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Court RJ, Swallow V, El-Yousfi S, Gray-Burrows K, Sotir F, Wheeler G, Kellar I, Lee JM, Mitchell R, Mlynarczyk W, Ramavath A, Dimitri P, Phillips B, Prodgers L, Pownall M, Kowalczyk M, Branchflower J, Powell L, Bhanbhro S, Weighall A, Martin-Kerry J. Children and young people's preferences and needs when using health technology to self-manage a long-term condition: a scoping review. Arch Dis Child 2024:archdischild-2023-326044. [PMID: 39142825 DOI: 10.1136/archdischild-2023-326044] [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: 07/04/2023] [Accepted: 05/27/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND The use of patient-facing health technologies to manage long-term conditions (LTCs) is increasing; however, children and young people (CYP) may have preferences about health technologies which they interact or engage with, that influence their decision to use these technologies. AIMS To identify CYP's reported preferences about health technologies to self-manage LTCs. METHODS We undertook a scoping review, searching MEDLINE, PsycINFO and CINAHL in July 2021. Searches were limited to papers published between January 2015 and July 2021. We included any health technologies used to manage physical and mental LTCs. Qualitative content analysis of study data was undertaken to categorise data into themes and quantitative data were described and visually represented. We engaged CYP with LTCs to support the review design, interpretation of findings and development of recommendations. RESULTS 161 journal articles were included, describing preferences of CYP. Most included studies were undertaken in high-income countries. CYP's main preferences and needs were: design and functionality; privacy and sharing; customisation and personalisation of the technology; and interaction options within the technology. CONCLUSIONS This review highlights important preferences and needs that CYP may have before using technologies to self-manage their LTC. These should be considered when developing technology for this population. Future research should involve CYP throughout the development of the technologies, from identifying their unmet needs through to final design, development, evaluation and implementation of the intervention.
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Affiliation(s)
- Rosemary Jane Court
- Nursing and Midwifery, Sheffield Hallam University College of Health Wellbeing and Life Sciences, Sheffield, UK
| | - Veronica Swallow
- College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, UK
| | - Sarab El-Yousfi
- School of Clinical Dentistry, The University of Sheffield, Sheffield, UK
| | - Kara Gray-Burrows
- School of Dentistry, University of Leeds Faculty of Medicine and Health, Leeds, UK
| | - Fiona Sotir
- School of Clinical Dentistry, The University of Sheffield, Sheffield, UK
| | - Gemma Wheeler
- NIHR MedTech & In Vitro Diagnostics Co-operative Sheffield Children's Hospital, NIHR Sheffield CRF, Sheffield, UK
| | - Ian Kellar
- Department of Psychology, The University of Sheffield, Sheffield, UK
| | - Jia Mang Lee
- Hull York Medical School, University of York, York, UK
| | - Robyn Mitchell
- Patient and Public Involvement (PPI) Group Member, University of York, York, UK
| | - Wiktoria Mlynarczyk
- Patient and Public Involvement (PPI) Group Member, University of York, York, UK
| | - Arnav Ramavath
- Patient and Public Involvement (PPI) Group Member, University of York, York, UK
| | - Paul Dimitri
- NIHR Children and Young People MedTech Cooperative, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Bob Phillips
- Leeds Children's Hospital, Leeds, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Lucy Prodgers
- School of Psychology, University of Leeds, Leeds, UK
| | | | | | - Jacob Branchflower
- NIHR MedTech & In Vitro Diagnostics Co-operative Sheffield Children's Hospital, NIHR Sheffield CRF, Sheffield, UK
| | - Lauren Powell
- School of Education, The University of Sheffield, Sheffield, UK
| | - Sadiq Bhanbhro
- Health Research Institute, Sheffield Hallam University, Sheffield, UK
| | - Anna Weighall
- School of Education, The University of Sheffield, Sheffield, UK
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2
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Baines R, Stevens S, Austin D, Anil K, Bradwell H, Cooper L, Maramba ID, Chatterjee A, Leigh S. Patient and Public Willingness to Share Personal Health Data for Third-Party or Secondary Uses: Systematic Review. J Med Internet Res 2024; 26:e50421. [PMID: 38441944 PMCID: PMC10951832 DOI: 10.2196/50421] [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: 06/30/2023] [Revised: 12/01/2023] [Accepted: 12/18/2023] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND International advances in information communication, eHealth, and other digital health technologies have led to significant expansions in the collection and analysis of personal health data. However, following a series of high-profile data sharing scandals and the emergence of COVID-19, critical exploration of public willingness to share personal health data remains limited, particularly for third-party or secondary uses. OBJECTIVE This systematic review aims to explore factors that affect public willingness to share personal health data for third-party or secondary uses. METHODS A systematic search of 6 databases (MEDLINE, Embase, PsycINFO, CINAHL, Scopus, and SocINDEX) was conducted with review findings analyzed using inductive-thematic analysis and synthesized using a narrative approach. RESULTS Of the 13,949 papers identified, 135 were included. Factors most commonly identified as a barrier to data sharing from a public perspective included data privacy, security, and management concerns. Other factors found to influence willingness to share personal health data included the type of data being collected (ie, perceived sensitivity); the type of user requesting their data to be shared, including their perceived motivation, profit prioritization, and ability to directly impact patient care; trust in the data user, as well as in associated processes, often established through individual choice and control over what data are shared with whom, when, and for how long, supported by appropriate models of dynamic consent; the presence of a feedback loop; and clearly articulated benefits or issue relevance including valued incentivization and compensation at both an individual and collective or societal level. CONCLUSIONS There is general, yet conditional public support for sharing personal health data for third-party or secondary use. Clarity, transparency, and individual control over who has access to what data, when, and for how long are widely regarded as essential prerequisites for public data sharing support. Individual levels of control and choice need to operate within the auspices of assured data privacy and security processes, underpinned by dynamic and responsive models of consent that prioritize individual or collective benefits over and above commercial gain. Failure to understand, design, and refine data sharing approaches in response to changeable patient preferences will only jeopardize the tangible benefits of data sharing practices being fully realized.
