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Oslin SJ, Shi HH, Conner AK. Preventing Sudden Cessation of Implantable Pulse Generators in Deep Brain Stimulation: A Systematic Review and Protocol Proposal. Stereotact Funct Neurosurg 2024; 102:127-134. [PMID: 38432221 DOI: 10.1159/000535880] [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: 09/09/2023] [Accepted: 12/14/2023] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Deep brain stimulation (DBS) requires a consistent electrical supply from the implantable pulse generator (IPG). Patients may struggle to monitor their IPG, risking severe complications in battery failure. This review assesses current literature on DBS IPG battery life management and proposes a protocol for healthcare providers. METHODS A literature search using four databases identified best practices for DBS IPG management. Studies were appraised for IPG management guidelines, categorized as qualitative, quantitative, or both. RESULTS Of 408 citations, only seven studies were eligible, none providing clear patient management strategies. Current guidelines lack specificity, relying on clinician suggestions. CONCLUSION Limited guidelines exist for IPG management. Specificity and adaptability to emerging technology are crucial. The findings highlight the need for specificity in patients' needs and adaptability to emerging technology in future studies. To address this need, we developed a protocol for DBS IPG management that we have implemented at our own institution. Further research is needed for effective DBS IPG battery life management, preventing therapy cessation complications.
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Affiliation(s)
- Spencer J Oslin
- Department of Neurosurgery, University of Oklahoma, Health Sciences Center, Oklahoma City, Oklahoma, USA,
| | - Helen H Shi
- Department of Neurosurgery, University of Oklahoma, Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Andrew K Conner
- Department of Neurosurgery, University of Oklahoma, Health Sciences Center, Oklahoma City, Oklahoma, USA
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Liu F, Song T, Yu P, Deng N, Guan Y, Yang Y, Ma Y. Efficacy of an mHealth App to Support Patients' Self-Management of Hypertension: Randomized Controlled Trial. J Med Internet Res 2023; 25:e43809. [PMID: 38113071 PMCID: PMC10762623 DOI: 10.2196/43809] [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: 10/25/2022] [Revised: 01/27/2023] [Accepted: 11/17/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Hypertension is a significant global disease burden. Mobile health (mHealth) offers a promising means to provide patients with hypertension with easy access to health care services. Yet, its efficacy needs to be validated, especially in lower-income areas with a high-salt diet. OBJECTIVE This study aims to assess the efficacy of an mHealth app-based intervention in supporting patients' self-management of hypertension. METHODS A 2-arm randomized controlled trial was conducted among 297 patients with hypertension at the General Hospital of Ningxia Medical University, Ningxia Hui Autonomous Region, China. Participants selected via convenience sampling were randomly allocated into intervention and control groups. Intervention group participants were trained and asked to use an mHealth app named Blood Pressure Assistant for 6 months. They could use the app to record and upload vital signs, access educational materials, and receive self-management reminders and feedback from health care providers based on the analysis of the uploaded data. Control group participants received usual care. Blood pressure (BP) and 2 questionnaire surveys about hypertension knowledge and lifestyle behavior were used to assess all participants at baseline and 6 months. Data analysis was performed with SPSS software using 2-tailed t tests and a chi-square test. RESULTS There were no significant differences in baseline characteristics and medication use between the 2 groups (all P>.05). After 6 months, although both groups show a significant pre-post improvement (P<.001 each), the BP control rate (ie, the proportion of patients with a systolic BP of <140 mm Hg and diastolic BP of <90 mm Hg) in the intervention group was better than that in the control group (100/111, 90.1% vs 75/115, 65.2%; P<.001). The mean systolic and diastolic BP were significantly reduced by 25.83 (SD 8.99) and 14.28 (SD 3.74) mm Hg in the intervention group (P<.001) and by 21.83 (SD 6.86) and 8.87 (SD 4.22) mm Hg in the control group (P<.001), respectively. The differences in systolic and diastolic BP between the 2 groups were significant (P<.001 and P=.01, respectively). Hypertension knowledge significantly improved only in the intervention group in both pre-post and intergroup comparisons (both P<.001). However, only intragroup improvement was observed for lifestyle behaviors in the intervention group (P<.001), including medication adherence (P<.001), healthy diet (P=.02), low salt intake (P<.001), and physical exercises (P=.02), and no significant difference was observed in the control group or on intergroup comparisons. CONCLUSIONS This research shows that the mHealth app-based intervention has the potential to improve patient health knowledge and support self-management among them toward a healthier lifestyle, including medication adherence, low-salt diets, and physical exercises, thereby achieving optimal BP control. Further research is still needed to verify the specific effects of these interventions. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR1900026437; https://www.chictr.org.cn/showproj.html?proj=38801.
