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Martiniuk A, Toepfer A, Lane-Brown A. A review of risks, adverse effects and mitigation strategies when delivering mental health services using telehealth. J Ment Health 2024; 33:415-438. [PMID: 36866784 DOI: 10.1080/09638237.2023.2182422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 08/31/2022] [Accepted: 01/07/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND This paper presents a scoping review of the peer-reviewed literature regarding reported risks, adverse effects and mitigation factors related to providing mental health services using telehealth. AIMS The paper aims to describe risks and risk management strategies. METHODS Publications were included if they reported upon risks, adverse events or mitigation factors experienced, hypothesised or discussed for: any population (any country, any age), service (any mental health services), intervention (telehealth), English language, 2010 to 10 July 2021, any publication type (commentary, research, policy), excluding protocol papers, and self-help tools. The following databases were searched: PsycINFO (from 2010 to 10 July 2021), MEDLINE (2010 to 10 July 2021) and the Cochrane Database from 2010 to 10 July 2021. RESULTS The search strategy resulted in 1,497 papers and after exclusions a final 55 articles were selected. Results of this scoping review are presented in terms of types of risk, risk by client population, risk by modality (eg group therapy using telehealth) and risk management. CONCLUSIONS Recommendations for future research include gathering and publishing more detailed information regarding near-miss and actual adverse events when delivering mental health assessment and care using telehealth. In clinical practice, training is required for potential adverse events, and to prevent them and reporting mechanisms in place to collate and learn from these.
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Affiliation(s)
| | - Amy Toepfer
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Amanda Lane-Brown
- Work: Clinical Psychologist, KidsRehab, Children's Hospital Westmead, South Turramurra, NSW, Australia
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2
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Wolff JL, Wec A, Peereboom D, Gleason KT, Amjad H, Burgdorf JG, Cassidy J, DesRoches CM, Fabius CD, Green AR, Lin CT, Nothelle SK, Powell DS, Riffin CA, Smith J, Lum HD. Care partners and consumer health information technology: A framework to guide systems-level initiatives in support of digital health equity. Learn Health Syst 2024; 8:e10408. [PMID: 38883870 PMCID: PMC11176584 DOI: 10.1002/lrh2.10408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/08/2024] [Accepted: 01/17/2024] [Indexed: 06/18/2024] Open
Abstract
Introduction Consumer-oriented health information technologies (CHIT) such as the patient portal have a growing role in care delivery redesign initiatives such as the Learning Health System. Care partners commonly navigate CHIT demands alongside persons with complex health and social needs, but their role is not well specified. Methods We assemble evidence and concepts from the literature describing interpersonal communication, relational coordination theory, and systems-thinking to develop an integrative framework describing the care partner's role in applied CHIT innovations. Our framework describes pathways through which systematic engagement of the care partner affects longitudinal work processes and multi-level outcomes relevant to Learning Health Systems. Results Our framework is grounded in relational coordination, an emerging theory for understanding the dynamics of coordinating work that emphasizes role-based relationships and communication, and the Systems Engineering Initiative for Patient Safety (SEIPS) model. Cross-cutting work systems geared toward explicit and purposeful support of the care partner role through CHIT may advance work processes by promoting frequent, timely, accurate, problem-solving communication, reinforced by shared goals, shared knowledge, and mutual respect between patients, care partners, and care team. We further contend that systematic engagement of the care partner in longitudinal work processes exerts beneficial effects on care delivery experiences and efficiencies at both individual and organizational levels. We discuss the utility of our framework through the lens of an illustrative case study involving patient portal-mediated pre-visit agenda setting. Conclusions Our framework can be used to guide applied embedded CHIT interventions that support the care partner role and bring value to Learning Health Systems through advancing digital health equity, improving user experiences, and driving efficiencies through improved coordination within complex work systems.
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Affiliation(s)
- Jennifer L. Wolff
- Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Aleksandra Wec
- Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Danielle Peereboom
- Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | | | - Halima Amjad
- Division of Geriatric Medicine and GerontologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Julia G. Burgdorf
- Center for Home Care Policy & Research Visiting Nurse Service of New YorkNew YorkNew YorkUSA
| | - Jessica Cassidy
- School of Social Work University of Texas at ArlingtonArlingtonTexasUSA
| | | | - Chanee D. Fabius
- Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Ariel R. Green
- Division of Geriatric Medicine and GerontologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - C. T. Lin
- University of ColoradoAuroraColoradoUSA
| | - Stephanie K. Nothelle
- Division of Geriatric Medicine and GerontologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Danielle S. Powell
- Department of Hearing & Speech SciencesUniversity of MarylandCollege ParkMarylandUSA
| | - Catherine A. Riffin
- Division of Geriatrics and Palliative MedicineWeill Cornell Medical CenterNew YorkNew YorkUSA
| | - Jamie Smith
- Johns Hopkins School of NursingBaltimoreMarylandUSA
| | - Hillary D. Lum
- Division of Geriatric MedicineUniversity of Colorado School of MedicineAuroraColoradoUSA
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3
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Kelley MM, Powell T, Camara D, Shah N, Norton JM, Deitelzweig C, Vaidy N, Hsiao CJ, Wang J, Bierman AS. Mobile Health Apps, Family Caregivers, and Care Planning: Scoping Review. J Med Internet Res 2024; 26:e46108. [PMID: 38781588 PMCID: PMC11157180 DOI: 10.2196/46108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 09/28/2023] [Accepted: 03/01/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND People living with multiple chronic conditions (MCCs) face substantial challenges in planning and coordinating increasingly complex care. Family caregivers provide important assistance for people with MCCs but lack sufficient support. Caregiver apps have the potential to help by enhancing care coordination and planning among the health care team, including patients, caregivers, and clinicians. OBJECTIVE We aim to conduct a scoping review to assess the evidence on the development and use of caregiver apps that support care planning and coordination, as well as to identify key factors (ie, needs, barriers, and facilitators) related to their use and desired caregiver app functionalities. METHODS Papers intersecting 2 major domains, mobile health (mHealth) apps and caregivers, that were in English and published from 2015 to 2021 were included in the initial search from 6 databases and gray literature and ancestry searches. As per JBI (Joanna Briggs Institute) Scoping Review guidelines and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews), 2 authors independently screened full texts with disagreements resolved by a third author. Working in pairs, the authors extracted data using a pilot-tested JBI extraction table and compared results for consensus. RESULTS We identified 34 papers representing 25 individual studies, including 18 (53%) pilot and feasibility studies, 13 (38%) qualitative studies, and 2 experimental or quasi-experimental studies. None of the identified studies assessed an intervention of a caregiver app for care planning and coordination for people with MCCs. We identified important caregiver needs in terms of information, support, and care coordination related to both caregiving and self-care. We compiled desired functionalities and features enabling apps to meet the care planning and care coordination needs of caregivers, in particular, the integration of caregiver roles into the electronic health record. CONCLUSIONS Caregiver needs identified through this study can inform developers and researchers in the design and implementation of mHealth apps that integrate with the electronic health record to link caregivers, patients, and clinicians to support coordinated care for people with MCCs. In addition, this study highlights the need for more rigorous research on the use of mHealth apps to support caregivers in care planning and coordination.
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Affiliation(s)
- Marjorie M Kelley
- The Ohio State University College of Nursing, Columbus, OH, United States
| | - Tia Powell
- Montefiore Einstein Center for Bioethics, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Djibril Camara
- Credence Management Solution, USAID Global Health Technical Professionals, Washington, DC, United States
| | - Neha Shah
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, United States
| | - Jenna M Norton
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, United States
| | | | - Nivedha Vaidy
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, United States
| | - Chun-Ju Hsiao
- Center for Evidence and Practice Improvement, Agency for Health Care Research and Quality, Rockville, MD, United States
| | - Jing Wang
- Florida State University College of Nursing, Tallahassee, FL, United States
| | - Arlene S Bierman
- Agency for Health Care Research and Quality, Rockville, MD, United States
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4
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Hahn C, Tilstra-Ferrell E, Salim S, Goodrum N, Rheingold A, Gilmore AK, Barber S, Moreland A. Web-Based Screening, Brief Intervention, and Referral to Treatment for Traumatic Stress and Alcohol Misuse Among Survivors of Sexual Assault and Intimate Partner Violence: Usability and Acceptability Study. JMIR Form Res 2024; 8:e49557. [PMID: 38358791 PMCID: PMC10905344 DOI: 10.2196/49557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 12/14/2023] [Accepted: 01/07/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Recent survivors of intimate partner violence (IPV) and sexual assault (SA) are at a high risk for traumatic stress and alcohol misuse. IPV and SA survivors face barriers to services for traumatic stress and alcohol misuse and have low service utilization rates. One way to increase access to services for this population is the use of web-based screening, brief intervention, and referral to treatment (SBIRT), an evidence-informed approach for early identification of traumatic stress and alcohol and drug misuse and connecting individuals to treatment. OBJECTIVE This study aims to assess the usability and acceptability of a web-based SBIRT called CHAT (Choices For Your Health After Trauma) tailored to address traumatic stress and alcohol misuse following past-year IPV, SA, or both. METHODS Phase 1 involved gathering feedback about usability and acceptability from focus groups with victim service professionals (22/52, 42%) and interviews with past-year survivors of IPV, SA, or both (13/52, 25%). Phase 2 involved gathering feedback about the acceptability of an adapted version of CHAT in an additional sample of recent survivors (17/52, 33%). Survey data on history of IPV and SA, posttraumatic stress disorder symptoms, alcohol and drug use, and service use were collected from survivors in both phases to characterize the samples. Qualitative content and thematic analyses of the interviews and focus group data were conducted using a coding template analysis comprising 6 a priori themes (usability, visual design, user engagement, content, therapeutic persuasiveness, and therapeutic alliance). RESULTS Six themes emerged during the focus groups and interviews related to CHAT: usability, visual design, user engagement, content, therapeutic persuasiveness, and therapeutic alliance. Phase 1 providers and survivors viewed CHAT as acceptable, easy to understand, and helpful. Participants reported that the intervention could facilitate higher engagement in this population as the web-based modality is anonymous, easily accessible, and brief. Participants offered helpful suggestions for improving CHAT by updating images, increasing content personalization, reducing text, and making users aware that the intervention is confidential. The recommendations of phase 1 participants were incorporated into CHAT. Phase 2 survivors viewed the revised intervention and found it highly acceptable (mean 4.1 out of 5, SD 1.29). A total of 4 themes encapsulated participant's favorite aspects of CHAT: (1) content and features, (2) accessible and easy to use, (3) education, and (4) personalization. Six survivors denied disliking any aspect. The themes on recommended changes included content and features, brevity, personalization, and language access. Participants provided dissemination recommendations. CONCLUSIONS Overall, CHAT was acceptable among victim service professionals and survivors. Positive reactions to CHAT show promise for future research investigating the efficacy and potential benefit of CHAT when integrated into services for people with traumatic stress and alcohol misuse after recent IPV and SA.
