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Scheibe M, Lang C, Druschke D, Arnold K, Luntz E, Schmitt J, Holthoff-Detto V. Independent Use of a Home-Based Telemonitoring App by Older Patients With Multimorbidity and Mild Cognitive Impairment: Qualitative Study. JMIR Hum Factors 2021; 8:e27156. [PMID: 34255664 PMCID: PMC8314150 DOI: 10.2196/27156] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/16/2021] [Accepted: 05/03/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The management of multimorbidity is complex and patients have a high burden of disease. When symptoms of dementia also appear, it becomes even more difficult for patients to cope with their everyday lives and manage their diseases. Home-based telemonitoring may support older patients with multimorbidity and mild cognitive impairment (MCI) in their regular monitoring and self-management. However, to date, there has been no investigation into whether patients with MCI are able to operate a telemonitoring app independently to manage their own diseases. This question has become even more important during the current COVID-19 pandemic to maintain high-quality medical care for this patient group. OBJECTIVE We examined the following research questions: (1) How do patients with MCI assess the usability of the telemonitoring app? (2) How do patients with MCI assess the range of functions offered by the telemonitoring app? (3) Was there an additional benefit for the patients with MCI in using the telemonitoring app? (4) Were patients with MCI able to use the telemonitoring app independently and without restrictions? (5) To what extent does previous experience with smartphones, tablets, or computers influence the perceived ease of use of the telemonitoring app? METHODS We performed a formative evaluation of a telemonitoring app. Therefore, we carried out a qualitative study and conducted guided interviews. All interviews were audio-recorded, transcribed verbatim, and analyzed using the Mayring method of structured content analysis. RESULTS Twelve patients (8 women, 4 men) were interviewed; they had an average age of 78.7 years (SD 5.6) and an average Mini-Mental State Examination score of 24.5 (SD 1.6). The interviews lasted between 17 and 75 minutes (mean 41.8 minutes, SD 19.4). Nine patients reported that the telemonitoring app was easy to use. All respondents assessed the range of functions as good or adequate. Desired functionalities mainly included more innovative and varied educational material, better fit of the telemonitoring app for specific needs of patients with MCI, and a more individually tailored content. Ten of the 12 patients stated that the telemonitoring app had an additional benefit for them. Most frequently reported benefits included increased feeling of security, appreciation of regular monitoring of vital parameters, and increased independence due to telemonitoring. Eight patients were able to operate the app independently. Participants found the app easy to use regardless of whether they had prior experience with smartphones, tablets, or computers. CONCLUSIONS The majority of examined patients with MCI were capable of operating the telemonitoring app independently. Crucial components in attaining independent use were comprehensive personal support from the start of use and appropriate design features. This study provides initial evidence that patients with MCI could increasingly be considered as a relevant user group of telemonitoring apps.
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Affiliation(s)
- Madlen Scheibe
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Caroline Lang
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Diana Druschke
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Katrin Arnold
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Edwin Luntz
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Vjera Holthoff-Detto
- Department of Psychiatry, Psychotherapy and Psychosomatics, Alexianer Hospital Hedwigshöhe, St Hedwig Hospital Berlin, Berlin, Germany
- Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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Leppert F, Siebermair J, Wesemann U, Martens E, Sattler SM, Scholz S, Veith S, Greiner W, Rassaf T, Kääb S, Wakili R. The INFluence of Remote monitoring on Anxiety/depRession, quality of lifE, and Device acceptance in ICD patients: a prospective, randomized, controlled, single-center trial. Clin Res Cardiol 2020; 110:789-800. [PMID: 32417952 PMCID: PMC8166667 DOI: 10.1007/s00392-020-01667-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 05/07/2020] [Indexed: 11/27/2022]
Abstract
