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Man JP, Dijkgraaf MG, Handoko ML, de Lange FJ, Winter MM, Schijven MP, Stienen S, Meregalli P, Kok WE, Kuipers DI, van der Harst P, Koole MA, Chamuleau SA, Schuuring MJ. Digital consults to optimize guideline-directed therapy: design of a pragmatic multicenter randomized controlled trial. ESC Heart Fail 2024; 11:560-569. [PMID: 38146630 PMCID: PMC10804150 DOI: 10.1002/ehf2.14634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/16/2023] [Accepted: 11/26/2023] [Indexed: 12/27/2023] Open
Abstract
AIMS Many heart failure (HF) patients do not receive optimal guideline-directed medical therapy (GDMT) despite clear benefit on morbidity and mortality outcomes. Digital consults (DCs) have the potential to improve efficiency on GDMT optimization to serve the growing HF population. The investigator-initiated ADMINISTER trial was designed as a pragmatic multicenter randomized controlled open-label trial to evaluate efficacy and safety of DC in patients on HF treatment. METHODS AND RESULTS Patients (n = 150) diagnosed with HF with a reduced ejection fraction will be randomized to DC or standard care (1:1). The intervention group receives multifaceted DCs including (i) digital data sharing (e.g. exchange of pharmacotherapy use and home-measured vital signs), (ii) patient education via an e-learning, and (iii) digital guideline recommendations to treating clinicians. The consults are performed remotely unless there is an indication to perform the consult physically. The primary outcome is the GDMT prescription rate score, and secondary outcomes include time till full GDMT optimization, patient and clinician satisfaction, time spent on healthcare, and Kansas City Cardiomyopathy Questionnaire. Results will be reported in accordance to the CONSORT statement. CONCLUSIONS The ADMINISTER trial will offer the first randomized controlled data on GDMT prescription rates, time till full GDMT optimization, time spent on healthcare, quality of life, and patient and clinician satisfaction of the multifaceted patient- and clinician-targeted DC for GDMT optimization.
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Affiliation(s)
- Jelle P. Man
- Department of CardiologyAmsterdam UMC location AMCAmsterdamThe Netherlands
- Department of CardiologyAmsterdam UMC location VUmcAmsterdamThe Netherlands
- Netherlands Heart InstituteUtrechtThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
| | - Marcel G.W. Dijkgraaf
- Department of Epidemiology and Data ScienceAmsterdam UMCAmsterdamThe Netherlands
- Department of MethodologyAmsterdam Public HealthAmsterdamThe Netherlands
| | - M. Louis Handoko
- Department of CardiologyAmsterdam UMC location VUmcAmsterdamThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
| | - Frederik J. de Lange
- Department of CardiologyAmsterdam UMC location AMCAmsterdamThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
| | - Michiel M. Winter
- Department of CardiologyAmsterdam UMC location AMCAmsterdamThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
- Cardiology Center of the NetherlandsAmsterdamThe Netherlands
| | | | - Susan Stienen
- Department of CardiologyAmsterdam UMC location AMCAmsterdamThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
| | - Paola Meregalli
- Department of CardiologyAmsterdam UMC location AMCAmsterdamThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
| | - Wouter E.M. Kok
- Department of CardiologyAmsterdam UMC location AMCAmsterdamThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
| | - Dorianne I. Kuipers
- Department of CardiologyAmsterdam UMC location AMCAmsterdamThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
| | - Pim van der Harst
- Department of CardiologyUniversity Medical Center UtrechtHeidelberglaan 1003584 CXUtrechtThe Netherlands
| | - Maarten A.C. Koole
- Department of CardiologyAmsterdam UMC location AMCAmsterdamThe Netherlands
- Cardiology Center of the NetherlandsAmsterdamThe Netherlands
- Department of CardiologyRed Cross HospitalBeverwijkThe Netherlands
| | - Steven A.J. Chamuleau
- Department of CardiologyAmsterdam UMC location AMCAmsterdamThe Netherlands
- Department of CardiologyAmsterdam UMC location VUmcAmsterdamThe Netherlands
- Netherlands Heart InstituteUtrechtThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
| | - Mark J. Schuuring
- Department of CardiologyAmsterdam UMC location VUmcAmsterdamThe Netherlands
- Netherlands Heart InstituteUtrechtThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
- Department of CardiologyUniversity Medical Center UtrechtHeidelberglaan 1003584 CXUtrechtThe Netherlands
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McDonagh ST, Dalal H, Moore S, Clark CE, Dean SG, Jolly K, Cowie A, Afzal J, Taylor RS. Home-based versus centre-based cardiac rehabilitation. Cochrane Database Syst Rev 2023; 10:CD007130. [PMID: 37888805 PMCID: PMC10604509 DOI: 10.1002/14651858.cd007130.pub5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
BACKGROUND Cardiovascular disease is the most common cause of death globally. Traditionally, centre-based cardiac rehabilitation programmes are offered to individuals after cardiac events to aid recovery and prevent further cardiac illness. Home-based and technology-supported cardiac rehabilitation programmes have been introduced in an attempt to widen access and participation, especially during the SARS-CoV-2 pandemic. This is an update of a review previously published in 2009, 2015, and 2017. OBJECTIVES To compare the effect of home-based (which may include digital/telehealth interventions) and supervised centre-based cardiac rehabilitation on mortality and morbidity, exercise-capacity, health-related quality of life, and modifiable cardiac risk factors in patients with heart disease SEARCH METHODS: We updated searches from the previous Cochrane Review by searching the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid) and CINAHL (EBSCO) on 16 September 2022. We also searched two clinical trials registers as well as previous systematic reviews and reference lists of included studies. No language restrictions were applied. SELECTION CRITERIA We included randomised controlled trials that compared centre-based cardiac rehabilitation (e.g. hospital, sports/community centre) with home-based programmes (± digital/telehealth platforms) in adults with myocardial infarction, angina, heart failure, or who had undergone revascularisation. DATA COLLECTION AND ANALYSIS Two review authors independently screened all identified references for inclusion based on predefined inclusion criteria. Disagreements were resolved through discussion or by involving a third review author. Two authors independently extracted outcome data and study characteristics and assessed risk of bias. Certainty of evidence was assessed using GRADE. MAIN RESULTS We included three new trials in this update, bringing a total of 24 trials that have randomised a total of 3046 participants undergoing cardiac rehabilitation. A further nine studies were identified and are awaiting classification. Manual searching of trial registers until 16 September 2022 revealed a further 14 clinical trial registrations - these are ongoing. Participants had a history of acute myocardial infarction, revascularisation, or heart failure. Although there was little evidence of high risk of bias, a number of studies provided insufficient detail to enable assessment of potential risk of bias; in particular, details of generation and concealment of random allocation sequencing and blinding of outcome assessment were poorly reported. No evidence of a difference was seen between home- and centre-based cardiac rehabilitation in our primary outcomes up to 12 months of follow-up: total mortality (risk ratio [RR] = 1.19, 95% confidence interval [CI] 0.65 to 2.16; participants = 1647; studies = 12/comparisons = 14; low-certainty evidence) or exercise capacity (standardised mean difference (SMD) = -0.10, 95% CI -0.24 to 0.04; participants = 2343; studies = 24/comparisons = 28; low-certainty evidence). The majority of evidence (N=71 / 77 comparisons of either total or domain scores) showed no significant difference in health-related quality of life up to 24 months follow-up between home- and centre-based cardiac rehabilitation. Trials were generally of short duration, with only three studies reporting outcomes beyond 12 months (exercise capacity: SMD 0.11, 95% CI -0.01 to 0.23; participants = 1074; studies = 3; moderate-certainty evidence). There was a similar level of trial completion (RR 1.03, 95% CI 0.99 to 1.08; participants = 2638; studies = 22/comparisons = 26; low-certainty evidence) between home-based and centre-based participants. The cost per patient of centre- and home-based programmes was similar. AUTHORS' CONCLUSIONS This update supports previous conclusions that home- (± digital/telehealth platforms) and centre-based forms of cardiac rehabilitation formally supported by healthcare staff seem to be similarly effective in improving clinical and health-related quality of life outcomes in patients after myocardial infarction, or revascularisation, or with heart failure. This finding supports the continued expansion of healthcare professional supervised home-based cardiac rehabilitation programmes (± digital/telehealth platforms), especially important in the context of the ongoing global SARS-CoV-2 pandemic that has much limited patients in face-to-face access of hospital and community health services. Where settings are able to provide both supervised centre- and home-based programmes, consideration of the preference of the individual patient would seem appropriate. Although not included in the scope of this review, there is an increasing evidence base supporting the use of hybrid models that combine elements of both centre-based and home-based cardiac rehabilitation delivery. Further data are needed to determine: (1) whether the short-term effects of home/digital-telehealth and centre-based cardiac rehabilitation models of delivery can be confirmed in the longer term; (2) the relative clinical effectiveness and safety of home-based programmes for other heart patients, e.g. post-valve surgery and atrial fibrillation.