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Affiliation(s)
- Rebecca Baines
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | - Sebastian Stevens
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
- Prometheus Health Technologies Ltd, Newquay, United Kingdom
| | - Daniela Austin
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | | | - Hannah Bradwell
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | - Leonie Cooper
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | | | - Arunangsu Chatterjee
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
- School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Simon Leigh
- Prometheus Health Technologies Ltd, Newquay, United Kingdom
- Warwick Medical School, University of Warwick, Conventry, United Kingdom
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3
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Hesso I, Nabhani-Gebara S, Kayyali R. Objective Assessment of Adherence and Inhaler Technique among Asthma and COPD Patients in London: A Study in Community Pharmacies Using an Electronic Monitoring Device. PHARMACY 2023; 11:94. [PMID: 37368420 DOI: 10.3390/pharmacy11030094] [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: 04/28/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND The INhaler Compliance Assessment (INCATM) device is an electronic monitoring device (EMD) that assesses both patient's adherence and inhaler technique (IT). This study aimed, first, to assess the value of using the INCATM device as an objective measure during medicine use review (MUR) consultations provided by community pharmacists (CPs) on patients' adherence and IT. Second, we aimed to explore patients' perceptions about the INCATM device. METHODS A mixed methods approach was used, involving two phases. Phase one was a service evaluation in independent community pharmacies in London with a before-and-after study design. The service included provision of an MUR consultation to asthma and COPD patients using objective feedback about adherence and IT generated with the INCATM device. Descriptive and inferential statistics were performed using SPSS. Phase two involved semi-structured interviews with respiratory patients. Thematic analysis was performed to generate key findings. MAIN FINDINGS Eighteen patients participated in the study (12 COPD and 6 asthma). The results showed significant improvement in the INCATM actual adherence from 30% to 68% (p = 0.001) and significant reduction in IT error rate from 51% to 12% (p = 0.002) after conducting the service. Analysis of the interviews revealed patients' positive attitudes in terms of the perceived benefits of the technology and a desire for future use and recommendation for others. Patients had also positive attitudes towards the consultations provided. CONCLUSION Embedding an objective measure about adherence and IT during CPs' consultations showed a significant improvement in patients' adherence and IT and was accepted by patients as well.
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Affiliation(s)
- Iman Hesso
- School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Penrhyn Road, Kingston upon Thames, London KT1 2EE, UK
| | - Shereen Nabhani-Gebara
- School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Penrhyn Road, Kingston upon Thames, London KT1 2EE, UK
| | - Reem Kayyali
- School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Penrhyn Road, Kingston upon Thames, London KT1 2EE, UK
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4
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Mahmoud RAA, Boshra MS, Saeed H, Abdelrahim MEA. The impact of the clip-tone training device and its smartphone application to pressurized metered-dose inhaler in adult asthmatics. J Asthma 2023; 60:227-234. [PMID: 35171742 DOI: 10.1080/02770903.2022.2043359] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Despite traditional inhaler technique counseling, many patients make clinically important mistakes when they use their inhalers. This study investigates the value of using a connected inhalation aid when adults with asthma use their metered-dose inhaler (pMDI). METHODS Adult asthmatics (n = 221), using a pMDI, were randomly divided into a verbal training group (n = 110) and an enhanced training group (n = 111). 21 subjects were lost during the study, each group included 100 subjects at the end of the study. The study was divided into 3 visits. Traditional pMDI training was delivered at visit 1 to both groups which included an explanation of the steps with special stress on frequently mistaken steps e.g. exhalation before use and inhaling slowly and deeply. The enhanced training group was enhanced by using the Clip-Tone training aid linked to its dedicated smartphone app. enhanced training patients were encouraged to use this connected training aid during real-life use between the study visits. Baseline data were collected at the first visit. At all three visits (baseline, 1 month, and 2 months), subjects first completed all inhaler techniques, health outcome measures, received inhaler training, then took bronchodilators, and 30 min later repeated the lung function outcome measures. RESULTS Both groups showed a significant decrease (p < 0.001) in the total mean number of pMDI inhalation techniques mistakes at visits 2 and 3, with a lower number of mistakes (p < 0.05) for slower inhalations for the enhanced training group compared to the verbal training group. Inhalation time (an indicator of a slow inhalation) significantly (p < 0.05) improved at each visit in the enhanced training group. In the enhanced training group, there was a gradual significant increase (p < 0.05) in lung functions while the improvements in the verbal training group were only significant (p < 0.05) at visit 3, and by visit 3, the enhanced training group had significantly higher scores than the verbal training group on both FEV1 and PEF% predicted. The asthma control test (ACT) score improved at each visit in both groups with a greater increase in the enhanced training group (p < 0.05) and more patients (44 and 21) improved their score by 3 or more in the second and third visit respectively. CONCLUSION The connected Clip-Tone training aid helped patients improve their pMDI inhaler technique and their asthma control compared to traditional methods. These results highlight the potential of connected inhalers in the future management of inhaled therapy.
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Affiliation(s)
- Rania A A Mahmoud
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Marian S Boshra
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Haitham Saeed
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Mohamed E A Abdelrahim
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
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5
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Qualitative study of user perspectives and experiences of digital inhaler technology. NPJ Prim Care Respir Med 2022; 32:57. [PMID: 36550136 PMCID: PMC9780314 DOI: 10.1038/s41533-022-00320-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
Electronic monitoring devices (EMDs) have been trialled in interventions to improve inhaled corticosteroid adherence and clinical outcomes. This study sought to understand the perceptions and experiences of EMD end-users. Participants recruited into a six-month EMD study were invited to a semi-structured interview. Interviews were audio-recorded, transcribed verbatim and analysed using the framework approach. Twenty-eight participants (68% female, median age 47) were interviewed. Individuals described feeling responsible for their asthma control. Recent attacks motivated a desire to maintain control. Study participation led to increased awareness of asthma status and medication use. Several individuals were open to integrating digital monitoring data with other mHealth inputs, perceiving the potential to enhance communication with clinicians and empower self-management. Openness to data sharing was tied to expectations of transparent data use. Data supported integrating beliefs and habit formation to achieve behaviour change. There was a willingness for an integrated, platform-based approach to digital self-management.
