˜ DANIELLA PENA ROSALIND LOUVET PREVENTIVE HEALTHCARE FALL 2011 WORK
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CONTENTS
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About this book Research question Hypothesis Research Overview Case Studies Interviews CMOM Observations Journals Medicine Cabinets Key Findings
4 | INTRODUCTION: ABOUT THIS BOOK
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ABOUT THIS BOOK This book is the first in the series documenting our Thesis Project. It showcases the research obtained during the first semester of this year long project. The subject we both really wanted to explore was healthcare as it is a system with many opportunities for design. Being both international students, we also wanted to gain a better understanding of healthcare in the USA and find a way to improve upon it as our experiences with it have been everything but positive and care free. As healthcare is a very broad subject we had to narrow it down into something more attainable therefore our concentration is on preventive care. We felt this was a good choice as when we were deciding upon a project we wanted to make sure we incorporated both our interests in consumer behavior, education and design. Healthcare is a topic frequently discussed in the news and debated among policy makers and wellness as a subtopic has definetly become a buzz in the past year. Despite better access to diagnostic equiptment and surgical procedures, American life expectancy is shorter than for all peer countries around the world. Experts believe that this may be due in part to the United States’ lag in basic preventive care.
| INTRODUCTION: RESEARCH QUESTION
INTRODUCTION: RESEARCH QUESTION |
OUR RESEARCH QUESTION
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WE ARE RESEARCHING PEOPLE’S ATTITUDES, BEHAVIORS, AND HABITS TOWARDS PREVENTIVE AND HOME HEALTH CARE BECAUSE WE WANT TO BETTER UNDERSTAND AND IDENTIFY OPPORTUNITES FOR INTERVENTION TO OPTIMIZE THE RELATIONSHIP BETWEEN PEOPLE, CONVENTIONAL HEALTH CARE AND PREVENTIVE APPROACHES TO HEALTHCARE. OUR OVERALL OBJECTIVE IS TO EXPLORE ALTERNATIVE OPTIONS TO PRIMARY CARE AS OPPOSED TO DEALING WITH THE EXPENSIVE CONVENTIONAL HEALTHCARE PROVISIONS FOR LOW LEVEL HEALTH NEEDS.
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| INTRODUCTION: FORMING A HYPOTHESIS
FORMING A HYPOTHESIS Going into the project we had some preliminary assumptions of what we were going to find through our research. These assumptions helped us develop our hypthesis and guided our research methodologies and focus areas.
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CHILDREN VS. ADULTS
AWARENESS VS. ACTION
LIFESTYLE VS. WELLNESS
Alot of preventive programs are getting implemented in schools and at a young age at home; however, the concentration shifts as people get older and independance and self reliance kick in. We think there is a lack of innovative solutions when they are most needed.
People are aware of all they should be doing but do not necessarily take action in terms of preventive healthcare.
Lifestyles are not going to be too troublesome; people are going to be relatively healthy but health habits in terms of over the counter drug use, public sanitation and contamination and actions relating more to sickness etc. are going to be areas where we will find inconsistencies.
10 | INTRODUCTION: HYPOTHESIS
INTRODUCTION: HYPOTHESIS |
OUR HYPOTHESIS
PREVENTIVE HEALTH IS PRACTICED MORE AT A YOUNGER AGE WHEN IT IS NOT SO MUCH UNDER YOUR CONTROL. CONCENTRATION ON PREVENTIVE AND HOME HEALTH SHIFTS AS PEOPLE GET OLDER AND INDEPENDANCE AND SELF RELIANCE KICK IN. WHILE THERE ARE ALOT OF PROGRAMS TARGETED AT CHILDREN, THERE IS A LACK OF INNOVATIVE SOLUTIONS WHERE THEY ARE MOST NEEDED.
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| INTRODUCTION: RESEARCH OVERVIEW
INTRODUCTION: RESEARCH OVERVIEW |
RESEARCH OVERVIEW
SECONDARY RESEARCH
PRIMARY RESEARCH
INDUSTRY DATA GOVERNMENT POLICIES MARKET RESEARCH
18-40 years old
SURVEY JOURNAL CMOM OBSERVATION MEDICINE CABINET VISITS
CASE STUDIES PROFESSIONAL JOURNALS CDC
IRB
ROUND ROBIN
JOURNAL DISTRIBUTION
THANKSGIVING
HEALTH CARE PROVIDERS
INTERVIEWS
JOURNAL COLLECTION
FINAL PRESENTATION
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CASE STUDIES
CASE STUDIES: WORREL DESIGN | 17
WORREL DESIGN
INSIGHTS FROM THE ER Worrell Design set out to observe in the ER to identify ways of improvement; nevertheless, after conducting their research they realized it was not about improving the ER because the ER was in fact already working well - but about taking the findings and insights and seeing if there was a better opportunity for design intervention. | Image from Worrel Design website: www.worrel.com
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| CASE STUDIES: WORREL DESIGN
orrell is a product design, strategy, research and development firm based in Minneapolis. Worrell was founded in 1976 by Bob and Judy Worrell and has a staff size of 21-50. As a firm that does alot of their work within the Healthcare industry, Worrell likes to observe in extreme situations to better understand and obtain insights. They looked into emergency medicine to look at the provision of care in a dramatic environment. Through ethnographic research they looked to see what emergency medicine was like from a variety of perspectives including those of health care professional and patients. Ethnographic techniques, such as observation and shadowing, strip away biases that the subjects could contribute through an interview or survey.
BACKGROUND: The design team identified a number of key insights that were both positive and negative. The main pros they saw in the ER include: - Trauma care is a rapid process and a
PROBLEM/ CASE QUESTION: 1. How can we learn and apply success factors from existing models of care to improve the patient experience? 2. What components need improving for better functionality in the ER environment? demonstration of care coordination. - Protocol helps manage crisis scenarios. At the same time issues such as proffesionals relying on patients to give crucial diagnostics are making the overall system less effective as many patients tend to exagerate and mis-communicate symptoms. Patients that call into nurselines are receiveing delayed care, as they have to spend 10-15 minutes giving basic information before a nurse can actually begin to help them. Worrel took these key principles of emergency health care and applied them to general medicine practices to attempt to reduce the unnecessary number of hospital
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| CASE STUDIES: WORREL DESIGN
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WE ARE AT A MOMENT IN TIME IN HEALTHCARE WHERE WE HAVE AN OPPORTUNITY TO RETHINK HOW WE SERVE PATIENTS” - KAI WORREL visits and better the patient experience. In their brainstorming session they had to rethink how healthcare professionals took care of patients, rediscover the patients role in the healthcare system, find ways to reduce hospital visits, give patients independence while maintaining nurturing relationship with care givers. In the end they defined their design criteria: - Technology based but still in keeping with human interaction - A solution that takes patients from defaulting into a predetermined category to going to the highest level of care without them leaving their home - How do health care providers fit into a system that patients want, desire and need?
SOLUTION: Worrell designed a 21st century kit: an inexpensive kit where patients can upload and show basic information as opposed to telling it. This kit acts as an interface to communicate with health professionals. The kit makes use of technology but continues the interactivity and human contact of healthcare. Worrell discovered a trend in the medical
industry: currently health is getting delivered at locations that professionals see comfortable and appropriate (hospitals, back of an ambulance, clinics etc) but in the future healthcare is going to get delivered with patients in a way that patients feel is appropriate. The company believes that a new relationship is going to build between patient and Doctor; while medical providers are going to remain key players, patients are going to play a larger role in the health system.
IMPLICATIONS: Worrell’s health aid kit can better diagnostics of health professionals because patients can show symptoms and are not just limited to telling them to doctors. Taking the tool into the home adds the value of conveniece; this convenience could result in happier and more patient consumers as they are no longer in an uncomfortable environment. Worrel’s kit takes away an element of frustration that is usually present when dealing with health professionals; patients tend to think that they are not getting heard. As the kit requires patients to input data for response every patient can feel like they are getting taken care of.
CASE STUDIES: WORREL DESIGN |23
KEY PLAYERS:
OPPORTUNITIES:
Patients Paramedics Doctors Nurses Hospitals
- This model of care can expand beyond Emergency Room application. Doctors can use the kit to communicate with patients who may be travelling or nurses could use to conduct basic examinations to determine if the patient should come in. - This kit extends beyond health; if all patients have such a product in their homes it can be used as means for emergency preparedness and a way to reassure that general public has basic first aid supplies in their homes. - Saved costs from unnecessary ER visits could get repurposed for improvement of facilities, further research or hiring of more personnel.
PROS: + reduces unnecessary hospital visits + patient stays in the convenience of their home without losing the care of a health care professional + nurse does not have to rely on patient for diagnostic
CONS: - technology based so if there is an outage the whole system fails - more man power needed at hospitals; some nurses on the floor while others are monitoring patients. - symptoms that cannot get measured through kit could be crucial in diagnostic and as data is not input could get overlooked
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THESE PRINCIPLES OF TRAUMA CARE INSPIRED US TO ASK THE QUESTION, IF THESE PRINCIPLES WERE APPLIED TO GENERAL MEDICINE, HOW COULD THE SYSTEM WORK BETTER ON BEHALF OF THE PATIENT?� - KRISTIN SHARDLOW
GAPS/MISSING COMPONENTS: - Kit acts only as a way to communicate with nurse but it could also act as a way for patients to keep a centralized documentation of all medical information. - Limited in the amount of tests you can do through the kit: there are blood works, blood pressure etc. that are commonly used for diagnostic. - There is a greater chance for mis-diagnosis of things because the information you show is limited. - Liability if the patient is sicker than can be seen through the kit and something happens. - Is there servicing for the kit? Make sure the instruments are taking measurements correctly.
Photo credits: All images from p8-15 are courtesy of Worrel Design and can be found on www.worrel.com
24 | CASE STUDIES: EVIVE HEALTH
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EVIVE HEALTH
ONE SIZE FITS ONE DATA Evive has become and industry leading innovator in designing personalized communication tools that motivate people to engage in important health decisions and activities. They bring simple presentation to complex data and information.
| Image from Evive Health website: www.evivehealth,com
26 | CASE STUDIES: EVIVE HEALTH
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vive Health was started in 2007 on a dinner napkin mapping out ways to increase engagement with the Healthcare system. Evive’s first idea was a Health reminder letter that approached patients with information they need to make appointments, where to make them and the reasons why they should make them. Evive’s initiative reformats the Heathcare industry from one focused on condition management to one of prevention, engagement and early
BACKGROUND: The challenge in health care today is consumer engagement. Only about half of patients get their recommended screening even though most are low or no cost. Employer and health plans want consumers to participate in certain programs and have certain visits to keep them healthy and reduce costs in the long run. Engagement requires one to one personal messaging not a “one fits all” mentality.
PROBLEM/ CASE QUESTION: 1. How can we get patients more involved with their health regimens? 2. Just having insurance and provided care does not mean consumers will make better choices. Most of the time patients don’t know what to do, when to do it or how much it will cost. Patients need to stay engaged to keep them healthy and in the long run save money. How it works: Data shows the what and the when of each patient. Evivie receives the data and creates custome care schedules. The personalization aspect comes into play when Evive delivers each patient the how and why of what they need; Evive suggests Doctors, programs and outlines the cost associated with all suggestions.
28 | CASE STUDIES: EVIVE HEALTH
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PERSONALIZATION IN HEALTH CARE HAS BEEN ‘DEAR MEMBER.’” - EVIVE HEALTH
IMPLICATIONS: Evive claims that their service “generates response rates 3-5 times that of traditional” health care communication. In the first year alone of Evive gettiing implemented into offices, adherence rates raise an average of 19%. These results show that lack of patient knowledge about what, where, and how much procedures cost are a barrier affecting preventive care visits. - Personal and more accessible presentations of information encourage action on the patients part. - Mass standards of health information are not getting through to consumers. Making suggestions to a broad demographic does not cause action because individuals do not know what the suggestions mean for them personally in terms of costs and reason. - Incentives can come in non-monetary rewards; patients are acting without people paying them to do so.