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Affiliation(s)
- Fang Liu
- Health Management Center, General Hospital of Ningxia Medical University, Yinchuan, China
- Department of Cardiology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Ting Song
- Centre for Digital Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
| | - Ping Yu
- Centre for Digital Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, Australia
| | - Ning Deng
- The Ministry of Education Key Laboratory of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Yingping Guan
- Health Management Center, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Yang Yang
- Department of Cardiology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Yuanji Ma
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute Of Cardiovascular Diseases, Shanghai, China
- National Clinical Research Center for International Medicine, Shanghai, China
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Calderon SJ, Comnick CL, Villhauer A, Marshall T, Dahl JU, Banas JA, Drake DR. A Social Media Intervention for Promoting Oral Health Behaviors in Adolescents: A Non-Randomized Pilot Clinical Trial. ORAL (BASEL, SWITZERLAND) 2023; 3:203-214. [PMID: 38162993 PMCID: PMC10757568 DOI: 10.3390/oral3020018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Poor oral hygiene and excessive consumption of soda are among the main drivers of systemic health issues in adolescents in the United States. This non-randomized pilot clinical trial focused on the effects of a health text message system and smartphone-based intervention on adolescent tooth-brushing behavior and dietary choices, with a convenience sample of 94 participants aged 12 to 14 years old. A group of 75 participants agreed to use a tooth-brushing app and received a health text message; the other group of 15 agreed to use the tooth-brushing app, but did not receive a health text message. Saliva specimens were collected directly before and at the end of each experiment; changes in the salivary presence of cariogenic bacteria over the duration of the study were evaluated and compared with the demographics and behavioral variables. Within the text message group, 5% of participants increased the frequency of daily tooth brushing. Within the non-intervention group, 29% of participants increased the frequency of their daily tooth brushing. There were reductions in the total salivary bacteria and total streptococci in both groups (p < 0.001), but no change in the presence of cariogenic Mutans streptococci. Raising adolescents' consciousness of oral health behavior resulted in marginal to moderate improvements to oral hygiene and dietary choices, as well as reductions in total salivary bacteria.
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Affiliation(s)
- Susana J. Calderon
- Mennonite College of Nursing, Illinois State University, Normal, IL 61790, USA
| | - Carissa L. Comnick
- Iowa Institute for Oral Health Research, College of Dentistry, University of Iowa, Iowa City, IA 52242, USA
| | - Alissa Villhauer
- Iowa Institute for Oral Health Research, College of Dentistry, University of Iowa, Iowa City, IA 52242, USA
| | - Teresa Marshall
- Iowa Institute for Oral Health Research, College of Dentistry, University of Iowa, Iowa City, IA 52242, USA
| | - Jan-Ulrik Dahl
- School of Biological Sciences, Illinois State University, Normal, IL 61790, USA
| | - Jeffrey A. Banas
- Iowa Institute for Oral Health Research, College of Dentistry, University of Iowa, Iowa City, IA 52242, USA
| | - David R. Drake
- Iowa Institute for Oral Health Research, College of Dentistry, University of Iowa, Iowa City, IA 52242, USA
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Benzo RM, Farag A, Whitaker KM, Xiao Q, Carr LJ. Examining the impact of 12-hour day and night shifts on nurses' fatigue: A prospective cohort study. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100076. [PMID: 38745643 PMCID: PMC11080398 DOI: 10.1016/j.ijnsa.2022.100076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/09/2022] [Accepted: 03/14/2022] [Indexed: 11/26/2022] Open
Abstract
Background: Fatigue is prevalent among hospital nurses and has been linked to medical errors and decreased patient safety. However, little is known regarding the relationship between occupational physical activity, sedentary behavior, and fatigue. Objective: To assess the impact of 12-hour shifts on nurses' fatigue and its relationship to occupational physical activity and sedentary behavior. Design: Prospective-cohort study design Setting(s): Midwestern trauma one academic medical center Participants: A total of 80 registered nurses working 12-hour day and night shifts participated in this study and completed momentary measures of fatigue (texting, aim one). Only 52 participants were included in aim two analyses (included activity monitoring, aim two). Methods: Occupational patterns of momentary fatigue was measured via ecological momentary assessments. Occupational physical activity and sedentary behaviors (e.g., step count, time spent sitting, standing, and walking) were measured for 14 continuous days using the ActivPAL3 micro activity monitor. Mixed models were used to examine the effects of shift type and time within a shift on occupational fatigue. General estimation equations were used to examine the relationship between time spent sitting, standing, and walking on fatigue. Results: Regardless of shift type, nurses exhibited a significant rise in fatigue; however, the rise was greater during night shifts compared to day shifts. Walking was positively associated with fatigue during day shifts, and negatively associated with fatigue during night shifts. Conclusions: The rise in fatigue was greater among nurses working night shifts compared to day shifts, which could place them at greater risk for fatigue-related consequences. The relationship between walking and fatigue was moderated by shift-type. Tweetable abstract: Nursing fatigue rises during 12-hour shifts, but the rise is greater for those working night shifts @DrRobertoBenzo.