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Affiliation(s)
- Sinead Tj McDonagh
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Hasnain Dalal
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Sarah Moore
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Christopher E Clark
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Sarah G Dean
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Aynsley Cowie
- Cardiac Rehabilitation, University Hospital Crosshouse, NHS Ayrshire and Arran, Kilmarnock, UK
| | | | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
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3
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Scheckel B, Schmidt K, Stock S, Redaèlli M. Patient Portals as Facilitators of Engagement in Patients With Diabetes and Chronic Heart Disease: Scoping Review of Usage and Usability. J Med Internet Res 2023; 25:e38447. [PMID: 37624629 PMCID: PMC10492174 DOI: 10.2196/38447] [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: 04/02/2022] [Revised: 02/08/2023] [Accepted: 06/28/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Patient portals have the potential to improve care for chronically ill patients by engaging them in their treatment. These platforms can work, for example, as a standalone self-management intervention or a tethered link to treatment providers in routine care. Many different types of portals are available for different patient groups, providing various features. OBJECTIVE This scoping review aims to summarize the current literature on patient portals for patients with diabetes mellitus and chronic heart disease regarding usage behavior and usability. METHODS We conducted this review according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement for scoping reviews. We performed database searches using PubMed, PsycInfo, and CINAHL, as well as additional searches in reviews and reference lists. We restricted our search to 2010. Qualitative and quantitative studies, and studies using both approaches that analyzed usage behavior or usability of patient portals were eligible. We mapped portal features according to broad thematic categories and summarized the results of the included studies separately according to outcome and research design. RESULTS After screening, we finally included 85 studies. Most studies were about patients with diabetes, included patients younger than 65 years, and were conducted in the United States. Portal features were categorized into educational/general information, reminder, monitoring, interactivity, personal health information, electronic/personal health record, and communication. Portals mostly provided educational, monitoring, and communication-related features. Studies reported on usage behavior including associated variables, usability dimensions, and suggestions for improvement. Various ways of reporting usage frequency were identified. A noticeable decline in portal usage over time was reported frequently. Age was most frequently studied in association with portal use, followed by gender, education, and eHealth literacy. Younger age and higher education were often associated with higher portal use. In two-thirds of studies reporting on portal usability, the portals were rated as user friendly and comprehensible, although measurement and reporting were heterogeneous. Portals were considered helpful for self-management through positive influences on motivation, health awareness, and behavioral changes. Helpful features for self-management were educational/general information and monitoring. Barriers to portal use were general (eg, aspects of design or general usability), related to specific situations during portal use (eg, login procedure), or not portal specific (eg, user skills and preferences). Frequent themes were aspects of design, usability, and technology. Suggestions for improvement were mainly related to technical issues and need for support. CONCLUSIONS The current state of research emphasizes the importance of involving patients in the development and evaluation of patient portals. The consideration of various research designs in a scoping review is helpful for a deeper understanding of usage behavior and usability. Future research should focus on the role of disease burden, and usage behavior and usability among older patients.
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Affiliation(s)
- Benjamin Scheckel
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Katharina Schmidt
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marcus Redaèlli
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Pedroni C, Djuric O, Bassi MC, Mione L, Caleffi D, Testa G, Prandi C, Navazio A, Giorgi Rossi P. Elements Characterising Multicomponent Interventions Used to Improve Disease Management Models and Clinical Pathways in Acute and Chronic Heart Failure: A Scoping Review. Healthcare (Basel) 2023; 11:1227. [PMID: 37174769 PMCID: PMC10178532 DOI: 10.3390/healthcare11091227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/17/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
This study aimed to summarise different interventions used to improve clinical models and pathways in the management of chronic and acute heart failure (HF). A scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. MEDLINE (via PubMed), Embase, The Cochrane Library, and CINAHL were searched for systematic reviews (SR) published in the period from 2014 to 2019 in the English language. Primary articles cited in SR that fulfil inclusion and exclusion criteria were extracted and examined using narrative synthesis. Interventions were classified based on five chosen elements of the Chronic Care Model (CCM) framework (self-management support, decision support, community resources and policies, delivery system, and clinical information system). Out of 155 SRs retrieved, 7 were considered for the extraction of 166 primary articles. The prevailing setting was the patient's home. Only 46 studies specified the severity of HF by reporting the level of left ventricular ejection fraction (LVEF) impairment in a heterogeneous manner. However, most studies targeted the populations with LVEF ≤ 45% and LVEF < 40%. Self-management and delivery systems were the most evaluated CCM elements. Interventions related to community resources and policy and advising/reminding systems for providers were rarely evaluated. No studies addressed the implementation of a disease registry. A multidisciplinary team was available with similarly low frequency in each setting. Although HF care should be a multi-component model, most studies did not analyse the role of some important components, such as the decision support tools to disseminate guidelines and program planning that includes measurable targets.
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Affiliation(s)
- Cristina Pedroni
- Direzione delle Professioni Sanitarie, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
- Laurea Magistrale in Scienze Infermieristiche e Ostetriche, University of Modena and Reggio Emilia, 42122 Reggio Emilia, Italy;
| | - Olivera Djuric
- Epidemiology Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
- Centre for Environmental, Nutritional and Genetic Epidemiology (CREAGEN), Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Maria Chiara Bassi
- Medical Library, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Lorenzo Mione
- Laurea Magistrale in Scienze Infermieristiche e Ostetriche, University of Modena and Reggio Emilia, 42122 Reggio Emilia, Italy;
| | - Dalia Caleffi
- Cardiology Division, Azienda Ospedaliera Universitaria di Modena, 41124 Modena, Italy;
| | - Giacomo Testa
- UO Medicina, Ospedale Giuseppe Dossetti, Azienda Unità Sanitaria Locale di Bologna, 40053 Bologna, Italy;
| | - Cesarina Prandi
- Department of Business Economics, Health & Social Care, University of Applied Sciences & Arts of Southern Switzerland, CH-6928 Manno, Switzerland;
| | - Alessandro Navazio
- Cardiology Division, Arcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
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Kallmerten PS, Chia LR, Jakub K, Turk MT. Patient Portal Use by Adults With Heart Failure: An Integrative Review. Comput Inform Nurs 2021; 39:418-431. [PMID: 33782319 DOI: 10.1097/cin.0000000000000733] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Heart failure is a chronic condition affecting many with an emphasis on self-management to improve outcomes and decrease the cost of care. A potential strategy to improve the self-management of heart failure includes the use of a patient portal. The purpose of this integrative review is to synthesize what is known about patient portal use by adults with heart failure to identify contributing factors for use and areas for future research. Within the three zones of the Health Information Technology Acceptance Model, predominant themes contributing to patient portal use were identified. Within the health zone, the predominant themes were physical and mental health, quality of life, and social interaction. Within the information zone, the predominant themes included knowledge about heart failure and self-care, information sharing, and communication. Within the technology zone, the predominant themes include the barriers and facilitators of patient portal use and overall usability. Overall, the patient perceptions of the patient portal can lead to the acceptance and use of the technology that can enhance self-management. Healthcare providers should partner with adults with heart failure to maximize the features of the patient portal to support self-management.
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Onyeaka HK, Romero P, Healy BC, Celano CM. Age Differences in the Use of Health Information Technology Among Adults in the United States: An Analysis of the Health Information National Trends Survey. J Aging Health 2020; 33:147-154. [PMID: 33031007 DOI: 10.1177/0898264320966266] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Despite significant advancements in the use of health information technologies (HITs) in health care, older adults' adoption of new technologies has consistently lagged behind that of younger adults. Objective: To compare ownership rates and preferences for utilizing technology for health information exchange among older and younger adults. Methods: Utilizing data from the 2017 and 2018 iterations of the Health Information National Trends Survey (n = 6789), we performed multivariable logistic regression while controlling for sociodemographic characteristics. Results: Older adults were less likely than younger adults to own technological devices such as smartphones, less likely to report finding these tools beneficial in monitoring their health, and less likely to use these tools in communicating with their health providers. However, these differences were substantially attenuated after adjustment for technology ownership. Discussion: Future research should aim to identify factors associated with access, usability, and adoption of HIT for managing care among older adults.