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6
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Dauletbaev N, Oftring ZS, Akik W, Michaelis-Braun L, Korel J, Lands LC, Waldmann S, Müller BS, Dreher M, Rohde G, Vogelmeier CF, Kuhn S. A scoping review of mHealth monitoring of pediatric bronchial asthma before and during COVID-19 pandemic. Paediatr Respir Rev 2022; 43:67-77. [PMID: 35131174 PMCID: PMC8761580 DOI: 10.1016/j.prrv.2022.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/10/2022] [Indexed: 12/02/2022]
Abstract
Mobile (m) Health technology is well-suited for Remote Patient Monitoring (RPM) in a patient's habitual environment. In recent years there have been fast-paced developments in mHealth-enabled pediatric RPM, especially during the COVID-19 pandemic, necessitating evidence synthesis. To this end, we conducted a scoping review of clinical trials that had utilized mHealth-enabled RPM of pediatric asthma. MEDLINE, Embase and Web of Science were searched from September 1, 2016 through August 31, 2021. Our scoping review identified 25 publications that utilized synchronous and asynchronous mHealth-enabled RPM in pediatric asthma, either involving mobile applications or via individual devices. The last three years has seen the development of evidence-based, multidisciplinary, and participatory mHealth interventions. The quality of the studies has been improving, such that 40% of included study reports were randomized controlled trials. In conclusion, there exists high-quality evidence on mHealth-enabled RPM in pediatric asthma, warranting future systematic reviews and/or meta-analyses of the benefits of such RPM.
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Affiliation(s)
- Nurlan Dauletbaev
- Department of Internal, Respiratory and Critical Care Medicine, Philipps University of Marburg, Marburg, Germany (Member of the German Center for Lung Research (DZL)), Germany; Department of Pediatrics, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada; The Research Institute of McGill University Health Centre, Montreal, QC, Canada; al-Farabi Kazakh National University, Almaty, Kazakhstan.
| | - Zoe S. Oftring
- Department of Digital Medicine, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany
| | - Wided Akik
- Division of Experimental Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Lukas Michaelis-Braun
- Department of Internal, Respiratory and Critical Care Medicine, Philipps University of Marburg, Marburg, Germany (Member of the German Center for Lung Research (DZL)), Germany
| | - Julia Korel
- Department of Internal, Respiratory and Critical Care Medicine, Philipps University of Marburg, Marburg, Germany (Member of the German Center for Lung Research (DZL)), Germany
| | - Larry C. Lands
- Department of Pediatrics, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada,The Research Institute of McGill University Health Centre, Montreal, QC, Canada
| | - Susanne Waldmann
- Central Medical Library, Philipps University of Marburg, Marburg, Germany
| | - Beate S. Müller
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, University Hospital Aachen, Aachen, Germany
| | - Gernot Rohde
- Medical Clinic 1, Department of Respiratory Medicine, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Claus F. Vogelmeier
- Department of Internal, Respiratory and Critical Care Medicine, Philipps University of Marburg, Marburg, Germany (Member of the German Center for Lung Research (DZL)), Germany
| | - Sebastian Kuhn
- Department of Digital Medicine, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany
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7
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Dimitri P, Pignataro V, Lupo M, Bonifazi D, Henke M, Musazzi UM, Ernst F, Minghetti P, Redaelli DF, Antimisiaris SG, Migliaccio G, Bonifazi F, Marciani L, Courtenay AJ, Denora N, Lopedota A. Medical Device Development for Children and Young People-Reviewing the Challenges and Opportunities. Pharmaceutics 2021; 13:pharmaceutics13122178. [PMID: 34959459 PMCID: PMC8706877 DOI: 10.3390/pharmaceutics13122178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/25/2021] [Accepted: 12/02/2021] [Indexed: 02/07/2023] Open
Abstract
Development of specific medical devices (MDs) is required to meet the healthcare needs of children and young people (CYP). In this context, MD development should address changes in growth and psychosocial maturation, physiology, and pathophysiology, and avoid inappropriate repurposing of adult technologies. Underpinning the development of MD for CYP is the need to ensure MD safety and effectiveness through pediatric MD-specific regulations. Contrary to current perceptions of limited market potential, the global pediatric healthcare market is expected to generate around USD 15,984 million by 2025. There are 1.8 billion young people in the world today; 40% of the global population is under 24, creating significant future healthcare market opportunities. This review highlights a number of technology areas that have led to successful pediatric MD, including 3D printing, advanced materials, drug delivery, and diagnostic imaging. To ensure the targeted development of MD for CYP, collaboration across multiple professional disciplines is required, facilitated by a platform to foster collaboration and drive innovation. The European Pediatric Translational Research Infrastructure (EPTRI) will be established as the European platform to support collaboration, including the life sciences industrial sector, to identify unmet needs in child health and support the development, adoption, and commercialization of pediatric MDs.