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Affiliation(s)
- Christine Hahn
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Emily Tilstra-Ferrell
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Selime Salim
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Nada Goodrum
- Department of Psychology, University of South Carolina, Charleston, SC, United States
| | - Alyssa Rheingold
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Amanda K Gilmore
- Department of Health Policy & Behavioral Sciences, Georgia State University, Atlanta, GA, United States
| | - Sara Barber
- South Carolina Coalition Against Domestic Violence and Sexual Assault, Columbia, SC, United States
| | - Angela Moreland
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
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5
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Leiz M, Pfeuffer N, Rehner L, Stentzel U, van den Berg N. Telemedicine as a Tool to Improve Medicine Adherence in Patients with Affective Disorders - A Systematic Literature Review. Patient Prefer Adherence 2022; 16:3441-3463. [PMID: 36605330 PMCID: PMC9809413 DOI: 10.2147/ppa.s388106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/17/2022] [Indexed: 12/31/2022] Open
Abstract
Affective disorders are a common psychological impairment. A major problem with respect to treatment is medication non-adherence. eHealth interventions are already widely used in the treatment of patients living with affective disorders. The aim of this systematic literature review is to obtain the current scientific evidence to eHealth as a tool to improve medication adherence in patients with affective disorders. A systematic search was performed across PubMed, Cochrane Library, Web of Science and PsycInfo. Studies in English and German published between 2007 and 2020 were included. The review followed the PRISMA guidelines and were performed with the CADIMA online tool. A total of 17 articles were included in this review. Eleven studies were randomized controlled trials, two were controlled clinical trials, and four had a pre-/post-design. Three different types of interventions could be identified: internet-based self-management programs (n=4), multi-faceted interventions addressing different dimensions of medication adherence (n=4), and single-faceted interventions (n=9) comprising four mobile interventions and five telehealth interventions. Eleven interventions addressed patients with (comorbid) depressions and six addressed patients with bipolar disorders. Six interventions showed a statistically significant positive effect on medication adherence. None of the studies showed a statistically significant negative effect. All interventions which had a statistically significant positive effect on medication adherence involved personal contacts between therapists and patients. All included eHealth interventions are at least as effective as control conditions and seems to be effective for patients with depression as well as with bipolar disorders. Personal contacts seem to improve the effectiveness of eHealth interventions. eHealth interventions are an effective way to improve medication adherence in patients with affective disorders. In rural or underserved regions, eHealth can supplement usual care interventions on medication adherence by expanding access. More analyses are needed in order to understand determinants for the effectiveness of eHealth interventions on medication adherence enhancement.
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Affiliation(s)
- Maren Leiz
- Institute for Community Medicine, University Medicine, Greifswald, Germany
| | - Nils Pfeuffer
- Institute for Community Medicine, University Medicine, Greifswald, Germany
| | - Laura Rehner
- Institute for Nursing Science and Interprofessional Learning, University Medicine, Greifswald, Germany
| | - Ulrike Stentzel
- Institute for Community Medicine, University Medicine, Greifswald, Germany
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6
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Donovan G, Hall N, Ling J, Smith F, Wilkes S. Influencing medication taking behaviors using automated two-way digital communication: A narrative synthesis systematic review informed by the Behavior Change Wheel. Br J Health Psychol 2022; 27:861-890. [PMID: 35080811 PMCID: PMC9541766 DOI: 10.1111/bjhp.12580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/28/2021] [Accepted: 12/21/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Around half of prescribed medications for long-term conditions are not taken as directed. Automated two-way digital communication, such as text messaging and interactive voice response technology, could deliver interventions to improve medication adherence, and subsequently health. However, exploration of how such interventions may improve medication adherence is limited. This review aimed to explore how automated two-way digital communication can improve medication taking with or without using non-digital intervention components, such as phone calls with healthcare professionals. METHODS A theory-informed narrative synthesis systematic review. Several databases were searched including CINAHL, Embase, Medline, and Web of Science using key words relating to 'medication adherence' and digital communication technologies. The Behavior Change Technique (BCT) coding using the BCT Taxonomy V1 and the Behavior Change Wheel were used to identify BCTs delivered within the included interventions. RESULTS A total of 3,018 records were screened with 43 study reports included in the review. Four medication-taking behaviors: taking medication, obtaining medication, self-testing, and asking for support were identified as targets for behavior change within the included interventions. Most BCTs within the digital communication component aimed to increase motivation for medication adherence, with non-digital intervention components included to address other medication taking barriers, such as physical and psychological capability. CONCLUSION Automated two-way digital communication can detect barriers to medication adherence by monitoring performance of the taking medication behavior. Monitoring outcomes from taking medication may increase reflective motivation to take medicines. Addressing physical opportunity to taking medication by facilitating the behavior obtaining medication may also increase adherence.
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Affiliation(s)
- Gemma Donovan
- Faculty of Health Sciences and WellbeingSchool of Pharmacy and Pharmaceutical SciencesUniversity of SunderlandUK
| | - Nicola Hall
- Faculty of Medical SciencesPopulation Health Sciences InstituteNewcastle UniversityUK
| | - Jonathan Ling
- Faculty of Health Sciences and WellbeingUniversity of SunderlandUK
| | | | - Scott Wilkes
- Faculty of Health Sciences and WellbeingSchool of MedicineUniversity of SunderlandUK
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7
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Aikens JE, Valenstein M, Plegue MA, Sen A, Marinec N, Achtyes E, Piette JD. Technology-Facilitated Depression Self-Management Linked with Lay Supporters and Primary Care Clinics: Randomized Controlled Trial in a Low-Income Sample. Telemed J E Health 2022; 28:399-406. [PMID: 34086485 PMCID: PMC8968843 DOI: 10.1089/tmj.2021.0042] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To test whether technology-facilitated self-management support improves depression in primary care settings. Methods: We randomized 204 low-income primary care patients who had at least moderate depressive symptoms to intervention or control. Intervention participants received 12 months of weekly automated interactive voice response telephone calls that assessed their symptom severity and provided self-management strategies. Their patient-nominated supporter (CarePartner) received corresponding guidance on self-management support, and their primary care team received urgent notifications. Those randomized to enhanced usual care received printed generic self-management instructions. Results: One-year attrition rate was 14%. By month 6, symptom severity on the Patient Health Questionnaire-9 (PHQ-9) decreased 2.5 points more in the intervention arm than in the control arm (95% CI -4.2 to -0.8, p = 0.003). This benefit was similar at month 12 (p = 0.004). Intervention was also over twice as likely to lead to ≥50% reduction in symptom severity by month 6 (OR = 2.2 (1.1, 4.7)) and a decrease of ≥5 PHQ-9 points by month 12 (OR = 2.3 (1.2, 4.4)). Conclusions: Technology-facilitated self-management guidance with lay support and clinician notifications improves depression for primary care patients. Subsequent research should examine implementation and generalization to other chronic conditions. clinicaltrials.gov, identifier NCT01834534.
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Affiliation(s)
- James E. Aikens
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Address correspondence to: James Aikens, PhD, Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI 48104-1213, USA
| | - Marcia Valenstein
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA.,VA Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan, USA
| | - Melissa A. Plegue
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Ananda Sen
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicolle Marinec
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan, USA.,Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Eric Achtyes
- Cherry Health, Heart of the City Health Center, Grand Rapids, Michigan, USA.,Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Lansing, Michigan, USA
| | - John D. Piette
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan, USA.,Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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Hodgson J, Welch M, Tucker E, Forbes T, Pye J. Utilization of EHR to Improve Support Person Engagement in Health Care for Patients With Chronic Conditions. J Patient Exp 2022; 9:23743735221077528. [PMID: 35155752 PMCID: PMC8832579 DOI: 10.1177/23743735221077528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Innovations in electronic health record (EHR) systems invite new patient and family engagement methods and create opportunities to reduce healthcare disparities. However, many patients and their identified support persons (ie, proxies) are unsure how to interface with the technology. This phenomenological qualitative study served as a pilot study to investigate the patient, proxy, and provider lived experiences utilizing patient-facing EHR portals. Individual interviews and focus groups were utilized to collect qualitative data from 21 patient, proxy, and healthcare provider participants across 3 time points. Colaizzi's phenomenological data analysis method was utilized to interpret the data. Four themes emerged highlighting critical benefits and obstacles for patients and support persons interfacing with a patient portal: (a) agency, (b) connection, (c) support, and (d) technology literacy. Results help highlight strategies and dispel myths essential to advancing patient and family engagement using EHR patient portal systems. The study's outcomes reflect recommendations for onboarding proxies and improving patient/family engagement and family-centered care models.