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Affiliation(s)
- Henry K Onyeaka
- 2348Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Perla Romero
- 2348Massachusetts General Hospital, Boston, MA, USA
| | - Brian C Healy
- Harvard Medical School, Boston, MA, USA.,Harvard T.H Chan School of Public Health, Boston, MA, USA.,1861Brigham and Women's Hospital, Boston, MA, USA
| | - Christopher M Celano
- 2348Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Alexander GL, Georgiou A, Doughty K, Hornblow A, Livingstone A, Dougherty M, Jacobs S, Fisk MJ. Advancing health information technology roadmaps in long term care. Int J Med Inform 2020; 136:104088. [PMID: 32120318 DOI: 10.1016/j.ijmedinf.2020.104088] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 12/11/2019] [Accepted: 01/23/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Our purpose is to provide evidence that health information technology should be a mainstay of all future health and social support services for older people globally, both within and across community and residential care services. METHODS This work was conducted in two phases. In phase I, the authors conducted a focused exploration by selecting a convenience sample of four long term care health information technology roadmaps, developed by members of four different long term care health information technology collaboratives in United States, Australia, United Kingdom, and New Zealand. During Phase II the research team carried out an extensive systematic review of existing literature sources (2000-2018) to support roadmap assumptions. RESULTS Using converging domains and content, we offer recommendations among five aged care roadmap domains: Strategy/Vision, Continuing Care Community, Services and Support Provided, External Clinical Support, and Administrative. Within these domains we provide recommendations in five content areas: Innovation, Policy, Evaluation, Delivery Systems and Human Resources. We recommend future strategies for LTC HIT roadmaps that include 61 emphasis areas in aged care in these content areas and domains. CONCLUSIONS The roadmap provides a navigation tool for LTC leaders to take a strategic and comprehensive approach as they harness the potential of health information technologies to address the challenges and opportunities of LTC in the future.
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Affiliation(s)
- Gregory L Alexander
- University of Missouri, Sinclair School of Nursing S415, Columbia, MO 65211.
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW Australia 2109.
| | - Kevin Doughty
- Director at i-Centre for Usable Home Technology, Caernarfon, Gwynedd United Kingdom.
| | | | - Anne Livingstone
- Research and Development Lead, Global Community Resourcing, 1/747 Lytton Road, Murarrie, QLD 4172.
| | - Michelle Dougherty
- Sr. Health Informatics Research Scientist, RTI International, Digital Health Policy & Standards.
| | - Stephen Jacobs
- Senior Lecturer, The School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92-019, Auckland Mail Centre, Auckland NZ 1142.
| | - Malcolm J Fisk
- Senior Research Fellow, Centre for Computing and Social Responsibility, De Montfort University, Leicester., Director, Telehealth Quality Group EEIG.
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Santos GC, Liljeroos M, Dwyer AA, Jaques C, Girard J, Strömberg A, Hullin R, Schäfer-Keller P. Symptom perception in heart failure - Interventions and outcomes: A scoping review. Int J Nurs Stud 2020; 116:103524. [PMID: 32063295 DOI: 10.1016/j.ijnurstu.2020.103524] [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] [Received: 07/15/2019] [Revised: 12/12/2019] [Accepted: 01/02/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Symptom perception in heart failure has recently been described as essential in the self-care process bridging self-care maintenance and self-care management. Accordingly, symptom perception appears to be critical for improving patient outcomes such as decreased hospital readmission and increased survival. OBJECTIVES To explore what interventions have been reported on heart failure symptom perception and to describe outcomes responsive to symptom perception. DESIGN We conducted a scoping review using PRISMA Extension for Scoping Reviews. DATA SOURCES Structured searches of Medline, PubMed, Embase, CINAHL, PsychINFO, Web of Science, Cochrane, Joanna Briggs Institute and Grey literature databases. REVIEW METHODS Two authors independently screened references for eligibility. Eligible articles were written in English, French, German, Swedish, Italian or Spanish and concerned symptom perception in adults with heart failure. Data were extracted and charted in tables by three reviewers. Results were narratively summarized. RESULTS We identified 99 eligible studies from 3055 references. Seven interventional studies targeted symptom perception as the single intervention component. Mixed results have been found: while some reported decreased symptom frequency, intensity and distress, enhanced health-related quality of life, improved heart failure self-care maintenance and management as well as a greater ability to mention heart failure symptoms, others found more contacts with healthcare providers or no impact on anxiety, heart failure self-care nor a number of diary reported symptoms. Additional interventional studies included symptom perception as one component of a multi-faceted intervention. Outcomes responsive to symptom perception were improved general and physical health, decreased mortality, heart failure decompensation, as hospital/emergency visits, shorter delays in seeking care, more consistent weight monitoring, improved symptom recognition as well as self-care management, decreased hospital length of stay and decreased costs. CONCLUSIONS While many studies allowed to map a comprehensive overview of interventions supporting symptom perception in heart failure as well as responsiveness to outcomes, only a few single component intervention studies targeting symptom perception have been reported and study designs preclude assessing intervention effectiveness. With regard to multiple component interventions, the specific impact of symptom perception interventions on outcomes remains uncertain to date. Well-designed studies are needed to test the effectiveness of symptom perception interventions and to elucidate relationships with outcomes.
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Affiliation(s)
- Gabrielle Cécile Santos
- School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland Fribourg, Haute Ecole de Santé Fribourg, Route des Arsenaux 16a, CH-1700 Fribourg, Switzerland; PhD Student at Institute of Higher Education and Research in Healthcare IUFRS, Faculty of Biology and Medicine, University of Lausanne and Lausanne University Hospital, SV-A Secteur Vennes, Route de la Corniche 10, CH-1010 Lausanne, Switzerland.
| | - Maria Liljeroos
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83 Linköping, Sweden; Centre for Clinical Research Sörmland, Uppsala University, 631 88 Eskilstuna, Sweden.
| | - Andrew A Dwyer
- William F. Connell School of Nursing, Boston College, 140 Commonwealth Avenue, Chestnut Hill, Massachusetts 02467, United State of America.
| | - Cécile Jaques
- Medical Library, Research and Education Department, Lausanne University Hospital, Route du Bugnon 46, CH-1011 Lausanne, Switzerland.
| | - Josepha Girard
- School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland Fribourg, Haute Ecole de Santé Fribourg, Route des Arsenaux 16a, CH-1700 Fribourg, Switzerland.
| | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83 Linköping, Sweden.
| | - Roger Hullin
- Department of cardiology, Lausanne University Hospital, Route du Bugnon 46, CH-1011 Lausanne, Switzerland; Faculty of biology and medicine, University of Lausanne, CH-1015 Lausanne, Switzerland.
| | - Petra Schäfer-Keller
- School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland Fribourg, Haute Ecole de Santé Fribourg, Route des Arsenaux 16a, CH-1700 Fribourg, Switzerland.
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Strategies, facilitators and barriers to implementation of evidence-based practice in community nursing: a systematic mixed-studies review and qualitative synthesis. Prim Health Care Res Dev 2018; 20:e6. [PMID: 30068402 PMCID: PMC6476399 DOI: 10.1017/s1463423618000488] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim To appraise and synthesize empirical literature on implementation of evidence within community nursing. To explore the use of implementation theory and identify the strategies required for, and the barriers and facilitators to, successful implementation within this context. Background There is an international consensus that evidence-based practice can improve outcomes for people using health and social care services. However, these practices are not always translated into care delivery. Community nursing is a relatively understudied area; little is known about how innovations in practice are implemented within this setting. Methods Systematic mixed-studies review, synthesizing quantitative and qualitative research. The electronic databases AMED, PsycINFO, Ovid Medline, CINAHL Plus, ASSIA, British Nursing Index and EMBASE were used. Two grey literature databases were also searched: OpenGrey and EThOS. English language, peer-reviewed papers published between January 2010 and July 2017 were considered. Criteria included implementation of an innovation and change to practice within adult community nursing. An approach called Critical Interpretive Synthesis was used to integrate the evidence from across the studies into a comprehensible theoretical framework. Results In total, 22 papers were reviewed. Few studies discussed the use of theory when planning, guiding and evaluating the implementation of the innovation (n=6). A number of implementation strategies, facilitators and barriers were identified across the included studies, highlighting the interplay of both service context and individual factors in successful implementation. Conclusion Implementation is an expanding area of research; yet is challenged by a lack of consistency in terminology and limited use of theory. Implementation within community nursing is a complex process, requiring both individual and organizational adoption, and managerial support. Successful adoption of evidence-based practice however, is only possible if community nurses themselves deem it useful and there is evidence that it could have a positive impact on the patient and/or their primary carer.