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Affiliation(s)
- Paul Dimitri
- Department of Pediatric Endocrinology, Sheffield Children’s NHS Foundation Trust & Sheffield Hallam University, Shefeld S10 2TH, UK;
| | - Valeria Pignataro
- Consorzio per Valutazioni Biologiche e Farmacologiche, Via N. Putignani 178, 70122 Bari, Italy; (V.P.); (D.B.); (G.M.)
| | - Mariangela Lupo
- TEDDY European Network of Excellence for Paediatric Research, Via Luigi Porta 14, 27100 Pavia, Italy;
| | - Donato Bonifazi
- Consorzio per Valutazioni Biologiche e Farmacologiche, Via N. Putignani 178, 70122 Bari, Italy; (V.P.); (D.B.); (G.M.)
| | - Maria Henke
- Institute for Robotics and Cognitive Systems, University of Luebeck, Ratzeburger Allee 160, 23562 Luebeck, Germany; (M.H.); (F.E.)
| | - Umberto M. Musazzi
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, Via G. Colombo, 20133 Milan, Italy; (U.M.M.); (P.M.)
| | - Floris Ernst
- Institute for Robotics and Cognitive Systems, University of Luebeck, Ratzeburger Allee 160, 23562 Luebeck, Germany; (M.H.); (F.E.)
| | - Paola Minghetti
- Department of Pharmaceutical Sciences, Università degli Studi di Milano, Via G. Colombo, 20133 Milan, Italy; (U.M.M.); (P.M.)
| | - Davide F. Redaelli
- Scientific Institute IRCCS E. Medea, Bosisio Parini, 23843 Lecco, Italy;
| | | | - Giovanni Migliaccio
- Consorzio per Valutazioni Biologiche e Farmacologiche, Via N. Putignani 178, 70122 Bari, Italy; (V.P.); (D.B.); (G.M.)
| | - Fedele Bonifazi
- Fondazione per la ricerca farmacologica Gianni Benzionlus, Via Abate Eustasio, 30, 70010 Valenzano, Italy;
| | - Luca Marciani
- Translational Medical Sciences, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Derby Road, Nottingham NG7 2UH, UK;
| | - Aaron J. Courtenay
- School of Pharmacy and Pharmaceutical Sciences, Coleraine Campus, Ulster University, Cromore Road, Coleraine, Co. Londonderry, Northern Ireland BT52 1SA, UK;
| | - Nunzio Denora
- Department of Pharmacy-Pharmaceutical Sciences, University of Bari Aldo Moro, Via E. Orabona 4, 70125 Bari, Italy
- Correspondence: (N.D.); (A.L.)
| | - Angela Lopedota
- Department of Pharmacy-Pharmaceutical Sciences, University of Bari Aldo Moro, Via E. Orabona 4, 70125 Bari, Italy
- Correspondence: (N.D.); (A.L.)
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8
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Jansen EM, van de Hei SJ, Dierick BJH, Kerstjens HAM, Kocks JWH, van Boven JFM. Global burden of medication non-adherence in chronic obstructive pulmonary disease (COPD) and asthma: a narrative review of the clinical and economic case for smart inhalers. J Thorac Dis 2021; 13:3846-3864. [PMID: 34277075 PMCID: PMC8264677 DOI: 10.21037/jtd-20-2360] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 01/18/2021] [Indexed: 12/14/2022]
Abstract
Medication non-adherence to asthma and chronic obstructive pulmonary disease therapy poses a significant burden for patients and societies. Non-adherence encompasses poor initiation, implementation (including poor inhalation technique) and non-persistence. Globally, non-adherence is associated with poor clinical outcomes, reduced quality of life and high healthcare and societal costs. Costs are mainly caused by excess hospitalizations and impaired work productivity. Multiple intervention programs to increase adherence in patients with asthma and chronic obstructive pulmonary disease have been conducted. However, these intervention programs are generally not as effective as intended. Additionally, adherence outcomes are mostly examined with non-objective or non-granular measures (e.g., self-report, dose count, pharmacy records). Recently developed smart inhalers could be the key to objectively diagnose and manage non-adherence effectively in patients with asthma and chronic obstructive pulmonary disease. Smart inhalers register usage of the inhaler, record time and date, send reminders, give feedback about adherence and some are able to assess inhaler technique and predict exacerbations. Still, some limitations need to be overcome before smart inhalers can be incorporated in usual care. For example, their cost-effectiveness and budget impact need to be examined. It is likely that smart inhalers are particularly cost-effective in specific asthma and chronic obstructive pulmonary disease subgroups, including patients with asthma eligible for additional GINA-5 therapy (oral corticosteroids or biologics), patients with severe asthma in GINA-5, patients with asthma with short-acting beta2 agonists overuse, patients with asthma and chronic obstructive pulmonary disease with frequent exacerbations and patients with asthma and chronic obstructive pulmonary disease of working-age. While there is high potential and evidence is accumulating, a final push seems needed to cost-effectively integrate smart inhalers in the daily management of patients with asthma and chronic obstructive pulmonary disease.
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Affiliation(s)
- Evalyne M Jansen
- Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Susanne J van de Hei
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
| | - Boudewijn J H Dierick
- Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands.,Department of General Practice & Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Huib A M Kerstjens
- Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands.,Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Medication Adherence Expertise Center of the northern Netherlands (MAECON), Groningen, The Netherlands
| | - Janwillem W H Kocks
- Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands.,Medication Adherence Expertise Center of the northern Netherlands (MAECON), Groningen, The Netherlands.,General Practitioners Research Institute (GPRI), Groningen, The Netherlands.,Observational and Pragmatic Research Institute (OPRI), Singapore
| | - Job F M van Boven
- Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands.,Medication Adherence Expertise Center of the northern Netherlands (MAECON), Groningen, The Netherlands
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9
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Nanzer AM, Lawton A, D'Ancona G, Gupta A. How I Do It: Transitioning Asthma Care From Adolescents to Adults. Chest 2021; 160:1192-1199. [PMID: 34019863 DOI: 10.1016/j.chest.2021.05.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/05/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022] Open
Abstract
Children with asthma grow to become adults with asthma. Adolescents are not simply older children and do not automatically transform into independent adults, nor do they become proficient in self-management of their condition overnight. Adolescence is a high-risk time for many people with asthma, with increased risk of asthma-related morbidity and mortality. Children with high-risk asthma attend hospital-based asthma clinics with their parents until they reach young adulthood, and parents usually take on the significant burden of disease management on behalf of their children. Once patients are transferred to adult medical teams, many will continue to have limited knowledge about their asthma, limited understanding of how to manage their symptoms and comorbidities, and limited comprehension of how and why to take their regular medication. Adolescence is a critical time of change during which young people yearn for autonomy. Effective transition gives young people the skills and knowledge necessary to manage their health independently and provides the substrate for autonomous care, the bed rock of long-term conditions. This review focuses on the challenges of adolescent health care and provides guidance on how to take a planned, patient-centered approach to ensure each transition is effective and safe.