OPPORTUNITIES: Relatively speaking Evive is reaching a small portion of consumers as their entry point is by targeting employers. The model they have created can reach a larger population if they target large Doctors groups or even health insurance companies. With the
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American health system taking a shift to one of prevention and wellness, Evive has a major opportunity in expanding their services because Evive can also take advantage of advances in mobile technology and test various methods of delivering information to consumers. Different family members can get the information in the form they most prefer; email, text, push notification etc. By using these platforms, Evive can perhaps also reduce some costs in terms of printing and distribution.
GAPS & MISSING OPPORTUNITIES: - When reminders are sent to consumers, Evive could also include an up to date copy of medical history so the consumer always has them on hand. - Follow up with patients to see if they were satisfied with recommendations of facilities and professionals. This way Evive can address issues relating to incompatible doctor/ patient relationships by suggesting alternative options on the next reminder. - Sync with more than just insurance benefits covered by employer. A lot of households have a primary and a secondary insurance and often the secondary insurance covers remaining costs that the primary insurance did not cover. If costs are further reduced for consumers, this could provide an additional incentive to engage. - Do not just outline programs and groups offered through Employee health programs, recommend reputable programs in a
consumers community outside of the work environment.
PROS: + promotes long term cost saving + promotes health engagement + does not incentivize with monetaryrewards but with knowledge + personalized delivery of information + small work on the consumers part + increases health visits to the right places
CONS: - only available to employees whose employers are enrolled in Evive. - not available on a mass scale - no follow up if patient does not respond to Evive memos - only syncs with what your company benefits cover not personal coverage so if you have more than one insurance it does not tell you how they interact - reminders only come annually
KEY PLAYERS: Employers Evive Health Patients Health care provider: -Physicians -Onsite clinics -Wellness Programs -Health Coaching -Health Resources
Photo credits: All images from p16-21 are courtesy of Evive Health and can be found on www.evivehealth.com
CASE STUDIES: EMBLEM HEALTH |
EMBLEM HEALTH
WHAT CARE FEELS LIKE Emblem Health, like many other Insurance companies have undergone internal changes since the Affordable Health Care Act passed in an effort to promote more preventive wealthness habits.
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32 | CASE STUDIES: EMBLEM HEALTH
CASE STUDIES: EMBLEM HEALTH |
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mblem health is a locally based health insurance company whose mission is to help members stay healthy, get well faster and live better with chronic illnesses. With some 2.9 million members Emblem has undergone internal changes since the passage of health care reform legislation including investing in preventive care and wellness programs and incentive plans to boost member participation. EMBLEM: HEALTH AND WELLNESS Under that category of health and wellness, Emblem offers targeted programs, discounts and tools to members. POSITIVE ACTIONS TOWARDS HEALTH: 1. Wellness PATH: For: eligible members are EmblemHealth subscribers who receive benefits directly from employer not as a dependent - no additional costs - wellness coaching by phone or online
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PROBLEM/ CASE QUESTION: 1. How are insurance companies incorporating the notion of prevention and wellness? 2. What is the role of health regulation and government policy when it comes to health insurance companies? 3. Are companies supporting their customers with prevention and wellness options and decisions? - combines coaching with a health assessment tool that provides snapshots of your helath status and risks. 2. Healthy Beginnings PATH Program: For: pregnant mothers and babies - offered at no cost - provides tollfree 24 hour access to a maternity nurse, educational materials and a post delivery follow up
CASE STUDIES: EMBLEM HEALTH |
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- high risk cases receive attention of a dedicated nurse that call patients regularly to make sure everything is on track and they are keeping up with health visits etc. HEALTHY DICOUNTS: - savings on Weight Watchers, Jenny Craig, health clubs, vitamins etc. - weekly coupons from local stores and select online merchants - 25% on nutrition counseling OUTREACH PROGRAMS: For: members with chronic illnesses - nurse follow up calls and support - shows commitment to address fundamental needs of members HEALTH MANAGER TOOLS: - lets members take a more active role in their health with online self management tools - health risk assessment - personal health insights/reminders: personalized care guidelines and screening reminders - personal health record keeper
BACKGROUND: In 2010 the health care reform legislation passed triggered many insurance companies to evaluate their systems and plans. This legislation made The Affordable Care Act a law. As a result in the past year over 22.6 million people with medicare have received free preventive care benefits and even more have saved on prescription costs (healthcare.
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gov).The Affordable Care Act delineates patients rights and protections and employer and insurance responsibilities. In terms of preventive care the Affordable Care Act allows patients to get certain preventive services such as screenings, vaccinations and counseling at no additional costs (no co-payment, co-insurance or deductibles). The law also created a temporary program until January 2014 that makes health coverage available for people who have pre-existing conditions and have not had insurance for six months (PCIP).
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FOR MY FIRST PREGNANCY IT WAS SO HELPFUL TO HAVE A NURSE CHECKING ON ME AND TO BE ABLE TO CALL HER ANYTIME!� - TARA SZANDYBA-ALLEN KEY PLAYERS: Employers Consumers: Families and Individuals Labor Unions Health Care providers Government Retailers linked with the discounts
36 | CASE STUDIES: EMBLEM HEALTH
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IMPLICATIONS:
GAPS & MISSING COMPONENTS:
- Government involvement and promotion is necessary to change behaviors. - Financial costs remain a crucial factor in health care decisions - Individuals are responsible for their own health regimens but without the correct tools they cannot be expected to do so - Insurance companies are major players who can make an impact on changing consumer behavior; insurance companies will always be a consumer’s portal to information so it is important that they supply up to date, and beneficial lifestyle knowledge not just technical information about their coverage.
- While emblem is offering great tools, they are not accompanying them with an incentive to motivate members. Incentives do not have to be monetary but can simply be outlining what the member gets in the long term if they use the services. - Programs only touch the surface of preventive care and wellness.
PROS: + improvement in an existing established system as opposed to starting a system and reaching out to individuals from scratch + no added costs to consumers; in some instances costs have been lowered + better accessibility to preventive care
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HELPING MEMBERS STAY HEALTHY, GET WELL FASTER AND LIVE BETTER WITH CHRONIC ILLNESS – THAT’S WHO WE ARE” - EMBLEM REPORT
CONS: - costs not covered by insurance - tools are only available in physical stores; no take home resources - not available in all stores
OPPORTUNITIES: With the new focus on prevention, Emblem has the opportunity to expand their offerings and cater specific plans around prevention for a targeted age group. Photo credits: All images from p30-53 are courtesy of Emblem Health and can be found on www.emblemhealth.com
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| CASE STUDIES: WHOLE FOODS
CASE STUDIES: WHOLE FOODS |
WHOLE FOODS
WELLNESS CLUB Emblem Health, like many other Insurance companies have undergone internal changes since the Affordable Health Care Act passed in an effort to promote more preventive wealthness habits.
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| CASE STUDIES: WHOLE FOODS
CASE STUDIES: WHOLE FOODS |
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hole Foods Wellness Club is a club that educates, inspires and empowers individuals who want to live and make positive lifestyle choices. The club is a membership based community that offers coaching, education, cooking and a support system so people have the knowledge make long - term health and well-being decisions. All the tools offered to members not only indicate how to make these changes but also explain why the changes are beneficial and needed.
BACKGROUND Whole Foods Market is one of the Word’s leading retailers of natural and organic foods. The company’s goal is to promote healthy living and well-being by providing consumers with the highest quality food products. - no additional costs - wellness coaching by phone or online - combines coaching with a health assessment tool that provides snapshots of your helath status and risks. The program includes: 1. 10% discount on certain healthy food options at Whole Foods 2. Supper Club: discounted ready made healthy meal options 3. unlimited access to core classes: Classes range from nutrition, cooking and exercise to practical technique classes intended to offer support. 4. Cooking Demos and Community Events: unlimited access to demos and events including educational talks, inspirational speakers etc.
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PROBLEM/ CASE QUESTION: - Do people know how to lead healthy lives? - Do people have the information they need to make healthy choices? - How can non traditional “health” businesses make a difference in prevention and wellness?
5. Exclusive access to support meetings and private coaching
KEY PLAYERS: - whole foods inc. - consumers - employees - community
PROS: + operates with an existing network of people so ‘community’ is already established + incorporated into an existing reputable and successful infrastructure + community support and friendship so people can share their experiences + self sustaining
CONS: - costs not covered by insurance - tools are only available in physical stores; no take home resources - not available in all stores
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| CASE STUDIES: WHOLE FOODS
CASE STUDIES: WHOLE FOODS |
IMPLICATIONS:
OPPORTUNITIES:
- It does not have to be traditional medical organizations that make a change and affect consumer behavior. - Community is valued when making a change; when everyone around you is doing it it is easier for you to change. - Having all preventive services under one roof is an incentive and can result in more participation; exercise, nutrition, cooking classes and shopping are all under one roof.
- Whole Foods can also suply a natural remedies bar/ assistance for when it comes to sickness. This can add to this idea of everything under one roof. - They can implement a rewards systm with membership that gives you points for every event/class you attend. These points can then go towards your Whole Foods shopping trip. This point system would not only creative incentive and motivation but it would also reassure that members are shopping in stores and increases customer loyalty.
GAPS/MISSING COMPONENTS: - Not available in all stores; limited accessibility - Only one membership type; multiple should be offered to adapt to different needs - More promotion
Photo credits: All images from p38-43 are courtesy of Whole foods and can be found on www.wholefoods.com
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| CASE STUDIES: JAWBONE
MAIN TITLE: SUBTITLE | 45
JAWBONE UP
UP FOR IT? UP is a revolutionary system (wristband + iPhone App) that tracks your daily activity and inspires you to live a healthier life.
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| CASE STUDIES: JAWBONE
MAIN TITLE: SUBTITLE |
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awbone is a company addressing lifestyle incorporating technology. With their Up brand they are trying to tackle the wellness issue in today’s society by creating wristband that keep track of your health. The wristband is connected to the Up brand app. The goal is to track and measure your wellness in order to live a better life. Jawbone’s response to the question of how you make it convenient for someone to live healthy is a highly interactive product connecting real life to technology by wristband and by application to your cellphone.
PROBLEM/ CASE QUESTION: 1. Wellness and daily activity 2. How do you track your lifestyle success and how do you know what to improve? 3. How do you motivate people to do better?
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COMPONENTS OF APP & WRISTBAND - Sleep - Food - Exercise - Challenge - Friend
BACKGROUND: Jawbone, a company founded in 1999 by two Stanford students, creates products and services for the mobile lifestyle unparalleled in their innovation, ease-of-use and sophistication of design. They are committed to delivering innovative products that improve the mobile lifestyle through ever-changing software and wear-ability. The first product launched by Jawbone was a blueotooth headset that gained a lot of recognition. The newest innovation Up brand will embody the same attributes but targeting health and social lifestyle. The one factor that strongly supports the new UP brand is the fact that in today’s society you are required as a product
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SUBTITLE | MAIN CASE TITLE: STUDIES: JAWBONE or service to exist on a mobile device i order to matter.
KEY PLAYERS: The key players in this service is the individual and the company Jawbone. The interaction between the app and the person using the wristband will showcase and track your won data but also let you measure and challenge yourself in relation to your friends.
PROS: + Social aspect - including your friends in your challenges + Personalized to every individual + Discrete way to measure + The duality of application and wristband helps integrating the product into consumers life + Expanding the notion of health and wellness to more than “going to the gym three times a week” + Acknowledging sleep and movement patterns at work into a daily routine. Factors we might oversee from day to day
CONS: - Should be marketed to the outside urban areas where exercises doesn’t come as easy - Don’t separate drink and food categories, therefore a drink can replace one of the three daily meals - Application doesn’t let you view the separate fields - Application doesn’t let you pick from preset alternatives with food but asks you questions in relation to what you uploaded.