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Mishra SR, Miller AD, Haldar S, Khelifi M, Eschler J, Elera RG, Pollack AH, Pratt W. Supporting Collaborative Health Tracking in the Hospital: Patients' Perspectives. PROCEEDINGS OF THE SIGCHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS. CHI CONFERENCE 2018; 2018:650. [PMID: 29721554 PMCID: PMC5927606 DOI: 10.1145/3173574.3174224] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The hospital setting creates a high-stakes environment where patients' lives depend on accurate tracking of health data. Despite recent work emphasizing the importance of patients' engagement in their own health care, less is known about how patients track their health and care in the hospital. Through interviews and design probes, we investigated hospitalized patients' tracking activity and analyzed our results using the stage-based personal informatics model. We used this model to understand how to support the tracking needs of hospitalized patients at each stage. In this paper, we discuss hospitalized patients' needs for collaboratively tracking their health with their care team. We suggest future extensions of the stage-based model to accommodate collaborative tracking situations, such as hospitals, where data is collected, analyzed, and acted on by multiple people. Our findings uncover new directions for HCI research and highlight ways to support patients in tracking their care and improving patient safety.
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Affiliation(s)
- Sonali R Mishra
- The Information School, University of Washington, Seattle, WA, USA
| | - Andrew D Miller
- Human Centered Computing Indiana University, IUPUI Indianapolis, IN, USA
| | - Shefali Haldar
- Biomedical & Health Informatics, University of Washington, Seattle, WA, USA
| | - Maher Khelifi
- Biomedical & Health Informatics, University of Washington, Seattle, WA, USA
| | - Jordan Eschler
- The Information School, University of Washington, Seattle, WA, USA
| | - Rashmi G Elera
- The Information School, University of Washington, Seattle, WA, USA
| | - Ari H Pollack
- Biomedical & Health Informatics, University of Washington, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
- Division of Nephrology, Seattle Children's Hospital, Seattle, WA, USA
| | - Wanda Pratt
- The Information School, University of Washington, Seattle, WA, USA
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Veen EV, Bovendeert JFM, Backx FJG, Huisstede BMA. E-coaching: New future for cardiac rehabilitation? A systematic review. PATIENT EDUCATION AND COUNSELING 2017; 100:2218-2230. [PMID: 28662874 DOI: 10.1016/j.pec.2017.04.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 04/27/2017] [Accepted: 04/28/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To provide an evidence-based overview of the effectiveness of e-coaching as a cardiac rehabilitation program (CRP). METHODS Pubmed, Embase, PEDro and CINAHL were searched to identify relevant RCTs. The e-coaching programs were divided into basic or complex depending on their content. Two reviewers independently assessed the methodological quality and extracted the data. A best-evidence synthesis was used to summarize the results. RESULTS 19 RCTs were included. Detailed descriptions of the e-coaching programs were lacking. Complex e-coaching was more effective than usual-care for physical capacity (moderate evidence for short-, and mid-term; strong evidence for long-term), for clinical status (limited evidence for short- and mid-term; moderate evidence for the long-term), and for psychosocial health (moderate evidence for short-term; strong evidence for mid-, and long-term). For basic e-coaching only limited or no evidence for effectiveness was found. CONCLUSION Promising results were found for the effectiveness of complex e-coaching as a CRP to improve a patients' physical capacity, clinical status and psychosocial health. PRACTICE IMPLICATIONS The content of the e-coaching programs were not clearly described. This makes it difficult to identify which components of e-coaching are most effective and should be further developed to deliver the most optimal care for cardiac rehabilitation patients.
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Affiliation(s)
- Eva van Veen
- University Medical Center Utrecht, Rudolf Magnus Institute of Neurosciences, Department of Rehabilitation, Nursing Science & Sports, Utrecht, The Netherlands
| | - Jeske F M Bovendeert
- University Medical Center Utrecht, Rudolf Magnus Institute of Neurosciences, Department of Rehabilitation, Nursing Science & Sports, Utrecht, The Netherlands
| | - Frank J G Backx
- University Medical Center Utrecht, Rudolf Magnus Institute of Neurosciences, Department of Rehabilitation, Nursing Science & Sports, Utrecht, The Netherlands
| | - Bionka M A Huisstede
- University Medical Center Utrecht, Rudolf Magnus Institute of Neurosciences, Department of Rehabilitation, Nursing Science & Sports, Utrecht, The Netherlands.
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Boisvert S, Proulx-Belhumeur A, Gonçalves N, Doré M, Francoeur J, Gallani MC. An integrative literature review on nursing interventions aimed at increasing self-care among heart failure patients. Rev Lat Am Enfermagem 2017; 23:753-68. [PMID: 26444179 PMCID: PMC4623739 DOI: 10.1590/0104-1169.0370.2612] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to analyze and summarize knowledge concerning critical components of interventions that have been proposed and implemented by nurses with the aim of optimizing self-care by heart failure patients. METHODS PubMed and CINAHL were the electronic databases used to search full peer-reviewed papers, presenting descriptions of nursing interventions directed to patients or to patients and their families and designed to optimize self-care. Forty-two studies were included in the final sample (n=4,799 patients). RESULTS this review pointed to a variety and complexity of nursing interventions. As self-care encompasses several behaviors, interventions targeted an average of 3.6 behaviors. Educational/counselling activities were combined or not with cognitive behavioral strategies, but only about half of the studies used a theoretical background to guide interventions. Clinical assessment and management were frequently associated with self-care interventions, which varied in number of sessions (1 to 30); length of follow-up (2 weeks to 12 months) and endpoints. CONCLUSIONS these findings may be useful to inform nurses about further research in self-care interventions in order to propose the comparison of different modalities of intervention, the use of theoretical background and the establishment of endpoints to evaluate their effectiveness.
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Affiliation(s)
- Sophie Boisvert
- Faculté des sciences infirmières, Université Laval, Québec, QC, CA
| | | | - Natalia Gonçalves
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, BR
| | - Michel Doré
- Faculté des sciences infirmières, Université Laval, Québec, QC, CA
| | - Julie Francoeur
- Institut universitaire de cardiologie et pneumologie de Québec, Québec, QC, CA
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Bryant R, Alonzo A, Schmillen H. Systematic review of provider involvement in heart failure self-care interventions. J Am Assoc Nurse Pract 2017; 29:682-694. [PMID: 28805305 DOI: 10.1002/2327-6924.12501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 06/12/2017] [Accepted: 06/28/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND PURPOSE Heart failure is a global concern impacting patient outcomes. Self-care interventions improve self-care behaviors in heart failure patients. The impact of direct provider involvement on patient self-care outcomes is unknown in research. The purpose is to review self-care interventions for adults with heart failure and describe direct provider involvement versus no direct provider involvement on patient self-care behaviors. METHODS Review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were independently selected, grounded in the population, intervention, comparison, and outcome (PICO) question, and predetermined inclusion/exclusion criteria, including self-care interventions, adult heart failure patients, self-care behavior measurement, and 10-year publication. Quality assessment of studies was conducted. CONCLUSION There was a lack of data and quality studies to answer the PICO question. Comparison of variables that impact self-care behaviors is problematic because the interventions are heterogeneous, which limits interpretation of results. There were minimal studies with direct provider involvement. None of the studies conceptually addressed direct provider involvement. IMPLICATIONS FOR PRACTICE The involvement of providers, health systems, and patients in pragmatic research can impact the integration of research, policy, and practice. Strategies to decrease threats to internal validity need to be addressed as research is translated into practice.
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Cestari VRF, Florêncio RS, Moreira TMM, Pessoa VLMDP, Barbosa IV, Lima FET, Custódio IL. Competências do enfermeiro na promoção da saúde de indivíduos com cardiopatias crônicas. Rev Bras Enferm 2016; 69:1195-1203. [DOI: 10.1590/0034-7167-2016-0312] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 07/28/2016] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: identificar as competências do enfermeiro relacionadas à promoção da saúde de indivíduos com cardiopatas crônicas, à luz do Consenso de Galway. Método: revisão integrativa da literatura, com busca de artigos publicados entre os anos de 2010 e 2014, nas bases de dados LILACS, BDENF, IBECS; e no portal PubMed, em fevereiro de 2015. Os 21 artigos selecionados foram analisados de acordo com os oito domínios de competências: Catalisar mudanças, Liderança, Avaliação das necessidades, Planejamento, Implementação, Avaliação do impacto, Defesa de direitos e Parcerias. Resultados: todos os domínios de competências foram contemplados nas intervenções do enfermeiro na promoção da saúde de cardiopatas crônicos, sendo o Planejamento e a Avaliação os mais evidenciados. Conclusão: os resultados desta pesquisa destacaram o enfermeiro como agente capaz de operar a gestão do cuidado, com vistas a melhorar articulação deste último com o trabalho e educação e, desta maneira, a assistência à saúde da população.