Background Impact of telemedicine with remote patient monitoring (RPM) in implantable cardioverter–defibrillator (ICD) patients on clinical outcomes has been investigated in various clinical settings with divergent results. However, role of RPM on patient-reported-outcomes (PRO) is unclear. The INFRARED-ICD trial aimed to investigate the effect of RPM in addition to standard-of-care on PRO in a mixed ICD patient cohort. Methods and results Patients were randomized to RPM (n = 92) or standard in-office-FU (n = 88) serving as control group (CTL). At baseline and on a monthly basis over 1 year, study participants completed the EQ-5D questionnaire for the primary outcome Quality of Life (QoL), the Hospital Anxiety and Depression Scale, and the Florida Patient Acceptance Survey questionnaire for secondary outcomes. Demographic characteristics (82% men, mean age 62.3 years) and PRO at baseline were not different between RPM and CTL. Primary outcome analysis showed that additional RPM was not superior to CTL with respect to QoL over 12 months [+ 1.2 vs. + 3.9 points in CTL and RPM group, respectively (p = 0.24)]. Pre-specified analyses could not identify subgroups with improved QoL by the use of RPM. Neither levels of anxiety (− 0.4 vs. − 0.3, p = 0.88), depression (+ 0.3 vs. ± 0.0, p = 0.38), nor device acceptance (+ 1.1 vs. + 1.6, p = 0.20) were influenced by additional use of RPM. Conclusion The results of the present study show that PRO were not improved by RPM in addition to standard-of-care FU. Careful evaluation and planning of future trials in selected ICD patients are warranted before implementing RPM in routine practice. Graphic abstract ![]()
Electronic supplementary material The online version of this article (10.1007/s00392-020-01667-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Florian Leppert
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Johannes Siebermair
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany.,Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Essen Medical School, University Duisburg-Essen, Essen, Germany.,Deutsches Zentrum für Herz-Kreislauferkrankungen (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Ulrich Wesemann
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehr Hospital, Berlin, Germany
| | - Eimo Martens
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany.,Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Stefan M Sattler
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany.,Department of Cardiology, Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Stefan Scholz
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Stefan Veith
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany
| | - Wolfgang Greiner
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Essen Medical School, University Duisburg-Essen, Essen, Germany
| | - Stefan Kääb
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany.,Deutsches Zentrum für Herz-Kreislauferkrankungen (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Reza Wakili
- Department of Medicine I, University Hospital Munich, Ludwig Maximilians University, Munich, Germany. .,Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Essen Medical School, University Duisburg-Essen, Essen, Germany. .,Deutsches Zentrum für Herz-Kreislauferkrankungen (DZHK), Partner Site Munich Heart Alliance, Munich, Germany.
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An IoT architecture for preventive maintenance of medical devices in healthcare organizations. HEALTH AND TECHNOLOGY 2019. [DOI: 10.1007/s12553-018-00286-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Timmermans I, Meine M, Szendey I, Aring J, Romero Roldán J, van Erven L, Kahlert P, Zitron E, Mabo P, Denollet J, Versteeg H. Remote monitoring of implantable cardioverter defibrillators: Patient experiences and preferences for follow-up. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:120-129. [PMID: 30536931 PMCID: PMC6849564 DOI: 10.1111/pace.13574] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/18/2018] [Accepted: 11/06/2018] [Indexed: 12/29/2022]
Abstract
Background Patient satisfaction with remote patient monitoring (RPM) of implantable cardioverter defibrillators (ICDs) seems to be high, yet knowledge on long‐term patient experiences is limited. The European REMOTE‐CIED study explored patients' experiences with RPM, examined patient's preferences for ICD follow‐up, and identified determinants of patient's preferences in the first 2 years postimplantation. Methods European heart failure patients (N = 300; median age = 66 years [interquartile range (IQR) = 59‐73], and 22% female) with a first‐time ICD received a Boston Scientific LATITUDE RPM system (Marlborough, MA, USA) and had scheduled in‐clinic follow‐ups once a year. Patients completed questionnaires at 1‐2 weeks and also at 3, 6, 12, and 24 months postimplantation and clinical data were obtained from their medical records. Patient evaluation data were analyzed descriptively, and Student's t‐tests/Man‐Whitney U tests or Chi‐square tests/Fisher's exact tests were performed to examine determinants of patient preferences. Results At 2 years postimplantation, the median patient satisfaction score with the RPM system was 9 out of 10 (IQR = 8‐10), despite 53% of the patients experiencing issues (eg, failure to transmit data). Of the 221 patients who reported their follow‐up preferences, 43% preferred RPM and 19% preferred in‐clinic follow‐up. Patients with a preference for RPM were more likely to be higher educated (P = 0.04), employed (P = 0.04), and equipped with a new LATITUDE model (P = 0.04), but less likely to suffer from chronic obstructive pulmonary disease (P = 0.009). Conclusion In general, patients were highly satisfied with RPM, but a subgroup preferred in‐clinic follow‐up. Therefore, physicians should include patients’ concerns and preferences in the decision‐making process, to tailor device follow‐up to individual patients’ needs and preferences.