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Affiliation(s)
- Jennifer Hodgson
- Department of Human Development and Family Science, East Carolina University, Greenville, NC, USA
| | - Melissa Welch
- Department of Community Health and Family Medicine, University of Florida, College of Medicine, Gainesville, FL, USA
| | - Emily Tucker
- Department of Human Development and Family Science, East Carolina University, Greenville, NC, USA
| | - Thompson Forbes
- Department of Advanced Nursing Practice and Education, East Carolina University, Greenville, NC, USA
| | - Joseph Pye
- Division of Medical Affairs, Vidant Health, Greenville, NC, USA
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9
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Willis VC, Thomas Craig KJ, Jabbarpour Y, Scheufele EL, Arriaga YE, Ajinkya M, Rhee KB, Bazemore A. Digital Health Interventions to Enhance Prevention in Primary Care: Scoping Review. JMIR Med Inform 2022; 10:e33518. [PMID: 35060909 PMCID: PMC8817213 DOI: 10.2196/33518] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/19/2021] [Accepted: 12/04/2021] [Indexed: 12/20/2022] Open
Abstract
Background Disease prevention is a central aspect of primary care practice and is comprised of primary (eg, vaccinations), secondary (eg, screenings), tertiary (eg, chronic condition monitoring), and quaternary (eg, prevention of overmedicalization) levels. Despite rapid digital transformation of primary care practices, digital health interventions (DHIs) in preventive care have yet to be systematically evaluated. Objective This review aimed to identify and describe the scope and use of current DHIs for preventive care in primary care settings. Methods A scoping review to identify literature published from 2014 to 2020 was conducted across multiple databases using keywords and Medical Subject Headings terms covering primary care professionals, prevention and care management, and digital health. A subgroup analysis identified relevant studies conducted in US primary care settings, excluding DHIs that use the electronic health record (EHR) as a retrospective data capture tool. Technology descriptions, outcomes (eg, health care performance and implementation science), and study quality as per Oxford levels of evidence were abstracted. Results The search yielded 5274 citations, of which 1060 full-text articles were identified. Following a subgroup analysis, 241 articles met the inclusion criteria. Studies primarily examined DHIs among health information technologies, including EHRs (166/241, 68.9%), clinical decision support (88/241, 36.5%), telehealth (88/241, 36.5%), and multiple technologies (154/241, 63.9%). DHIs were predominantly used for tertiary prevention (131/241, 54.4%). Of the core primary care functions, comprehensiveness was addressed most frequently (213/241, 88.4%). DHI users were providers (205/241, 85.1%), patients (111/241, 46.1%), or multiple types (89/241, 36.9%). Reported outcomes were primarily clinical (179/241, 70.1%), and statistically significant improvements were common (192/241, 79.7%). Results were summarized across the following 5 topics for the most novel/distinct DHIs: population-centered, patient-centered, care access expansion, panel-centered (dashboarding), and application-driven DHIs. The quality of the included studies was moderate to low. Conclusions Preventive DHIs in primary care settings demonstrated meaningful improvements in both clinical and nonclinical outcomes, and across user types; however, adoption and implementation in the US were limited primarily to EHR platforms, and users were mainly clinicians receiving alerts regarding care management for their patients. Evaluations of negative results, effects on health disparities, and many other gaps remain to be explored.
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Affiliation(s)
- Van C Willis
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Kelly Jean Thomas Craig
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Yalda Jabbarpour
- Policy Studies in Family Medicine and Primary Care, The Robert Graham Center, American Academy of Family Physicians, Washington, DC, United States
| | - Elisabeth L Scheufele
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Yull E Arriaga
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Monica Ajinkya
- Policy Studies in Family Medicine and Primary Care, The Robert Graham Center, American Academy of Family Physicians, Washington, DC, United States
| | - Kyu B Rhee
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA, United States
| | - Andrew Bazemore
- The American Board of Family Medicine, Lexington, KY, United States
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10
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Nguyen HL, Tran K, Doan PLN, Nguyen T. Demand for Mobile Health in Developing Countries During COVID-19: Vietnamese's Perspectives from Different Age Groups and Health Conditions. Patient Prefer Adherence 2022; 16:265-284. [PMID: 35140459 PMCID: PMC8819166 DOI: 10.2147/ppa.s348790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/15/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Vietnam's economy and intellectual standards have witnessed significant development, improving conditions for residents to acquire novel mHealth applications. Additionally, the outbreak of the COVID-19 pandemic has influenced Vietnamese awareness of healthcare; however, previous studies have only been clinician-centered rather than customer-centered. METHODS This study addresses this literature gap by interviewing 50 Vietnamese participants grouped by age, namely Generation X, Generation Y, and Generation Z, and health conditions, namely whether participants or family members have chronic illness. The study utilized semi-structured and in-depth interviews to collect the data and used thematic analysis to analyze the data under the unified theory of acceptance and use of technology framework. RESULTS Most participants were willing to adopt this technology and demanded a convenient and user-friendly one-stop-shop solution, endorsements from credible and authoritative sources, and professional customer services. However, each group also had distinctive demands and behaviors. CONCLUSION This study contributes theoretically by providing context-rich demand for Vietnamese customers across three generations and healthcare conditions during the COVID-19 pandemic and comparing their behavior with pre-COVID literature. While this research provides helpful information for potential app developers, this study also suggests that mHealth developers and policymakers should pay more attention to the differences in the demand of age groups and health conditions.
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Affiliation(s)
- Hung Long Nguyen
- Department of Youth Lab for Social Innovation, MiYork Research, Ho Chi Minh City, Vietnam
- Department of Biology, Vietnam National University Ho Chi Minh City - High School for the Gifted, Ho Chi Minh City, Vietnam
| | - Khoa Tran
- Department of Youth Lab for Social Innovation, MiYork Research, Ho Chi Minh City, Vietnam
- Correspondence: Khoa Tran, Youth Lab for Social Innovation, MiYork Research, Ho Chi Minh City, Vietnam, Email
| | - Phuong Le Nam Doan
- Department of Youth Lab for Social Innovation, MiYork Research, Ho Chi Minh City, Vietnam
- Department of Biology, Vietnam National University Ho Chi Minh City - High School for the Gifted, Ho Chi Minh City, Vietnam
| | - Tuyet Nguyen
- Department of Youth Lab for Social Innovation, MiYork Research, Ho Chi Minh City, Vietnam
- Department of Business, Minerva University, San Francisco, CA, USA
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11
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van Zyl C, Badenhorst M, Hanekom S, Heine M. Unravelling 'low-resource settings': a systematic scoping review with qualitative content analysis. BMJ Glob Health 2021; 6:e005190. [PMID: 34083239 PMCID: PMC8183220 DOI: 10.1136/bmjgh-2021-005190] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The effects of healthcare-related inequalities are most evident in low-resource settings. Such settings are often not explicitly defined, and umbrella terms which are easier to operationalise, such as 'low-to-middle-income countries' or 'developing countries', are often used. Without a deeper understanding of context, such proxies are pregnant with assumptions, insinuate homogeneity that is unsupported and hamper knowledge translation between settings. METHODS A systematic scoping review was undertaken to start unravelling the term 'low-resource setting'. PubMed, Africa-Wide, Web of Science and Scopus were searched (24 June 2019), dating back ≤5 years, using terms related to 'low-resource setting' and 'rehabilitation'. Rehabilitation was chosen as a methodological vehicle due to its holistic nature (eg, multidisciplinary, relevance across burden of disease, and throughout continuum of care) and expertise within the research team. Qualitative content analysis through an inductive approach was used. RESULTS A total of 410 codes were derived from 48 unique articles within the field of rehabilitation, grouped into 63 content categories, and identified nine major themes relating to the term 'low-resource setting'. Themes that emerged relate to (1) financial pressure, (2) suboptimal healthcare service delivery, (3) underdeveloped infrastructure, (4) paucity of knowledge, (5) research challenges and considerations, (6) restricted social resources, (7) geographical and environmental factors, (8) human resource limitations and (9) the influence of beliefs and practices. CONCLUSION The emerging themes may assist with (1) the groundwork needed to unravel 'low-resource settings' in health-related research, (2) moving away from assumptive umbrella terms like 'low-to-middle-income countries' or 'low/middle-income countries' and (3) promoting effective knowledge transfer between settings.
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Affiliation(s)
- Chanel van Zyl
- Division of Physiotherapy, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Marelise Badenhorst
- Institute of Sport and Exercise Medicine, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Susan Hanekom
- Division of Physiotherapy, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Martin Heine
- Institute of Sport and Exercise Medicine, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa
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12
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Piette JD, Striplin D, Aikens JE, Lee A, Marinec N, Mansabdar M, Chen J, Gregory LA, Kim CS. Impacts of Post-Hospitalization Accessible Health Technology and Caregiver Support on 90-Day Acute Care Use and Self-Care Assistance: A Randomized Clinical Trial. Am J Med Qual 2021; 36:145-155. [PMID: 32723072 DOI: 10.1177/1062860620943673] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hospitalized patients often are readmitted soon after discharge, with many hospitalizations being potentially preventable. The authors evaluated a mobile health intervention designed to improve post-hospitalization support for older adults with common chronic conditions. All participants enrolled with an informal caregiver or "CarePartner" (CP). Intervention patients received automated assessment and behavior change calls. CPs received automated, structured feedback following each assessment. Clinicians received alerts about serious problems identified during patient calls. Controls had a 65% greater risk of hospitalization within 90 days post discharge than intervention patients (P = .041). For every 6.8 enrollees, the intervention prevented 1 rehospitalization or emergency department encounter. The intervention improved physical functioning at 90 days (P = .012). The intervention also improved medication adherence and indicators of the quality of communication with CPs (all P < .01). Automated telephone patient monitoring and self-care advice with feedback to primary care teams and CPs reduces readmission rates over 90 days.