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Affiliation(s)
- Roberto M. Benzo
- Department of Psychology, University of Miami, Miami, Florida 33136, United States of America
- Department of Health & Human Physiology, University of Iowa, E102 Field House, Iowa City, Iowa 52242, United States of America
| | - Amany Farag
- College of Nursing, University of Iowa, 101 College of Nursing Building; 50 Newton Road, Iowa City, Iowa 52242, United States of America
| | - Kara M. Whitaker
- Department of Health & Human Physiology, University of Iowa, E102 Field House, Iowa City, Iowa 52242, United States of America
- Department of Epidemiology, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Qian Xiao
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Lucas J. Carr
- Department of Health & Human Physiology, University of Iowa, E102 Field House, Iowa City, Iowa 52242, United States of America
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Rodrigues MA, Hercules ABS, Gnatta JR, Coelho JC, Mota ANB, Pierin AMG, Santana RF. Teleconsultation as an advanced practice nursing during the COVID-19 pandemic based on Roy and Chick-Meleis. Rev Esc Enferm USP 2022; 56:e20210438. [PMID: 35766921 DOI: 10.1590/1980-220x-reeusp-2021-0438en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/26/2021] [Indexed: 11/22/2022] Open
Abstract
Teleconsultation can be classified as an advanced practice nursing that requires nurses' clinical reasoning based on a consistent theoretical framework to use in the nursing process. Our study conducted a theoretical-reflective analysis, based on Callista Roy's Adaptation Model of Nursing and Chick-Meleis' Transition Theory, about the contribution of teleconsultation as an advanced practice nursing in the care of older adults with chronic diseases during the COVID-19 pandemic. We reflect on this in two moments: "nursing theories and dealing with COVID-19" and "ways of adapting to new care models and advanced practice nursing," based on communication and information technologies. The worsening of the pandemic in Brazil changed life cycles, health/disease and organizational processes, demanding the development of an adaptive-transactional state by users and health care providers. Thus, information and communication technologies combined with advanced practice nursing can relieve social distancing and its repercussions on health care.
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Anthony CA, Rojas E, Glass N, Keffala V, Noiseux N, Elkins J, Brown TS, Bedard NA. A Psycholgical Intervention Delivered by Automated Mobile Phone Messaging Stabilized Hip and Knee Function During the COVID-19 Pandemic: A Randomized Controlled Trial. J Arthroplasty 2022; 37:431-437.e3. [PMID: 34906660 PMCID: PMC8665663 DOI: 10.1016/j.arth.2021.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/29/2021] [Accepted: 12/07/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND We conducted a randomized controlled trial to evaluate the effectiveness of acceptance and commitment therapy (ACT) delivered via a mobile phone messaging robot to patients who had their total hip arthroplasty or total knee arthroplasty procedures postponed due to the COVID-19 pandemic. METHODS Ninety patients scheduled for total hip arthroplasty or total knee arthroplasty who experienced surgical delay due to the COVID-19 pandemic were randomized to the ACT group, receiving 14 days of twice daily automated mobile phone messages, or the control group, who received no messages. Minimal clinically important differences (MCIDs) in preintervention and postintervention patient-reported outcome measures were utilized to evaluate the intervention. RESULTS Thirty-eight percent of ACT group participants improved and achieved MCID on the Patient-Reported Outcome Measure Information System Physical Health compared to 17.5% in the control group (P = .038; number needed to treat [NNT] 5). For the joint-specific Hip Disability and Osteoarthritis Outcome Score Joint Replacement and Knee Disability and Osteoarthritis Outcome Score Joint Replacement (KOOS JR), 24% of the ACT group achieved MCID compared to 2.5% in the control group (P = .004; NNT 5). An improvement in the KOOS JR was found in 29% of the ACT group compared to 4.2% in the control group (P = .028; NNT 5). Fourteen percent of the ACT group participants experienced a clinical important decline in the KOOS JR compared to 41.7% in the control group (P = .027; NNT 4). CONCLUSION A psychological intervention delivered via a text messaging robot improved physical function and prevented decline in patient-reported outcome measures in patients who experienced an unexpected surgical delay during the COVID-19 pandemic. LEVEL OF EVIDENCE 1.