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Ulin K, Malm D, Nygårdh A. What Is Known About the Benefits of Patient-Centered Care in Patients with Heart Failure. Curr Heart Fail Rep 2016; 12:350-9. [PMID: 26497193 DOI: 10.1007/s11897-015-0272-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Treatment for chronic heart failure (CHF) has improved, and symptom burden has been identified as an important treatment goal. Because patient-centered care may ease the burden, we need to know its benefits for patients with CHF, hence this systematic literature review. We found that one benefit of person-centered care is an increase in quality of life in patients with CHF. Improvements were found in self-care, physical and mental status, health care costs, general uncertainty regarding illness and recovery, patient dignity, treatment, and systems of care. Improvements also were observed in symptom burden, self-efficacy, and quality of life. These findings indicate that person-centered care is a powerful approach to current and future health care. However, because an appropriate tool to measure person-centered care does not yet exist, it will be a challenge to determine whether the goal has been reached from a long-term and patient perspective.
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Affiliation(s)
- Kerstin Ulin
- Institute of Health and Care Science, Sahlgrenska Academy, University of Gothenburg, 40530, Gothenburg, Sweden. .,Centre for Person-Centred Care (GPCC) University of Gothenburg, Gothenburg, Sweden.
| | - Dan Malm
- School of Health Sciences, Jönköping University, Jönköping, Sweden. .,Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden.
| | - Annette Nygårdh
- School of Health Sciences, Jönköping University, Jönköping, Sweden.
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Jensen L, Troster SM, Cai K, Shack A, Chang YJR, Wang D, Kim JS, Turial D, Bierman AS. Improving Heart Failure Outcomes in Ambulatory and Community Care: A Scoping Study. Med Care Res Rev 2016; 74:551-581. [DOI: 10.1177/1077558716655451] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Despite a large body of literature testing interventions to improve heart failure care, care is often suboptimal. This scoping study assesses organizational interventions to improve heart failure outcomes in ambulatory settings. Fifty-two studies and systematic reviews assessing multicomponent, self-management support, and eHealth interventions were included. Studies dating from the 1990s demonstrated that multicomponent interventions could reduce hospitalizations, readmissions, mortality, and costs and improve quality of life. Self-management support appeared more effective when included in multicomponent interventions. The independent contribution of eHealth interventions remains unclear. No studies addressed management of comorbidities, geriatric syndromes, frailty, or end of life care. Few studies addressed risk stratification or vulnerable populations. Limited reporting about intervention components, implementation methods, and fidelity presents challenges in adapting this literature to scale interventions. The use of standardized reporting guidelines and study designs that produce more contextual evidence would better enable application of this work in health system redesign.
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Affiliation(s)
| | | | | | - Avram Shack
- Ben-Gurion University of the Negev, Beersheba, Israel
| | | | - Dorothy Wang
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ji Soo Kim
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Arlene S. Bierman
- University of Toronto, Ontario, Canada
- St. Michael’s Hospital, Toronto, Ontario, Canada
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Jacelon CS, Gibbs MA, Ridgway JV. Computer technology for self-management: a scoping review. J Clin Nurs 2016; 25:1179-92. [PMID: 26990364 DOI: 10.1111/jocn.13221] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2016] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES The purpose of this scoping review of literature is to explore the types of computer-based systems used for self-management of chronic disease, the goals and success of these systems, the value added by technology integration and the target audience for these systems. BACKGROUND Technology is changing the way health care is provided and the way that individuals manage their health. Individuals with chronic diseases are now able to use computer-based systems to self-manage their health. These systems have the ability to remind users of daily activities, and to help them recognise when symptoms are worsening and intervention is indicated. However, there are many questions about the types of systems available, the goals of these systems and the success with which individuals with chronic illness are using them. DESIGN This is a scoping review in which the Cumulative Index of Nursing and Allied Health Literature, PubMed and IEEE Xplore databases were searched. A total of 303 articles were reviewed, 89 articles were read in-depth and 30 were included in the scoping review. The Substitution, Augmentation, Modification, Redefinition model was used to evaluate the value added by the technology integration. FINDINGS Research on technology for self-management was conducted in 13 countries. Data analysis identified five kinds of platforms on which the systems were based, some systems were focused on a specific disease management processes, others were not. CONCLUSIONS For individuals to effectively use systems to maintain maximum wellness, the systems must have a strong component of self-management and provide the user with meaningful information regarding their health states. RELEVANCE TO CLINICAL PRACTICE Clinicians should choose systems for their clients based on the design, components and goals of the systems.
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Affiliation(s)
| | - Molly A Gibbs
- College of Nursing, University of Massachusetts, Amherst, MA, USA
| | - John Ve Ridgway
- College of Informatics and Computer Science, University of Massachusetts, Amherst, MA, USA
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Beishuizen CRL, Stephan BCM, van Gool WA, Brayne C, Peters RJG, Andrieu S, Kivipelto M, Soininen H, Busschers WB, Moll van Charante EP, Richard E. Web-Based Interventions Targeting Cardiovascular Risk Factors in Middle-Aged and Older People: A Systematic Review and Meta-Analysis. J Med Internet Res 2016; 18:e55. [PMID: 26968879 PMCID: PMC4808240 DOI: 10.2196/jmir.5218] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 12/18/2015] [Accepted: 01/17/2016] [Indexed: 01/15/2023] Open
Abstract
Background Web-based interventions can improve single cardiovascular risk factors in adult populations. In view of global aging and the associated increasing burden of cardiovascular disease, older people form an important target population as well. Objective In this systematic review and meta-analysis, we evaluated whether Web-based interventions for cardiovascular risk factor management reduce the risk of cardiovascular disease in older people. Methods Embase, Medline, Cochrane and CINAHL were systematically searched from January 1995 to November 2014. Search terms included cardiovascular risk factors and diseases (specified), Web-based interventions (and synonyms) and randomized controlled trial. Two authors independently performed study selection, data-extraction and risk of bias assessment. In a meta-analysis, outcomes regarding treatment effects on cardiovascular risk factors (blood pressure, glycated hemoglobin A1c (HbA1C), low-density lipoprotein (LDL) cholesterol, smoking status, weight and physical inactivity) and incident cardiovascular disease were pooled with random effects models. Results A total of 57 studies (N=19,862) fulfilled eligibility criteria and 47 studies contributed to the meta-analysis. A significant reduction in systolic blood pressure (mean difference –2.66 mmHg, 95% CI –3.81 to –1.52), diastolic blood pressure (mean difference –1.26 mmHg, 95% CI –1.92 to –0.60), HbA1c level (mean difference –0.13%, 95% CI –0.22 to –0.05), LDL cholesterol level (mean difference –2.18 mg/dL, 95% CI –3.96 to –0.41), weight (mean difference –1.34 kg, 95% CI –1.91 to –0.77), and an increase of physical activity (standardized mean difference 0.25, 95% CI 0.10-0.39) in the Web-based intervention group was found. The observed effects were more pronounced in studies with short (<12 months) follow-up and studies that combined the Internet application with human support (blended care). No difference in incident cardiovascular disease was found between groups (6 studies). Conclusions Web-based interventions have the potential to improve the cardiovascular risk profile of older people, but the effects are modest and decline with time. Currently, there is insufficient evidence for an effect on incident cardiovascular disease. A focus on long-term effects, clinical endpoints, and strategies to increase sustainability of treatment effects is recommended for future studies.
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Affiliation(s)
- Cathrien R L Beishuizen
- Academic Medical Center, Department of Neurology, University of Amsterdam, Amsterdam, Netherlands
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Sebern M, Brown R, Flatley-Brennan P. Shared Care Contributions to Self-Care and Quality of Life in Chronic Cardiac Patients. West J Nurs Res 2016; 38:837-57. [DOI: 10.1177/0193945915626877] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Shared care is an interpersonal interaction system composed of communication, decision making, and reciprocity; it is used by patients and family caregivers (care dyads) to exchange social support. This study’s purpose was to describe the contributions of shared care to outcomes for individuals with cardiac disease. A secondary data analysis was used to answer the following questions. What is the association between elements of shared care and patient outcomes? Do dyad perceptions of shared care differentially contribute to patient outcomes? Participants in this study were 93 individuals with a cardiac disease and 93 family caregivers. Composite index structured equation modeling was the analytic tool. Caregiver communication and reciprocity were related to patient mental quality of life. Patient communication and reciprocity were related to their own mental and physical quality of life and self-care confidence. Findings from this study contribute a better understanding of how care dyads are integral to patient outcomes.
