart disease
• respiratory diseases
• movement disorders.

Traditionally, chronic disease monitoring has often been recorded on a piece of paper. But smartwatches are much more effective at collecting data, said Professor Sepehr Shakib, professor of clinical pharmacology at the University of Adelaide’s School of Health and Medical Sciences.

“They can then monitor that information and see trends or changes over time,” he said. “By having that data readily available, patients can then communicate it much more easily to healthcare professionals such as pharmacists.”

Synchronization with other devices

There are a variety of monitoring devices readily available in pharmacies that can be synced with smartwatches, Professor Shakib said, including:

• automatic blood pressure measuring devices
• continuous glucose monitors
• smart scales
• ovulation trackers.

With the average patient consulting their pharmacist far more often than their GP, they can facilitate patient self-monitoring through connected devices.

For example, a diabetic veteran might visit his pharmacist every 11 days to pick up medication or test strips.

“If the patient is recording their health data, having a clinician involved every 11 days, including answering questions about monitoring or management, could be very effective,” Professor Shakib said.

When home devices are synced with smartwatches, pharmacists also have the ability to validate the accuracy of these devices.

“They can then confirm to the patient whether their device is accurate or not and reassure them about their [technique],’ he said.

Interpreting smartwatch data

Pharmacists have an important role to play in helping patients understand smartwatch data for chronic conditions. Take hypertension, for example.

“This type of condition lends itself well to self-management because you can measure your blood pressure, upload it to an app and track it,” Prof Shakib said. “When you notice your blood pressure is rising, you don’t have to wait 3 to 6 months to see your GP,” he said.

But a key problem with self-assessment of blood pressure is understanding the variance.

“Patients may feel stressed when their blood pressure rises and feel falsely reassured when it falls,” said Professor Shakib. “They may not understand how labile and fluctuating blood pressure data is.”

This is where pharmacists can reassure: it is the average that counts.

Using the patient’s medication history, they can also indicate whether a GP consultation is necessary or whether there is a problem with the way they measure their blood pressure.

Pharmacists may also suggest lifestyle and dietary changes when overall blood pressure is high.

“Simple measures like reducing salt and alcohol intake and increasing physical activity can make a big difference,” he said.

This doesn’t necessarily mean hitting the gym, but rather incorporating more “exercise snacks” throughout the day, such as increasing walking by parking further away from your workplace.

“If the pharmacist repeats it and complements it with self-monitoring applications, it is an effective way to improve behavior,” Professor Shakib said.

Interface difficulties

Smartwatch apps have user interfaces designed by computer science experts who test their underlying technological functionalities, Prof Shakib said.

“For example, smartwatches have a fall detection system that can be useful for older people. So if someone suddenly falls, it can trigger an alert saying ‘it looks like you’ve fallen. Would you like to call 000?'” he said.

“This requires a smart approach [perception] deceleration models to detect a fall as opposed to a person kneeling on the ground.

But the user interface is not always suitable for people with poor health or who are not familiar with technology.

‘[Considering whether] “The user interface is adapted to the eyesight of older people and the colours are adapted to people with cataracts. It doesn’t capture people’s imagination as much as its appearance and the fabulous things it might be able to do,” Professor Shakib said.

Using multiple tracking apps and connecting other devices to smartwatches also requires patients to be somewhat tech-savvy.

“Using apps instead of paper to record health data requires the patient to know how to use them and enter the information in the right way,” said Professor Shakib.

This is where pharmacists need to have a clear understanding of the role they are expected to fulfill.

“If a patient presents data, pharmacists should help them understand it clinically, for example if the patient asks, ‘I checked my blood sugar, I’m not sure what that means,'” he said.

“But it should not be up to the pharmacist to show patients how to do this. [sync] the device, enter data and operate the application.

The challenges of interoperability

While it is possible to track many different markers for chronic disease, the downside is that lack of interoperability between smartwatch apps.

Although Apple’s system health app allows other devices and apps to connect and transmit data through it, it is difficult to account for multimorbidity, at least at this stage.

“For example, diabetic patients can see their physical activity recorded on one app, their anxiety level on another and their blood sugar level on a third,” he said.

“When measured in three separate systems, it’s not easy to put the data together to determine whether stress about an upcoming event, for example, is disrupting everything.”

While smartwatches have very extensive health tracking capabilities, their accuracy is also unclear.

“Many of these have not been properly validated, which raises questions about their accuracy,” Professor Shakib said.

Learn more about the role of smartwatches in healthcare at Atrial Fibrillation: Can Your Watch Save Your Life? session under the name PSA24, led by Professor Sepehr Shakib.