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The Pharmacist’s Prescription for Digital Health

In this exclusive interview with 1Twenty80, we delve into the insights of Dr. Navin Kumar Loganadan, the Senior Clinical Pharmacist at Putrajaya Hospital, Malaysia. With 16 years of experience as a Diabetes Care Clinical Pharmacist, Dr. Navin is currently at the forefront of digital health initiatives, serving as the Head of Specialist Clinic Pharmacy & Diabetes Medication Therapy Adherence Clinic (MTAC) Services at the Endocrine Institute.

1Twenty80 explores Dr. Navin’s perspectives on digital health, focusing on the pharmacist’s role in leveraging technology to enhance pharmaceutical care outcomes. The discussion touches upon various aspects, including the definition of digital health from a pharmacist’s standpoint, the role of health monitoring apps in promoting overall well-being, specific health conditions benefiting from such apps, and Dr. Navin’s recommendations for valuable health monitoring apps. Join us as we step into the realm of digital health.

Dr. Navin Kumar, Senior Clinical Pharmacist at Putrajaya Hospital, Malaysia

Interesting Facts about Dr Navin:

  • Dr. Navin has presented his research at several international conferences including that of the American Diabetes Association and International Diabetes Federation.
  • Dr. Navin is also among the 20 global recipients of the ‘Next Generation Scientist Award 2016’ by the University of Basel, Switzerland.

1Twenty80: How would you define digital health from a pharmacist’s standpoint?

Dr Navin Kumar: The pharmacist’s perspective on digital health involves the utilisation of various technologies, primarily digital platforms, to enhance pharmaceutical care outcomes, with a specific focus on treatment effectiveness. We actively seek technologies and solutions aimed at improving these outcomes. For instance, digital solutions addressing medication adherence, such as apps or applications, play a crucial role. These tools serve as reminders for patients to take their medication, replacing the manual methods we used previously, such as pill boxes or handwritten reminder cards featuring symbols like the sun and the moon.

The advent of digital platforms has significantly streamlined these processes, leveraging the widespread use of smartphones. Despite initial doubts, the widespread adoption of smartphone applications like MySejahtera among Malaysians has exceeded 90%, making it feasible to implement digital solutions. Apps designed to help patients remember and correctly take their medications on time not only enhance adherence but also provide valuable information about the medication itself, including anticipated side effects and guidance on how to manage them. This integration of information and solutions characterises digital health.

In the absence of physical presence, healthcare professionals, including pharmacists, play a temporary but crucial role through these digital tools. The app serves as a companion, offering support and information to patients when professionals are not physically present. Essentially, it functions as a personalised and intelligent pharmacist, tailored to meet individual needs and providing a holistic approach to healthcare.

1Twenty80: Are there specific health conditions or parameters for which you see health monitoring apps being particularly beneficial?

Dr Navin: In my professional field, I find diabetes to be an area where apps and technologies can be highly beneficial. At Putrajaya Hospital, I’ve utilised several apps and software that facilitate direct interactions with patients, especially those managing diabetes with insulin injections.

In such cases, doctors prescribe a specific insulin dose, and when patients return for their next appointment in three or four months, their blood sugar levels may have fluctuated due to various factors, such as dietary changes. These patients can use apps to input their blood glucose levels measured at home, and the app allows direct interaction of the patient with the doctor, DMTAC pharmacist or a diabetes educator to get the recommended appropriate insulin dose to be injected. This personalised approach helps maintain tighter control, preventing extreme highs and lows in glucose levels and avoiding potential side effects.

Another significant application of these apps is in improving the management experience for patients. Some apps serve as proactive reminders, prompting users to take their medication at the designated times. Users confirm their adherence with a simple response, similar to responding to a WhatsApp message. This proactive reminder reduces the risk of unintentional medication skips, addressing the common issue of forgetfulness, especially in busy or hectic schedules.

This approach extends beyond diabetes management and is applicable to chronic diseases like asthma and heart conditions. The use of apps becomes particularly relevant for long-term conditions, offering a companion and guide to patients. The development of these apps involves collaboration with clinicians and pharmacists to ensure accuracy and address any limitations.

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These apps also leverage patient-provided information, with users entering details such as age, gender, duration of diabetes, physical activity, and lifestyle. While maintaining confidentiality, this data enables more accurate and personalised advice for disease management. Patients willingly provide this information after consenting to use the app, understanding its potential benefits in enhancing their daily health management.

In essence, these apps play a crucial role in preventive care, personalised disease management, and overall improvement of the patient experience. They empower individuals to take charge of their health by providing timely reminders, tailored advice, and risk assessments based on their unique health profiles.

1Twenty80: Can you provide examples of health monitoring apps that you find valuable or that you often recommend to patients?

Dr Navin: I am particularly concerned about diabetes, and I strongly recommend using apps for blood glucose level monitoring. Although I won’t mention specific names, various blood glucose monitoring apps are available, compatible with glucose metres from widely used brands. The key point is that any glucose metre requires a connection to internal software, necessitating the download of a corresponding app on the phone. By activating Bluetooth on both the glucometer and the phone, users can seamlessly pair the devices, allowing the app to import all blood glucose readings directly.

This digital approach proves far more efficient than traditional methods where patients manually record their readings in diaries, a process prone to errors and forgetfulness.