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Affiliation(s)
- John D Piette
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI University of Michigan, Ann Arbor, MI University of Mississippi, Oxford, MS MidMichigan Health Network, Midland, MI University of Washington, Seattle, WA
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13
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Wolff JL, Aufill J, Echavarria D, Blackford AL, Connolly RM, Fetting JH, Jelovac D, Papathakis K, Riley C, Stearns V, Zafman N, Thorner E, Levy HP, Guo A, Dy SM, Wolff AC. A randomized intervention involving family to improve communication in breast cancer care. NPJ Breast Cancer 2021; 7:14. [PMID: 33579966 PMCID: PMC7881185 DOI: 10.1038/s41523-021-00217-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 12/02/2020] [Indexed: 01/01/2023] Open
Abstract
We examined the effects of a communication intervention to engage family care partners on patient portal (MyChart) use, illness understanding, satisfaction with cancer care, and symptoms of anxiety in a single-blind randomized trial of patients in treatment for breast cancer. Patient-family dyads were recruited and randomly assigned a self-administered checklist to clarify the care partner role, establish a shared visit agenda, and facilitate MyChart access (n = 63) or usual care (n = 55). Interviews administered at baseline, 3, 9 (primary endpoint), and 12 months assessed anxiety (GAD-2), mean FAMCARE satisfaction, and complete illness understanding (4 of 4 items correct). Time-stamped electronic interactions measured MyChart use. By 9 months, more intervention than control care partners registered for MyChart (77.8 % vs 1.8%; p < 0.001) and logged into the patient’s account (61.2% vs 0% of those registered; p < 0.001), but few sent messages to clinicians (6.1% vs 0%; p = 0.247). More intervention than control patients viewed clinical notes (60.3% vs 32.7%; p = 0.003). No pre-post group differences in patient or care partner symptoms of anxiety, satisfaction, or complete illness understanding were found. Intervention patients whose care partners logged into MyChart were more likely to have complete illness understanding at 9 months (changed 70.0% to 80.0% vs 69.7% to 54.6%; p = 0.03); symptoms of anxiety were numerically lower (16.7% to 6.7% vs 15.2% to 15.2%; p = 0.24) and satisfaction numerically higher (15.8–16.2 vs 18.0–17.4; p = 0.25). A brief, scalable communication intervention led to greater care partner MyChart use and increased illness understanding among patients with more engaged care partners (NCT03283553).
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Affiliation(s)
- Jennifer L Wolff
- Roger C. Lipitz Center for Integrated Health Care, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - Jennifer Aufill
- Roger C. Lipitz Center for Integrated Health Care, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Diane Echavarria
- Roger C. Lipitz Center for Integrated Health Care, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Amanda L Blackford
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Roisin M Connolly
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - John H Fetting
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Danijela Jelovac
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Katie Papathakis
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carol Riley
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vered Stearns
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Nelli Zafman
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elissa Thorner
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Howard P Levy
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amy Guo
- Roger C. Lipitz Center for Integrated Health Care, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Sydney M Dy
- Roger C. Lipitz Center for Integrated Health Care, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Antonio C Wolff
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA.
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14
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Chang D, Carlo AD, Khor S, Drake L, Lee ES, Avery M, Unützer J, Flum DR. Transforming Population-Based Depression Care: a Quality Improvement Initiative Using Remote, Centralized Care Management. J Gen Intern Med 2021; 36:333-340. [PMID: 32869208 PMCID: PMC7878605 DOI: 10.1007/s11606-020-06136-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION With the growing prevalence of value-based contracts, health systems are incentivized to consider population approaches to service delivery, particularly for chronic conditions like depression. To this end, UW Medicine implemented the Depression-Population Approach to Health (PATH) program in primary care (PC) as part of a system-wide Center for Medicare and Medicaid Innovation (CMMI) quality improvement (QI) initiative. AIM To examine the feasibility of a pilot PATH program and its impact on clinical and process-of-care outcomes. SETTING A large, diverse, geographically disparate academic health system in Western Washington State including 28 PC clinics across five networks. PROGRAM DESCRIPTION The PATH program was a population-level, centralized, measurement-based care intervention that utilized a clinician to provide remote monitoring of treatment progress via chart review and facilitate patient engagement when appropriate. The primary goals of the program were to improve care engagement and increase follow-up PHQ-9 assessments for patients with depression and elevated initial PHQ-9 scores. PROGRAM EVALUATION We employed a prospective, observational study design, including commercially insured adult patients with new depression diagnoses and elevated initial PHQ-9 scores. The pilot intervention group, consisting of accountable care network (ACN) self-enrollees (N = 262), was compared with a similar commercially insured cohort (N = 2527) using difference-in-differences analyses adjusted for patient comorbidities, initial PHQ-9 score, and time trends. The PATH program was associated with three times the odds of PHQ-9 follow-up (OR 3.28, 95% CI 1.79-5.99), twice the odds of a follow-up PC clinic visit (OR 1.74, 95% CI 0.99-3.08), and twice the odds of treatment response, defined as reduction in PHQ-9 score by ≥ 50% (OR 2.02, 95% CI 0.97-4.21). DISCUSSION Our results demonstrate that a centralized, remote care management initiative is both feasible and effective for large academic health systems aiming to improve depression outcome ascertainment, treatment engagement, and clinical care.
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Affiliation(s)
- Denise Chang
- Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, WA, USA.
| | - Andrew D Carlo
- Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, WA, USA
| | - Sara Khor
- Department of Surgery, University of Washington, Seattle, WA, USA.,The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA, USA
| | - Lauren Drake
- UW Medicine Population Health Management, Seattle, WA, USA
| | - E Sally Lee
- UW Medicine, Population Health Analytics, Seattle, WA, USA
| | - Marc Avery
- Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, WA, USA.,Health Management Associates, Seattle, WA, USA
| | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, WA, USA
| | - David R Flum
- Department of Surgery, University of Washington, Seattle, WA, USA
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15
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Shaffer KM, Tigershtrom A, Badr H, Benvengo S, Hernandez M, Ritterband LM. Dyadic Psychosocial eHealth Interventions: Systematic Scoping Review. J Med Internet Res 2020; 22:e15509. [PMID: 32130143 PMCID: PMC7081137 DOI: 10.2196/15509] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/08/2019] [Accepted: 12/19/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Dyadic psychosocial interventions have been found beneficial both for people coping with mental or physical health conditions as well as their family members and friends who provide them with support. Delivering these interventions via electronic health (eHealth) may help increase their scalability. OBJECTIVE This scoping review aimed to provide the first comprehensive overview of dyadic eHealth interventions for individuals of all ages affected by mental or physical illness and their family members or friends who support them. The goal was to understand how dyadic eHealth interventions have been used and to highlight areas of research needed to advance dyadic eHealth intervention development and dissemination. METHODS A comprehensive electronic literature search of PubMed, EMBASE, Cochrane, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO was conducted for articles published in the English language through March 2019. Eligible records described a psychosocial eHealth intervention that intervened with both care recipients and their support person. RESULTS A total of 7113 records were reviewed of which 101 met eligibility criteria. There were 52 unique dyadic eHealth interventions identified, which were tested across 73 different trials. Of the unique interventions, 33 were conducted among dyads of children and their supporting parent, 1 was conducted with an adolescent-young adult care recipient population, and the remaining 18 were conducted among adult dyads. Interventions targeting pediatric dyads most commonly addressed a mental health condition (n=10); interventions targeting adult dyads most commonly addressed cancer (n=9). More than three-fourths of interventions (n=40) required some human support from research staff or clinicians. Most studies (n=64) specified one or more primary outcomes for care recipients, whereas less than one-fourth (n=22) specified primary outcomes for support persons. Where specified, primary outcomes were most commonly self-reported psychosocial or health factors for both care recipients (n=43) and support persons (n=18). Results of the dyadic eHealth intervention tended to be positive for care recipients, but evidence of effects for support persons was limited because of few studies specifying primary outcomes for supporters. Trials of dyadic eHealth interventions were most commonly randomized controlled trials (RCTs; n=44), and RCTs most commonly compared the dyadic eHealth intervention to usual care alone (n=22). CONCLUSIONS This first comprehensive review of dyadic eHealth interventions demonstrates that there is substantial, diverse, and growing literature supporting this interventional approach. However, several significant gaps were identified. Few studies were designed to evaluate the unique effects of dyadic interventions relative to individual interventions. There was also limited assessment and reporting of outcomes for support persons, and there were no interventions meeting our eligibility criteria specifically targeting the needs of older adult dyads. Findings highlight areas of research opportunities for developing dyadic eHealth interventions for novel populations and for increasing access to dyadic care.
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Affiliation(s)
- Kelly M Shaffer
- Center for Behavioral Health and Technology, University of Virginia School of Medicine, Charlottesville, VA, United States
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | | | - Hoda Badr
- Baylor College of Medicine, Houston, TX, United States
| | | | - Marisol Hernandez
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
- CUNY School of Medicine/City College of New York, New York, NY, United States
| | - Lee M Ritterband
- Center for Behavioral Health and Technology, University of Virginia School of Medicine, Charlottesville, VA, United States
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16
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Robbins R, Affouf M, Seixas A, Beaugris L, Avirappattu G, Jean-Louis G. Four-Year Trends in Sleep Duration and Quality: A Longitudinal Study Using Data from a Commercially Available Sleep Tracker. J Med Internet Res 2020; 22:e14735. [PMID: 32078573 PMCID: PMC7059084 DOI: 10.2196/14735] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 10/20/2019] [Accepted: 11/18/2019] [Indexed: 01/29/2023] Open
Abstract
Background Population estimates of sleep duration and quality are inconsistent because they rely primarily on self-reported data. Passive and ubiquitous digital tracking and wearable devices may provide more accurate estimates of sleep duration and quality. Objective This study aimed to identify trends in sleep duration and quality in New York City based on 2 million nights of data from users of a popular mobile sleep app. Methods We examined sleep duration and quality using 2,161,067 nights of data captured from 2015 to 2018 by Sleep Cycle, a popular sleep-tracking app. In this analysis, we explored differences in sleep parameters based on demographic factors, including age and sex. We used graphical matrix representations of data (heat maps) and geospatial analyses to compare sleep duration (in hours) and sleep quality (based on time in bed, deep sleep time, sleep consistency, and number of times fully awake), considering potential effects of day of the week and seasonality. Results Women represented 46.43% (1,003,421/2,161,067) of the sample, and men represented 53.57% (1,157,646/2,161,067) of individuals in the sample. The average age of the sample was 31.0 years (SD 10.6). The mean sleep duration of the total sample was 7.11 hours (SD 1.4). Women slept longer on average (mean 7.27 hours, SD 1.4) than men (mean 7 hours, SD 1.3; P<.001). Trend analysis indicated longer sleep duration and higher sleep quality among older individuals than among younger (P<.001). On average, sleep duration was longer on the weekend nights (mean 7.19 hours, SD 1.5) than on weeknights (mean 7.09 hours, SD 1.3; P<.001). Conclusions Our study of data from a commercially available sleep tracker showed that women experienced longer sleep duration and higher sleep quality in nearly every age group than men, and a low proportion of young adults obtained the recommended sleep duration. Future research may compare sleep measures obtained via wearable sleep trackers with validated research-grade measures of sleep.