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A HEALTH DEVICE YOU ACTUALLY WON’T HATE TO WEAR.” - WIRED MAGAZINE - Too many ways to do the same thing
IMPLICATIONS: - The mobile device helps making the product relevant in peoples busy lives - The connection between friends and challenges on the device will motivate users to do better - The product is a part of a lifestyle and a mindset. It is not only an application. It needs to be integrated in your daily routine - There is a causation between doing better and the transparency of your progress
MAIN TITLE: SUBTITLE | 49 across all categories - Informational tools to broaden peoples perspectives regarding wellness - This technology can bridge the gap between active lifestyles and technology but only if the application allows the user to explore the serendipity of better-ness bY offering more tools and innovative ways to apply the tool in their lives. Rather than fitting the product into an already existing pattern, let it create its own.
OPPORTUNITIES: There are opportunities to expand the notion of wellness and add into the application by including ways to track medicines, such as vitamins, and ways you cook and eat your food. These small details can essentially determine how you feel at the end of the day and add an mental evaluation to the application. Furthermore, the app can target particular types of patients with IBS and diabetes to track their special lifestlye conditions and keep up with their wellbeing requirements.
GAPS/MISSING COMPONENTS: - There are a lack of consistent functionalities
Photo credits: All images from p8-15 are courtesy of Emblem Health and can be found on www.emblemhealth.com
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| CASE STUDIES: HEALTH VAULT
CASE STUDIES: HEALTH VAULT |
HEALTH VAULT
KEEP IT UP TO DATE! Health Vault is a consumer centric platform established by Microsoft to organize, store and share healthy information online.
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| CASE STUDIES: HEALTH VAULT
CASE STUDIES: HEALTH VAULT |
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record with Microsoft Health Vault stores an individual’s health information and gives access to this record is through a personalized account, which may be authorized to access records for multiple individuals. This allows a parent to manage a family account and keep track of the records for each of the family’s children or a son may have access to his father’s record to help the father deal with medical issues. Authorisation of the account can be through windows Live ID or a limited set of OpenID providers.
PROBLEM/ CASE QUESTION: 1. How can patients keep and centralized record of their health history? 2. How can patients and doctors share information electroncially in a way that does not limit patients to one doctor?
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DESCRIPTION - Track your medical records - Connect with medical providers - Keep all information to one place - Easy for consumer and transparency system with privacy regulations available
BACKGROUND: Created in 2007, Mircosoft wanted to track the consumers behaviors and allow them to be able to connect with health providers through one platform. This way you can as an individual keep track of your help and health under one consistent platform. When an individual first uses an Health Vault application, they are asked to authorize the application to access a specific set of data and those data are the only one the application can use. The application centers allows the health and fitness data to be transformed to the platform from different devices and this way yo u can record your progress and your personal record.
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| MAIN TITLE: SUBTITLE
CASE STUDIES: HEALTH VAULT | people coming together which can be hard convenient if successful. - Trust that information is secure - It is important to let the consumers track different part of health in different ways. Consumers shoul Can not be uniformed and too simple
OPPORTUNITIES - If a consumer form Health Vault would be moving countries an opportunity for Microsoft would be to create a system that could be transferable to multiple countries - Having a device which you could bring with you such as an tablet device that functions as a summery of all your activity. - If the information would be better applied without the consumers commitment to the account set up process.
GAPS/MISSING COMPONENTS KEY PLAYERS - Google announced in June 2011 that the Google Health will be discontinued as of January 1st, 2012, and has encouraged users to either download their data or to directly transfer it to Health Vault service before January 1st, 2013. - Consumers - Medical Providers - Insurance companies - Pharmacies personal record.
PROS + Targets different needs + Connects on many different platforms
+ Show different ways the system interacts in people’s lives
CONS - Doesn’t feel very personal and fun - need motivation - Do not entail a social aspect - Takes a long time to set up - access over platforms with different accounts - No transparency in benefits - No motivation or incentives to do this more than it being practical. Is that enough?
- Missing a social component that turns the fitness into something fun and can generate incentives - Mobile application that can work as a mobile medical record, being brought around to keep track of behaviors and patterns.
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THERE’S A PEACE OF MIND THAT COMES FROM KNOWING YOU’VE GOT YOUR HEALTH INFORMATION AT YOUR FINGERTIPS”
IMPLICATIONS - A system that requires many different Photo credits: All images from p8-15 are courtesy of Emblem Health and can be found on www.emblemhealth.com
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INTERVIEWS
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| INTERVIEWS: OVERVIEW
INTERVIEWS: OVERVIEW |
TALKING TO EXPERTS INTERVIEW QUESTIONS 1. How would you define preventive health? 2. Would you say there is a difference between health and wellness? 3. What would you say are the domains in preventive health? 4. In your opinion what are the top things people should do in terms of preventive health? 5. How do health and wellness play a role in the current health care system? 6. How do you see this changing in the future? 7. How would you describe the state of the current available preventive care options to the public? 8. How can you see government and insurance companies helping in preventive care? 9. What are the incentives for government to promote preventive health, if any? 10. What would you say are the drivers and key factors contributing to increasing health care costs? 11. Do you think that there has been a change in the way the public views health and
To gain more information about the health care industry and what is actually being done within the field of preventative medicine. We wanted to look at our topic from all perspectives to understand it better and identify areas of opportunity. While our ultimate goal is to see patterns in consumer’s attitudes and behaviors, speaking to experts from multiple fields in healthcare was a component we wanted to incorporate. We put together a general set of questions to lead these interviews (see opposite page) but ultimately the conversations with these individuals was determined by their relative fields of practice and how our conversation progressed. Despite the fact that the individuals were from different areas of health care various points and issues came up in all interviews. Thus far we have conducted 3 interviews:
wellness in the past ten years? Why? 12. Has there been a change to the approach of health and wellness in the health system system in the past ten years? How?
1. Miriam Laugesen: Public Health Researcher 2. Navid Rahman: Insurance Consultant 3. Melissa Wright: Medical Student
13. Where do you see a gap in health care services for the public? 14. Where do you see a gap in health information provided to the public? 15. If you could change any part of health care what would it be? 16. Do you think the health care system could be changed through design? How?
We have 4 contacts who we have reached out to and have agreed to talk to us; however, interview however scheduling did not allow us to have them done for this book. These individuals are: 1. Dr Terrence McCoy: Primary Care Physician 2. Dr Briana Sinatra: Naturopathic Doctor 3. Dr Drew Sinatra: Naturopathic Doctor 4. Ashley Wang: Student of Chinese Medicine
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INTERVIEWS: MIRIAM |
| INTERVIEWS: MIRIAM
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Hello! My name is Miriam...
MIRIAM LAUGESEN POLITICAL SCIENTIST
CURRENT: Public Health Professor & Researcher at Columbia University Miriam Laugesen is a political scientist. Much of her research is focused on the design and politics of physician payment policy. Her international health policy research explores public opinion on health care and cross-border health care. She also studies the costs and political determinants of regulations for mandated benefits, coverage expansions, public opinion, and cancer prevention policies at the state level.
KEY TAKEAWAYS - Primary Care physicians are getting underpaid and undervalued. - People are talking alot about preventive care but it really hasn’t happened. - No way to keep medical history and this has to change because people don’t know what they do and don’t have. This directly affects Preventive Care because if you do not know against what you have been immunized, or when you got a shot you do not know if you are up to date. - Design can intervene with an education campaign about vaccinations, environment changes to force people to make a change, find a way to keep medical records together. - Thinking in public health right now is around Active living; making tweeks in the environment to change calorie consumtion. - There is a alot of opportunity in health for design thinking and perspectives.
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INTERVIEWS: MIRIAM |
| INTERVIEWS: MIRIAM
TRANSCRIPT OF INTERVIEW WHERE DO YOU SEE OPPORTUNITY IN PREVENTIVE HEALTH? One of the major areas that people have been trying to prevent is fall prevention. Basically people falling, elderly people falling. And I don’t do research in this area but I do research on Medicare. I think there have been studies shown that basically people who fall usually die within that year, and nobody really knows why. It could be that people who fall are frail or it could be in the set change of decline. I don’t think we really know; however, it seemed like there should be a lot more attention to why people fall, how they fall and if there is any sort of product or intervention that could help prevent it. It could be really simple it doesn’t have to be complex. So I don’t know, this is the kind of segment you are talking about, I use more examples and you might want to choose one specific thing and do it more in depth. Because I think that’s the only way to give leverage on the question you’re asking. We haven’t actually come across fall prevention, that’s a really good insight. The survey we sent out to people focused more on exercise, eating, medication at home, like them going to pharmacies and taking OTC drugs and peoples habits on vitamins and supplements. It is more of what the survey is asking about and what the action is on.
Instead of trying to find out how people take that stuff, or why…
you can take a multivitamin and assume your helping anything.
Yes, like where they are going to get it first, how are they going to get it, how often they take them? their habits? Do they look at the instructions? We went to people medicine cabinets to see what they have, checking the expiration dates. How are they using the medicine, in conjunction with how they are using the vitamins, minerals and supplements. What is going on in terms of that? With health, more lifestyle things, sleeping habits, exercise, and eating. Pretty much asking them to write out menus. They get the journal for two weeks. So its tracking their habits over 2 weeks. Focusing on the age group between 18 and 35. This was the age group we chose to survey with the CDC. I don’t know if this is narrowing it down anymore?
We found a couple of studies that butt heads in that sense but we mainly brought it up because when we were talking about medicines people were bringing up the vit and supps, because people were seeing that as medicine.
Yeah I mean the use of supplements, the diet, did you mention exercise? (yes I did). These are also preventative strategies for rising diseases like cancer, not so much the supplements. I think one of the things we have to be careful is the evidence based, I don’t know if you have an hypothesis about vitamins and supplements, but im not sure that there is a great number of evidence based data out there that have shown to help people a great deal. I think theres a lot of findings that show certain things like calcium. Its kind of more like does a particular medicine do a particular thing. Its not like
So that came up in the context when you were exploring their health? Correct, but you bring up an interesting point saying that there may not be proof but a lot of people are thinking that it is making it better, then there could be an area of opportunity for us to educate the public that its not a necessary “medicine” in that sense. I think, I recall a study that came out a few weeks ago which said that took that vit were more likely to get cancer. So with all these studies I don’t encourage to get bogged down because people get very particular with their selection of treatment. So yeah anyway, I thought that maybe you were thinking that vitamins could be used to help prevent disease, im not sure they can. No that’s a very good point thank you. Right now in public health it is a very interesting time because people are talking
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about how to change the environment for people who live and work in the city. Consider educating them, preaching to them. To help them make healthy choices a lot easier. One area that I thought about it terms of design would be this whole area of research called active living. Where the Robert Wood Johnson foundation have sponsored and have information on their website about different issues surrounding active living. Things like opening up stair wells to make them more attractive or making elevators go slower so people have more of a tendency to take the stairs. Little tweaks like that. In the aggregate, things like that can really change the calorie consumption. So that’s the thinking in public health right now and trying to think from a design perspective. Making healthy choices is what it should be about. So youre looking at peoples habits, what sort of product would you want me to talk about just as an example? Well we’re looking at a lot of diff things whether its something to design for insurances to promote or whether its going to go into the general public. It’s a very broad spectrum right now. Whether its an individual product for a consumer, a service, letting our research lead this to see what seems to be the issue or how we can intervene and get in there. We are asking about insurance companies to see if they are affecting people somehow in terms of preventative habits. The survey is still out so we don’t get the journals back yet.
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| INTERVIEWS: MIRIAM
How many people have participated?
effective
There is forty people participating in the journal.
You are probably looking at things where the timeline is actually a bit shorter. This is the problem with prevention, things cant be assessed for sometimes fifty years so some people are not willing to invest in these preventative services. The payoff is too far away.