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Wilcox L, Woollen J, Prey J, Restaino S, Bakken S, Feiner S, Sackeim A, Vawdrey DK. Interactive tools for inpatient medication tracking: a multi-phase study with cardiothoracic surgery patients. J Am Med Inform Assoc 2016; 23:144-58. [PMID: 26744489 DOI: 10.1093/jamia/ocv160] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 09/22/2015] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Prior studies of computing applications that support patients' medication knowledge and self-management offer valuable insights into effective application design, but do not address inpatient settings. This study is the first to explore the design and usefulness of patient-facing tools supporting inpatient medication management and tracking. MATERIALS AND METHODS We designed myNYP Inpatient, a custom personal health record application, through an iterative, user-centered approach. Medication-tracking tools in myNYP Inpatient include interactive views of home and hospital medication data and features for commenting on these data. In a two-phase pilot study, patients used the tools during cardiothoracic postoperative care at Columbia University Medical Center. In Phase One, we provided 20 patients with the application for 24-48 h and conducted a closing interview after this period. In Phase Two, we conducted semi-structured interviews with 12 patients and 5 clinical pharmacists who evaluated refinements to the tools based on the feedback received during Phase One. RESULTS Patients reported that the medication-tracking tools were useful. During Phase One, 14 of the 20 participants used the tools actively, to review medication lists and log comments and questions about their medications. Patients' interview responses and audit logs revealed that they made frequent use of the hospital medications feature and found electronic reporting of questions and comments useful. We also uncovered important considerations for subsequent design of such tools. In Phase Two, the patients and pharmacists participating in the study confirmed the usability and usefulness of the refined tools. CONCLUSIONS Inpatient medication-tracking tools, when designed to meet patients' needs, can play an important role in fostering patient participation in their own care and patient-provider communication during a hospital stay.
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Affiliation(s)
- Lauren Wilcox
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, USA Department of Computer Science, Columbia University, New York, NY, USA
| | - Janet Woollen
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Jennifer Prey
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Susan Restaino
- College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Suzanne Bakken
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Steven Feiner
- Department of Computer Science, Columbia University, New York, NY, USA
| | - Alexander Sackeim
- College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - David K Vawdrey
- Department of Biomedical Informatics, Columbia University, New York, NY, USA New York-Presbyterian Hospital, New York, NY, USA
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Devi R, Singh SJ, Powell J, Fulton EA, Igbinedion E, Rees K. Internet-based interventions for the secondary prevention of coronary heart disease. Cochrane Database Syst Rev 2015; 2015:CD009386. [PMID: 26691216 PMCID: PMC10819100 DOI: 10.1002/14651858.cd009386.pub2] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The Internet could provide a means of delivering secondary prevention programmes to people with coronary heart disease (CHD). OBJECTIVES To determine the effectiveness of Internet-based interventions targeting lifestyle changes and medicines management for the secondary prevention of CHD. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, in December 2014. We also searched six other databases in October 2014, and three trials registers in January 2015 together with reference checking and handsearching to identify additional studies. SELECTION CRITERIA Randomised controlled trials (RCTs) evaluating Internet-delivered secondary prevention interventions aimed at people with CHD. DATA COLLECTION AND ANALYSIS Two review authors independently assessed risk of bias and extracted data according to the Cochrane Handbook for Systematic Reviews of Interventions. We assessed evidence quality using the GRADE approach and presented this in a 'Summary of findings' table. MAIN RESULTS Eighteen trials met our inclusion criteria. Eleven studies are complete (1392 participants), and seven are ongoing. Of the completed studies, seven interventions are broad, targeting the lifestyle management of CHD, and four focused on physical activity promotion. The comparison group in trials was usual care (n = 6), minimal intervention (n = 3), or traditional cardiac rehabilitation (n = 2).We found no effects of Internet-based interventions for all-cause mortality (odds ratio (OR) 0.27, 95% confidence interval (CI) 0.04 to 1.63; participants = 895; studies = 6; low-quality evidence). There was only one case of cardiovascular mortality in a control group (participants = 895; studies = 6). No incidences of non-fatal re-infarction were reported across any of the studies. We found no effects for revascularisation (OR 0.69, 95% CI 0.37 to 1.27; participants = 895; studies = 6; low-quality evidence).We found no effects for total cholesterol (mean difference (MD) 0.00, 95% CI -0.27 to 0.28; participants = 439; studies = 4; low-quality evidence), high-density lipoprotein (HDL) cholesterol (MD 0.01, 95% CI -0.06 to 0.07; participants = 437; studies = 4; low-quality evidence), or triglycerides (MD 0.01, 95% CI -0.17 to 0.19; participants = 439; studies = 4; low-quality evidence). We did not pool the data for low-density lipoprotein (LDL) cholesterol due to considerable heterogeneity. Two out of six trials measuring LDL cholesterol detected favourable intervention effects, and four trials reported no effects. Seven studies measured systolic and diastolic blood pressure; we did not pool the data due to substantial heterogeneity. For systolic blood pressure, two studies showed a reduction with the intervention, but the remaining studies showed no effect. For diastolic blood pressure, two studies showed a reduction with the intervention, one study showed an increase with the intervention, and the remaining four studies showed no effect.Five trials measured health-related quality of life (HRQOL). We could draw no conclusions from one study due to incomplete reporting; one trial reported no effect; two studies reported a short- and medium-term effect respectively; and one study reported both short- and medium-term effects.Five trials assessed dietary outcomes: two reported favourable effects, and three reported no effects. Eight studies assessed physical activity: five of these trials reported no physical activity effects, and three reported effectiveness. Trials are yet to measure the impact of these interventions on compliance with medication.Two studies measured healthcare utilisation: one reported no effects, and the other reported increased usage of healthcare services compared to a control group in the intervention group at nine months' follow-up. Two trials collected cost data: both reported that Internet-delivered interventions are likely to be cost-effective.In terms of the risk of bias, the majority of studies reported appropriate randomisation and appropriate concealment of randomisation processes. A lack of blinding resulted in a risk of performance bias in seven studies, and a risk of detection bias in five trials. Two trials were at risk of attrition bias, and five were at risk for reporting bias. AUTHORS' CONCLUSIONS In general, evidence was of low quality due to lack of blinding, loss to follow-up, and uncertainty around the effect size. Few studies measured clinical events, and of those that did, a very small number of events were reported, and therefore no firm conclusions can be made. Similarly, there was no clear evidence of effect for cardiovascular risk factors, although again the number of studies reporting these was small. There was some evidence for beneficial effects on HRQOL, dietary outcomes, and physical activity, although firm conclusions cannot yet be made. The effects on healthcare utilisation and cost-effectiveness are also inconclusive, and trials are yet to measure the impact of Internet interventions on compliance with medication. The comparison groups differed across trials, and there were insufficient studies with usable data for subgroup analyses. We intend to study the intensity of comparison groups in future updates of this review when more evidence is available. The completion of the ongoing trials will add to the evidence base.
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Affiliation(s)
- Reena Devi
- University of NottinghamSchool of Medicine, Department of Rehabilitation and AgeingNottinghamUKNG7 2UH
| | - Sally J Singh
- Glenfield HospitalCardiac & Pulmonary RehabilitationUniversity Hospitals of LeicesterLeicesterUKLE3 9QP
| | - John Powell
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
| | - Emily A Fulton
- Coventry UniversityDepartment of Health and Life SciencesPriory StreetCoventryUKCV1 5FB
| | - Ewemade Igbinedion
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Karen Rees
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
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Harvey J, Dopson S, McManus RJ, Powell J. Factors influencing the adoption of self-management solutions: an interpretive synthesis of the literature on stakeholder experiences. Implement Sci 2015; 10:159. [PMID: 26566623 PMCID: PMC4644277 DOI: 10.1186/s13012-015-0350-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 11/10/2015] [Indexed: 11/10/2022] Open
Abstract
Background In a research context, self-management solutions, which may range from simple book diaries to complex telehealth packages, designed to facilitate patients in managing their long-term conditions, have often shown cost-effectiveness, but their implementation in practice has frequently been challenging. Methods We conducted an interpretive qualitative synthesis of relevant articles identified through systematic searches of bibliographic databases in July 2014. We searched PubMed (Medline/NLM), Web of Science, LISTA (EBSCO), CINAHL, Embase and PsycINFO. Coding and analysis was inductive, using the framework method to code and to categorise themes. We took a sensemaking approach to the interpretation of findings. Results Fifty-eight articles were selected for synthesis. Results showed that during adoption, factors identified as facilitators by some were experienced as barriers by others, and facilitators could change to barriers for the same adopter, depending on how adopters rationalise the solutions within their context when making decisions about (retaining) adoption. Sometimes, when adopters saw and experienced benefits of a solution, they continued using the solution but changed their minds when they could no longer see the benefits. Thus, adopters placed a positive value on the solution if they could constructively rationalise it (which increased adoption) and attached a negative rationale (decreasing adoption) if the solution did not meet their expectations. Key factors that influenced the way adopters rationalised the solutions consisted of costs and the added value of the solution to them and moral, social, motivational and cultural factors. Conclusions Considering ‘barriers’ and ‘facilitators’ for implementation may be too simplistic. Implementers could instead iteratively re-evaluate how potential facilitators and barriers are being experienced by adopters throughout the implementation process, to help adopters to retain constructive evaluations of the solution. Implementers need to pay attention to factors including (a) cost: how much resource will the intervention cost the patient or professional; (b) moral: to what extent will people adhere because they want to be ‘good’ patients and professionals; (c) social: the expectations of patients and professionals regarding the interactive support they will receive; (d) motivational: motivations to engage with the intervention and (e) cultural: how patients and professionals learn and integrate new skills into their daily routines, practices and cultures.
