From the Archives - 10/2/09, Hybrid Environments for Improving Student Outcomes: Contextual Innovation in Education through applications of Patient Adherence advancements in Medication-based healthcare services lifecycles
Pedagogy vs Adragogy
Centralization vs decentralization of learning
Technologies
and online resources
VLE’s vs PLE’s
Abstract / Introduction
Generally speaking, in education, the primary objective is
to transfer information to the learner in such a way that they can understand,
retain, and demonstrate an ability to use this information in an appropriate
context. While this may seem a safe statement
in educational theory, what we also know to be true is that each of the
individuals who are part of the “educational ecosystem” may at any point in
time have vastly different objectives, and/or be subject to restrictions that
prevent the realization of objectives in a manner that is most desired by the
individual. In fact, there are so many
external forces exacting their influence on our simple definition of
educational theory, that is almost seems irrelevant to state our definition of
the theory in the first place. In this
regard, Education is certainly not the only system that operates in a highly
conflicted context. The same is true
within the context of medication-based healthcare services.
We can
generally say, that the primary objective of medication-based healthcare
services healthcare is to transfer information and services to the patient in
such a way that they can understand, retain, and demonstrate an ability to use
this information in an appropriate context.
Sound familiar?
Student Outcomes
= Information retention and the ability to perform well on a test. Patient
Outcomes = Information retention and the ability to perform consistent
execution of a protocol. To formalize this concept we will say that:
Adherence
History(AHX) and Adherence Prescriptions(ARX)
Adherence is a common word when
we talk about medications, but what we think many people don't consider is that
Adherence is a process that is applicable to just about everything in our
lives, and we don't mean obvious things like "adhering to a diet", we
mean: teenage use of texting could be described in Adherence language, a drug
addicts' use of drugs could be described as Adherence, taking the car for
maintenance, getting your nails done. These all consist of protocols that are
easily followed or not, and the length of time for which they are followed can
be considered in terms of persistence. How about Religion? your job? same basic
formula. There is a protocol that describes the methods that need to be
followed to maintain the prescription, and there is a length of time over which
the protocol is followed. For almost every activity, adherence will wax and
wane. This is true for drug addicts, teenage texters, religious folk, and
everyone else.
Broadening our field of analysis
when we consider adherence is interesting because when we talk about adherence,
the conversation is almost always dominated by "negative adjustments"
that must be adhered to. Fine. We understand. People who don’t like to exercise, or who
need to eat less junk food, need to make what they perceive as "negative
adjustments" to their lives. Or in other words, the level of pleasurable
activity they are accustomed to is being curtailed, and the perception of this
requirement is "negative but necessary".
Lets now consider activities
which are inherently pleasurable, and should not need to be curtailed(due to
adverse effects) but demonstrate waxing and waning adherence. We use
Mafia Wars on Face Book as an example.
It failed to engage our research team, but it has succeeded with 5
million other people. These folks comply with the protocol: they press the
buttons, do the jobs, make the money, etc.
And they persist. Every day, lots
of times every day....make the money, do the job, click, click. So now we have a sample size of 5m people
clicking away daily. All pleasure. They are not gaining weight, cholesterol is
not going up, etc. but........after awhile.......game players stop
playing. If this were not true, everyone
today would still be obsessed with Pac Man.
So what happens? Why stop adhering to such an entertaining protocol?
Boredom, popularity shifts, competing games, who knows. What is important is that even the most
purely pleasurable activities see Adherence wax and wane. We need to know exactly why this is, in order
to understand why people do not Adhere to health prescriptions.
The solution is Adherence
Profiles. Adherence Profiles are constructed by gathering data that describes a
patients lifelong performance in regards to a myriad of activities: from
brushing teeth, to watching football, to mowing the lawn, religion, etc. The
point is: we must accept that there are unique profiles that describe a
person’s track record to adhere to anything. Through the definition and
analysis of this profile, we can then construct an Adherence Program that will
best suit the patient.
Adherence Program may in many
ways be exactly the same, but the essential difference will be an
"Engagement Skin", which is an overlay on top of a common
infrastructure, designed to provide an engaging Adherence Program to align with
an Adherence Profile. Virtual Reality is
the only medium that bring all of the resources required to make this possible,
in healthcare, but the concept of engagement overlays is a proven technique in
digital entertainment. Same customer base, different application of a proven
technique.
How Virtual Reality
addresses Persistence
Patients
fail with Adherence for a variety of reasons that include: lack of
understanding, and undesirable sides. Patients who want to persist, but feel that
they need support, quite often seek out other patients who are like themselves:
suffering from an ailment and looking for support, information, and a safe
environment comprised of patients like themselves. This search for community is
evidenced by the popularity of web portals that enable this sort of gathering
through message boards and chat. We have
also seen the rise of Virtual Reality deployed for the benefit of patient
groups. What we have not seen is the right
combination of an engaging environment, combined with safety, and wrapped in
medical authority. We believe that as an
extension of drug promotion, and with the goal being patient Outcomes driven by
adherence, a Virtual Reality based community, that is properly sanctioned,
provides safety, and can only be accessed by doctor prescription, provides the
right combination of captivating attributes needed to make great strides in
Adherence. The WX represents authority
and safety, certification and regulation ensures accuracy. Combined with
Virtual Reality, the patient now has access to special resources tailored to
meet their unique needs, provided via a mechanism that brings their health to
starting lifelike visualization and interaction, and the means to communicate
and receive knowledge and support. This is a powerful combination of
patient-engaging services that have never before been aggregated in such a
compelling way(if at all).
Accessibility and
Affordability
Virtual
Reality based health services are not only effective and unique, they are
universally accessible and affordable.
Cost should not be a factor when supplying meaningful solutions that can
and do impact patient outcomes.
Under-served populations and mobility restricted demographics are among
those that can benefit tremendously.
Combined with Payer-recognized Online Consultations facilitated via EMR
infrastructure, not only will more people be able to receive needed care, we
will be able to redirect a critical mass of in-office consultations to the
Virtual Reality platform. While the AMA estimates that as much as 70% of the
current volume of in-office consultations could be handled effectively using
digital communication, current Online Consultation methods will only be
suitable to facilitate a small percentage of the volume identified by the
AMA. The unique qualities of Virtual
Reality not only enable us to facilitate the majority of volume targeted by the
AMA without sacrificing quality of care, we believe that that there are many
inherent deficiencies associated with in-office consultations that we can
improve, such that in a variety of cases, Online Virtual Consultations will be
perceived as more desirable and effective than in-office visits.
Conclusion: Outcomes
and General Patient Health as impacted by Virtual Reality
In our
ongoing study, collaborations, and implementations, we will not only discover
and publish the useful information regarding Best Practices and efficient
methods of work, we will also be able to quantify the meaningful improvements
in Patient Outcomes as achived through the introduction of Virtual Reality in
healthcare.
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