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Affiliation(s)
- Alexandra M Nanzer
- Guy's and St Thomas' NHS Foundation Trust, Thoracic Medicine, Guy's Severe Asthma Service, London, England.
| | - Adam Lawton
- Paediatrics Department, North Middlesex University Hospital Trust, London, England
| | - Grainne D'Ancona
- Guy's and St Thomas' NHS Foundation Trust, Thoracic Medicine, Guy's Severe Asthma Service, London, England
| | - Atul Gupta
- Department of Paediatric Respiratory Medicine, King's College Hospital, London, United Kingdom; King's College London, London, England
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10
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Blower S, Swallow V, Maturana C, Stones S, Phillips R, Dimitri P, Marshman Z, Knapp P, Dean A, Higgins S, Kellar I, Curtis P, Mills N, Martin-Kerry J. Children and young people's concerns and needs relating to their use of health technology to self-manage long-term conditions: a scoping review. Arch Dis Child 2020; 105:1093-1104. [PMID: 32444448 PMCID: PMC7588410 DOI: 10.1136/archdischild-2020-319103] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The use of patient-facing health technologies to manage long-term conditions is increasing; however, children and young people may have particular concerns or needs before deciding to use different health technologies. AIMS To identify children and young people's reported concerns or needs in relation to using health technologies to self-manage long-term conditions. METHODS A scoping review was conducted. We searched MEDLINE, PsycINFO and CINAHL in February 2019. Searches were limited to papers published between January 2008 and February 2019. We included any health technology used to manage long-term conditions. A thematic synthesis of the data from the included studies was undertaken. We engaged children with long-term conditions (and parents) to support review design, interpretation of findings and development of recommendations. RESULTS Thirty-eight journal articles were included, describing concerns or needs expressed by n=970 children and/or young people aged 5-18 years. Most included studies were undertaken in high-income countries with children aged 11 years and older. Studies examined concerns with mobile applications (n=14), internet (n=9), social media (n=3), interactive online treatment programmes (n=3), telehealth (n=1), devices (n=3) or a combination (n=5). Children and young people's main concerns were labelling and identity; accessibility; privacy and reliability; and trustworthiness of information. DISCUSSION This review highlights important concerns that children and young people may have before using technology to self-manage their long-term condition. In future, research should involve children and young people throughout the development of technology, from identifying their unmet needs through to design and evaluation of interventions.
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Affiliation(s)
- Sarah Blower
- Department of Health Sciences, University of York, York, UK
| | - Veronica Swallow
- College of Health, Wellbeing & Life Sciences, Sheffield Hallam University, Sheffield, South Yorkshire, UK
| | - Camila Maturana
- York Trials Unit, University of York, York, North Yorkshire, UK
| | - Simon Stones
- School of Healthcare, University of Leeds, Leeds, West Yorkshire, UK
| | - Robert Phillips
- Centre for Reviews and Dissemination, University of York, York, North Yorkshire, UK
| | - Paul Dimitri
- NIHR Children and Young People MedTech Cooperative, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, Sheffield, UK
| | - Zoe Marshman
- School of Clinical Dentistry, The University of Sheffield, Sheffield, Sheffield, UK
| | - Peter Knapp
- Department of Health Sciences and Hull York Medical School, University of York, York, North Yorkshire, UK
| | - Alexandra Dean
- York Trials Unit, University of York, York, North Yorkshire, UK
| | | | - Ian Kellar
- School of Psychology, University of Leeds, Leeds, West Yorkshire, UK
| | - Penny Curtis
- School of Nursing and Midwifery, The University of Sheffield, Sheffield, Sheffield, UK
| | - Nathaniel Mills
- NIHR Children and Young People MedTech Co-operative and NIHR Devices for Dignity MedTech Co-operative, Sheffield Children's NHS Trust, Sheffield, UK
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11
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Mosler G, Harris K, Grigg J, Steed L. Developing a theory-based multimedia intervention for schools to improve young people's asthma: my asthma in school (MAIS). Pilot Feasibility Stud 2020; 6:122. [PMID: 32884832 PMCID: PMC7465390 DOI: 10.1186/s40814-020-00670-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 08/19/2020] [Indexed: 01/30/2023] Open
Abstract
Background Asthma control in adolescents is low with half of the young people in a London study identified as having suboptimal control when measured using the Asthma Control Test. Control of asthma symptoms can be improved by addressing barriers to good self-management, such as poor understanding of asthma and adherence to medication. The aim of this study was therefore to develop the My Asthma in School (MAIS) intervention for the improvement of asthma control and self-management in adolescents and to test its initial feasibility. The intervention intended to combine a strong focus on theory with a design specifically aimed to engage adolescents. Methods The intervention development was based on previous qualitative and quantitative findings, and on guidelines from the Medical Research Council for the development of complex interventions. The COM-B (Capability, Opportunity, Motivation-Behaviour) model was applied to inform the design of intervention elements. Behavioural targets were identified from existing barriers to good asthma self-management and were then used to guide the development of engaging intervention elements, which were described using the Behavioural Change Technique (BCT) Taxonomy version 1. Adolescents were involved throughout this process. The MAIS intervention was tested in a feasibility phase in London secondary schools with adolescents aged between 11 and 13. Results The complex school-based MAIS intervention comprised a first school visit from a theatre group, who conducted a workshop with all year 7-8 students and addressed peer understanding and attitudes to asthma. The second visit included four self-management workshops for adolescents with asthma, including games, short-films and role play activities. Forty different types of techniques to change behaviour were applied, totalling 163 instances of BCT use across intervention elements, addressing all areas of capability, opportunity and motivation. In this initial feasibility study, 1814 adolescents with and without asthma from nine schools received the theatre intervention visit; 23 adolescents with asthma from one of the schools attended the workshop visit. The intervention was found acceptable and engaging, and 91.4% of participants agreed that the workshops changed how they think or feel about asthma. Conclusion This study demonstrates development and initial feasibility of a complex theory-based intervention, and how it can combine engaging media and interactive elements, to achieve a multi-directional approach to behavioural change. However more work is needed to assess the feasibility of trial processes, including recruitment and delivery format of the workshops.