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Affiliation(s)
- J Harvey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock road, Oxford, OX2 6GG, UK.
| | - S Dopson
- Saïd Business School, University of Oxford, Park End Street, Oxford, OX1 1HP, UK.
| | - R J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock road, Oxford, OX2 6GG, UK.
| | - J Powell
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock road, Oxford, OX2 6GG, UK.
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Inglis SC, Clark RA, Dierckx R, Prieto-Merino D, Cleland JGF. Structured telephone support or non-invasive telemonitoring for patients with heart failure. Cochrane Database Syst Rev 2015; 2015:CD007228. [PMID: 26517969 PMCID: PMC8482064 DOI: 10.1002/14651858.cd007228.pub3] [Citation(s) in RCA: 177] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Specialised disease management programmes for heart failure aim to improve care, clinical outcomes and/or reduce healthcare utilisation. Since the last version of this review in 2010, several new trials of structured telephone support and non-invasive home telemonitoring have been published which have raised questions about their effectiveness. OBJECTIVES To review randomised controlled trials (RCTs) of structured telephone support or non-invasive home telemonitoring compared to standard practice for people with heart failure, in order to quantify the effects of these interventions over and above usual care. SEARCH METHODS We updated the searches of the Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), Health Technology AsseFssment Database (HTA) on the Cochrane Library; MEDLINE (OVID), EMBASE (OVID), CINAHL (EBSCO), Science Citation Index Expanded (SCI-EXPANDED), Conference Proceedings Citation Index- Science (CPCI-S) on Web of Science (Thomson Reuters), AMED, Proquest Theses and Dissertations, IEEE Xplore and TROVE in January 2015. We handsearched bibliographies of relevant studies and systematic reviews and abstract conference proceedings. We applied no language limits. SELECTION CRITERIA We included only peer-reviewed, published RCTs comparing structured telephone support or non-invasive home telemonitoring to usual care of people with chronic heart failure. The intervention or usual care could not include protocol-driven home visits or more intensive than usual (typically four to six weeks) clinic follow-up. DATA COLLECTION AND ANALYSIS We present data as risk ratios (RRs) with 95% confidence intervals (CIs). Primary outcomes included all-cause mortality, all-cause and heart failure-related hospitalisations, which we analysed using a fixed-effect model. Other outcomes included length of stay, health-related quality of life, heart failure knowledge and self care, acceptability and cost; we described and tabulated these. We performed meta-regression to assess homogeneity (the null hypothesis) in each subgroup analysis and to see if the effect of the intervention varied according to some quantitative variable (such as year of publication or median age). MAIN RESULTS We include 41 studies of either structured telephone support or non-invasive home telemonitoring for people with heart failure, of which 17 were new and 24 had been included in the previous Cochrane review. In the current review, 25 studies evaluated structured telephone support (eight new studies, plus one study previously included but classified as telemonitoring; total of 9332 participants), 18 evaluated telemonitoring (nine new studies; total of 3860 participants). Two of the included studies trialled both structured telephone support and telemonitoring compared to usual care, therefore 43 comparisons are evident.Non-invasive telemonitoring reduced all-cause mortality (RR 0.80, 95% CI 0.68 to 0.94; participants = 3740; studies = 17; I² = 24%, GRADE: moderate-quality evidence) and heart failure-related hospitalisations (RR 0.71, 95% CI 0.60 to 0.83; participants = 2148; studies = 8; I² = 20%, GRADE: moderate-quality evidence). Structured telephone support reduced all-cause mortality (RR 0.87, 95% CI 0.77 to 0.98; participants = 9222; studies = 22; I² = 0%, GRADE: moderate-quality evidence) and heart failure-related hospitalisations (RR 0.85, 95% CI 0.77 to 0.93; participants = 7030; studies = 16; I² = 27%, GRADE: moderate-quality evidence).Neither structured telephone support nor telemonitoring demonstrated effectiveness in reducing the risk of all-cause hospitalisations (structured telephone support: RR 0.95, 95% CI 0.90 to 1.00; participants = 7216; studies = 16; I² = 47%, GRADE: very low-quality evidence; non-invasive telemonitoring: RR 0.95, 95% CI 0.89 to 1.01; participants = 3332; studies = 13; I² = 71%, GRADE: very low-quality evidence).Seven structured telephone support studies reported length of stay, with one reporting a significant reduction in length of stay in hospital. Nine telemonitoring studies reported length of stay outcome, with one study reporting a significant reduction in the length of stay with the intervention. One telemonitoring study reported a large difference in the total number of hospitalisations for more than three days, but this was not an analysis of length of stay per hospitalisation. Nine of 11 structured telephone support studies and five of 11 telemonitoring studies reported significant improvements in health-related quality of life. Nine structured telephone support studies and six telemonitoring studies reported costs of the intervention or cost effectiveness. Three structured telephone support studies and one telemonitoring study reported a decrease in costs and two telemonitoring studies reported increases in cost, due both to the cost of the intervention and to increased medical management. Adherence was rated between 55.1% and 98.5% for those structured telephone support and telemonitoring studies which reported this outcome. Participant acceptance of the intervention was reported in the range of 76% to 97% for studies which evaluated this outcome. Seven of nine studies that measured these outcomes reported significant improvements in heart failure knowledge and self-care behaviours. AUTHORS' CONCLUSIONS For people with heart failure, structured telephone support and non-invasive home telemonitoring reduce the risk of all-cause mortality and heart failure-related hospitalisations; these interventions also demonstrated improvements in health-related quality of life and heart failure knowledge and self-care behaviours. Studies also demonstrated participant satisfaction with the majority of the interventions which assessed this outcome.
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Affiliation(s)
- Sally C Inglis
- Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, Sydney, Australia
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24
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An Interprofessional Virtual Healthcare Neighborhood for Caregivers of Elderly With Dementia. J Nurse Pract 2014. [DOI: 10.1016/j.nurpra.2014.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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25
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Fredericks S, Martorella G, Catallo C. A Systematic Review of Web-Based Educational Interventions. Clin Nurs Res 2014; 24:91-113. [DOI: 10.1177/1054773814522829] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A complement to in-hospital educational interventions is web-based patient education accessed during the home recovery period. While findings demonstrate the effectiveness of web-based patient education interventions on patient outcomes, they fall short of identifying the characteristics that are associated with desired outcomes. The purpose of this systematic review was to determine the characteristics of web-based patient education interventions that are associated with producing changes in self-care behaviors. A systematic review involving 19 studies was conducted to determine the most effective components of a web-based intervention. Findings suggest that the most effective form of web-based patient education is one that is interactive and allows patients to navigate the online system on their own. The findings from this systematic review allow for the design of a web-based educational intervention that will promote increased performance of self-care behaviors during the home recovery period.
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26
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Knight EP, Shea K. A Patient-Focused Framework Integrating Self-Management and Informatics. J Nurs Scholarsh 2013; 46:91-7. [DOI: 10.1111/jnu.12059] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Elizabeth P. Knight
- Beta Mu, PhD/DNP student; University of Arizona, College of Nursing; Tucson AZ USA
| | - Kimberly Shea
- Beta Mu, Assistant Professor; University of Arizona, College of Nursing; Tucson AZ USA
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27
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Peeters JM, Wiegers TA, Friele RD. How technology in care at home affects patient self-care and self-management: a scoping review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:5541-64. [PMID: 24173139 PMCID: PMC3863859 DOI: 10.3390/ijerph10115541] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 10/17/2013] [Accepted: 10/17/2013] [Indexed: 11/18/2022]
Abstract
The use of technology in care at home has potential benefits such as improved quality of care. This includes greater focus on the patients’ role in managing their health and increased patient involvement in the care process. The objective of this scoping review is to analyse the existing evidence for effects of technology in home-based care on patients’ self-care and self-management. Using suitable search terms we searched the databases of Pubmed, Embase, Cochrane Library, Cinahl, Picarta and NIVEL dating from 2002 to 2012. Thirty-three studies (six review studies and twenty-seven individual studies) were selected. Effects were extracted from each study and were classified. In almost all the studies, the concepts self-care and self-management are not clearly defined or operationalized. Therefore, based on a meta-analysis, we made a new classification of outcome measures, with hierarchical levels: (1) competence (2) illness-management (3) independence (social participation, autonomy). In general, patient outcomes appear to be positive or promising, but most studies were pilot studies. We did not find strong evidence that technology in care at home has (a positive) effect on patient self-care and self-management according to the above classification. Future research is needed to clarify how technology can be used to maximize its benefits.