The one comment I would have about the age group, is what you have to do is kind of frame it because being 18-35 year olds has the most healthy population. Lower health care expenditure and lower healthcare services. They are not the most in need people, but it is important for them to develop good habits. Right, that’s what we were thinking, more of the way we ended up going. we were saying by the time you were forty five you would start getting the effects of things, so that’s the main reasoning for choosing the age group. R-seeing if there were certain behaviors or habits that we have that we learn as children and as adults might disappear the older you get. As soon as we reach independence we feel that some preventative habits might have gone away. We are looking at that shift which is why we started with 18. Also because researching with adults is a lot less obstacles with the school. The objective to doing your thesis is to develop a commercially available product that would be in demand, would be a preventative impact on the health? Yeah product/service/initiative/design interventions for environment/feasible/
There is more long term benefits as opposed to short term? Yeah. But if youre in the marketplace, you have to think of long term but you also have to think of who is getting the benefits. If an individual is paying for it and they are getting the benefits it makes a lot of sense, but someone else is paying for it they are not going to accrue the benefits. You would think that more people would want to spend money on their health, but its not that easy. Young people tend to think nothing will happen to them. they are the hardest group to get through to. WOULD YOU SAY THAT THERE IS ANY INCENTIVE TO GET THE GOVERNMENT TO PROMOTE PEOPLE TO DO MORE PREVENTIVE CARE? Yeah. If you were looking at NY, there is a lot of effort going into peoples health. And im trying to wrap my head around it still of what you are trying to get to?
Would you mind explaining to us a little bit more of what you do? I am doing the study of blue book administration of public health. Like transportation paths. It is not micro, more gross areas. Like where bike paths are, it would impact the market for bikes. The amount doctors are paid. Why don’t primary care physicians get paid as much as specialists? Those things have very little to do with preventive medicine. IN TERMS OF THE BLOOMBERG ADMINISTRATION HOW CAN YOU TELL US SOME OF THE THINGS THAT HAVE THEM INVOLVED IN HEALTHCARE IN GENERAL OR HAS THEM IMPROVING HEALTHCARE? I know they have an electronic healthcare initiative. We are focusing on prevention, but we are not focusing so much on the impact of prevention, just trying to figure out how they did it. Can you give us an example of something they’ve done? The trans fats ban, to stop using trans fat. It was a voluntary agreement and then eventually 100% compliant. It hasn’t been that easy in other areas. There are a lot of bakers. Usually when you have a policy, there is an agency that doesn’t want to see things change. You cannot notice the difference
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if someone is using trans fat or not in new York. Bloomberg is also getting different departments to work together to get more people thinking about health and improving it. It goes beyond the department of health. WOULD YOU SAY THERE IS AN AREA IN BLOOMBERG WHICH THEY ARE NOT TACKLING OR ARE GOING TO TACKLE OR HAVEN’T SUCCEEDED IN? That’s a great question. I think, well there is one area is with welfare food stamps. It limits the amount of sugary foods you are able to purchase. I am two minded about it, but I think it was paternalistic than the average policy. They were turned down for this idea. It was a slightly different policy and at the federal level was turned down. IS THERE AN AREA THAT YOU PERSONALLY THINK NEEDS IMPROVEMENT? Everyone is concerned about inequalities in health and disparity of treatment by race and its shocking. The diff between black and white. And that is something that isn’t being handled very well. How about in terms of health info or how public is educated about healthcare? I don’t think they know how much it costs. I think they are still very unaware of what everything costs. I think it would be a good
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| INTERVIEWS: MIRIAM
intervention to have more private information available. Private information in terms of how much its costing insurances and actual medical providers? Yeah, I mean to inform people that the $10 drug copay they just paid for is actually costing the insurance 1000 dollars. WE HAVE ANOTHER QUESTION THAT MIGHT BE MORE COMPLICATED TO EXPLAIN. NEITHER OF US ARE FROM THE US? HOW WOULD YOU EXPLAIN HOW THE HEALTHCARE SYSTEM TO A PERSON WHO IS NOT FROM THE US? HOW DOES IT WORK? I’ll try. I know less about Colombia but I do know a little about Sweden. Basically the government does not own a lot of hospitals, does not employ a lot of doctors. The providers are usually not for profit, in the case of hospitals. The physicians, who are often affiliated with hospitals are paid for each procedure. The government covers those who are poor, elderly or disabled. In order to get subsidized health insurance. Or belong to military. The private sector is by employer based health insurance which is people are covered mostly by their employer and it is very different than people who are covered by private insurance. This leaves 50 million people uninsured. That’s the main problem,
the other is prices are costly. There is not enough planning at the national level to address these issues. What would you say are the main reasons for these high prices? Cause of the chaotic system, it hasn’t really been kept in check, other countries have a heavier involvement in the HC system. In the private sector, people are allowed to charge whatever they want and overtime I believe that leads to chaos. And since we let the market dictate prices, the prices are rising while other countries regulate the drugs. No one is willing to step in and say we are not going to pay that much (in the US). For primary care physicians and specialists, why do you think that one is paid more than the other? The PCP don’t charge as much. They haven’t been values as much as the specialists. There are fees between the PCP and the specialist. IF THERE IS MORE PROMOTION IN THE PREVENTION HEALTHCARE DO YOU THINK THE ROLE OF THE PCP WILL BE MORE VALUED. DO YOU SEE A CHANGE? People talk about it but it hasn’t happened. It hasn’t happened yet there is a lot of support for it, but it will take some time.
WHAT ARE THE REASONS PEOPLE ARE VALUING PCP LESS AND WHAT DO YOU THINK PEOPLE SHOULD KNOW TO VALUE THEM MORE? Its good to have one person overseeing your different treatments. One thing I was thinking about was how when you’re a kid you have a really good record of your vaccinations, I was thinking about when you get older you don’t have a card to fill out anymore. So I have no idea what vaccinations I’ve had in the last ten years. If people don’t know how will they get what they need, or already have? People also don’t realize how much time it has been since their previous one. That is definitely something the 18-35 year olds can do is keep a record of their vaccinations. That is an interesting point you’re bringing up because we are interviewing a lot of internationals and they have no idea of their vaccinations so they don’t know where or what they’ve had. Most of them are sure they have had a vaccination more than once. Yeah. I would be interested in seeing what they have had and if they have gotten it again and collaborate with your findings. Yeah its interesting because we did a trial interview on my roommate who is also Swedish but grew up in the states. Sweden is more organized
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What you should do is look at each state, Ive done some work on HPV, and having a child and keeping track of the IM, having a card or online record to tract the IM and having the date. It should be something that when people turn 18 their child record gets transferred. It doesn’t have to be just vaccinations but also screenings. There is a device on the web from the CDC that has recommended screenings. When you bring in your kid they don’t ask you what vaccinations they’ve had. No they really don’t. but some schools make sure by requiring the vaccination records But also with the flu shot, it is possible to forget you got the flu shot. Just having a known record. They are working on electronic medical records. Say you are 19 and sexually active and come from a religious family. Confidentiality is still a necessity. I have a question cause you said its something that operates at the state level. Could you explain that? Controlled by state? I should know the details, basically the state has the special power police power which the fed gov cant tell states what to do. Fed gov can only do a certain amount. Each state has minor variations of what kids need. If we had a service for screening or medical records would it have to be different for every state?
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| INTERVIEWS: MIRIAM
No its fine, for adults there is no law to get vaccinated, but it can be updated and go across states. That’s just an idea. I just got my shot for tetanus and diphtheria after I changed doctors. My husband got whooping cough because he was in California and kids who were not vaccinated gave it to my husband and he got really sick. I didn’t get it cause I was vaccinated. His doctor should have also given it to him. You might have had a tetanus shot, but you really don’t know if it was five or fifteen years ago if you do recall it. I have a question there is a lot of debates about vacc, what are the most common misconceptions? That it causes autism. Flu shot gives you the flu? You could design an education campaign saying giving you the shot is not going to make you sick. Look up the stats of CDC but most people who die from the flu are old and frail. The young population can still get sick, there are consequences for not getting the flu shot. If you vaccinate one person how many other people can you be saving. Just another question about health and wellness, thinking about it ten years ago and in the future, has prevention in wellness changed at all in the healthcare system, has it gotten worse/better? They are trying to incorporate it more, no one knows how to change peoples behavior.
Will it really work is the question. Companies and employers are getting more interested in wellness cause of HC costs. Will anything change with these interventions? It will take time to tell. If you do something with vaccinations let me know because I would love to help out.
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INTERVIEWS: NAVID |
| INTERVIEWS: NAVID
Hello! My name is Navid...
NAVID RAHMAN
INSURANCE CONSULTANT
KEY TAKEAWAYS
CURRENT: Insurance Consultant at Aetna
- Preventive health is the entry gate to healthcare - you change that and you get the chain moving - To be successful, preventive care has to be appealing - you have to make the Apple of healthcare - There is a alot of opportunity in health for design thinking and perspectives. - 44 million uninsured and the majority are in mid 20s because they think they are the healthiest. - If the consumer had the money to spend they become better consumers - Make HSAs more appealing so consumer have more control of money. - People have changing perception of preventive health care because of information technology - Preventive care is beginning but ALOT of improvement is needed.
Navid Rahman is a Senior Consultant in the Technology Integration practice, with over five years of experience with Deloitte Consulting LLP. He serves clients in the Financial Services, Healthcare, Life Sciences and Public Sector industries. He has a background in biomedical research.
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| INTERVIEWS: MELISSA
INTERVIEWS: MELISSA |
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Hello! My name is Melissa...
MELISSA WRIGHT MED STUDENT
KEY TAKEAWAYS - Improvements in healthcare lie in getting more people to primary care doctors so they use less emergency facilities - Reorganization of the health care system with more of a focus on patient specific primary care (i.e. medical homes) to provide for more continuous care of a patient among providers and more efficient use of medical resources to treat patient. - There is information out there and enought of it but its getting put out in the world in an incorrect way; it’s easy to read a brochure about healthy eating, but much harder to implement it. - Our current healthcare system is very “health” driven. Do you have an abnormal lab value? Is there something we can see on a CT scan? While it is improving somewhat, there has historically been little role for patients’ own perceptions of wellness in our healthcare system.
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| INTERVIEWS: MELISSA
TRANSCRIPT OF INTERVIEW HOW WOULD YOU DEFINE PREVENTIVE HEALTH? To me, preventive health can encompass anything aimed at reducing the incidence or the severity of a disease process. Primary preventive measures like vaccines, condoms, a well balanced diet, and exercise all have the goal of actually preventing an illness – making sure someone never develops an infection, an STD, diabetes, or heart disease. But there are secondary prevention measures too. Things like prostate cancer screenings, PAP smears, and mammograms which all aim to catch disease processes as early as possible, before they cause symptoms, so that they can be treated early. WOULD YOU SAY THERE’S A DIFFERENCE BETWEEN HEALTH AND WELLNESS? I think it depends somewhat on who you talk to. To me they are a little bit different. Health is more about the physical state of your body while wellness is more about how a person feels. So someone who is obese with undiagnosed type 2 diabetes and atherosclerosis may feel perfectly well while his/her health is not actually so great. Other individuals may feel a lack of wellness despite no evidence of a health problem. WHAT WOULD YOU SAY ARE THE DOMAINS IN PREVENTIVE HEALTH?
Not totally sure what you mean by domains. Let me know and I’d be happy to answer. IN YOUR OPINION WHAT ARE THE TOP THINGS PEOPLE SHOULD DO IN TERMS OF PREVENTIVE HEALTH? Don’t smoke, eat a balanced diet, exercise moderately (even just walking), and see your doctor when something seems wrong (a person knows their own body best). HOW DO HEALTH AND WELLNESS PLAY A ROLE IN THE CURRENT HEALTH CARE SYSTEM? Our current healthcare system is very “health” driven. Do you have an abnormal lab value? Is there something we can see on a CT scan? While it is improving somewhat, there has historically been little role for patients’ own perceptions of wellness in our healthcare system. Functional disorders like fibromyalgia and irritable bowel syndrome that are devastating to a patient’s sense of wellness but have no identifiable causes and no corresponding laboratory or exam findings were once written off as “all in the patient’s head.” Certain disciplines are better at promoting wellness along with health. A lot of cancer centers are very focused on patients’ health and wellness. A multi-disciplinary approach is taken to treating the patient – the disease and the person are cared for with everything from chemotherapy to dietary
counseling to yoga and psychosocial therapy. HOW DO YOU SEE THIS CHANGING IN THE FUTURE? In general I think medicine is moving towards more recognition of the importance of health as well as wellness – the importance of how the patient views his/her own health, the importance of treating a patient not just a disease. It’s much better now then in was in the past and will continue to improve. HOW WOULD YOU DESCRIBE THE STATE OF THE CURRENT AVAILABLE PREVENTIVE CARE OPTIONS TO THE PUBLIC? Not great. There is a lot information out there – how to eat healthy, exercise is important, don’t smoke etc. However I don’t think that is always enough. Its easy to read a brochure about healthy eating, but much harder to implement it. There has definitely been improvement though. More states have special programs to help people quit smoking. A lot of large employers are promoting exercise programs and farmer’s markets. But there is still a lack of primary care options for the uninsured & underinsured, which limits preventive care options fro those groups. HOW CAN YOU SEE GOVERNMENT AND INSURANCE COMPANIES HELPING IN PREVENTIVE CARE?
