Bengaluru: When Abhishek Shah’s father got diagnosed with pre-diabetes and his mom with type-2, their behaviour stumped him. Despite being veterans of the medicine business, they continued with the same lifestyles and food habits as before.
“My parents are extremely smart, I’m sure they saw these diagnoses coming a mile away,” said Shah, whose father owns a pharmaceutical business and mother runs a medical consumables operation.
“Yet, they chose to do nothing. When they were scared, they made little changes, but that was not consistent.”
The situation forced Shah into contemplation: Could there be a way for patients to follow a disciplined regimen without it seeming like a frightening life change they would rather avoid?
Out of this came Wellthy, a digital therapeutics company that acts as a gateway between the patient and the doctor in accompaniment to traditional healthcare.
After a patient is prescribed medicines and tests, doctors identify those who need assistance with improving their self-management. These patients then sign up on the Wellthy app, an interactive portal that acts as a personal medical assistant.
It allows patients and doctors to chat with each other, and reminds patients to take medicines or log in their hours of walking.
If someone has been asked to walk half an hour daily, the app prompts for incremental changes: First, wear walking shoes for five minutes daily, irrespective of what activity is being done. Then, if the patient likes talking on the phone, Wellthy encourages them to wear those shoes while using their mobiles. And so on.
Design engineers involved in the app’s development attempted to ensure that using the platform isn’t fatiguing and that it is intuitive enough for users to keep coming back. Experts in behavioural science were also looped in to ensure this.
The app provides feedback to the patients about their activities, behaviours and readings. When appropriate, it prompts with changes the patients need to follow. All the readings are first evaluated by third-party diagnostics who’ve partnered with Wellthy, and the changes advised are approved by medical professionals.
Additionally, the app also stores data and sends it to one’s doctor, who then has a better idea of a patient’s growth and status. Both doctors and patients use the platform.
On the side accessible by doctors and dieticians, there are dashboards that track each patient and their numbers.
On the patient side, the app displays their numbers, motivational messages, a gaming system that tracks their data, and more.
How the app helps patients
Shabana Tinwala, a diabetes patient from Mumbai, installed Wellthy on the recommendation of her doctor and dietician.
“My sugar levels were very high and my parameters were going totally haywire,” she said. Tinwala was told she was on the brink of hospitalisation and required urgent lifestyle change.
Initially doubtful, Tinwala nevertheless used Wellthy everyday because of “its ease and the fact that it allowed her to communicate instantly with her dietician”.
Her regimen included uploading a picture of every meal on the app so her dietician could track it. And steadily, she saw her numbers changing.
“My post-lunch sugar has come into control and my other parameters are slowly steadying now,” said Tinwala. “Had it not been for this app and my diligent dietician, I would not have improved at all, I’m 200 per cent sure.”
What seems to be the biggest advantage of the app isn’t a radical idea at all: The fact that doctors and patients can now chat on instant message, with patient history available for instant perusal.
“The biggest advantage for me is that patients can reach me whenever they want,” said Shehla Sheikh, a consulting endocrinologist practising at Saifee Hospital, Mumbai.
“Our common follow-ups range from 1 to 3 months, and in the intermediate period, we typically don’t interact with patients. Because of this, we often miss the opportunity to diagnose what went wrong or where the patient stumbled when they were doing so well. It also provides real-time feedback, which helps the patient understand their body better.”
Sheikh said the app had helped patients get in touch and make a wise choice at times when they aren’t sure what to do.
“For any lifestyle or diet change to succeed, you need compliance from the patient. The app makes this a lot easier,” she added.
Wellthy’s researchers regularly publish papers with their findings on modifying human behaviour, potentially building up the framework for a revolution in healthcare.
The role of patient behaviour
Medicines have always been aimed at getting more potent and to cure even the most reticent of patients. But after a drug is prescribed, it is human behaviour that shapes its effectiveness.
In clinical trials, the environment is controlled and set up for success. But in real life, this isn’t so — if a patient isn’t required to log in their food every day, they are not going to.
It’s this aspect of medicine — patient behaviour — that fascinated Shah.
“Changing user behaviour is a lot less risky and expensive, but it is more time-consuming,” said Shah. “But the impact can be life-changing and cost-saving.”
Shah started out on his mission with two questions in mind. One, are patients capable of managing their own health? Two, if they’re given small inputs, can they steer their health in the direction required?
“Navigation and self-management cannot function in silos. They needed to be connected to one another,” he said.
“As the health changes, the medicine would change also, requiring more behavioural change. This is the way you can build for better health outcomes by augmenting existing traditional healthcare.”
Such therapy, called companion therapy, is delivered in conjunction with traditional care.
‘Changing behaviour for changed outcomes’
Growing up with parents involved in the field, Shah said, helped turn him in this direction.
“Everything they did, that I saw growing up, was about improving lives,” he said. “No matter what metrics they were using, the core of the result needed to be better patient outcome.”
Shah, who earlier worked for a venture capitalist firm where he had to analyse accident risk for an insurance company, likened medical treatment to insurance premium.
“You might have a Mercedes and yet be paying less premium than a woman working multiple jobs and driving on the highways regularly,” he said. “This is what is needed in healthcare, individual treatment for individual patients.
“All industries like entertainment and consumer manufacturing are entirely driven to make experiences unique and convenient to individuals,” he added. “Why can medicine not do the same?”