One of the challenges the Obama administration has taken on is antibiotic resistance stemming, in part, from the overprescription of antibiotics. Kognito Solutions views it as a communication issue and is responding with a program that simulates the roles of patients and physicians to change attitudes to antibiotic prescriptions.
Kognito develops simulation programs centered on physician role-playing for difficult patient conversations, such as helping primary care doctors identify signs of post traumatic stress disorder, child obesity and managing post deployment stress. This latest program will let users role play not only the doctor but also the patient — a first for the New York-based company. It has received backing from the Robert Wood Johnson Foundation as part of its Pioneers program.
In a phone interview with MedCity News, Robert Wood Johnson Foundation Pioneer Portfolio Director Lori Melichar said it was interested in the use of virtual reality as a way to change behavior, particularly changing outcomes for challenging conversations between healthcare professionals and patients. Lois Drapin, who is in charge of New Health Markets at Kognito, connected Kognito co-founder Ron Goldman and Melichar.
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Goldman said that its approach is driven by creating natural conversations that don’t feel scripted.
“We are focused on the power of conversations to change attitudes and behaviors
for individual health and public health. We have done programs for providers on very challenging conversations on topics like PTSD, substance abuse, child obesity — the daily conversations that occur that have an impact between the provider and patients. We should not just focus on helping providers be better at these conversations but should also help consumers get better at these conversations.”
Melichar said she was “blown away” by Kognito’s approach. The foundation awarded the company a major grant from its Pioneer program to support Kognito’s program for antibiotics as well as another virtual reality training module to help guide parents on how to speak to toddlers and children to better manage adverse experiences in their early years of development from ages 2-5.
Goldman said one reason it decided to focus on simulated conversations was the significant connection between miscommunication, poor medication adherence and low patient satisfaction. “We chose overprescribing of antibiotics because it is a huge issue in primary care.” There are two factors behind this, as Goldman sees it. Many patients don’t feel like they are being treated well by doctors unless they are given a prescription. On the other hand, some doctors are prescribing antibiotics frequently because they feel pressured by patients rather than because they feel it’s medically necessary.
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Goldman stressed that when it developed the program it didn’t want to simplify the roles: it neither wanted to portray patients as idiotic nor physicians as uncaring. The patient comes across as insistent, but not unreasonable nor unintelligent.
Users are given a few different options of what the physician or patient should say at certain points in their interaction. Depending on the choice made, a dashboard breaks down the conversation technique. Empathy, building trust are important parts of the program and the simulation is designed to give users the ability to experience the consequences of positive and negative interactions.
Drapin noted that both patients and physicians get their own coach who advises and praises them when they choose the right answer and offers tips.
“You are in the driver’s seat,” said Goldman. “Nobody learned to ride a bike by watching a video.”
A two month pilot of the antibiotic role playing simulation program will start in October at New York University School of Medicine. It will be studied with 35 primary care providers and 35 patients. At the end of the pilot, the company will report the data to RWJF, but it will be up to the foundation on what to do with the program. There are a lot of possibilities for it, from accountable care organizations, payers, and patient advocate groups.
Although the program seeks to change individual behaviors, Kognito is also focused on the larger goal of impacting population health.
Among the people who have advised the company for its latest installment are Dr. Adina Kalet, director of the program on Professional Development Assessment and Outcomes at New York University School of Medicine; Martin Blaser, director of the Human Microbiome program at New York University Langone Medical Center; Antoinette Schoenthaler, an assistant professor of medicine at the Center for Healthful Behavior Change at NYU; and Riva Greenberg, a certified health coach.
Photo: Kognito/RWJF