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Affiliation(s)
- Rebecca Robbins
- Division of Sleep and Circadian Disorders, Harvard Medical School, Boston, MA, United States.,Brigham and Women's Hospital, Boston, MA, United States
| | - Mahmoud Affouf
- Mathematical Sciences, Kean University, Union, NJ, United States
| | - Azizi Seixas
- Center for Healthful Behavior Change, Department of Population Health, NYU School of Medicine, New York, NY, United States
| | - Louis Beaugris
- Mathematical Sciences, Kean University, Union, NJ, United States
| | | | - Girardin Jean-Louis
- Center for Healthful Behavior Change, Department of Population Health, NYU School of Medicine, New York, NY, United States
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17
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Irani E, Niyomyart A, Hickman RL. Systematic Review of Technology-Based Interventions Targeting Chronically Ill Adults and Their Caregivers. West J Nurs Res 2020; 42:974-992. [PMID: 31941418 DOI: 10.1177/0193945919897011] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this systematic review is to synthesize the study design features as well as the attributes and outcomes of technology-based health interventions targeting chronically ill adults and their family caregivers. Twenty papers representing 19 studies met the inclusion criteria. Various theoretical foundations or approaches guided the interventions in 11 studies. Interventions either aimed to support patient self-management and improve patient outcomes or enhance shared illness management and improve patient and caregiver outcomes. The interventions included educational, behavioral, and support components and were delivered using various technologies ranging from text messaging to using the Internet. Overall, patients and caregivers expressed improvements in self-management outcomes (or support) and quality of life. Interventions with a dyadic focus reported on interpersonal outcomes, with improvements noted mostly in patients. This review captures an emerging area of science, and findings should be interpreted in light of the methodological limitations of the included studies.
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Affiliation(s)
- Elliane Irani
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Atsadaporn Niyomyart
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Ronald L Hickman
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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18
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Dell'Osso B, Albert U, Carrà G, Pompili M, Nanni MG, Pasquini M, Poloni N, Raballo A, Sambataro F, Serafini G, Viganò C, Demyttenaere K, McIntyre RS, Fiorillo A. How to improve adherence to antidepressant treatments in patients with major depression: a psychoeducational consensus checklist. Ann Gen Psychiatry 2020; 19:61. [PMID: 33062034 PMCID: PMC7552507 DOI: 10.1186/s12991-020-00306-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 09/20/2020] [Indexed: 11/13/2022] Open
Abstract
Studies conducted in primary care as well as in psychiatric settings show that more than half of patients suffering from major depressive disorder (MDD) have poor adherence to antidepressants. Patients prematurely discontinue antidepressant therapy for various reasons, including patient-related (e.g., misperceptions about antidepressants, side-effects, and lack of tolerability), clinician-related (e.g., insufficient instruction received by clinicians about the medication, lack of shared decision-making, and follow-up care), as well as structural factors (e.g., access, cost, and stigma). The high rate of poor adherence to antidepressant treatments provides the impetus for identifying factors that are contributing to noncompliance in an individual patient, to implement a careful education about this phenomenon. As adherence to antidepressants is one of the major unmet needs in MDD treatment, being associated with negative outcomes, we sought to identify a series of priorities to be discussed with persons with MDD with the larger aim to improve treatment adherence. To do so, we analyzed a series of epidemiological findings and clinical reasons for this phenomenon, and then proceeded to define through a multi-step consensus a set of recommendations to be provided by psychiatrists and other practitioners at the time of the first (prescription) visit with patients. Herein, we report the results of this initiative.
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Affiliation(s)
- Bernardo Dell'Osso
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy.,Department of Mental Health, ASST Fatebenefratelli-Sacco, Milan, Italy.,Aldo Ravelli' Research Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan Medical School, Milan, Italy.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA USA
| | - Umberto Albert
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy.,Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, Clinica Psichiatrica, Trieste, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | - Maurizio Pompili
- Dept. of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Maria Giulia Nanni
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Massimo Pasquini
- Department of Human Neurosciences-Faculty of Medicine and Dentistry-SAPIENZA University of Rome, Rome, Italy
| | - Nicola Poloni
- Department of Medicine and Surgery, Section of Psychiatry, University of Insubria, Varese, Italy
| | - Andrea Raballo
- Section of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, University of Perugia, Perugia, Italy.,Center for Translational, Phenomenological and Developmental Psychopathology, Perugia University Hospital, Perugia, Italy
| | - Fabio Sambataro
- Section of Psychiatry, Department of Neuroscience, University of Padova, Padua, Italy.,Padua Neuroscience Center, University of Padova, Padua, Italy
| | - Gianluca Serafini
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Caterina Viganò
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy.,Department of Mental Health, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Koen Demyttenaere
- Center for Public Health Psychiatry, KU Leuven, Leuven, Belgium.,Campus Gasthuisberg, Universitair Psychiatrisch Centrum KU Leuven (UPC-KUL), Leuven, Belgium
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON Canada.,Institute of Medical Science, University of Toronto, Toronto, ON Canada.,Department of Pharmacology, University of Toronto, Toronto, ON Canada.,Department of Psychiatry, University of Toronto, Toronto, ON Canada.,Brain and Cognition Discovery Foundation, Toronto, ON Canada
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
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19
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Piette JD, Striplin D, Fisher L, Aikens JE, Lee A, Marinec N, Mansabdar M, Chen J, Gregory LA, Kim CS. Effects of Accessible Health Technology and Caregiver Support Posthospitalization on 30-Day Readmission Risk: A Randomized Trial. Jt Comm J Qual Patient Saf 2019; 46:109-117. [PMID: 31810829 DOI: 10.1016/j.jcjq.2019.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Patients with chronic illness often require ongoing support postdischarge. This study evaluated a simple-to-use, mobile health-based program designed to improve postdischarge follow-up via (1) tailored communication to patients using automated calls, (2) structured feedback to informal caregivers, and (3) automated alerts to clinicians about urgent problems. METHODS A total of 283 patients with common medical diagnoses, including chronic obstructive pulmonary disease, coronary artery disease, pneumonia, and diabetes, were recruited from a university hospital, a community hospital, and a US Department of Veterans Affairs hospital. All patients identified an informal caregiver or "care partner" (CP) to participate in their postdischarge support. Patient-CP dyads were randomized to the intervention or usual care. Intervention patients received weekly automated assessment and behavior change calls. CPs received structured e-mail feedback. Outpatient clinicians received fax alerts about serious problems. Primary outcomes were 30-day readmission rate and the combined outcome of readmission/emergency department (ED) use. Information about postdischarge outpatient visits, rehospitalizations, and ED encounters was obtained from medical records. RESULTS Overall, 11.4% of intervention patients and 17.9% of controls were rehospitalized within 30 days postdischarge (hazard ratio [HR]: 0.59; 95% confidence interval [CI]: 0.31-1.11; p = 0.102). Compared to intervention patients with other illnesses, those with pulmonary diagnoses generated the most clinical alerts (p = 0.004). Pulmonary patients in the intervention group showed significantly reduced 30-day risk of rehospitalization relative to controls (HR: 0.31; 95% CI: 0.11-0.87; p = 0.026). CONCLUSION The CP intervention did not improve 30-day readmission rates overall, although post hoc analyses suggested that it may be promising among patients with pulmonary diagnoses.
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20
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Secure Messaging with Physicians by Proxies for Patients with Diabetes: Findings from the ECLIPPSE Study. J Gen Intern Med 2019; 34:2490-2496. [PMID: 31428986 PMCID: PMC6848304 DOI: 10.1007/s11606-019-05259-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 05/14/2019] [Accepted: 07/18/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND Little is known about patients who have caregiver proxies communicate with healthcare providers via portal secure messaging (SM). Since proxy portal use is often informal (e.g., sharing patient accounts), novel methods are needed to estimate the prevalence of proxy-authored SMs. OBJECTIVE (1) Develop an algorithm to identify proxy-authored SMs, (2) apply this algorithm to estimate predicted proxy SM (PPSM) prevalence among patients with diabetes, and (3) explore patient characteristics associated with having PPSMs. DESIGN Retrospective cohort study. PARTICIPANTS We examined 9856 patients from Diabetes Study of Northern California (DISTANCE) who sent ≥ 1 English-language SM to their primary care physician between July 1, 2006, and Dec. 31, 2015. MAIN MEASURES Using computational linguistics, we developed ProxyID, an algorithm that identifies phrases frequently found in registered proxy SMs. ProxyID was validated against blinded expert categorization of proxy status among an SM sample, then applied to identify PPSM prevalence across patients. We examined patients' sociodemographic and clinical characteristics according to PPSM penetrance, "none" (0%), "low" (≥ 0-50%), and "high" (≥ 50-100%). KEY RESULTS Only 2.3% of patients had ≥ 1 registered proxy-authored SM. ProxyID demonstrated moderate agreement with expert classification (Κ = 0.58); 45.7% of patients had PPSMs (40.2% low and 5.5% high). Patients with high percent PPSMs were older than those with low percent and no PPSMs (66.5 vs 57.4 vs 56.2 years, p < 0.001) had higher rates of limited English proficiency (16.1% vs 3.2% vs 3.5%, p < 0.05), lower self-reported health literacy (3.83 vs 4.43 vs 4.44, p < 0.001), and more comorbidities (Charlson index 3.78 vs 2.35 vs 2.18, p < 0.001). CONCLUSIONS Among patients with diabetes, informal proxy SM use is more common than registered use and prevalent among socially and medically vulnerable patients. Future research should explore whether proxy portal use improves patient and/or caregiver outcomes and consider policies that integrate caregivers in portal communication.
