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Kaplan A, Boivin M, Bouchard J, Kim J, Hayes S, Licskai C. The emerging role of digital health in the management of asthma. Ther Adv Chronic Dis 2023; 14:20406223231209329. [PMID: 38028951 PMCID: PMC10657529 DOI: 10.1177/20406223231209329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/25/2023] [Indexed: 12/01/2023] Open
Abstract
The most common reasons seen for lack of asthma control include misconceptions about disease control, low controller treatment adherence, poor inhaler technique, and the resulting underuse of controllers and overuse of short-acting beta2 agonists (SABAs). Narrowing these care gaps may be achieved through well-designed patient education that considers the patient's motivation, beliefs, and capabilities regarding their asthma and its management and empowers the patient to become an active participant in treatment decisions. Digital health technologies (DHTs) and digital therapeutic (DT) devices provide new opportunities to monitor treatment behaviors, improve communication between healthcare providers and patients, and generate data that inform educational interactions. DHT and DT have been proven effective in enhancing patient self-management in other chronic conditions, particularly diabetes. Accelerated integration of DHT and DT into the management of asthma patients is facilitated by the use of digital inhalers that employ sensor technology ("smart" inhalers). These devices efficiently provide real-time feedback on controller adherence, SABA use, and inhaler technique that have the strong potential to optimize asthma control.
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Affiliation(s)
- Alan Kaplan
- Department of Family and Community Medicine, University of Toronto, 14872 Yonge Street, Aurora, Toronto, ON L4G 1N2, Canada
- Family Physician Airways Group of Canada, Markham, ON, Canada
| | | | | | - James Kim
- Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Christopher Licskai
- Division of Respirology, Department of Medicine, Western University, London, ON, Canada
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Dhippayom T, Saldanha IJ, Chaiyakunapruk N, Devine B. Characterizing health services interventions for evidence syntheses by using the theme, intensity, provider/platform (TIP) framework. J Evid Based Med 2022; 15:333-337. [PMID: 36529853 DOI: 10.1111/jebm.12511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
Health services interventions comprise a range of elements and procedures that contribute to their effects. However, there is currently limited guidance to systematically classify different features of health services interventions. We propose an approach to aid in classifying health services interventions using three potential elements: theme, intensity, and provider/platform (TIP). We designed the TIP framework to be analogous to three elements of a medication intervention that contribute to its pharmaceutical effects: 1) active ingredient, 2) dose, and 3) dosage form or route of administration. Health services interventions encompass similar elements: 1) "theme", which corresponds to the active ingredient and specifies the main element of the intervention; 2) "intensity", which corresponds to the dose regimen; and 3) "provider" or "platform", which corresponds to the dosage form or route of administration and indicates how the main element is delivered. Each health services intervention can be classified into a set of unique TIP features, which can then be compared with others using either a qualitative or qualitative approach. The TIP framework is not suitable for multicomponent health services interventions, in which a singular main theme or active component cannot be identified. The TIP framework enables researchers to systematically characterize health services interventions according to their unique features that contribute to its effects. It also helps to generate evidence to determine not only what service is more effective, but also how to best deliver such service.
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Affiliation(s)
- Teerapon Dhippayom
- The Research Unit of Evidence Synthesis (TRUES), Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Ian J Saldanha
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, and Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, United States
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, United States
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, United States
| | - Beth Devine
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, Washington, United States
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Wang M, Wang Y, Lei J. Assessing safety and efficacy in a network meta-analysis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:3047. [PMID: 36357054 DOI: 10.1016/j.jaip.2022.08.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 07/25/2022] [Accepted: 08/21/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Miaomiao Wang
- The First Clinical Medical College of Lanzhou University, Lanzhou City, Gansu Province, China; Department of Radiology, The First Hospital of Lanzhou University, Lanzhou City, Gansu Province, China; Intelligent Imaging Medical Engineering Research Center of Gansu Province, Lanzhou City, Gansu Province, China
| | - Yinzhong Wang
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou City, Gansu Province, China; Intelligent Imaging Medical Engineering Research Center of Gansu Province, Lanzhou City, Gansu Province, China
| | - Junqiang Lei
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou City, Gansu Province, China; Intelligent Imaging Medical Engineering Research Center of Gansu Province, Lanzhou City, Gansu Province, China.
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Dhippayom T, Devine B. Reply to "Assessing safety and efficacy in a network meta-analysis". THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:3047-3048.e5. [PMID: 36357053 DOI: 10.1016/j.jaip.2022.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 08/21/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Teerapon Dhippayom
- The Research Unit of Evidence Synthesis (TRUES), Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.
| | - Beth Devine
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, Wash
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Dhippayom T, Boonpattharatthiti K, Thammathuros T, Dilokthornsakul P, Sakunrag I, Devine B. Clinical Outcomes of Different Warfarin Self-Care Strategies: A Systematic Review and Network Meta-Analysis. Thromb Haemost 2022; 122:492-505. [PMID: 34695873 DOI: 10.1055/a-1677-9608] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
AIM To compare the effects of different strategies for warfarin self-care. METHODS PubMed, EMBASE, CENTRAL, CINAHL, ProQuest Dissertations & Theses, and OpenGrey were searched from inception to August 2021. Randomized controlled trials (RCTs) of warfarin self-care, either patient self-testing (PST) or patient self-management (PSM), were included. Self-care approaches were classified based on the TIP framework (theme, intensity, provider): (1) PST ≥1/week via e-Health (PST/High/e-Health); (2) PST ≥1/week by health care practitioner (PST/High/HCP); (3) PST <1/week via e-Health (PST/Low/e-Health); (4) PSM ≥1/week by e-Health (PSM/High/e-Health); (5) PSM ≥1/week by patient (PSM/High/Pt); (6) PSM <1/week by patient (PSM/Low/Pt); and (7) PSM with flexible frequency by patient (PSM/Flex/Pt). Mean differences (MDs) and risk ratios (RRs) with 95% confidence interval (CI) were estimated using frequentist network meta-analyses with a random-effects model. The certainty of evidence was evaluated using CINeMA (Confidence in Network Meta-Analysis). RESULTS Sixteen RCTs involving 5,895 participants were included. When compared with usual care, time in therapeutic range was higher in PSM/High/Pt and PST/High/e-Health with MD [95% CI] of 7.67% [0.26-15.08] and 5.65% [0.04-11.26], respectively. The certainty of evidence was rated as moderate for these findings. The risk of thromboembolic events was lower in the PSM/Flex/Pt group when compared with PST/High/e-Health (RR: 0.39 [0.20-0.77]) and usual care (RR: 0.38 [0.17-0.88]) with low and very low level of evidence, respectively. There was no significant difference in the proportion of international normalized ratio (INR) values in range, major bleeding, and all-cause mortality among different self-care features. CONCLUSION Patient self-care (either PST or PSM) by measuring INR values at least once weekly is more effective in controlling the INR level.
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Affiliation(s)
- Teerapon Dhippayom
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Kansak Boonpattharatthiti
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.,Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Burapha University, Chon Buri, Thailand
| | - Treeluck Thammathuros
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Piyameth Dilokthornsakul
- Department of Pharmacy Practice, Center of Pharmaceutical Outcomes Research, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Itsarawan Sakunrag
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Beth Devine
- The Comparative Health Outcomes, Policy, and Economics Institute, School of Pharmacy, University of Washington, Seattle, Washington, United States
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