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Insurance companies need to start by covering preventive care measures. Many insurance companies will cover big expensive life saving procedures but will refuse to cover earlier tests or small procedures that could potentially have prevented the later problem; they are betting on the fact that they may no longer be providing insurance to that individual by the time the big problem arises. The government is moving to universal healthcare coverage in order to play a bigger role in preventive care/getting people primary care. There is also going to be some changes to reimbursement schemes for Medicare & Medicaid to try and emphasize the importance of early preventative measures. WHAT ARE THE INCENTIVES FOR GOVERNMENT TO PROMOTE PREVENTIVE HEALTH, IF ANY? Saving money- it has been shown over and over again that health care costs go down if the money is used up front for extensive primary care and preventative measures. Then fewer super expensive tertiary care measures are needed. And there is the added benefit of having a healthier population. WHAT WOULD YOU SAY ARE THE DRIVERS AND KEY FACTORS CONTRIBUTING TO INCREASING HEALTH CARE COSTS? There is a lot of inefficiency – referrals to lots of different specialists unnecessarily,
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INTERVIEWS: MELISSA |
| INTERVIEWS: MELISSA
unnecessary lab tests and imaging etc. There is a lot of cost in pharmaceuticals – drugs are extremely expensive while under patent, particularly highly specific drugs like a lot of oncology chemotherapy. And there is a lack of investment in primary care and preventative measures – we end up paying for people to be on dialysis for years instead of working earlier to prevent or control diabetes and reduce the incidence of renal failure. DO YOU THINK THAT THERE HAS BEEN A CHANGE IN THE WAY THE PUBLIC VIEWS HEALTH AND WELLNESS IN THE PAST TEN YEARS? WHY? I think that the public is more invested in their own health and wellness. I think part of that has to do with increases in information. I think that the government as well as organizations like the American Heart Association etc. have done a good job (with the help of the internet) in increasing how much people now about their own health and thus putting some control in the hands of individuals to improve their own health and wellness. HAS THERE BEEN A CHANGE TO THE APPROACH OF HEALTH AND WELLNESS IN THE HEALTH SYSTEM IN THE PAST TEN YEARS? HOW? I think there is more and more of an acceptance of the importance of overall health and wellness in the prevention and
even treatment of diseases. I think access to things like dieticians and nutrition counseling, physical therapy, etc. along with traditional medical therapy is definitely increasing – although still mostly only in large health care centers, and typically only for individuals with complex and/or chronic health conditions, not as part of standard primary care. Medicine is moving to being more holistic and not just looking at health specific problems but how those problems fit into the context of a person. I did my senior thesis working with a chronic pain management group that used things like group counseling, yoga, and biofeedback to manage individuals with intractable chronic pain. We worked with the doctors providing medical treatment for the pain to try and improve the individuals’ wellness overall. WHERE DO YOU SEE A GAP IN HEALTH CARE SERVICES FOR THE PUBLIC? Primary care provision; there is a huge lack of primary care for certain groups of people (uninsured/underinsured). And there are huge regional disparities in general in terms of services and the quality of health care services. WHERE DO YOU SEE A GAP IN HEALTH INFORMATION PROVIDED TO THE PUBLIC? I think there are 2 extremes in terms of the gaps in health care information provided
to the public – on one end there are people who know very little, and have little access to primary care. They have a low level of medical literacy and often even if they get to the doctor they can’t understand the doctor’s instructions, or how to take certain medications or whatever. On the other end of the spectrum I think sometimes people have almost too much access to information. The internet allows people a lot of freedom to take their health into their own hands and have higher efficacy in terms of health care decisions; but it also can provide misinformation, which is a different kind of information gap. IF YOU COULD CHANGE ANY PART OF HEALTH CARE WHAT WOULD IT BE? Get people to primary care providers in an easier manner – so people stop using the emergency department as a primary healthcare source. DO YOU THINK THE HEALTH CARE SYSTEM COULD BE CHANGED THROUGH DESIGN? HOW? I’m not sure exactly what you mean by changed through design. I do think that there should be reorganization of the health care system with more of a focus on patient specific primary care (i.e. medical homes) to provide for more continuous care of a patient among providers and more efficient use of medical resources to treat patient.
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| MAIN TITLE: SUBTITLE
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CMOM OBSERVATION
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| MAIN TITLE: SUBTITLE
CMOM OBSERVATION: INTRO |
CMOM: BUILDING HEALTH EVERY DAY Eat, Sleep, Play is an interactive exhibit experience at the Children’s Museum that shows families how to live healthier lives. The exhibit was put together by a team of doctors, educators and designers and is based on the latest medical and behavioral research. The exhibit presents information as if it were teaching family skills to make healthy changes in their lifestyles. Each section of the exhibit is also accompanied with “tips” for parents to teach respective subjects to their kids. The exhibit has 5 overarching areas with multiple touchpoints within each area: 1. THE DECISION CENTER 2. CONSEQUENCES 3. THE SLEEP CENTER 4. PLAY CENTER 5. NYC GREEN CART In addition to the physical installation, the exhibit has classes and programs that run throughout the week. Classes vary from Yoga for Kids, to Family Cooking Demos. The exhibit is now recognized as one of the Let’s Move! Museums and Gardens and has received the seal of approval from Michelle Obama.
“
MUSEUMS INSPIRE US TO STRETCH OUR IMAGINATIONS, AND PLAY AN IMPORTANT ROLE IN EXPOSING AMERICANS OF ALL AGES AND BACKGROUNDS TO NEW IDEAS” - MICHELLE OBAMA
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| CMOM OBSERVATION: PRE-VISIT
CMOM OBSERVATION: PRE-VISIT |
WHY GO TO CMOM? 1. An example of a community initiative for preventive care. 2. Learning through children: - when you look at things at a simplified level it is easier to identify patterns. - how they teach children can be used to teach adults 3. Identify what habits are getting taught to children to compare with habits adults say they continue later. 4. See what medical professionals want to put an emphasis on.
RESEARCH QUESTIONS: Are there patterns of behavior? What are adults drawn to the most? What key takeaways does the exhibit want people to leave with? How are subjects getting taught to participants? How is the interaction between parent and child? What were the parents intentions for bringing their children here?
HOW WILL WE DO THIS? Interview parents & families. Go through the exhibit as a participant and read all material and play all games. Watch the exhibit and observe key individuals. Attend a class/program. Talk to employees.
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| CMOM OBSERVATION: THE LAYOUT
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THE LAYOUT
CONSEQUENCES
HEALTHY CHOICES
SLEEP
HEART
HEALTHY EATING EXERCISE
The exhibit is laid out in a very open space and combines one-on-one interactions with mass participation touchpoints. As mentioned the exhibit focuses on 5 overarching subjects which also divide the space. The spaces interact with each other physically to reflect how they play with each other in real life. For example the healthy choices section, which is housed in a giant brain and talks about perceptions and thinking, is at the center of the room and all the other sections revolve around it. Furthermore, the heart is strategically placed so it it neither in the center nor off to the side but linked to all other areas. The diagram to the left illustrates patterns of behavior that we identified through our observation. Upon entering the exhibit it was clear that the majority of people go to the left towards the food section as opposed to going to the exercise activities. While we asked employees if this is how it was intended to be, they did not know and had not realized the pattern. As you can see by the diagram the only section that adults and children are interacting together are the sleep and exercise sections. In the healthy choices section they are more mixed with each other but it is more of an observer-participant relationship. In the food section was where most adults were interacting independantly from their kids. What was also evident was that all the adults that were sitting down away from the exhibit seemed to be grandparents. Adult Child
ENTRANCE
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| CMOM OBSERVATION: THE DECISION CENTER
CONSEQUENCES
HEALTHY CHOICES
HEART
HEALTHY EXERCISE
ENTRANCE
THE DECISION CENTER Houses discover games and simple family routines that support and develop your brain’s ability to make healthier choices. The decision center was the area where the interaction between parents and children was limited to participant-oberver where the parent was the observer. Nevertheless, the decision center was the one section we felt was targeted at adults because of text heavy signs, complex information, high to reach and read interaction points and the game table in the center. - parent more of an observer - most catered to adults but children taking over - section with most text heavy signs - complexity of information
Photo credit: Image from www.cmom.org
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| CMOM
INTERACTIVE GAME TABLE
TIPS AND SKILLS
ADVERTISING MYTHS VS. FACTS
This was the most interesting touchpoint in the whole exhibit which gave you the most relevant and shocking feedback; however due to its placement we feel like it was not used to its full potential. The table is designed for adults because of the complexity of the decisions but the fact that it is placed in the center of the room, at a low level and is essentially a giant tounch screen attracts too many kids that adults cannot use it properly. The game breaks up choices by life stages and asks player to answer questions based on what they do currently or would do in certain scenarios. The questions have to be answered by dragging the respective answer flying across the table into its category. The game is timed so players do not overthink their decisions. Once it is done the table calculates your life expectancy and tells you which choices hurt you the most and which ones would of added more years to your life.
Tips and skills in this section were places very high and out of reach from children making us assume that they were targeted solely at adults. Tips included ways parents could teach their kids to make healthy choices, how they could explain decisions to them and how they themselves can change their habits.
This was a popular touchpoint among adults with virtually no participation from children The popular advertised items were placed on levers and when the lever is pulled down the fact about the item is revealed. Items included: cigarettes, chips, fries, soda, burger, and spaghetti.
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| MAIN TITLE: SUBTITLE
MAIN TITLE: SUBTITLE |
CONSEQUENCES
HEALTHY CHOICES
HEART
HEALTHY EXERCISE
ENTRANCE
THE SLEEP CENTER The sleep center was all about praising sleep and the role it plays in one’s overall health. The exhibition presents sleep as an invaluable component of leading a healthy life as it is one that cannot be replaced.
- only section where parents and children were interacting collaboratively - only section where parents were explaining things to kid - section that parents led kids to
Photo credit: Image from www.cmom.org
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| CMOM OBSERVATION: SLEEP
GERM INVASION GAME In addition to sleep facts this section has alot of pieces that talk about germ invasion. In particular, the interactive screen that worked along side panles of information displayed a story game about a boy named Chris who has to get to his music recital but germs are taking over his body. The rules of the game act as the means to explain how germs can get into your body and the journey the germs take to make you sick. The game is a number of Scenarios where you have to fight the gersm as they enter Chris’s body.
MAIN TITLE: SUBTITLE |
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| CMOM OBSERVATION: CONSEQUENCES
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CONSEQUENCES
HEALTHY CHOICES
HEART
HEALTHY EXERCISE
ENTRANCE
CONSEQUENCES Consequences section is primarily a giant digestive system that children can enter and follow nutrients into the body. It is named consequences because this area highlights everything that happens to your body after certain decisions are made. It covers the more literal consequences about going to the bathroom to the more complex ones about chronic conditions. The condequences section also houses the heart. - least adult interaction - area that was most physically constrained to children - area where most children were interacting
Photo credit: Image from www.cmom.org
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| CMOM OBSERVATION
MAIN TITLE: SUBTITLE |
INTESTINES
INTERACTIVE TOILET
The intestines are blown up and represented as a climbing frame and tunnel which children can crawl through. The sides of the tunnels are covered in intestine like patterns that light up as the germ passes through the small intestine into the large.
One of the touchpoints in the consequences section is an interacitve toilet. As you can see in the pictures above the toilet seat and whole is a TV screen and when the toilet is flushed the content on the screen flushes down the toilet and reloads new content. The objective of the interactive toilet is that it shows different types of feces and explains which are healthy and which show certain definciencies.