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Affiliation(s)
- Chris A. Anthony
- Department of Orthopaedics, University of Pennsylvania, Philadelphia, PA,Address correspondence to: Chris A. Anthony, MD, Department of Orthopaedics, University of Pennsylvania, 800 Spruce Street, 1st Floor Cathcart Building, Philadelphia, PA
| | - Edward Rojas
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA
| | - Natalie Glass
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA
| | - Valerie Keffala
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA
| | - Nicholas Noiseux
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA
| | - Jacob Elkins
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA
| | - Timothy S. Brown
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA
| | - Nicholas A. Bedard
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA
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Shea S, Thompson JLP, Schwartz JE, Chen Y, de Ferrante M, Vanderbeek AM, Buchsbaum R, Vargas C, Siddiqui KM, Moran AE, Stockwell M. The Retail Outlet Health Kiosk Hypertension Trial (ROKHYT): Pilot Results. Am J Hypertens 2022; 35:103-110. [PMID: 34382648 DOI: 10.1093/ajh/hpab129] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 07/29/2021] [Accepted: 08/10/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Blood pressure (BP) control was only 43.7% in the National Health and Nutrition Survey (NHANES) survey in 2017-2018. Scalable, nonclinic-based strategies to control BP are needed. We therefore conducted a pilot trial of a text-messaging intervention in a national network of retail outlet health kiosks with BP devices. All study procedures were conducted remotely. METHODS Eligible individuals (N = 140), based on average BP greater than or equal to 140/90 mm Hg at kiosks during the prior year, were randomized to intervention vs. usual care. Intervention consisted of tailored text messages providing educational information with embedded links to educational videos on topics related to BP control. BP measurements were obtained at kiosks at 3, 6, and 12 months following randomization; control was defined as BP < 140/90 mm Hg. Follow-up at 12 months was curtailed due to SARS-CoV-2. We therefore combined 12-month (N = 62) or carried forward 6-month (N = 61) data as the primary end point. RESULTS Participants were 51.4% male, 70.7% white/Caucasian, had mean age of 52.1 years, and mean baseline BP 145.5/91.8 mm Hg. At the end point, 37.7% intervention vs. 27.4% usual care subjects achieved BP control (difference, 10.3%, 95% confidence interval -6.2%, 26.8%). In an intention-to-treat analysis with multiple imputation of missing data, 12-month BP control was 29.0% vs. 19.8% favoring intervention (difference, 9.2%. 95% confidence interval -7.3%, 25.7%); intervention vs. control differences in adjusted mean BP levels were systolic BP: -5.4 mm Hg (95% confidence interval: -13.5, 2.7) and diastolic BP: +0.6 mm Hg (95% confidence interval: -4.2, 5.4). CONCLUSIONS These pilot results support the potential for a highly scalable text-messaging intervention to improve BP. CLINICAL TRIALS REGISTRATION Trial Number NCT03515681.
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Affiliation(s)
- Steven Shea
- Department of Medicine, Columbia University, New York, New York, USA
- Department of Epidemiology, Columbia University, New York, New York, USA
| | - John L P Thompson
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Joseph E Schwartz
- Department of Psychiatry and Behavioral Science, Stony Brook University, Stony Brook, New York, USA
| | - Yineng Chen
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Morgan de Ferrante
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, USA
- Advanced Imaging and Research, Edwards Lifesciences, Irvine, California, USA
| | - Alyssa M Vanderbeek
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, USA
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Richard Buchsbaum
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Celibell Vargas
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | | | - Andrew E Moran
- Department of Medicine, Columbia University, New York, New York, USA
| | - Melissa Stockwell
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York, USA
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Rodrigues MA, Hercules ABS, Gnatta JR, Coelho JC, Mota ANB, Pierin AMG, Santana RF. Teleconsulta como prática avançada de enfermagem na pandemia de COVID-19 à luz de Roy e Chick-Meleis. Rev Esc Enferm USP 2022. [DOI: 10.1590/1980-220x-reeusp-2021-0438pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO A teleconsulta pode ser definida como uma prática avançada de enfermagem que requer do enfermeiro raciocínio clínico fundamentado em um arcabouço teórico consistente para aplicação no processo de enfermagem. No presente estudo, realizou-se uma análise teórico-reflexiva, fundamentada no Modelo de Adaptação de Callista Roy e na Teoria de Transição de Chick-Meleis, sobre a contribuição da teleconsulta como prática avançada de enfermagem no atendimento a pacientes idosos e com doenças crônicas no contexto da pandemia de covid-19. A reflexão é apresentada em dois momentos: “teorias de enfermagem e o enfrentamento da covid-19” e “formas de adaptação a novos modelos de assistência e as práticas avançadas em enfermagem”, norteados pelas tecnologias de comunicação e informação. O agravamento da pandemia no Brasil trouxe mudanças relacionadas aos ciclos de vida, aos processos saúde/doença e organizacionais, demandando o desenvolvimento de um estado adaptativo-transacional por parte dos usuários e profissionais de saúde. Neste contexto, as tecnologias da informação e comunicação aliadas à prática avançada de enfermagem representam papel fundamental para atenuar o distanciamento social e suas repercussões na assistência à saúde.