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Affiliation(s)
- Gioia Mosler
- Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark St, London, E1 2AT UK
| | - Katherine Harris
- Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark St, London, E1 2AT UK
| | - Jonathan Grigg
- Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark St, London, E1 2AT UK
| | - Liz Steed
- Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, 58 Turner St, London, E1 2AB UK
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12
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McGrady ME, Ramsey RR. Using Electronic Monitoring Devices to Assess Medication Adherence: a Research Methods Framework. J Gen Intern Med 2020; 35:2707-2714. [PMID: 32440997 PMCID: PMC7459024 DOI: 10.1007/s11606-020-05905-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 05/04/2020] [Indexed: 11/30/2022]
Abstract
While electronic adherence monitoring devices (EAMDs) are the preferred and most objective medication adherence measurement strategy for many populations and research questions, there is no comprehensive methodological framework for EAMD use. We synthesize recommendations from experts in adherence science and the scientific literature to create a temporal framework of EAMD research methods. The goal of this framework is to provide a step-by-step guide that will enable researchers to design, prepare, implement, and clean data from rigorous, high-quality studies using EAMDs to assess adherence. Resources including a checklist of methodological considerations and example protocols have been created to assist readers in using this framework.
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Affiliation(s)
- Meghan E McGrady
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. .,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Rachelle R Ramsey
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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13
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Dundon A, Cipolla D, Mitchell J, Lyapustina S. Reflections on Digital Health Tools for Respiratory Applications. J Aerosol Med Pulm Drug Deliv 2020; 33:127-132. [DOI: 10.1089/jamp.2020.1597] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Andy Dundon
- Pharmechceutics Ltd., Ware, Hertfordshire, United Kingdom
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14
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Hesso I, Nabhani Gebara S, Greene G, Co Stello RW, Kayyali R. A quantitative evaluation of adherence and inhalation technique among respiratory patients: An observational study using an electronic inhaler assessment device. Int J Clin Pract 2020; 74:e13437. [PMID: 31621983 DOI: 10.1111/ijcp.13437] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 10/09/2019] [Accepted: 10/13/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Problems related to poor adherence and inhaler technique (IT) are historically reported in the literature. Most common methods used for adherence and IT assessment are reported to be either inaccurate or subjective. Few electronic monitoring devices (EMDs) that provide an objective measure of both adherence and IT while patients use inhalers at home now exist. Therefore, this study aimed to examine adherence level and IT among respiratory patients in community care using such an EMD for the first time in England. METHODS A prospective, multicentre, observational cohort study was conducted. Patients with chronic obstructive pulmonary disease (COPD) or asthma were recruited from independent community pharmacies within West and South London. Patients were provided with a dry-powder inhaler (DPI) mounted with an EMD to use for 1 month. Adherence was also assessed using pharmacy dispensing data, inhaler dose counter and self-reporting. RESULTS Data were available for 48 patients. Only eight patients used their inhaler in the correct manner at the correct interval as identified by the chosen EMD. The median actual adherence rate, as measured by the EMD, was 42.7%. This was significantly different from the median dose counter adherence (100%), medication refill adherence (MRA) (100%), proportions of days covered (PDC) (97.8%) and self-reported adherence (P < .001, each). Within a 1-month period, there were 2188 files showing attempted use of the DPI, of which 840 had IT errors. The median technique error rate (TER) was 30.1%. Most common errors recorded were as follows: multiple inhalations, drug priming without inhalation and failure to prime the device correctly. CONCLUSION The current study demonstrates that measures such as dose counter, prescription refill and self-reporting showed a high level of adherence among the observed patients. However, the objective data provided by the EMD showed a significantly lower actual adherence rate, reflecting how adherence remains variable and problematic among patients in the community.
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Affiliation(s)
- Iman Hesso
- School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Kingston upon Thames, United Kingdom
| | - Shereen Nabhani Gebara
- School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Kingston upon Thames, United Kingdom
| | - Garrett Greene
- Clinical Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - R W Co Stello
- Clinical Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Respiratory Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Reem Kayyali
- School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Kingston upon Thames, United Kingdom
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15
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Kaplan A, Price D. Treatment Adherence in Adolescents with Asthma. J Asthma Allergy 2020; 13:39-49. [PMID: 32021311 PMCID: PMC6969681 DOI: 10.2147/jaa.s233268] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/09/2019] [Indexed: 12/11/2022] Open
Abstract
The burden of asthma is particularly notable in adolescents, and is associated with higher rates of prevalence and mortality compared with younger children. One factor contributing to inadequate asthma control in adolescents is poor treatment adherence, with many pediatric studies reporting mean adherence rates of 50% or lower. Identifying the reasons for poor disease control and adherence is essential in order to help improve patient quality of life. In this review, we explore the driving factors behind non-adherence in adolescents with asthma, consider their consequences and suggest possible solutions to ensure better disease control. We examine the impact of appropriate inhaler choice and good inhaler technique on adherence, as well as discuss the importance of selecting the right medication, including the possible role of as-needed inhaled corticosteroids/long-acting β2-agonists vs short-acting β2-agonists, for improving outcomes in patients with mild asthma and poor adherence. Effective patient/healthcare practitioner communication also has a significant role to engage and motivate adolescents to take their medication regularly.
