Designing for continuity in chronic care

Most patients leave a consultation with a result and a recommendation, then are largely on their own to interpret it, act on it, and stay on track. For Doctor Anywhere, this was bigger than any single feature: how might we support patients beyond the appointment itself, across the full arc of chronic care?

Understanding where chronic care breaks down

Before proposing anything, we needed to know where patients were actually getting stuck, and whether that matched what our doctors believed was happening. Research ran across three tracks in parallel: expert input, an audit of what DA already offered, and direct conversations with patients managing chronic conditions.

Three things kept getting in the way

Weak adherence, difficulty sustaining lifestyle change, and trust gaps in existing systems came up again and again, regardless of condition, age, or how engaged the patient was at the outset.

In their own words, from patient interviews:

What we held ourselves to

These five principles came directly out of the research, and became the test every design decision had to pass.

Personalising plans

For each condition, we mapped which levers to emphasise and, just as importantly, which underlying driver would actually move someone to act on the plan.

This model became the logic behind each action plan — what got recommended, and how it was framed, shifted with both the condition and what we'd learned would actually get someone to follow through.

Living with a condition, beyond the clinic

Our research showed patients feel overwhelmed right after receiving results, and struggle to sustain habits long after the appointment ends. We designed the journey around four connected moments.

Mapping how doctor, patient and system interact

To make the journey actionable, we mapped how patients, doctors, and the platform interact at every stage of care. In this future state, the doctor's advice doesn't end when the consultation does. The system keeps supporting the patient through reminders, tracking, and marketplace recommendations drawn from DA's 37+ existing services, aligned to their plan instead of sitting fragmented across the app.

Socialising the Vision

We created a set of storyboards to communicate the holistic care journey to upper management, weaving in real patient challenges and research insights to make the vision tangible and easy to relate to. This helped leadership quickly grasp the value of the experience and build alignment around it.

From result to routine

The vision translated into working flows: patient and doctor reviewing results together, and a personalised action plan with clear next steps. Doctors set a follow-up together with the patient, with a reminder sent ahead of it, and patients can choose to see the same doctor on upcoming appointments. Reminders also cover medication top-ups, so patients stay on track before they fall behind.

What this makes possible

Follow-up booking, reminders, and same-doctor continuity are live today. The research also gave the care team the validation to roll out home-based health screening, and gave management a clearer picture of what patients actually want beyond medication and lab reports. The numbers below are projections drawn from that research and our existing patient usage data, showing what we'd expect once results, consultations, and recommendations are fully connected.

What this taught me

This project helped me understand what patients actually need in a moment of overwhelm. They need fewer things to read and clear steps they can act on. Simplifying results, embedding follow-up booking, and connecting everything to lifestyle adjustment gave both patients and doctors a journey that felt cohesive and connected.

The next step is measuring real adoption. Follow-up bookings and turnout, use of complementary products and services, and marketplace engagement will show where the solution works and where it needs to evolve.

More broadly, this work strengthened my ability to design at the intersection of user needs, clinical workflow, and business outcomes, and reinforced how much long-term engagement has to be designed for deliberately.