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Glöggler M, Ammenwerth E. Development and Validation of a Useful Taxonomy of Patient Portals Based on Characteristics of Patient Engagement. Methods Inf Med 2021; 60:e44-e55. [PMID: 34243191 PMCID: PMC8294937 DOI: 10.1055/s-0041-1730284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective
Taxonomies are classification systems used to reduce complexity and better understand a domain. The present research aims to develop a useful taxonomy for health information managers to classify and compare patient portals based on characteristics appropriate to promote patient engagement. As a result, the taxonomy should contribute to understanding the differences and similarities of the portals. Further, the taxonomy shall support health information managers to more easily define which general type and functionalities of patient portals they need and to select the most suitable solution offered on the market.
Methods
We followed the formal taxonomy-building method proposed by Nickerson et al. Based on a literature review, we created a preliminary taxonomy following the conceptional approach of the model. We then evaluated each taxa's appropriateness by analyzing and classifying 17 patient portals offered by software vendors and 11 patient portals offered by health care providers. After each iteration, we examined the achievement of the determined objective and subjective ending conditions.
Results
After two conceptional approaches to create our taxonomy, and two empirical approaches to evaluate it, the final taxonomy consists of 20 dimensions and 49 characteristics. To make the taxonomy easy to comprehend, we assigned to the dimensions seven aspects related to patient engagement. These aspects are (1) portal design, (2) management, (3) communication, (4) instruction, (5) self-management, (6) self-determination, and (7) data management. The taxonomy is considered finished and useful after all ending conditions that defined beforehand have been fulfilled. We demonstrated that the taxonomy serves to understand the differences and similarities by comparing patient portals. We call our taxonomy “Taxonomy of Patient Portals based on Characteristics of Patient Engagement (TOPCOP).”
Conclusion
We developed the first useful taxonomy for health information managers to classify and compare patient portals. The taxonomy is based on characteristics promoting patient engagement. With 20 dimensions and 49 characteristics, our taxonomy is particularly suitable to discriminate among patient portals and can easily be applied to compare portals. The TOPCOP taxonomy enables health information managers to better understand the differences and similarities of patient portals. Further, the taxonomy may help them to define the type and general functionalities needed. But it also supports them in searching and comparing patient portals offered on the market to select the most suitable solution.
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Affiliation(s)
- Michael Glöggler
- Institute of Medical Informatics, UMIT-Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Elske Ammenwerth
- Institute of Medical Informatics, UMIT-Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
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Schorr EN, Gepner AD, Dolansky MA, Forman DE, Park LG, Petersen KS, Still CH, Wang TY, Wenger NK. Harnessing Mobile Health Technology for Secondary Cardiovascular Disease Prevention in Older Adults: A Scientific Statement From the American Heart Association. Circ Cardiovasc Qual Outcomes 2021; 14:e000103. [PMID: 33793309 DOI: 10.1161/hcq.0000000000000103] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Secondary prevention of cardiovascular disease (CVD), the leading cause of morbidity and mortality, is critical to improving health outcomes and quality of life in our aging population. As mobile health (mHealth) technology gains universal leverage and popularity, it is becoming more user-friendly for older adults and an adjunct to manage CVD risk and improve overall cardiovascular health. With the rapid advances in mHealth technology and increasing technological engagement of older adults, a comprehensive understanding of the current literature and knowledge of gaps and barriers surrounding the impact of mHealth on secondary CVD prevention is essential. After a systematic review of the literature, 26 studies that used mHealth for secondary CVD prevention focusing on lifestyle behavior change and medication adherence in cohorts with a mean age of ≥60 years were identified. Improvements in health behaviors and medication adherence were observed, particularly when there was a short message service (ie, texting) component involved. Although mobile technologies are becoming more mainstream and are starting to blend more seamlessly with standard health care, there are still distinct barriers that limit implementation particularly in older adults, including affordability, usability, privacy, and security issues. Furthermore, studies on the type of mHealth that is the most effective for older adults with longer study duration are essential as the field continues to grow. As our population ages, identifying and implementing effective, widely accepted, cost-effective, and time-efficient mHealth interventions to improve CVD health in a vulnerable demographic group should be a top health priority.