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Affiliation(s)
- Alan Kaplan
- University of Toronto Department of Family and Community Medicine, Toronto, ON, Canada.,Family Physician Airways Group of Canada, Edmonton, AB, Canada.,Observational and Pragmatic Research Institute, Singapore, Singapore
| | - David Price
- Observational and Pragmatic Research Institute, Singapore, Singapore.,Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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16
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Chen A, Halton AJ, Rhoades RD, Booth JC, Shi X, Bu X, Wu N, Chae J. Wireless Wearable Ultrasound Sensor on a Paper Substrate to Characterize Respiratory Behavior. ACS Sens 2019; 4:944-952. [PMID: 30855133 DOI: 10.1021/acssensors.9b00043] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Respiratory behavior contains crucial parameters to feature lung functionality, including respiratory rate, profile, and volume. The current well-adopted method to characterize respiratory behavior is spirometry using a spirometer, which is bulky, heavy, expensive, requires a trained provider to operate, and is incapable of continuous monitoring of respiratory behavior, which is often critical to assess chronic respiratory diseases. This work presents a wireless wearable sensor on a paper substrate that is capable of continuous monitoring of respiratory behavior and delivering the clinically relevant respiratory information to a smartphone. The wireless wearable sensor was attached on the midway of the xiphoid process and the costal margin, corresponding to the abdomen-apposed rib cage, based on the anatomical and experimental analysis. The sensor, with a footprint of 40 × 35 × 6 mm3 and weighing 6.5 g, including a 2.7 g battery, consists of three subsystems, (i) ultrasound emitter, (ii) ultrasound receiver, and (iii) data acquisition and wireless transmitter. The sensor converts the linear strain at the wearing site to the lung volume change by measuring the change in ultrasound pressure as a function of the distance between the emitter and the receiver. The temporal lung volume change data, directly converted from the ultrasound pressure, is wirelessly transmitted to a smartphone where a custom-designed app computes to show volume-time and flow rate-volume loop graphs, standard respiratory analysis plots. The app analyzes the plots to show the clinically relevant respiratory behavioral parameters, such as forced vital capacity (FVC) and forced expiratory volume delivered in the first second (FEV1). Potential user-induced error on sensor placement and temperature sensitivity were studied to demonstrate the sensor maintains its performance within a reasonable range of those variables. Eight volunteers were recruited to evaluate the sensor, which showed the mean deviation of the FEV1/FVC ratio in the range of 0.00-4.25% when benchmarked by the spirometer. The continuous measurement of respiratory behavioral parameters helps track the progression of the respiratory diseases, including asthma progression to provide alerts to relevant caregivers to seek needed timely treatment.
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Affiliation(s)
- Ang Chen
- School of Electrical, Computer, and Energy Engineering, Arizona State University, Tempe, Arizona 85281, United States
| | - Andrew Joshua Halton
- School of Electrical, Computer, and Energy Engineering, Arizona State University, Tempe, Arizona 85281, United States
| | - Rachel Diane Rhoades
- School of Electrical, Computer, and Energy Engineering, Arizona State University, Tempe, Arizona 85281, United States
| | - Jayden Charles Booth
- School of Electrical, Computer, and Energy Engineering, Arizona State University, Tempe, Arizona 85281, United States
| | - Xinhao Shi
- College of Electrical and Information Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing 210016, China
| | - Xiangli Bu
- College of Electrical and Information Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing 210016, China
| | - Ning Wu
- College of Electrical and Information Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing 210016, China
| | - Junseok Chae
- School of Electrical, Computer, and Energy Engineering, Arizona State University, Tempe, Arizona 85281, United States
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17
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Wallin M, Tagami T, Chen L, Yang M, Chan HK. Pulmonary drug delivery to older people. Adv Drug Deliv Rev 2018; 135:50-61. [PMID: 29197631 DOI: 10.1016/j.addr.2017.11.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 11/20/2017] [Accepted: 11/27/2017] [Indexed: 12/20/2022]
Abstract
Pulmonary diseases, such as asthma and chronic obstructive pulmonary disease (COPD), are common in older people. Treatment principles are well established in this group of patients; however, inadequate training and improper inhaler techniques often results in poor treatment outcomes. Healthcare professionals often do not have the required knowledge about the most common inhaler devices. Age-related conditions like cognitive ability and physical strength would also impact on the inhaler usage. Pharmacokinetics and pharmacodynamics may be affected by physiological changes, like impaired renal and hepatic functions and reduced lung functions. Adjusting and optimizing the inhaler device to the patient preferences, improvement of the drug formulation and inhalers, and using different adherence strategies might improve the treatment outcomes in elderly patients.
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18
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Merchant R, Inamdar R, Henderson K, Barrett M, Su JG, Riley J, Van Sickle D, Stempel D. Digital Health Intervention for Asthma: Patient-Reported Value and Usability. JMIR Mhealth Uhealth 2018; 6:e133. [PMID: 29866644 PMCID: PMC6006012 DOI: 10.2196/mhealth.7362] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 08/16/2017] [Accepted: 03/16/2018] [Indexed: 11/13/2022] Open
Abstract
Background Although digital health tools are increasingly recognized as effective in improving clinical outcomes such as asthma control and medication adherence, few studies have assessed patient experiences and perception of value. Objective The aim of this study was to evaluate patient satisfaction, perception of usability and value, and desire to continue after 12 months of using a digital health intervention to support asthma management. Methods Participants were enrolled in a randomized controlled study evaluating the impact of a digital health platform for asthma management. Participants used electronic inhaler sensors to track medication use and accessed their information in a digital health platform. Electronic surveys were administered to intervention arm participants aged 12 years and older after 12 months of use. The survey assessed asthma control, patient satisfaction with the sensor device, and perception of the usability and value of the digital health platform through closed-ended and open-ended questions. Logistic regression models were used to assess the impact of participants’ characteristics on survey completion, satisfaction, and perception of value. Results Of the 207 intervention arm participants aged 12 years and older, 89 submitted survey responses (42.9% response rate). Of these 89 participants, 70 reported being very satisfied (79%, 70/89) or somewhat satisfied (20%, 18/89) with the inhaler sensor device. Moreover, 93% (83/89) expressed satisfaction with the reports, and 90% (80/89) found the information from the reports useful for learning about their asthma. In addition, 72% (64/89) of the participants reported that they were interested in continuing to use the sensor and platform beyond the study. There were no significant differences in satisfaction with the device or the platform across participants’ characteristics, including device type, age, sex, insurance type, asthma control, or syncing history; however, participants with smartphones and longer participation were more likely to take the survey. Conclusions Electronic sensors and a digital health platform were well received by participants who reported satisfaction and perceived value. These results were consistent across multiple participants’ characteristics. These findings can add to a limited literature to keep improving digital health interventions and ensure the meaningful and enduring impact on patient outcomes.