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| CMOM OBSERVATION
MAIN TITLE: SUBTITLE | 99
TYPE 2 DIABETES
EXERCISE BIKE
The exhibit uses specific models and explanation sections to connect two areas together. For example, the linkage piece between healthy eating and heart health is the type 3 diabetes stand. These knowledge columns cover the top chroncic problems in the US including asthma and obesity.
Next to the brain in the center of the exhibit, the heart is the other area that has a direct connection through ceiling tubes to all other components. The heart is portrayed half healthy and half unhealthy. The signage on the floor explains to visitors what causes the heart to turn that way. The model also has a turn lever that users can turn to activate the pumping and trigger the tubes to pump blood around the museum.
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CMOM OBSERVATION: EXERCISE |
CONSEQUENCES
HEALTHY CHOICES
HEART
HEALTHY EXERCISE
ENTRANCE
PLAY CENTER: EXERCISE This is the most hands on and physically demanding section. The activities focus on pedaling, dancing, running, bouncing, jumping and balance. Exercise equiptment is made for both adults and children sizes so everyone can partcipate. - section where adults were most annoyed that children were interrupting them - section where adults tried the most to win - balance game was most challenging so got the most adults to really concentrate Photo credit: Image from www.cmom.org
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MAIN TITLE: SUBTITLE | 103
EXERCISE BIKE Adults had alot to say about his exercise bike as it set the resistance and time accoring to the calories for the respective item you pressed on the button. We thought this was a great idea to indicate how many calories we have to burn. This was a piece we could see getting implemented in gyms with an interactive screen where you could select the foods you had eaten and resistance and time would get calculated.
104 | CMOM OBSERVATION: HEALTHY EATING
MAIN TITLE: SUBTITLE | 105
CONSEQUENCES
HEALTHY CHOICES
HEART
HEALTHY EXERCISE
ENTRANCE
NYC GREEN CART In this section families are shown the benefits of fruits and vegetable through the personofication of fruits and vegetables and creation of the “Super Sprowtz.” This section is the one most focused for kids but was also the section that most interested adults. Benefits of healthy eating are presented as super powers and bad guys are the consequences that come from not eating your greens. - section where adults were most drawn to and were interacting independantly - section adults found most interesting - adults read all material in this section
Photo credit: Image from www.cmom.org
106 | CMOM OBSERVATION: INTERVIEWS
107
FAMILY 2
FAMILY 1 I’M 8 YEARS OLD!
I’M 5 YEARS OLD!
I’M 6 YEARS OLD!
I’M 4 YEARS OLD!
INTERVIEW SUMMARY:
INTERVIEW SUMMARY:
WHY DID YOU COME TO CMOM?
WHY DID YOU COME TO CMOM?
“We came for openning of exhibit last week and spoke to Doctors who were having FAQ. I heard about the exhibit through some parenting magazine and saw that is was associated with Lets Move! We came back this week and became members for the months the exhibit is on so we can take all the classes.”
“Friends recommended it. This is our second time here we went to the cooking demo today and of course the kids played again” “My husband loved it! Wanted to make habit of healthy learning so then it would be easier to actually have healthy habits when the exhibit is over.”
“You are doing it with your child so you pay attention and do everything in your mind with them. I am going to take the classes and want to take them. I know they will be valuable because my daughter will make sure I am paying attention”
“Classes are not just lectures they let you play and as a parent you want to pay attention because they are interesting - there is no zoning out.”
“If we bring kids over and over for all the classes they will get something new everytime; one time visit is just like a day to the playground and we want them to get everthing out of it.”
IS THIS YOUR FIRST TIME? “No we are now members but it was the first time when we came for the exhibit last week”
IS THIS YOUR FIRST TIME? “No I came with my daughter for a birthday party last year when she was 4.”
WHAT WAS YOUR FAVORITE PART?
WHAT WAS YOUR FAVORITE PART? “I liked the food section the most, it was the most surprising.”
“I thought the brain section was the best in terms of interaction” “I personally loved the exercise bike...I want one like that at home (as she looks at husband)”
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CMOM OBSERVATION: KEY TAKEAWAYS | 109
WHAT DID WE FIND? RESEARCH QUESTIONS: Are there patterns of behavior? What are adults drawn to the most? What key takeaways does the exhibit want people to leave with? How are subjects getting taught to participants? How is the interaction between parent and child? What were the parents intentions for bringing their children here?
ARE THERE KEY PATTERNS OF BEHAVIOR? Yes there are obvious patterns of behaviors among the adults. 1. Adults are trying to do things but kids keep intervening which results with adults getting annoyed. This is particularly present in balance section and touchpoints that emphasize ‘play to win.’ 2. Parents continually butting in when children are playing games. This is especially true for touchpoints where the learner gets points; the child is just playing the games and doing things without caring what the outcome is but parents want complete concentration and want the kids to end up with a high score.
WHAT ARE ADULTS DRAWN TO THE MOST? -
fruits and vegetables reading material the truth behind advertising: pull down truth vs misconception levers balancing game and adult bike calorie windows
WHAT KEY TAKEAWAYS DOES THE EXHIBIT WANT PEOPLE TO LEAVE WITH? The principal message that is repeated throughout the entire exhibition no matter what section is the importance of making healthy decisions. The exhibit makes it a point to illustrate what bad decisions can lead to and why good decisions are needed both in the short term and the long term. The exhibit does a good job at visualizing the consequences and of bad decisions.
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| CMOM OBSERVATION: KEY TAKEAWAYS
Moreover, the exhibit is successful at linking all the areas and showing how they interact with each other; this highlights the idea that even if you make a bad choice in one area it ultimately affects all the rest.
HOW ARE SUBJECTS GETTING TAUGHT TO PARTICIPANTS? The exhibit personifies everything; germs, fruits, muscles etc. are all characters and their actions are adventures and capabilities are super powers. Pedagogically speaking the museum uses a very progressive teaching style by promoting participation and interaction. The idea of learning through play is an evident strategy and goal for the exhibit. Alot of the physical body interactions are targeted for children > intestines are jungle gym, things set at lower levels, food section is a climb and slide. On the contrary cognitive interactions and knowledge is targeted to parents > text heavy posters/ signs and screens are too complex for children to read, signs contain tips for parents on how to promote these healthy choices at home, supplementary explanations are set higher for an adults eye level (too high for kids). Nevertheless, both the physical and the cognitive are delivered in a method that requires interaction or play.
HOW IS THE INTERACTION BETWEEN PARENT AND CHILD? The interaction between parent and child varies depending on which section of the museum you are in: The sleep section is the one section where adults are leading children and the interaction with activities and subject matter is collaborative. The sleep section is the only section where the adult actually takes on the role of teacher and parent eventhough like the other sections, the section can get experienced independantly by a child.
CMOM OBSERVATION: KEY TAKEAWAYS |
111
In the healthy choices section in the brain at the center, the adults take on a spectator role and look on as the kids all play on the one table. The adults were making an attempt to try and play correctly and seemed very intrigued by the interactive table; however, the large amounts of children dominated the section and the adults were always forced to retreat. Throughout the rest of the exhibit parent and child seemed to go around independant from one another; while children played in physical structures the adults fled to nearby interactions and knowledge columns. Each individual got some knowledge in the way that they preferred.
WHAT WERE THE PARENTS INTENTIONS FOR BRINGING THEIR CHILDREN HERE? - The parents came because of reputation of exhibit but left wanting to come back to actually so the information would stick in the children’s minds. - They brought them because they wanted to come themselves. - It made for a good day out; educational fieldtrip. - They wanted to start instilling healthy habits in their children’s everyday life and they thought the best way to do this was to start by making it fun - here they don’t think we are nagging them because they are playing. - They came because it’s a great way for adults to learn as well; if they went to an adult health seminar they predicted and assumed it would be boring.
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SURVEY JOURNALS
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| SURVEY JOURNALS: INTRODUCTION
SURVEY JOURNALS: INTRODUCTION |
115
SURVEY JOURNAL OBJECTIVES: 1. Narrow down which element of preventive care to explore indepth. 2. Find where the main issues lie in terms of consumer habits and attitudes.
my lifestyle jour
nal
no.
In order to find out where the gaps and misconceptions about preventative health were rooted we distributed a survey journal to 40 subjects in the New York city area, between the ages 18-26 and 26-40. The goal was to understand where the problem lied so we could continue to explore more and narrow down our research. The journal contains 80 multiple choice quesions, 4 charts/ menus/fill ins, 9 fill in scenarios and 39 truth and misconception questions.
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| SURVEY JOURNALS: SPECIFICS
UNDER 15 15-24 25-44 45-64 65+
SURVEY JOURNALS: SPECIFICS |
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THERE IS A DECREASE IN HEALTH INVOLVEMENT BETWEEN THE AGES 15-24... SPECIFICS
994, 321 TOTAL VISITS (IN THOUSANDS) * data obtained from latest published CDC figures (2007 year)
Before creating the questions and methodology we created a sample group for our study. Our target participants fall between the ages of 18-40. We chose this age range because it is seen as the time of life where your habits and choices influence your future health. 18 is the age when you officially break out on your own and take responsibility for your life and after 40, you start to experience the consequences of your younger years. We divided this age group into two: the younger group 18-25 and the older group 26-40. We used non probability sampling, specifically a combination of convenience sampling based on accessibility and
accessibility to the subjects and typical case sampling where we selected cases to we knew would be helpful in the process. Our sampling group was limited to the NYC area. We handed over the journals in person at which time the signed a data release form ans we collected there contact information. Initially the plan was to let each subject keep their journal for one month and we would check in with each at the two week mark; however, due to a set back with the IRB, the subjects only got to keep the journals over 2 week. Nevertheless, many of the subjects turned complete surveys back to us before the two week period was over.
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| MAIN TITLE: SUBTITLE
SURVEY JOURNALS: SPECIFICS |
BREAKDOWN OF PARTICIPANTS:
MALES = 14 FEMALES = 23 40 DISTRIBUTED 37 COMPLETED
18-25 = 22 26-40 = 15 AGE RANGE = 19 - 40
While initial distribution was equal, guys were less willing to participate and 3 returned journals unfinished.
WHAT DID WE ASK: 1. EXERCISE: Habits Attitudes & Thoughts 2. FOOD: Eating Habits Cooking Habits Shopping Habits 3. LIFESTYLE: Hobbies Employment Social Life 4. TRUTHS AND MISCONCEPTION: Health fact vs. Truths
5. CHILDHOOD VS. ADULTHOOD Habits when younger Habits when older Changes 6. HEALTH HABITS Medicines Supplements Doctors Visits 7. SICKNESS What do you do? Medicines Habits How do you know?
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SURVEY JOURNALS: RESULTS |
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RESULTS We have received most of the surveys completed and have analyzed the results on the surface. As the journals are extensive we have alot to look at and really have to take a closer at the qualitative indormation. However, just by grazing the surface there are patterns and opportunities that we are identifying.
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| SURVEY JOURNALS: RESULTS
SURVEY JOURNALS: RESULTS |
LOOKING AT RESULTS:
N
A
WHAT IS YOUR PLAN OF ACTION WHEN YOU GET SICK?
B
M
The most interesting results we received from this question was the fact the people do not really factor a doctor into their action plan. While some added it to their action paln as step 8/9/10 the majority did include it in the things they do. Majority of people, as you can see by the diagram, take off work, eat more vegetables, dress warmer and slow down their routine.
C
A = I GO VISIT A DOCTOR
L
D
B = I GO TO WEB MD AND SELF DIAGNOSE C = I GO TO THE PHARMACY D = I CONSULT MY PHARMACIST
K
E
E = I GO TO AN EMERGENCY CARE CLINIC F = I GO TO THE EMERGENCY ROOM G = I GO SEE WHAT I HAVE IN MY MEDICINE
J
F I
H
G
H = I SLOW DOWN MY ROUTINE AND TRY TO SLEEP MORE I=
I EAT MORE VEGETABLES
J=
I TAKE VITAMINS
K = I TAKE OFF WORK L = I DRESS WARM M = OTHER N = OTHER
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| SURVEY JOURNALS: RESULTS
SURVEY JOURNALS: RESULTS |
How do you know what to take when you are sick?