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Davoudi A, Lee NS, Chivers C, Delaney T, Asch EL, Reitz C, Mehta SJ, Chaiyachati KH, Mowery DL. Patient Interaction Phenotypes With an Automated Remote Hypertension Monitoring Program and Their Association With Blood Pressure Control: Observational Study. J Med Internet Res 2020; 22:e22493. [PMID: 33270032 PMCID: PMC7746494 DOI: 10.2196/22493] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/12/2020] [Accepted: 10/24/2020] [Indexed: 01/26/2023] Open
Abstract
Background Automated texting platforms have emerged as a tool to facilitate communication between patients and health care providers with variable effects on achieving target blood pressure (BP). Understanding differences in the way patients interact with these communication platforms can inform their use and design for hypertension management. Objective Our primary aim was to explore the unique phenotypes of patient interactions with an automated text messaging platform for BP monitoring. Our secondary aim was to estimate associations between interaction phenotypes and BP control. Methods This study was a secondary analysis of data from a randomized controlled trial for adults with poorly controlled hypertension. A total of 201 patients with established primary care were assigned to the automated texting platform; messages exchanged throughout the 4-month program were analyzed. We used the k-means clustering algorithm to characterize two different interaction phenotypes: program conformity and engagement style. First, we identified unique clusters signifying differences in program conformity based on the frequency over time of error alerts, which were generated to patients when they deviated from the requested text message format (eg, ###/## for BP). Second, we explored overall engagement styles, defined by error alerts and responsiveness to text prompts, unprompted messages, and word count averages. Finally, we applied the chi-square test to identify associations between each interaction phenotype and achieving the target BP. Results We observed 3 categories of program conformity based on their frequency of error alerts: those who immediately and consistently submitted texts without system errors (perfect users, 51/201), those who did so after an initial learning period (adaptive users, 66/201), and those who consistently submitted messages generating errors to the platform (nonadaptive users, 38/201). Next, we observed 3 categories of engagement style: the enthusiast, who tended to submit unprompted messages with high word counts (17/155); the student, who inconsistently engaged (35/155); and the minimalist, who engaged only when prompted (103/155). Of all 6 phenotypes, we observed a statistically significant association between patients demonstrating the minimalist communication style (high adherence, few unprompted messages, limited information sharing) and achieving target BP (P<.001). Conclusions We identified unique interaction phenotypes among patients engaging with an automated text message platform for remote BP monitoring. Only the minimalist communication style was associated with achieving target BP. Identifying and understanding interaction phenotypes may be useful for tailoring future automated texting interactions and designing future interventions to achieve better BP control.
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Affiliation(s)
- Anahita Davoudi
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania, Philadelphia, PA, United States
| | - Natalie S Lee
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia, PA, United States.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States.,Corporal Michael J Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States
| | - Corey Chivers
- Penn Medicine Predictive Healthcare, University of Pennsylvania Health System, Philadelphia, PA, United States
| | - Timothy Delaney
- Center for Healthcare Innovation, University of Pennsylvania, Philadelphia, PA, United States
| | - Elizabeth L Asch
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
| | - Catherine Reitz
- Center for Healthcare Innovation, University of Pennsylvania, Philadelphia, PA, United States.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Shivan J Mehta
- Center for Healthcare Innovation, University of Pennsylvania, Philadelphia, PA, United States.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Krisda H Chaiyachati
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States.,Center for Healthcare Innovation, University of Pennsylvania, Philadelphia, PA, United States.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Danielle L Mowery
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania, Philadelphia, PA, United States.,Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, PA, United States
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12
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A pharmacist intervention for monitoring and treating hypertension using bidirectional texting: PharmText BP. Contemp Clin Trials 2020; 98:106169. [PMID: 33038500 DOI: 10.1016/j.cct.2020.106169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/30/2020] [Accepted: 10/04/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND New approaches are needed to better monitor blood pressure (BP) between physician visits, especially for patients in rural areas or for those who lack transportation. We have developed a custom-built bi-directional texting platform for home BP measurements that can then be managed by clinical pharmacists located remotely. The purpose of this study is to evaluate whether the BP texting approach combined with a pharmacist-based intervention improves BP management and to determine if the approach is cost effective. METHODS This study is a randomized, prospective trial in four primary care offices that serve patients in rural areas. Subjects will receive standardized research BP measurements at baseline, 6 and 12 months. The primary outcome will be differences between the intervention and control group in mean systolic BP at 12 months. Secondary outcomes will include systolic BP at 6 months; diastolic BP at 6 and 12 months, number of medication changes and costs. CONCLUSIONS This study plans to enroll subjects through 2022, follow-up will be completed in 2023 and results will be available in 2024. This study will provide information on whether a combined approach using texting of home BP values and a pharmacist-based telehealth services can improve BP control.