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Wolff JL, Kim VS, Mintz S, Stametz R, Griffin JM. An environmental scan of shared access to patient portals. J Am Med Inform Assoc 2019; 25:408-412. [PMID: 29025034 DOI: 10.1093/jamia/ocx088] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 08/02/2017] [Indexed: 11/13/2022] Open
Abstract
We sought to understand the comprehensiveness of consumer-oriented information describing the availability of shared access to adult patient portals from publicly reported information on institutional websites of 20 large and geographically diverse health systems. All 20 health systems reported that they offer patients the ability to share access to their patient portal account with a family member or friend; however, the comprehensiveness of information regarding registration procedures, features, and terminology varied widely. Half of the systems (n = 10) reported having shared access available on their patient portal registration webpage. Few systems (n = 2) reported affording patients the ability to differentiate specific role-based privileges. No systems reported uptake of shared access among adult patients, which was variably described as "proxy," "caregiver," "parental," or "delegate" access. Findings suggest that engaging families through health information technology will require greater efforts to promote awareness and differentiate privileges that respect patients' choice and control in information-sharing preferences.
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Affiliation(s)
- Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Victoria S Kim
- University of Hawaii John A Burns School of Medicine, Honolulu, HI, USA
| | | | - Rebecca Stametz
- Clinical Innovation, Advanced Application Development Team, Geisinger Health System, Danville, PA, USA
| | - Joan M Griffin
- Health Sciences Research, Division of Health Care Policy and Research, and Robert D and Patricia E Kern Scientific Director in the Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA
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22
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Steinkamp JM, Goldblatt N, Borodovsky JT, LaVertu A, Kronish IM, Marsch LA, Schuman-Olivier Z. Technological Interventions for Medication Adherence in Adult Mental Health and Substance Use Disorders: A Systematic Review. JMIR Ment Health 2019; 6:e12493. [PMID: 30860493 PMCID: PMC6434404 DOI: 10.2196/12493] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/13/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Medication adherence is critical to the effectiveness of psychopharmacologic therapy. Psychiatric disorders present special adherence considerations, notably an altered capacity for decision making and the increased street value of controlled substances. A wide range of interventions designed to improve adherence in mental health and substance use disorders have been studied; recently, many have incorporated information technology (eg, mobile phone apps, electronic pill dispensers, and telehealth). Many intervention components have been studied across different disorders. Furthermore, many interventions incorporate multiple components, making it difficult to evaluate the effect of individual components in isolation. OBJECTIVE The aim of this study was to conduct a systematic scoping review to develop a literature-driven, transdiagnostic taxonomic framework of technology-based medication adherence intervention and measurement components used in mental health and substance use disorders. METHODS This review was conducted based on a published protocol (PROSPERO: CRD42018067902) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review guidelines. We searched 7 electronic databases: MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials, Web of Science, Engineering Village, and ClinicalTrials.gov from January 2000 to September 2018. Overall, 2 reviewers independently conducted title and abstract screens, full-text screens, and data extraction. We included all studies that evaluate populations or individuals with a mental health or substance use disorder and contain at least 1 technology-delivered component (eg, website, mobile phone app, biosensor, or algorithm) designed to improve medication adherence or the measurement thereof. Given the wide variety of studied interventions, populations, and outcomes, we did not conduct a risk of bias assessment or quantitative meta-analysis. We developed a taxonomic framework for intervention classification and applied it to multicomponent interventions across mental health disorders. RESULTS The initial search identified 21,749 results; after screening, 127 included studies remained (Cohen kappa: 0.8, 95% CI 0.72-0.87). Major intervention component categories include reminders, support messages, social support engagement, care team contact capabilities, data feedback, psychoeducation, adherence-based psychotherapy, remote care delivery, secure medication storage, and contingency management. Adherence measurement components include self-reports, remote direct visualization, fully automated computer vision algorithms, biosensors, smart pill bottles, ingestible sensors, pill counts, and utilization measures. Intervention modalities include short messaging service, mobile phone apps, websites, and interactive voice response. We provide graphical representations of intervention component categories and an element-wise breakdown of multicomponent interventions. CONCLUSIONS Many technology-based medication adherence and monitoring interventions have been studied across psychiatric disease contexts. Interventions that are useful in one psychiatric disorder may be useful in other disorders, and further research is necessary to elucidate the specific effects of individual intervention components. Our framework is directly developed from the substance use disorder and mental health treatment literature and allows for transdiagnostic comparisons and an organized conceptual mapping of interventions.
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Affiliation(s)
| | - Nathaniel Goldblatt
- Outpatient Addiction Services, Department of Psychiatry, Cambridge Health Alliance, Somerville, MA, United States
| | | | - Amy LaVertu
- Tufts University School of Medicine, Boston, MA, United States
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York City, NY, United States
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Zev Schuman-Olivier
- Outpatient Addiction Services, Department of Psychiatry, Cambridge Health Alliance, Somerville, MA, United States.,Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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Abstract
PURPOSE OF REVIEW This article systematically reviews studies examining remote measurement-based care (RMBC), defined as using technology to measure patients' psychiatric symptoms outside the context of a clinical encounter. RECENT FINDINGS Thirty-six studies were identified that measured patients' psychiatric symptoms remotely and provided feedback to treatment providers. The majority were single group designs. There was evidence supporting the short-term feasibility and acceptability of RMBC, although long-term sustainability was less clear. Thirteen randomized controlled trials were identified. RMBC was typically implemented as part of a multicomponent intervention (e.g., internet-based cognitive behavioral therapy with feedback to provider). Three studies experimentally isolated the clinical effects of RMBC, with two reporting no statistically significant differences between the RMBC and control conditions and one reporting greater symptom improvement associated with RMBC. RMBC appears feasible and acceptable and may be a promising intervention for improving mental health care, but additional experimental studies are needed.
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Mobile technology for medication adherence in people with mood disorders: A systematic review. J Affect Disord 2018; 227:613-617. [PMID: 29172054 DOI: 10.1016/j.jad.2017.11.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/27/2017] [Accepted: 11/07/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Medication non-adherence is a critical challenge for many patients diagnosed with mood disorders (Goodwin and Jamison, 1990). There is a need for alternative strategies that improve adherence among patients with mood disorders that are cost-effective, able to reach large patient populations, easy to implement, and that allow for communication with patients outside of in-person visits. Technology-based approaches to promote medication adherence are increasingly being explored to address this need. The aim of this paper is to provide a systematic review of the use of mobile technologies to improve medication adherence in patients with mood disorders. METHODS A total of nine articles were identified as describing mobile technology targeting medication adherence in mood disorder populations. RESULTS Results showed overall satisfaction and feasibility of mobile technology, and reduction in mood symptoms; however, few examined effectiveness of mobile technology improving medication adherence through randomized control trials. LIMITATIONS Given the limited number of studies, further research is needed to determine long term effectiveness. CONCLUSIONS Mobile technologies has the potential to improve medication adherence and can be further utilized for symptom tracking, side effects tracking, direct links to prescription refills, and provide patients with greater ownership over their treatment progress.
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Wolff JL, Darer JD, Berger A, Clarke D, Green JA, Stametz RA, Delbanco T, Walker J. Inviting patients and care partners to read doctors' notes: OpenNotes and shared access to electronic medical records. J Am Med Inform Assoc 2018; 24:e166-e172. [PMID: 27497795 DOI: 10.1093/jamia/ocw108] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 06/15/2016] [Indexed: 11/14/2022] Open
Abstract
We examined the acceptability and effects of delivering doctors' visit notes electronically (via OpenNotes) to patients and care partners with authorized access to patients' electronic medical records. Adult patients and care partners at Geisinger Health System were surveyed at baseline and after 12 months of exposure to OpenNotes. Reporting on care partner access to OpenNotes, patients and care partners stated that they had better agreement about patient treatment plans and more productive discussions about their care. At follow-up, patients were more confident in their ability to manage their health, felt better prepared for office visits, and reported understanding their care better than at baseline. Care partners were more likely to access and use patient portal functionality and reported improved communication with patients' providers at follow-up. Our findings suggest that offering patients and care partners access to doctors' notes is acceptable and improves communication and patients' confidence in managing their care.
