14 February 2017

Virtual Coaching for Patient Engagement

A recent study published in the American Journal of Managed Care found that patients who used “virtual health coach” (VHC) technology while waiting for their physicians in the exam room were encouraged to engage in conversation with their physicians about a healthy lifestyle topic that was not discussed during previous appointments. 

Eighty-nine patients who agreed to test out “new technology” during their exam room downtime were given handheld tablet computers equipped with virtual health coaches driven by artificial intelligence (AI) and natural language understanding (NLU) technologies, similar to Apple’s Siri or Google’s Alexa. The patients interacted with an animated VHC that questioned them about common health concerns, including weight, smoking, drinking, stress and medication adherence. The VHC advised the patient to have a conversation with the physician about any identified lifestyle concerns. 

The 63 patients who were available to be surveyed afterward said they felt encouraged by the VHC to talk with their doctor, and 51 percent reported having engaged in a conversation with their physician about the health topic they selected on the tablet. Twenty-six percent reported they had not discussed the topic with the physician previously.

“Patient ‘activation’ is a recognized concept that describes a person’s knowledge, confidence, and skills to manage his or her own health and healthcare; thus, patients who are activated in their health and healthcare generally have better outcomes and lower costs,” the study’s authors wrote. “Yet, 75% of patients are not adequately informed or confident, nor do they have the necessary skills to manage their health. In particular, healthy lifestyle behaviors are problematic for most patients. Those with lower activation rarely participate in behaviors that require active self-management, such as exercise, eating a healthy diet, and managing stress.”

Training patients to ask their doctors questions and giving them support to do so has been shown to increase both activation levels and participation in healthcare, they continued, but observations of patient–physician encounters suggest only 10% of the primary care visit is devoted to lifestyle topics and that even that brief time usually involves the physician bringing up a lifestyle concern.

“Patients are accepting of virtual agents and, interestingly, some disclose more to a computer interviewer than to its human counterpart,” the authors concluded. “Standardized behavioral change and motivational interventions can be built into VHC interactions. The ability to standardize conversations allows challenging and time-consuming interactions to be brief, consistent in quality, and scalable. VHCs could ultimately cost less than real providers in specific contexts. Thus, they are an attractive alternative to training physicians to be proficient in effective lifestyle discussions by using motivational interviewing strategies, which has proven to be challenging at best.”