Think about the past month (Last 30 days) How many different prescription drugs have you taken?
I take medicine I am familiar with from childhood/TV
None
1
I ask a friend or a family member
2
Ask Pharmacist
I look it up
3
I dont know
I just know
Doctor/Nurse/specialist tells me what to take.
Once you have already used a nonprescription medicine for which of the following reasons would you read the Label again? When giving the medicine to a child
5
6
Whether you visit the doctor or no. Do you have a primary care physician? Yes
If you are thinking about taking a nonprescription medicine at the same time
No Check for direction of use
I have one but not in NYC If you have not read the label in a long time I have one but I never actually see them To check for expiration
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SURVEY JOURNALS: RESULTS |
over the past six months have you taken a nonprescription medicine for any of the following?
over the past six months have you taken a nonprescription medicine for any of the following?
Pain relief
Pain relief
Cough, cold, flue or soar throat
Cough, cold, flue or soar throat
Allergy or sinus relief
Allergy or sinus relief
Skin Problem
Skin Problem
Heartburn, Indigestion, stomach problems
Infections such as Theltes Foot or yeast infections
Constipation, diareea or gas
Heartburn, Indigestion, stomach problems
Infections such as Theltes Foot or yeast infections
Constipation, diareea or gas
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SURVEY JOURNALS: RESULTS |
On a scale of 1-10 How bad do you have to feel to visit a health care professional?
Have you ever taken more than the recommended dose of a nonprescription medicine? Yes
1
No 2
If yes thinking about the last time you did this Why did you take more? Did not get any better taking the recommended dose
3
4
5
Had severe symptoms
6 Had taken the prescription version of the medicine previously
7 Believed would bring relief more quickly
8
9
10
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SURVEY JOURNALS: RESULTS |
KEY FINDINGS SO FAR - Most if not all people really enjoyed journals, found them entertaining - Proved one of our assumptions that it was not about lifestyle habits but medical/wellness habits - Majority of people lead healthy lives: 88% exercise regularly, everyone ate at least one serving of vegetables a day, food habits tended to be balanced, there was rarely any junk food mentioned. - However people do not really have primary care physicians - 18-26 year olds mainly students have the most extreme habits (ones that sleep the least, don’t take vitamins, eat the worst) - 50% of people had been to the doctor in the past year > most of these people were 26+ and were people who had grown up internationally - Everyone went to the doctor when they were younger 38% went to the doctor no matter what every year when they were younger (physicals) - People were conscious of unhealthy habits: eg notes were written to us saying “I know this is bad” - 66% of people believed or were not sure if the flu shot could give the flu (#1 misconception) - 88% of people no longer continue health habits they learned about or did when they were younger. (majority of people stopped when they got to college 13) - Doctor is the last resort when sick - Do not go because it takes too long, inconvenient appointment times and I have to take off work. - Biggest wish of people from doctor – teach me what I can do and have more of a personal relationship (not all symptoms and diagnostics)
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MEDICINE CABINETS
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| MEDICINE CABINETS: RESULTS
MEDICINE CABINETS: RESULTS |
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PRESCRIPTION
NATURAL REMEDIES MEDICINE CABINETS NONPRESCRIPTION
WHAT DO YOU DO....
In order to understand people’s behavior when it comes to using medication in their everyday life, we decided to conduct various home visits to look at medicine cabinets. We asked each subject to tell us about each medication they had. We looked asked when it was purchased and looked at the expiration dates to see if this was something the subject was aware of. Additionally we asked the subjects basic questions about what they do when they cut, burn or get a fever. Present in our result was that many of our subjects didn’t categorize many of the medication that they had at home as actual medicine. We had to ask about categories in order for them to remember their daily routine. Additionally very few owned a scale or a thermometer but did know where the closest hospital were located. Most surprisingly was that no one kept track of their medical records.
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| MEDICINE CABINETS: RESULTS
MAIN TITLE: SUBTITLE | 137
CHECK LIST THERMOMETER MEDICAL HISTORY SCALE FIRST AID KIT
FEMALE 23 New York City Assistant Manager
Total Medicine: 13
Food Industry
Expired: 3
International health insurance
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| MEDICINE CABINETS: RESULTS
MEDICINE CABINETS: RESULTS |
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INVENTORY 1. Bafucin Troath number
6. Eukalyptus Melsan Inhalt 10 ml
Expiration date 10/2011
For sleep - puts on pillow. Does it since
Instructions: Let it melt slowly 4 times a day
childhood and it keeps nose unclogged uses only when nose is clogged
2. Swedish medicine for soar throat. Itnumbs soar throats and she has been using it since
7. Caltrate 600 D
high school. Follow the instructions, each time she has a soar throat.
8. Calsium plus Vitamine D supplement Experation april 2011
3. Yasmin 28
Taking since she was 11. Dad made her take
Etinylestradiol Drospirenon 3 mg
it b/c she doesnt eat enough always does
Expiration 06/2013
cendrum brand for calcium
Instucion: daily 9. Centrum 4. Resorb dehydration
Multivitamin
Experation sep 2013
From a to zinc
5 Tobramycin ophthalmic Solution USB, 0,3 %
10. Kirkland Signature Omega 3, Fish Oil 100
Experation date 03/28/12
mg Experation 03/14
Antibiotic eye drops. Got eye infection in
Instuctions: two pills daily
march 2011. Kept it because she knows
Parents introduced to her and she was
symptoms so next time she gets it she can
deciding over her own diet so she felt she
use them; saves her the trip to the doctor and
should concentrate on getting a full, well
the money to buy more medicine
rounded diet food was of more interest to her because it was when she started cooking
140 | MEDICINE CABINETS: RESULTS
MEDICINE CABINETS: RESULTS | 11. Cough Supresant Delsym 12/2011 Bought last winter b/c she had a cough and couldn’t sleepwalked into target helped herself to somehas not taken since, would not normally have 12. Halls Defense Vitamin C troath ache 13. Ibuprofen Tablets 200 mg old bottle new pills Instructions: Not more than 6 tablets a day
WHAT DO YOU DO WHEN ... Cut : wash hands thou roughly and dry with paper towel Burn: at this point i ignore it but often I run it under cold water, aloe vera helps Fever: ill take an ibuprofen or sleep it off and rest Soar throat: medication
“
I SNEEZE A LOT THE DAY BEFORE I GET SICK. I EAT HEALTHY, DRINK A LOT OF LIQUIDS ETC. BUT BY THE TIME I AM SNEEXING IT’S TOO LATE.
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MAIN TITLE: SUBTITLE | 143
CHECK LIST THERMOMETER MEDICAL HISTORY SCALE FIRST AID KIT
MALE 24 New York City Consultant
Total Medicine: 4
Financial Industry
Expired: 0
American health insurance
144 | MEDICINE CABINETS: RESULTS
MEDICINE CABINETS: RESULTS |
INVENTORY 1. Epidual Gel 0,1 % / 2,5% ( Adapalene and benzoyl peroxide) No expiration date. Did not keep in the box. Says he replenishes when tubes runs out so about one in every 4th month. WHAT FOR: for my skin WHY: prescribed by dermatologist HOW LONG: for 2-3 years HOW MUCH: topical cream...a little I do not use that much cream 2. Astepro 0,15 % 3 oml Expiration date 11/2012 WHAT FOR: for asthma and allergies WHY: prescribed HOW LONG: 10 years HOW MUCH: when needed I just spray it and you know what comes out is the amount 3. Propercia 1 mg Refill again 09/19/12 got it 10/20/11 WHAT FOR: hairloss WHY: prescribed from general doctor HOW LONG: couple of years HOW MUCH: every day
145
4. Solodyner 65 mg tablets Make 1 tablet melt by mouth every day Expires 09/19/12 WHAT FOR: for my skin WHY: prescribed by dermatologist HOW LONG: coupld of months
WHAT DO YOU DO WHEN ... Cut : get a bandaid, wash it off, maybe some neosportin Burn: put finger under cold water Fever: Drink alot of water and take Tylenol and sleep Soar throat: medication
“
I BUY NYQUIL AND DAYQUIL WHEN I NEED IT BUT I DO NOT MAKE A CONSCIOUS EFFORT TO MAKE SURE I HAVE SOME IN STOCK”
146 | MEDICINE CABINETS: RESULTS
MAIN TITLE: SUBTITLE | 147
CHECK LIST THERMOMETER MEDICAL HISTORY SCALE FIRST AID KIT
FEMALE 31 Chicago Police Officer
Total Medicine: 5
Army
Expired: 2
American health insurance
148 | MEDICINE CABINETS: RESULTS
MEDICINE CABINETS: RESULTS |
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INVENTORY
3. Day quil and niquil pack
1. Protein Powder
Expiration date: 08/2013 (for both)
Expiration 7/2013
FOR: bad cough, cold, runny nose, sore throat
FOR: for extra vitamins and proteins
and cough
HOW MUCH: 5 days a week after going to
HOW MUCH: what it said on bottle (I normally
gym
just take recommended dosage)
HOW LONG: started a month ago
HOW LONG: I just bought it when I got sick...
WHY: a guy at the gym suggested because I
maybe used it a couple of times before then
am not seeing any physical results so he said
too
i’m probably no getting enough protein
WHY: I was sick and I recognize those brands
SAME BRAND: no whatever is on sale and
- parents gave me cough medicine when I
available where I am at the time shopping
was younger so I automatically look for similar brands when I am sick
2.Multivitamins for women
SAME BRAND: no whatever is on sale and
expiration: 4/12
available where I am at the time shopping
Bottle of pills: no box, directions on bottle FOR: everyday supplement for regualr bodily health
4. Bottle of Dimetap (liquid)
HOW MUCH: 2 pills per day
Expiration date 9/2010
HOW LONG: since teenager in college (19) I
FOR: night time version of cold and flu pill,
took vitamins but stopped taking regularly
more for cough
when I was deployed
HOW MUCH: whenever i get a sore throat
WHY: started taking again because of
HOW LONG: since kid
suggestion from physician. First time I went
WHY: something my parents gave me when I
to Doctor for a cold was last year because I
was younger every time I had a cold
coughed so much I actually cracked a rib
SAME BRAND: no whatever is on sale and
SAME BRAND: no whatever is on sale and
available where I am at the time shopping
available where I am at the time shopp
150 | MEDICINE CABINETS: RESULTS
MEDICINE CABINETS: RESULTS | 5. Walgreens cold and multi sympton (pill) expiration: 9/10 FOR: runny and stuffy nose, cough, I use more for nose though HOW MUCH: 2 - 3 times per year HOW LONG: since I was a kid WHY: bought with dimetap but used these at work because pills are easier than liquid while on duty SAME BRAND: no whatever is on sale and available where I am at the time shopping
WHAT DO YOU DO WHEN ... Cut : nothing i wash it...if I have a band aid I guess Ill use it but the normally don’t stay on Burn: dont really do anything make sure nothing is on it, occasionally put ice cube on it because it feels good Fever: nothing just let it be
“
I NORMALLY GET COLDS 2 TIMES PER YEAR: GENERALLY IN FEBRUARY AND NOVEMBER”
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| MEDICINE CABINETS: RESULTS
MAIN TITLE: SUBTITLE | 153
CHECK LIST THERMOMETER MEDICAL HISTORY SCALE FIRST AID KIT
MALE 27 Chicago Police Man
Total Medicine: 9
American health insurance
Expired: 5
154 | MEDICINE CABINETS: RESULTS
MEDICINE CABINETS: RESULTS |
INVENTORY 1. Extra Strenth: Non Aspirin Pain Reliever (pills) Expiration date 9/1997 Bottle of pills: instructions were non legible on bottle WHAT FOR: I do not know what this is for I have never used it WHY: i did not buy this my mum gave it to me when I went to college. I do not like to throw things HOW LONG: N/A HOW MUCH: N/A 2. Suphedrine PE Sinus and Allergy (pills) Nasal Decongestant Expiration date 8/2011 Box of pills, instructions on box but instruction paper no longer there WHAT FOR: when my sinus’s are dripping...I feel it and it is annoying WHY: my dad started giving them to me when I was younger HOW LONG: 10-12 years HOW MUCH: one pill when I feel symptoms... max 4 pills a day
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3. Tylenol Cold Expiration date 11/2010 Just pills no packaging, no instructions WHAT FOR: when I get a cold than I describe as severe: when I feel a tickle in my throat then I wait three days and then I take it. I do not like to take medicine unless I really have to WHY: again my mother HOW LONG: I can’t remember, I’ve know i’ve been using this since I have been in this place (3years) HOW MUCH: one of the packets = two pills 4. Multivitamin/multi mineral 400IU Vitamin D3 Expiration 03/2013 WHAT FOR: vitamins for health...I do not actually know what they are for you are just supposed to take vitamins WHY: my mum gave them to me and tells me to take them. I do not restock she restocks for me I tell her when I am out...or she asks and I go oh yea I am out. HOW LONG: since junior high HOW MUCH: one every morning with breakfast
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5.Advil Liquid-Gels
7. Protein Powder: Wrey Protein
Expiration 7/2010
Expiration 7/2013
WHAT FOR: headaches
WHAT FOR: to get protein and maintain
WHY: because they are a reputable brand and
muscle. Take with milk, ice and tablespoon of
liquid gels slide down my throat easily
peanut butter
HOW LONG: since high school
WHY: suggested by gym buddy ryan he is
HOW MUCH: 2 per taking
qualified to tell me because he is an air traffic controller
6. Complete multivitamin
HOW LONG: 13 years
Expiration 6/2011
HOW MUCH: once a day, go through it in 30-
WHAT FOR: vitamins for health...