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Affiliation(s)
- Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jonathan D Darer
- Geisinger Health System, Danville, Pennsylvania; as of September 2015: Medicalis, Kitchener, Ontario
| | | | - Deserae Clarke
- Center for Clinical Innovation, Geisinger Institute for Advanced Application
| | | | - Rebecca A Stametz
- Center for Clinical Innovation, Geisinger Institute for Advanced Application
| | - Tom Delbanco
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jan Walker
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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26
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Vick JB, Amjad H, Smith KC, Boyd CM, Gitlin LN, Roth DL, Roter DL, Wolff JL. "Let him speak:" a descriptive qualitative study of the roles and behaviors of family companions in primary care visits among older adults with cognitive impairment. Int J Geriatr Psychiatry 2018; 33:e103-e112. [PMID: 28585721 PMCID: PMC5862540 DOI: 10.1002/gps.4732] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 04/04/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Cognitive impairment poses communication challenges in primary care. Although family "companions" commonly attend primary care visits of older adults with cognitive impairment, little is known about how their involvement affects communication. Therefore, we sought to understand how companion involvement affects the quality of primary care visit communication for older adults with cognitive impairment. METHODS Cross-sectional, descriptive qualitative study participants were as follows: (1) English-speaking adults age 65 or older with mild, moderate, or severe cognitive impairment; (2) family members or other unpaid companions who accompany older adults to primary care visits; and (3) primary care clinicians. Twenty semi-structured and in-depth qualitative interviews of older adults and their companions (N = 20 dyads) and two focus groups (N = 10 primary care clinicians) were conducted. Interviews and focus groups were transcribed and analyzed thematically. RESULTS Family companions commonly facilitate communication by advocating for patients, ensuring the accuracy of information exchange and understanding, and preserving rapport. Significant communication challenges were also identified, including patient and companion role ambiguity, competing visit agendas, and primary care clinician confusion regarding the most accurate source of information. Patients, companions, and clinicians each identified strategies to improve communication, chief among them being to identify, differentiate, and respect both patient and companion priorities and perspectives. CONCLUSIONS Family companions actively participate in primary care visits of older adults with cognitive impairment in ways that promote and inhibit effective communication. Findings suggest the need for strategies that more effectively and purposefully involve family in the care of primary care patients with cognitive impairment. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
| | | | | | - Cynthia M. Boyd
- Johns Hopkins University School of Medicine
- Johns Hopkins Bloomberg School of Public Health
| | - Laura N. Gitlin
- Johns Hopkins University School of Medicine
- Johns Hopkins University School of Nursing, Center for Innovative Care in Aging
| | - David L. Roth
- Johns Hopkins University School of Medicine
- Johns Hopkins Bloomberg School of Public Health
| | | | - Jennifer L. Wolff
- Johns Hopkins University School of Medicine
- Johns Hopkins Bloomberg School of Public Health
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Kim H, Ray CD, Veluscek AM. Complementary Support from Facilitators and Peers for Promoting mHealth Engagement and Weight Loss. JOURNAL OF HEALTH COMMUNICATION 2017; 22:905-912. [PMID: 29125393 DOI: 10.1080/10810730.2017.1373876] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study investigates the effects of mHealth interventions on sustainable behavior change and weight loss, drawing on in-app user activity data and online survey data. Specifically, we focus on the interactions within mobile support groups in Noom, an mHealth application for obesity intervention, to delve into how social support from facilitators and peers may play differential roles in promoting health outcomes. The results of structural equation modeling (N = 301) demonstrated that (a) perceived facilitator support was positively associated with group members' health information acquisition such as fitness-themed article reading whereas perceived peer support was positively linked to group participation such as posting and responding; (b) perceived peer support was positively related to normative influence among group members, which subsequently increased group members' responses to others' posts; and (c) health information reading and in-group posting promoted weight loss; however, merely responding to others' posts did not lead to weight-loss success. The findings suggest that the complementary influences of facilitators and peers must be considered to enhance the efficacy of support group interventions.
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Affiliation(s)
- Heewon Kim
- a The Hugh Downs School of Communication , Arizona State University , Tempe , Arizona , USA
| | - Colter D Ray
- a The Hugh Downs School of Communication , Arizona State University , Tempe , Arizona , USA
| | - Alaina M Veluscek
- a The Hugh Downs School of Communication , Arizona State University , Tempe , Arizona , USA
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28
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Pfeiffer PN, Valenstein M, Ganoczy D, Henry J, Dobscha SK, Piette JD. Pilot study of enhanced social support with automated telephone monitoring after psychiatric hospitalization for depression. Soc Psychiatry Psychiatr Epidemiol 2017; 52:183-191. [PMID: 27783130 DOI: 10.1007/s00127-016-1288-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 10/10/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND Following discharge, patients hospitalized for depression are at high risk for poor retention in outpatient care and adverse outcomes. AIMS Pilot tests a post-hospital monitoring and enhanced support program for depression. METHOD 48 patients at a Veterans Affairs Medical Center discharged following a depression-related inpatient stay received weekly visits or phone calls for 6 months from their choice of either a family member/friend (n = 19) or a certified peer support specialist (n = 29). Participants also completed weekly automated telephone monitoring calls assessing depressive symptoms and antidepressant medication adherence. RESULTS Over 90% of participants were more satisfied with their care due to the service. The mean change from baseline to 6 months in depression symptoms was -7.9 (p < 0.05) according to the Patient Health Questionnaire and -11.2 (p < 0.05) according to the Beck Depression Inventory-II for those supported by a family member/friend, whereas those supported by a peer specialist had mean changes of -3.5 (p < 0.05) and -1.7 (p > 0.10), respectively. CONCLUSIONS Increased contact with a chosen support person coupled with automated telephone monitoring after psychiatric hospitalization is an acceptable service for patients with depression. Those who received the service, and particularly those supported by a family member/friend, experienced reductions in symptoms of depression.
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Affiliation(s)
- Paul N Pfeiffer
- University of Michigan Medical School, Ann Arbor, MI, USA. .,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
| | - Marcia Valenstein
- University of Michigan Medical School, Ann Arbor, MI, USA.,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Dara Ganoczy
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Jennifer Henry
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Steven K Dobscha
- VA Center for Veteran Involvement in Care, Portland Veterans Affairs Medical Center, Portland, MI, USA.,Oregon Health & Science University, Portland, OR, USA
| | - John D Piette
- University of Michigan Medical School, Ann Arbor, MI, USA.,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,University of Michigan School of Public Health, Ann Arbor, MI, USA
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29
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Janevic MR, Aruquipa Yujra AC, Marinec N, Aguilar J, Aikens JE, Tarrazona R, Piette JD. Feasibility of an interactive voice response system for monitoring depressive symptoms in a lower-middle income Latin American country. Int J Ment Health Syst 2016; 10:59. [PMID: 27688798 PMCID: PMC5034527 DOI: 10.1186/s13033-016-0093-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 09/17/2016] [Indexed: 11/10/2022] Open
Abstract
Background Innovative, scalable solutions are needed to address the vast unmet need for mental health care in low- and middle-income countries (LMICs). Methods We conducted a feasibility study of a 14-week automated telephonic interactive voice response (IVR) depression self-care service among Bolivian primary care patients with at least moderately severe depressive symptoms. We analyzed IVR call completion rates, the reliability and validity of IVR-collected data, and participant satisfaction. Results Of the 32 participants, the majority were women (78 % or 25/32) and non-indigenous (75 % or 24/32). Participants had moderate depressive symptoms at baseline (PHQ-8 score mean 13.3, SD = 3.5) and reported good or fair general health status (88 % or 28/32). Fifty-four percent of weekly IVR calls (approximately 7 out of 13 active call-weeks) were completed. Neither PHQ-8 scores nor IVR call completion differed significantly by ethnicity, education, self-reported depression diagnosis, self-reported overall health, number of chronic conditions, or health literacy. The reliability for IVR-collected PHQ-8 scores was good (Cronbach’s alpha = 0.83). Virtually every participant (97 %) was “mostly” or “very” satisfied with the program. Many described the program as beneficial for their mood and self-care, albeit limited by some technological difficulties and the lack of human interaction. Conclusion Findings suggest that IVR could feasibly be used to provide monitoring and self-care education to depressed patients in Bolivia. An expanded stepped-care service offering contact with lay health workers for more depressed individuals and expanded mHealth content may foster greater patient engagement and enhance its therapeutic value while remaining cost-effective. Trial registration ISRCTN ISRCTN 18403214. Registered 14 September 2016. Retrospectively registered
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Affiliation(s)
- Mary R Janevic
- Center for Managing Chronic Disease, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109 USA
| | | | - Nicolle Marinec
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI 48105 USA
| | - Juvenal Aguilar
- Estado Plurinacional de Bolivia Ministerio de Salud, La Paz, Bolivia
| | - James E Aikens
- School of Medicine, University of Michigan, 1018 Fuller St., Ann Arbor, MI 48104 USA
| | - Rosa Tarrazona
- QUANTICA Organización Profesional para el Avance de la Salud Mental, La Paz, Bolivia
| | - John D Piette
- Center for Managing Chronic Disease, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109 USA
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Trivedi R, Slightam C, Fan VS, Rosland AM, Nelson K, Timko C, Asch SM, Zeliadt SB, Heidenreich P, Hebert PL, Piette JD. A Couples' Based Self-Management Program for Heart Failure: Results of a Feasibility Study. Front Public Health 2016; 4:171. [PMID: 27626029 PMCID: PMC5004799 DOI: 10.3389/fpubh.2016.00171] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 08/03/2016] [Indexed: 11/15/2022] Open
Abstract
Background Heart failure (HF) is associated with frequent exacerbations and shortened lifespan. Informal caregivers such as significant others often support self-management in patients with HF. However, existing programs that aim to enhance self-management seldom engage informal caregivers or provide tools that can help alleviate caregiver burden or improve collaboration between patients and their informal caregivers. Objective To develop and pilot test a program targeting the needs of self-management support among HF patients as well as their significant others. Methods We developed the Dyadic Health Behavior Change model and conducted semi-structured interviews to determine barriers to self-management from various perspectives. Participants’ feedback was used to develop a family-centered self-management program called “SUCCEED: Self-management Using Couples’ Coping EnhancEment in Diseases.” The goals of this program are to improve HF self-management, quality of life, communication within couples, relationship quality, and stress and caregiver burden. We conducted a pilot study with 17 Veterans with HF and their significant others to determine acceptability of the program. We piloted psychosocial surveys at baseline and after participants’ program completion to evaluate change in depressive symptoms, caregiver burden, self-management of HF, communication, quality of relationship, relationship mutuality, and quality of life. Results Of the 17 couples, 14 completed at least 1 SUCCEED session. Results showed high acceptability for each of SUCCEED’s sessions. At baseline, patients reported poor quality of life, clinically significant depressive symptoms, and inadequate self-management of HF. After participating in SUCCEED, patients showed improvements in self-management of HF, communication, and relationship quality, while caregivers reported improvements in depressive symptoms and caregiver burden. Quality of life of both patients and significant others declined over time. Conclusion In this small pilot study, we showed positive trends with involving significant others in self-management. SUCCEED has the potential of addressing the growing public health problem of HF among patients who receive care from their significant other.