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Affiliation(s)
- Ivy Timmermans
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.,CoRPS-Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Mathias Meine
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Istvan Szendey
- Department of Cardiology, Kliniken Maria Hilf GmbH, Mönchengladbach, Germany
| | - Johannes Aring
- Department of Cardiology, Klinikum Leverkusen, Leverkusen, Germany
| | | | - Lieselotte van Erven
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Philipp Kahlert
- West German Heart and Vascular Center Essen, Essen University Hospital, Essen, Germany
| | - Edgar Zitron
- Department of Cardiology, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Philippe Mabo
- Department of Cardiology, Centre Hospitalier Universitaire Rennes, Rennes, France
| | - Johan Denollet
- CoRPS-Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Henneke Versteeg
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
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Timmermans I, Meine M, Zitron E, Widdershoven J, Kimman G, Prevot S, Rauwolf T, Anselme F, Szendey I, Romero Roldán J, Mabo P, Schaer B, Denollet J, Versteeg H. The patient perspective on remote monitoring of patients with an implantable cardioverter defibrillator: Narrative review and future directions. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:826-833. [DOI: 10.1111/pace.13123] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 04/14/2017] [Accepted: 05/15/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Ivy Timmermans
- Department of Cardiology; University Medical Center Utrecht; 3508 GA Utrecht the Netherlands
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology; Tilburg University; 5000 LE Tilburg the Netherlands
| | - Matias Meine
- Department of Cardiology; University Medical Center Utrecht; 3508 GA Utrecht the Netherlands
| | - Edgar Zitron
- Department of Cardiology; Universitätsklinikum Heidelberg; Heidelberg Germany
| | - Jos Widdershoven
- Department of Cardiology; Elisabeth Tweesteden Hospital; AD Tilburg the Netherlands
| | - Geert Kimman
- Department of Cardiology; Medisch Centrum Alkmaar; JD Alkmaar the Netherlands
| | - Sébastien Prevot
- Department of Cardiology; Hôpital Privé Clairval; Marseille France
| | - Thomas Rauwolf
- Department of Cardiology; Universitätsklinikum Magdeburg; Magdeburg Germany
| | | | - Istvan Szendey
- Department of Cardiology; Kliniken Maria Hilf GmbH; Mönchengladbach Germany
| | | | - Philippe Mabo
- Department of Cardiology; Centre Hospitalier Universitaire; Rennes France
| | - Beat Schaer
- Department of Cardiology; University Hospital Basel; Basel Switzerland
| | - Johan Denollet
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology; Tilburg University; 5000 LE Tilburg the Netherlands
| | - Henneke Versteeg
- Department of Cardiology; University Medical Center Utrecht; 3508 GA Utrecht the Netherlands
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[Implantable cardioverter-defibrillator: Is remote monitoring obligatory?]. Herzschrittmacherther Elektrophysiol 2015; 26:116-22. [PMID: 25900214 DOI: 10.1007/s00399-015-0368-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 03/31/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The possibilities of telemonitoring (TM) of patients with implantable cardioverter-defibrillators (ICD) have been rapidly improving over the last few years. Numerous studies have examined the effects of this development on the follow-up care of ICD patients. OBJECTIVES Technical implementation and safety of ICD telemonitoring. Effects on the treatment of cardiac arrhythmias, the management of cardiac insufficiency patients and morbidity as well as mortality. Illustration of patient acceptance and cost-benefit assessment. MATERIALS AND METHODS The current research situation regarding TM of ICDs is analyzed and the available evidence for the postulated advantages in the follow-up care of ICD patients are discussed. The current treatment guidelines and recommendations for implementation of TM in daily clinical praxis are presented. RESULTS AND CONCLUSIONS TM offers the possibility of faster reaction times to arrhythmias, cardiac decompensation and ICD malfunctions. At the same time, the outpatient follow-ups can be reduced without negatively affecting safety, quality of life or patient acceptance. TM has the potential to cost-neutrally improve the safety of ICD therapy and could lead to optimized management of heart insufficiency patients, while reducing morbidity and mortality. Following the evidence of these benefits as shown in numerous studies, TM has already been included in the current therapy guidelines.
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