The app transforms this data into a user-friendly format on the phone, presenting a comprehensive log of glucose levels checked on specific days and times. It even generates graphs and calculates average glucose levels over a week. This digital approach proves far more efficient than traditional methods where patients manually record their readings in diaries, a process prone to errors and forgetfulness.

The accuracy of information is significantly enhanced, as the direct transfer of data from the metre to the phone eliminates the risk of incomplete or inaccurately recorded details. This digital log not only ensures accuracy but also simplifies discussions during clinic visits, as healthcare professionals can readily access and analyse the data stored on the patient’s phone.

Apart from blood glucose monitoring apps, there are other applications that contribute to overall well-being. Calorie counter apps, for instance, prove beneficial for those aiming to maintain a healthy weight. Users can input their meals and receive information on the calorie content, helping them make informed choices about their diet. This app is particularly helpful for patients seeking weight loss, allowing them to track their calorie intake and plan meals accordingly.

Additionally, there are apps focused on healthy eating, providing nutritional information about various food choices. These apps empower individuals to make healthier dietary decisions by offering insights into the calorie content of different dishes and even suggesting alternatives to promote balanced nutrition.

In summary, the integration of health-related apps, specifically blood glucose monitoring and calorie counting, not only enhances disease management but also contributes to overall well-being by providing valuable insights into nutritional choices and fostering healthier lifestyles.

1Twenty80: In your experience, how receptive are patients to the idea of using apps for health monitoring?

Dr Navin: Even before the onset of COVID-19, around 2018, our hospital initiated app innovation on a smaller scale, particularly for diabetes patients. This in-house app allowed them to input blood glucose levels and aided in adjusting insulin doses. We assessed the app’s utilisation, recognizing a preference among the younger to middle-aged demographic, who found the app intuitive and user-friendly. Though some individuals aged 60 and above embraced conventional methods, such as writing in a book, the majority appreciated the simplicity and visibility of the app’s design.

Notably, the urban population, including the working class, displayed higher app utilisation. The familiarity with technologies like WhatsApp contributed to the acceptance of health monitoring apps. The design’s simplicity played a crucial role, making it accessible to a broader audience.

1Twenty80: How do you think health monitoring apps contribute to patient empowerment and engagement in their healthcare?

Dr Navin: Healthcare professionals acknowledge the limitation of their presence to specific appointments, usually occurring every three to four months. During these brief encounters, prescriptions and advice are provided, leaving patients to manage their health independently for the majority of the time.

Empowerment, in the context of health monitoring apps, is significant, particularly for conditions like diabetes. The app serves as a tool for immediate interaction during instances of fluctuating blood glucose levels. If a patient finds their levels elevated, they can input the data into the app, receive immediate guidance on dietary adjustments, and take proactive steps to manage their health.

This continuous engagement fosters a sense of control and responsibility among patients, as they can actively participate in managing their conditions on a day-to-day basis. The app acts as a virtual companion, offering timely advice and guidance when healthcare professionals are not readily available. Ultimately, it bridges the gap between periodic clinic visits, ensuring ongoing patient involvement in their healthcare journey.

The app acts as a virtual companion, offering timely advice and guidance when healthcare professionals are not readily available. 

Looking ahead, the future of pharmacy practice is envisioned as a collaborative effort between traditional practices and digital health advancements.

1Twenty80: What role do you believe pharmacists play in the integration and adoption of digital health solutions?

Dr Navin: We have implemented an app or software facilitating live interactions between healthcare professionals and patients for over two years. This platform enables direct communication between patients, doctors, and pharmacists. As part of this initiative, I, as a healthcare professional, log in regularly to monitor patient interactions. The app serves as a comprehensive tool, linking me directly to selected patients.

This allows me to review their activities throughout the week and send messages to encourage positive behaviours. For example, I can acknowledge a patient’s good glucose control over the past week and advise them to maintain their current medication dosage. This messaging system resembles the ease of communication found in platforms like WhatsApp.

Additionally, the app supports live interactions. If a patient is uncertain about the insulin dosage for a specific meal, they can send a photo of their food, and I can provide immediate guidance on the necessary insulin dosage. This proactive approach, in contrast to retrospective clinic visits, prevents blood glucose spikes and fosters better patient outcomes.

This real-time engagement contributes to improved patient empowerment and adherence to treatment plans. Rather than relying on reactive measures, the app allows for proactive intervention, enhancing overall patient care. This is just one of the many examples of how pharmacists can play a role in the integration of health apps in society.

1Twenty80: Looking ahead, how do you envision the future of pharmacy practice with the ongoing advancements in digital health?

Dr Navin: Looking ahead, the future of pharmacy practice is envisioned as a collaborative effort between traditional practices and digital health advancements. Digital apps and AI can complement pharmacy services by providing preventive measures, reminders, and educational content.

The role of pharmacists is seen as pivotal in ensuring patient compliance, offering advice, and addressing concerns between physical visits. Digital tools can serve as an extension of pharmacy services, tackling routine issues and allowing pharmacists to focus on more complex aspects during in-person consultations. The integration of technology is perceived as a means to enhance and complete pharmacy practices, not replace them. The emphasis is on leveraging technology to streamline services and improve patient outcomes.

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