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13
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Anthony CA, Rojas EO, Keffala V, Glass NA, Shah AS, Miller BJ, Hogue M, Willey MC, Karam M, Marsh JL. Acceptance and Commitment Therapy Delivered via a Mobile Phone Messaging Robot to Decrease Postoperative Opioid Use in Patients With Orthopedic Trauma: Randomized Controlled Trial. J Med Internet Res 2020; 22:e17750. [PMID: 32723723 PMCID: PMC7458063 DOI: 10.2196/17750] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/29/2020] [Accepted: 05/20/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Acceptance and commitment therapy (ACT) is a pragmatic approach to help individuals decrease avoidable pain. OBJECTIVE This study aims to evaluate the effects of ACT delivered via an automated mobile messaging robot on postoperative opioid use and patient-reported outcomes (PROs) in patients with orthopedic trauma who underwent operative intervention for their injuries. METHODS Adult patients presenting to a level 1 trauma center who underwent operative fixation of a traumatic upper or lower extremity fracture and who used mobile phone text messaging were eligible for the study. Patients were randomized in a 1:1 ratio to either the intervention group, who received twice-daily mobile phone messages communicating an ACT-based intervention for the first 2 weeks after surgery, or the control group, who received no messages. Baseline PROs were completed. Two weeks after the operative intervention, follow-up was performed in the form of an opioid medication pill count and postoperative administration of PROs. The mean number of opioid tablets used by patients was calculated and compared between groups. The mean PRO scores were also compared between the groups. RESULTS A total of 82 subjects were enrolled in the study. Of the 82 participants, 76 (38 ACT and 38 controls) completed the study. No differences between groups in demographic factors were identified. The intervention group used an average of 26.1 (SD 21.4) opioid tablets, whereas the control group used 41.1 (SD 22.0) tablets, resulting in 36.5% ([41.1-26.1]/41.1) less tablets used by subjects receiving the mobile phone-based ACT intervention (P=.004). The intervention group subjects reported a lower postoperative Patient-Reported Outcome Measure Information System Pain Intensity score (mean 45.9, SD 7.2) than control group subjects (mean 49.7, SD 8.8; P=.04). CONCLUSIONS In this study, the delivery of an ACT-based intervention via an automated mobile messaging robot in the acute postoperative period decreased opioid use in selected patients with orthopedic trauma. Participants receiving the ACT-based intervention also reported lower pain intensity after 2 weeks, although this may not represent a clinically important difference. TRIAL REGISTRATION ClinicalTrials.gov NCT03991546; https://clinicaltrials.gov/ct2/show/NCT03991546.
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Affiliation(s)
- Chris A Anthony
- Department of Orthopaedics, University of Pennsylvania, Philadelphia, PA, United States
- Department of Orthopedic Surgery, Washington University School of Medicine, St Louis, MO, United States
| | - Edward Octavio Rojas
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Valerie Keffala
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Natalie Ann Glass
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Apurva S Shah
- Children's Hospital of Philadelphia Main Campus Division of Orthopaedics, Philadelphia, PA, United States
| | - Benjamin J Miller
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Matthew Hogue
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Michael C Willey
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Matthew Karam
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - John Lawrence Marsh
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
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14
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Collection of Common Knee Patient-reported Outcome Instruments by Automated Mobile Phone Text Messaging in Pediatric Sports Medicine. J Pediatr Orthop 2020; 40:e91-e95. [PMID: 31107346 DOI: 10.1097/bpo.0000000000001403] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patient-reported outcome (PRO) instruments measure health status in a variety of domains. With the proliferation of mobile phones, delivering PROs across patient-friendly platforms (eg, apps, text messaging) may increase completion rates, particularly among children. The purpose of this study was to validate the collection of common knee PROs in sports medicine with text messaging by correlating text-messaging responses with paper delivery in adolescents. METHODS Patients presenting to a hospital-based pediatric orthopaedic sports medicine clinic with a knee injury were enrolled prospectively. Paper versions