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Affiliation(s)
- José M. Peeters
- NIVEL, Netherlands Institute for Health Services Research, Otterstraat 118-124, Utrecht 3513 CR, The Netherlands; E-Mails: (T.A.W.); (R.D.F.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +31-30-272-9628; Fax: +31-30-272-9729
| | - Therese A. Wiegers
- NIVEL, Netherlands Institute for Health Services Research, Otterstraat 118-124, Utrecht 3513 CR, The Netherlands; E-Mails: (T.A.W.); (R.D.F.)
| | - Roland D. Friele
- NIVEL, Netherlands Institute for Health Services Research, Otterstraat 118-124, Utrecht 3513 CR, The Netherlands; E-Mails: (T.A.W.); (R.D.F.)
- Faculty of Social and Behavioural Sciences, Tilburg University, Warandelaan 2, Tilburg 5037 AB, The Netherlands
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28
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Nevedal DC, Wang C, Oberleitner L, Schwartz S, Williams AM. Effects of an individually tailored Web-based chronic pain management program on pain severity, psychological health, and functioning. J Med Internet Res 2013; 15:e201. [PMID: 24067267 PMCID: PMC3785999 DOI: 10.2196/jmir.2296] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 03/04/2013] [Accepted: 06/16/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND It is estimated that 30% of adults in the United States experience daily chronic pain. This results in a significant burden on the health care system, in particular primary care, and on the workplace. Chronic pain management with cognitive-behavioral psychological treatment is effective in reducing pain intensity and interference, health-related quality of life, mood, and return to work. However, the population of individuals with chronic pain far exceeds the population of therapists that can provide this care face-to-face. The use of tailored, Web-based interventions for the management of chronic pain could address limitations to access by virtue of its unlimited scalability. OBJECTIVE To examine the effects of a tailored Web-based chronic pain management program on subjective pain, activity and work interference, quality of life and health, and stress. METHODS Eligible participants accessed the online pain management program and informed consent via participating employer or health care benefit systems; program participants who completed baseline, 1-, and 6-month assessments were included in the study. Of the 645 participants, the mean age was 56.16 years (SD 12.83), most were female (447/645, 69.3%), and white (505/641, 78.8%). Frequent pain complaints were joint (249/645, 38.6%), back (218/645, 33.8%), and osteoarthritis (174/654, 27.0%). The online pain management program used evidence-based theories of cognitive behavioral intervention, motivational enhancement, and health behavior change to address self-management, coping, medical adherence, social support, comorbidities, and productivity. The program content was individually tailored on several relevant participant variables. RESULTS Both pain intensity (mean 5.30, SD 2.46), and unpleasantness (mean 5.43, SD 2.52) decreased significantly from baseline to 1-month (mean 4.16, SD 2.69 and mean 4.24, 2.81, respectively) and 6-month (mean 3.78, SD 2.79 and mean 3.78, SD 2.79, respectively) assessments (P<.001). The magnitude of the 6-month effects were large. Trends for decreases in pain interference (36.8% reported moderate or enormous interference) reached significance at 6 months (28.9%, P<.001). The percentage of the sample reporting fair or poor quality of life decreased significantly from 20.6% at baseline to 16.5% at 6 months (P=.006). CONCLUSIONS Results suggest that the tailored online chronic pain management program showed promising effects on pain at 1 and 6 months posttreatment and quality of life at 6 months posttreatment in this naturalistic study. Further research is warranted to determine the significance and magnitude of the intervention's effects in a randomized controlled trial.
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Affiliation(s)
- Dana C Nevedal
- VA Connecticut Healthcare System, Department of Clinical Health Psychology, West Haven, CT, USA.
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29
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Paul CL, Carey ML, Sanson-Fisher RW, Houlcroft LE, Turon HE. The impact of web-based approaches on psychosocial health in chronic physical and mental health conditions. HEALTH EDUCATION RESEARCH 2013; 28:450-471. [PMID: 23660463 PMCID: PMC3649214 DOI: 10.1093/her/cyt053] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 03/24/2013] [Indexed: 06/02/2023]
Abstract
Chronic conditions such as cancer, cardiovascular disease and mental illness are increasingly prevalent and associated with considerable psychosocial burden. There is a need to consider population health approaches to reducing this burden. Web-based interventions offer an alternative to traditional face-to-face interventions with several potential advantages. This systematic review explores the effectiveness, reach and adoption of web-based approaches for improving psychosocial outcomes in patients with common chronic conditions. A systematic review of published work examining web-based psychosocial interventions for patients with chronic conditions from 2001 to 2011. Seventy-four publications were identified. Thirty-six studies met the criteria for robust research design. A consistent significant effect in favour of the web-based intervention was identified in 20 studies, particularly those using cognitive behavioural therapy for depression. No positive effect was found in 11 studies, and mixed effects were found in 5 studies. The role of sociodemographic characteristics in relation to outcomes or issues of reach and adoption was explored in very few studies. Although it is possible to achieve positive effects on psychosocial outcomes using web-based approaches, effects are not consistent across conditions. Robust comparisons of the reach, adoption and cost-effectiveness of web-based support compared with other options such as face-to-face and print-based approaches are needed.
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Affiliation(s)
- Christine L Paul
- Health Behaviour Research Group, University of Newcastle, HMRI Building, Callaghan, New South Wales 2308 and Public Health, Hunter Medical Research Institute HMRI, Newcastle 2300,
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Valdez RS, Gibbons MC, Siegel ER, Kukafka R, Brennan PF. Designing consumer health IT to enhance usability among different racial and ethnic groups within the United States. HEALTH AND TECHNOLOGY 2012. [DOI: 10.1007/s12553-012-0031-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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31
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Slack WV, Kowaloff HB, Davis RB, Delbanco T, Locke SE, Safran C, Bleich HL. Evaluation of computer-based medical histories taken by patients at home. J Am Med Inform Assoc 2012; 19:545-8. [PMID: 22237866 PMCID: PMC3384115 DOI: 10.1136/amiajnl-2011-000580] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 12/12/2011] [Indexed: 11/04/2022] Open
Abstract
The authors developed a computer-based general medical history to be taken by patients in their homes over the internet before their first visit with their primary care doctor, and asked six doctors and their participating patients to assess this history and its effect on their subsequent visit. Forty patients began the history; 32 completed the history and post-history assessment questionnaire and were for the most part positive in their assessment; and 23 continued on to complete their post-visit assessment questionnaire and were for the most part positive about the helpfulness of the history and its summary at the time of their visit with the doctor. The doctors in turn strongly favored the immediate, routine use of two modules of the history--the family and social histories--for all their new patients. The doctors suggested further that the summaries of the other modules of the history be revised and shortened to make it easier for them to focus on clinical issues in the order of their preference.
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Affiliation(s)
- Warner V Slack
- Division of Clinical Informatics, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.
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Valdez R, Burke L, Casper G, Sturgeon B, Rosmait C, Palzkill D, Hamann D, Murphy J, Brennan P. Service Desk Calls in a Home-based Clinical Informatics Study: Supporting End Users in the Field. NI 2012 : 11TH INTERNATIONAL CONGRESS ON NURSING INFORMATICS, JUNE 23-27, 2012, MONTREAL, CANADA. INTERNATIONAL CONGRESS IN NURSING INFORMATICS (11TH : 2012 : MONTREAL, QUEBEC) 2012; 2012:427. [PMID: 24199135 PMCID: PMC3799103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Home-based clinical informatics technologies are being developed to facilitate health care provision and management. Given the novelty of these technologies, end users such as patients and their formal and informal caregivers may require support during use. This paper presents a case study within the United States of the service desk calls generated over a 31-month period by patients enrolled in a large randomized field experiment, HeartCare II. This case study provides future deployers of home-based clinical information technologies with an understanding of the types of support that may be required during use. Our analysis reveals that calls to the service desk originated as a result of user problems, hardware problems, software problems, and internal communication problems among individuals involved in the delivery and use of the technology. Implications of these needs for support during use are also discussed.
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Affiliation(s)
- Rs Valdez
- University of Wisconsin-Madison, Madison, WI
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