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Affiliation(s)
- Ranak Trivedi
- Stanford University, Stanford, CA, USA; VA Palo Alto Health Care System, Menlo Park, CA, USA
| | | | - Vincent S Fan
- VA Puget Sound Health Care System, Seattle, WA, USA; University of Washington, Seattle, WA, USA
| | - Ann-Marie Rosland
- University of Michigan, Ann Arbor, MI, USA; VA Ann Arbor Health Care System, Ann Arbor, MI, USA
| | - Karin Nelson
- VA Puget Sound Health Care System, Seattle, WA, USA; University of Washington, Seattle, WA, USA
| | | | - Steven M Asch
- Stanford University, Stanford, CA, USA; VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Steven B Zeliadt
- VA Puget Sound Health Care System, Seattle, WA, USA; University of Washington, Seattle, WA, USA
| | - Paul Heidenreich
- Stanford University, Stanford, CA, USA; VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Paul L Hebert
- VA Puget Sound Health Care System, Seattle, WA, USA; University of Washington, Seattle, WA, USA
| | - John D Piette
- University of Michigan, Ann Arbor, MI, USA; VA Ann Arbor Health Care System, Ann Arbor, MI, USA
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Versluis A, Verkuil B, Spinhoven P, van der Ploeg MM, Brosschot JF. Changing Mental Health and Positive Psychological Well-Being Using Ecological Momentary Interventions: A Systematic Review and Meta-analysis. J Med Internet Res 2016; 18:e152. [PMID: 27349305 PMCID: PMC4940607 DOI: 10.2196/jmir.5642] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 04/04/2016] [Accepted: 04/21/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Mental health problems are highly prevalent, and there is need for the self-management of (mental) health. Ecological momentary interventions (EMIs) can be used to deliver interventions in the daily life of individuals using mobile devices. OBJECTIVES The aim of this study was to systematically assess and meta-analyze the effect of EMI on 3 highly prevalent mental health outcomes (anxiety, depression, and perceived stress) and positive psychological outcomes (eg, acceptance). METHODS PsycINFO and Web of Science were searched for relevant publications, and the last search was done in September 2015. Three concepts were used to find publications: (1) mental health, (2) mobile phones, and (3) interventions. A total of 33 studies (using either a within- or between-subject design) including 43 samples that received an EMI were identified (n=1301), and relevant study characteristics were coded using a standardized form. Quality assessment was done with the Cochrane Collaboration tool. RESULTS Most of the EMIs focused on a clinical sample, used an active intervention (that offered exercises), and in over half of the studies, additional support by a mental health professional (MHP) was given. The EMI lasted on average 7.48 weeks (SD=6.46), with 2.80 training episodes per day (SD=2.12) and 108.25 total training episodes (SD=123.00). Overall, 27 studies were included in the meta-analysis, and after removing 6 outliers, a medium effect was found on mental health in the within-subject analyses (n=1008), with g=0.57 and 95% CI (0.45-0.70). This effect did not differ as function of outcome type (ie, anxiety, depression, perceived stress, acceptance, relaxation, and quality of life). The only moderator for which the effect varied significantly was additional support by an MHP (MHP-supported EMI, g=0.73, 95% CI: 0.57-0.88; stand-alone EMI, g=0.45, 95% CI: 0.22-0.69; stand-alone EMI with access to care as usual, g=0.38, 95% CI: 0.11-0.64). In the between-subject studies, 13 studies were included, and a small to medium effect was found (g=0.40, 95% CI: 0.22-0.57). Yet, these between-subject analyses were at risk for publication bias and were not suited for moderator analyses. Furthermore, the overall quality of the studies was relatively low. CONCLUSIONS Results showed that there was a small to medium effect of EMIs on mental health and positive psychological well-being and that the effect was not different between outcome types. Moreover, the effect was larger with additional support by an MHP. Future randomized controlled trials are needed to further strengthen the results and to determine potential moderator variables. Overall, EMIs offer great potential for providing easy and cost-effective interventions to improve mental health and increase positive psychological well-being.
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Affiliation(s)
- Anke Versluis
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, Netherlands.
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Piette JD, Marinec N, Janda K, Morgan E, Schantz K, Yujra ACA, Pinto B, Soto JMH, Janevic M, Aikens JE. Structured Caregiver Feedback Enhances Engagement and Impact of Mobile Health Support: A Randomized Trial in a Lower-Middle-Income Country. Telemed J E Health 2016; 22:261-8. [PMID: 26352854 PMCID: PMC4968278 DOI: 10.1089/tmj.2015.0099] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 07/01/2015] [Accepted: 07/01/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Patients' engagement in mobile health (m-health) interventions using interactive voice response (IVR) calls is less in low- and middle-income countries (LMICs) than in industrialized ones. We conducted a study to determine whether automated telephone feedback to informal caregivers ("CarePartners") increased engagement in m-health support among diabetes and hypertension patients in Bolivia. MATERIALS AND METHODS Patients with diabetes and/or hypertension were identified through ambulatory clinics affiliated with four hospitals. All patients enrolled with a CarePartner. Patients were randomized to weekly IVR calls including self-management questions and self-care education either alone ("standard m-health") or with automated feedback about health and self-care needs sent to their CarePartner after each IVR call ("m-health+CP"). RESULTS The 72 participants included 39 with diabetes and 53 with hypertension, of whom 19 had ≤6 years of education. After 1,225 patient-weeks of attempted IVR assessments, the call completion rate was higher among patients randomized to m-health+CP compared with standard m-health (62.0% versus 44.9%; p < 0.047). CarePartner feedback more than tripled call completion rates among indigenous patients and patients with low literacy (p < 0.001 for both). M-health+CP patients were more likely to report excellent health via IVR (adjusted odds ratio [AOR] = 2.60; 95% confidence interval [CI], 1.07, 6.32) and less likely to report days in bed due to illness (AOR = 0.42; 95% CI, 0.19, 0.91). CONCLUSIONS In this study we found that caregiver feedback increased engagement in m-health and may improve patients' health status relative to standard approaches. M-health+CP represents a scalable strategy for increasing the reach of self-management support in LMICs.
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Affiliation(s)
- John D. Piette
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan
- School of Public Health, University of Michigan, Ann Arbor, Michigan
- School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Nicolle Marinec
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan
- School of Public Health, University of Michigan, Ann Arbor, Michigan
- School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Kathryn Janda
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Emily Morgan
- School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Karolina Schantz
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | | | | | | | - Mary Janevic
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - James E. Aikens
- School of Medicine, University of Michigan, Ann Arbor, Michigan
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Can we engage caregiver spouses of patients with heart failure with a low-intensity, symptom-guided intervention? Heart Lung 2016; 45:114-20. [DOI: 10.1016/j.hrtlng.2015.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/04/2015] [Accepted: 12/22/2015] [Indexed: 11/17/2022]
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Piette JD, Striplin D, Marinec N, Chen J, Gregory LA, Sumerlin DL, DeSantis AM, Gibson C, Crause I, Rouse M, Aikens JE. Improving Post-Hospitalization Transition Outcomes through Accessible Health Information Technology and Caregiver Support: Protocol for a Randomized Controlled Trial. JOURNAL OF CLINICAL TRIALS 2016; 5. [PMID: 26779394 PMCID: PMC4711915 DOI: 10.4172/2167-0870.1000240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective The goal of this trial is to evaluate a novel intervention designed to improve post-hospitalization support for older adults with chronic conditions via: (a) direct tailored communication to patients using regular automated calls post discharge, (b) support for informal caregivers outside of the patient’s household via structured automated feedback about the patient’s status plus advice about how caregivers can help, and (c) support for care management including a web-based disease management tool and alerts about potential problems. Methods 846 older adults with common chronic conditions are being identified upon hospital admission. Patients are asked to identify a “CarePartner” (CP) living outside their household, i.e., an adult child or other social network member willing to play an active role in their post-discharge transition support. Patient-CP pairs are randomized to the intervention or usual care. Intervention patients receive automated assessment and behavior change calls, and their CPs receives structured feedback and advice via email and automated calls following each assessment. Clinical teams have access to assessment results via the web and receive automated reports about urgent health problems. Patients complete surveys at baseline, 30 days, and 90 days post discharge; utilization data is obtained from hospital records. CPs, other caregivers, and clinicians are interviewed to evaluate intervention effects on processes of self-care support, caregiver stress and communication, and the intervention’s potential for broader implementation. The primary outcome is 30-day readmission rates; other outcomes measured at 30 days and 90 days include functional status, self-care behaviors, and mortality risk. Conclusion This trial uses accessible health technologies and coordinated communication among informal caregivers and clinicians to fill the growing gap between what discharged patients need and available resources. A unique feature of the intervention is the provision of transition support not only for patients but also for their informal caregivers.
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Affiliation(s)
- John D Piette
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA; Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Dana Striplin
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicolle Marinec
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Jenny Chen
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Lynn A Gregory
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Denise L Sumerlin
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Angela M DeSantis
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Carolyn Gibson
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Ingrid Crause
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Marylena Rouse
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - James E Aikens
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Wolff JL, Darer JD, Larsen KL. Family Caregivers and Consumer Health Information Technology. J Gen Intern Med 2016; 31:117-21. [PMID: 26311198 PMCID: PMC4699991 DOI: 10.1007/s11606-015-3494-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 06/10/2015] [Accepted: 08/05/2015] [Indexed: 10/23/2022]
Abstract
Health information technology has been embraced as a strategy to facilitate patients' access to their health information and engagement in care. However, not all patients are able to access, or are capable of using, a computer or mobile device. Although family caregivers assist individuals with some of the most challenging and costly health needs, their role in health information technology is largely undefined and poorly understood. This perspective discusses challenges and opportunities of engaging family caregivers through the use of consumer-oriented health information technology. We compile existing evidence to make the case that involving family caregivers in health information technology as desired by patients is technically feasible and consistent with the principles of patient-centered and family-centered care. We discuss how more explicit and purposeful engagement of family caregivers in health information technology could advance clinical quality and patient safety by increasing the transparency, accuracy, and comprehensiveness of patient health information across settings of care. Finally, we describe how clarifying and executing patients' desires to involve family members or friends through health information technology would provide family caregivers greater legitimacy, convenience, and timeliness in health system interactions, and facilitate stronger partnerships between patients, family caregivers, and health care professionals.
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Affiliation(s)
- Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Jonathan D Darer
- Division of Clinical Innovation, Geisinger Health System, Danville, PA, USA.
| | - Kevin L Larsen
- Office of the National Coordinator of Health Information Technology, Washington, DC, USA.
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