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Affiliation(s)
- Rajan Merchant
- Dignity Health Woodland Clinic Medical Group, Woodland, CA, United States
| | - Rubina Inamdar
- Dignity Health Mercy Medical Group, Sacramento, CA, United States
| | - Kelly Henderson
- Propeller Health, Research and Development, San Francisco, CA, United States
| | - Meredith Barrett
- Propeller Health, Research and Development, San Francisco, CA, United States
| | - Jason G Su
- University of California Berkeley, Berkeley, CA, United States
| | - Jesika Riley
- Propeller Health, Research and Development, San Francisco, CA, United States
| | - David Van Sickle
- Propeller Health, Research and Development, Madison, WI, United States
| | - David Stempel
- Propeller Health, Research and Development, San Francisco, CA, United States
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19
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Patient-perceived acceptability and behaviour change benefits of inhaler reminders and adherence feedback: A qualitative study. Respir Med 2017; 129:39-45. [PMID: 28732834 DOI: 10.1016/j.rmed.2017.05.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/10/2017] [Accepted: 05/25/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Little is known about patients' perceptions of electronic inhaler reminders, which have emerged in recent years as adherence promotion aids. This study explored asthma patients' attitudes toward the acceptability and utility of inhaler reminders. METHODS Participants from a 6-month cluster randomized controlled trial who received reminders for missed doses via SmartTrack adherence monitors (Adherium Ltd) were interviewed to explore their perceptions; interviews were audio-recorded, transcribed and analysed thematically. RESULTS 18 participants (50% male, mean age 39 years [range 17-68]) were interviewed. Three themes were identified. Acceptability and Feasibility: Interviewees found the monitor easy to use. For some, concerns about the monitor itself affected adherence, e.g. leaving it at home to avoid breakage. Positive features included that reminders played only for missed doses, and the choice of reminder tunes. Utility and Behavioural Impact: Interviewees described reminders as an effective "training" tool for adherence, encouraging habit-formation, behaviour change and attitude change. Reminders were considered less acceptable or useful by participants who preferred taking medication only when symptomatic or who doubted the necessity or safety of their medication. Sustainability: Some interviewees reported sustained behaviour change, supported by reminders, through the establishment of routine or via experiential learning that good adherence improved their asthma. Other interviewees wanted ongoing support (i.e. reminders or substitute adherence cues) after study end. CONCLUSION Patients with asthma found 6-months' use of reminders and adherence feedback acceptable and useful for improving their adherence attitudes, adherence behaviours and confidence in asthma self-management. Some patients may benefit from ongoing adherence support.
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20
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Chan AHY, Stewart AW, Harrison J, Black PN, Mitchell EA, Foster JM. Electronic adherence monitoring device performance and patient acceptability: a randomized control trial. Expert Rev Med Devices 2017; 14:401-411. [PMID: 28434269 DOI: 10.1080/17434440.2017.1322505] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND To investigate the performance and patient acceptability of an inhaler electronic monitoring device in a real-world childhood asthma population. METHODS Children 6 to 15 years presenting with asthma to the hospital emergency department and prescribed inhaled corticosteroids were included. Participants were randomized to receive a device with reminder features enabled or disabled for use with their preventer. Device quality control tests were conducted. Questionnaires on device acceptability, utility and ergonomics were completed at six months. RESULTS A total of 1306 quality control tests were conducted; 84% passed pre-issue and 87% return testing. The most common failure reason was actuation under-recording. Acceptability scores were high, with higher scores in the reminder than non-reminder group (median, 5th-95th percentile: 4.1, 3.1-5.0 versus 3.7, 2.3-4.8; p < 0.001). Most (>90%) rated the device easy to use. Feedback was positive across five themes: device acceptability, ringtone acceptability, suggestions for improvement, effect on medication use, and effect on asthma control. CONCLUSIONS This study investigates electronic monitoring device performance and acceptability in children using quantitative and qualitative measures. Results indicate satisfactory reliability, although failure rates of 13-16% indicate the importance of quality control. Favorable acceptability ratings support the use of these devices in children.
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Affiliation(s)
- Amy Hai Yan Chan
- a School of Pharmacy, Faculty of Medical and Health Sciences , The University of Auckland , Auckland , New Zealand.,b Department of Pediatrics: Child and Youth Health, Faculty of Medical and Health Sciences , The University of Auckland , Auckland , New Zealand
| | - Alistair William Stewart
- c Epidemiology & Biostatistics, School of Population Health, Faculty of Medical and Health Sciences , The University of Auckland , Auckland , New Zealand
| | - Jeff Harrison
- a School of Pharmacy, Faculty of Medical and Health Sciences , The University of Auckland , Auckland , New Zealand
| | - Peter Nigel Black
- d Department of Pharmacology, Faculty of Medical and Health Sciences , The University of Auckland , Auckland , New Zealand
| | - Edwin Arthur Mitchell
- b Department of Pediatrics: Child and Youth Health, Faculty of Medical and Health Sciences , The University of Auckland , Auckland , New Zealand
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