35 days
WHY: my mum gave me an extra bottle last
I buy my supplements online
time I saw her HOW LONG: haven’t started these will replace
8.Weight Gainer: Mass Peak
the other ones when I am out
Expiration 7/2012
HOW MUCH: one every morning with
WHAT FOR: to gain weight
breakfast
WHY: replace nutritional meals, HOW LONG: 7-8months
WHAT DO YOU DO WHEN ... Burn: run it under water
HOW MUCH: once a day with milk, peanut butter and ice, sometimes mix with protein I buy my supplements online
Fever:rget under alot of covers until it breaks
“
I DO NOT GET THE FLU SHOT, ONLY GOT IT PREVIOUSLY WHEN REQUIRED IMMUNIZATIONS WERE MADE FOR SCHOOL”
9. Creatine: dietary supplement Expiration 1/2013 WHAT FOR: make workouts last longer so you dont tier out as quick WHY: i saw it when I was shopping for regular protein powder and had good reviews HOW LONG: 8months HOW MUCH: take if every other month, take it everytime before I work out at least 6x per week
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MAIN TITLE: SUBTITLE | 159
CHECK LIST THERMOMETER MEDICAL HISTORY SCALE FIRST AID KIT
Total Medicine: 33 Expired: 2
FEMALE 45, 21 MALE 47, 23 New Jersey American health insurance
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MEDICINE CABINETS: RESULTS |
INVENTORY 1. Clindamycn phosphate benzoyl peroxide gel expiration: january 2013 prescription FOR: he got hair transplant so they gave him this to sanitize area where they did transplant HOW MUCH: I bought it 8 months ago because I burnt myself cooking HOW LONG: using it for past month 2. Doxycycline-hyclate prescriptions expiration: nov 3 2012 FOR: related to hair transplant 3. Crestor (DAD) expiration: july 2012
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FOR: allergies Started taking and stopped again. HOW LONG: for like a couple of days 4. NEXIUM (prescribed) expiration: april 2012 given april 2011 FOR: sick can’t remember what i had 5. Campho-phenique antibiotic prescribes expiration: june 1993 FOR: pain reliever for scrathches and bruises not really used but still kept - i think we forgot about it and we dont throw things out just incase someone may need it again someday.
HOW MUCH: 1 a day HOW LONG: got it in summer but I took it for 2 weeks and stopped WHY: prescribed
6. Scarzone burn gel expiration: non available (no longer with box) FOR: I bought it 8 months ago because I burnt myself cooking
4. QUALAQUIN (DAD)
HOW MUCH: put on 2x a day for 5 days
expiration: july 2012
Used ⅚ times
FOR: pain
good to have
HOW MUCH: 1 a day
not partial to brand...but she is partial to name
HOW LONG: got it in summer but stopped
brand rather than generic brand (unless it was
taking it
something I really didn’t care about
WHY: prescribed
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7. Pepto bismol (pill)
9. ROrajel (mother and sister occasionally)
expiration: november 2010
expiration: non stated
FOR: when my stomach bothers me,
FOR: mouth sores
constipation, diarrhea, pooping needs, when I
BRAND: usually buy gel kind but didnt have it
feel my stomach is going to explode
last time so she bought discs
I use pill because i think liquid it gross. My
HOW LONG: been using it more recently b/c
brother always uses the liquid.
of surgery but has been buying it for 5-7 years
HOW MUCH: follow directions (2 day)
HOW MUCH: use 2 times a day
HOW MUCH: follow directions (2 dat)
WHY: side affect of antibiotic (canker sore)
WHY: brand my mom buys so I just use it. She
caused by stress. Just bought because it is
in general stocks things up (the basics)
well known brand
SAME BRAND: same 10. allergy tablets (CVS) - unopenned 8. Nasonex (spray)
expiration: jan 2013
expiration: october 2012
FOR: dad and brother for allergies
sample from doctor
brother uses it: bad sore throats and runny
FOR: chronic bronchitis
nose
HOW LONG: using it past 5-6 years
when seasons changing he gets bad allergies
BRAND: yes prescription but sometimes
HOW LONG: 10 years
interchanged with Flonase
BRAND: either CVS brand or benedril
HOW MUCH: 2 sprays 3 times a day
depends on
obitusson cough and chest decongestant
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11. Joint flex expiration: unavaible (maybe came in box no longer in box) FOR: pain relever for joints (mum > for knees, dad > acute arthritis in hands and he shattered his elbow a vouple of years ago HOW MUCH: whenever I need it HOW LONG: dad for a while ( 8 years) mother: past couple of months because of injury WHY: went to pharmacies and bought it BRAND: yes usually same brand but it dad is buying it will just be cheaper (he has no brand loyalty) 12. Aleve liquid gels expiration: april 2013 FOR: headachesHOW MUCH: instructions (mother) sister (1 per doage) dad: goes crazy because he thinks that the more you take the faster it will wor he also thinks that because he is a bigger guy HOW LONG: 4 months WHY: stocked up pretty regularly BRAND: use to buy large bottles of advil but in the past 4 months my parents have switched to aleve because it is supposed to be better for headache.
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13. Walgreen hydrogen peroxide expiration: july 2013 FOR: sanitizes cuts...but brother uses it for hair thing HOW MUCH: follow directions (2 pills once a day) HOW LONG: since he got surgery 14.. Vaseline expiration: non available FOR: chapped lips in winter mother: to put earrings on HOW MUCH: every night before you go to sleep HOW LONG: bought 3 weeks ago...since I was a baby WHY: my mother used it and passed it on to me BRAND: always same brand > my grandmother used it, my mother used it, etc.
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15. Fish oil
18. Kirkland premium performanace multi
expiration: february 2012
vitamins
FOR: vitamin taken by mother and brother for
expiration: september 2013
heart health
Brother and mother use
HOW LONG: past 2 years
FOR: daily supplement for health
HOW MUCH: pills 2 a day (with breakfast)
HOW LONG: i used it alot when first bought
BRAND: finest natural but there is not
HOW MUCH: one pill a day (in the morning)
preference for brand > whatever is cheapeast
WHY: to maintain health. Was not suggested
and available
its just good for you isn’t it? BRAND: costco brand...alot in quantity and
16. OS-cal (mother and my brother)
good price
expirtation: april 2011 FOR: calcium supplement
19. Airborne (tablets) Father and daughter put
HOW LONG: 6 years
in water
HOW MUCH: 1 every 2 days (when I
expiration: june 2013
remember)
FOR: daily supplement for health
BRAND: usually oscal or one a day womens
HOW LONG: past 5 years HOW MUCH: one pill a day (in the morning)
17. Vegetarian calcium magnesium (pill)
WHY: Daughter’s art teacher took in when
expiration: dec 2009
she was feeling sick, she was young and we
FOR: vitamin for bone health but I used as
thought she was cool. When people were
daily vitamin
feeling sick she would give it to us. One day
Cara bought this b/c she went to doctor and
I had it and liked it. She introduced it to her
he suggested calcium magnesium.
family.
HOW LONG: i used it alot when first bought
BRAND: always airborne
HOW MUCH: one pill a day WHY: how is was suggested by doctor BRAND: this was brand pharmacists suggested)
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MEDICINE CABINETS: RESULTS | 20. Flavo-¸Zinc
23. Cholesto off (dad and brother)
expiration: not visible
expiration: october 2012
FOR: sore throat (suck)
FOR: lower cholesterol
dad uses it mostly because everybody else
HOW LONG: past 9 years
hates taste
WHY: doctor showed dad had high
HOW LONG: 7 years or so
cholesterol. Mother since surgery is taking
WHY: can’t remember
because inactivity.
BRAND: any brand
BRAND: no just the cheapest
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HOW MUCH 21. Amoxocillyn for mothers leg FOR: leg not really sure why
24. Vitamin D (brother bought on health
HOW MUCH: 6 hours after physical therapy
craze)
HOW LONG: since physical therapy started (5
expiration: february2012
months)
WHY: doctor told him he had to be healthier
expiration: November 2012
FOR: daily health HOW MUCH: daily when he first got it but
22. Zoloft for daughter depression and anxiety
now its just whenever he remembers
expiration: oct 2011
HOW LONG: 5 months
FOR: used to take for
BRAND: what was there when i bought
HOW MUCH: daily HOW LONG: 6 years (14-19) got taken off it gradually.
25. Vimovo prescription for mothers leg after injury
WHY: doctor prescribed because I had really
expiration: october 2012
bad anxiety
WHY: anti-inflammatory
have not taken it for about 2.5-3 years since I
HOW MUCH: one day
stopped taking it regularly
HOW LONG: this month (has had to take anti
But i take it when i am really stressed and self
inflammatories since surgey but just switched
medicate with what I have left. I will take one
kind)
pill a day during finals or half a pill here and there to chill out when I am like super anxious.
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26. Visine expiration: june 2006 Bottle: liquids FOR: eyes HOW MUCH: 2 pills per day HOW LONG: since teenager in college (19) I took vitamins but stopped taking regularly when I was deployed WHY: mother just bought it incase. Probably bought it because someone needed it at one point SAME BRAND: bought because it is recognized brand.
“
IF THERE IS A MEDICINE FOR IT THEY WILL TAKE IT RATHER THAN WAIT FOR IT TO GO OR CHANGE SOMEHTING THAT COULD BE AFFECTING IT NATURAL
MEDICINE CABINETS: RESULTS |
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KEY FINDINGS - people are keeping medicine in the wrong places: in hot, wet/humid areas - while journals showed that 35% of people check expiration date of medication, most people (1 did not) had at least 1 expired medication that they were still taking and had not realized until we went through this process - people are reusing bottles to store different or new medication which takes things out of context - people do not keep track of medical records (vaccines, screenings etc.) and when asked until what point they did they said until I left pediatrician. - When asked the question people reacted immediately saying they really should - People said they would ask their mother if they had to find out - Most people do not have primary care physician - Only 2 had them in the state they lived - Others stopped going after pediatrician - A lot of people were unclear as to what they should talk us through when we asked for medicine – some included supplements, some did not, some said they didn’t really have medicine but then when we started going through things one by one they realized how much they had - People save prescriptions – so they don’t have to go back for more if they ever get illness again - Only 1 had used a emergency care clinic – minute clinic and he said he went cause he needed antibiotics and they couldn’t give them to him so it was a waste of time. - Most people did not have basic first aid necessities - Most if not all found visits beneficial and threw out medicine when we left
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