of the Pediatric International Knee Documentation Committee (Pedi-IKDC) Subjective Knee Evaluation Form and the Pediatric Functional Activity Brief Scale (Pedi-Fab Scale) were completed during initial clinic visits. Over the next 72 hours, patients completed the text message delivery of the Pedi-IKDC and Pedi-Fab Scale. Correlations between paper and text message delivery of the 2 PROs were assessed. RESULTS Ninety-one patients (mean age: 16.0±2.0 y; 48% females) enrolled in the text-messaging study, with 55 (60.4%) completing the Pedi-Fab Scale, 48 (52.7%) completing the Pedi-IKDC, and 39 (42.9%) completing both PROs. The intraclass correlation coefficient between the paper and mobile phone delivery of the Pedi-Fab Scale was 0.95 (P<0.001; 95% confidence interval, 0.91-0.97). The intraclass correlation coefficient between the paper and mobile phone delivery of the Pedi-IKDC was 0.96 (P<0.001; 95% confidence interval, 0.93-0.98). Average Pedi-Fab scores on paper (M=12.7) and mobile phone (M=12.3) were not significantly different (P=0.52). Similarly, average Pedi-IKDC scores on paper (M=68.8) and mobile phone (M=67.7) were not significantly different (P=0.41). Average completion time for the text delivered Pedi-Fab and Pedi-IKDC were 102±224 and 159±155 minutes, respectively. High school enrollment (P=0.025), female sex (P=0.036), and race (P=0.002) were significantly associated with text completion of Pedi-IKDC. CONCLUSIONS Text message delivery using mobile phones permits valid assessment of Pedi-IKDC and Pedi-Fab scores in adolescents. Questionnaire delivery by automated text messaging allows asynchronous response and may increase compliance and reduce the labor cost of collecting PROs. LEVEL OF EVIDENCE Level III-prospective cohort study.
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15
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Hajewski C, Anthony CA, Rojas EO, Westermann R, Willey M. Detailing postoperative pain and opioid utilization after periacetabular osteotomy with automated mobile messaging. J Hip Preserv Surg 2019; 6:370-376. [PMID: 33354334 PMCID: PMC7742655 DOI: 10.1093/jhps/hnz049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/19/2019] [Accepted: 10/03/2019] [Indexed: 12/18/2022] Open
Abstract
In the setting of periacetabular osteotomy (PAO), this investigation sought to (i) describe patient-reported pain scores and opioid utilization in the first 6 weeks following surgery and (ii) evaluate the effectiveness of postoperative communication using a robotic mobile messaging platform. Subjects indicated for PAO were enrolled from a young adult hip clinic. For the first 2 weeks after surgery, subjects received daily mobile messages inquiring about pain level on a 0–10 scale and the number of opioid pain medication tablets they consumed in the previous 24 h. Messaging frequency decreased to 3 per week in Weeks 3–6. Pain scores, opioid utilization and response rates with our mobile messaging platform were quantified for the 6-week postoperative period. Twenty-nine subjects underwent PAO. Twenty-one had concurrent hip arthroscopy. Average daily pain scores decreased over the first four postoperative days. Average pain scores reported were 5.9 ± 1.9, 4.1 ± 3.3 and 3.0 ± 3.5 on Day 1, Day 14 and Week 6, respectively. Reported opioid tablet utilization was 5.0 ± 3.2, 2.2 ± 2.0 and 0.0 ± 0.0 on Days 1 and 14 and at 6 weeks. Response rate for participants completing the 6-week messaging protocol was 84.1%. Patient-reported pain scores decreased over the first two postoperative weeks following PAO before plateauing in weeks 3–6. Opioid pain medication utilization increased in the first postoperative week before gradually declining to no tabs consumed at 6 weeks after PAO. Automated mobile messaging is an effective method of perioperative communication for the collection of pain scores and opioid utilization in patients undergoing PAO.
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Affiliation(s)
- Christina Hajewski
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242, USA
| | - Chris A Anthony
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242, USA
| | - Edward O Rojas
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242, USA
| | - Robert Westermann
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242, USA
| | - Michael Willey
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242, USA
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16
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Zahr RS, Anthony CA, Polgreen PM, Simmering JE, Goerdt CJ, Hoth AB, Miller ML, Suneja M, Segre AM, Carter BL, Cavanaugh JE, Polgreen LA. A texting-based blood pressure surveillance intervention. J Clin Hypertens (Greenwich) 2019; 21:1463-1470. [PMID: 31503408 DOI: 10.1111/jch.13674] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/29/2019] [Accepted: 06/18/2019] [Indexed: 01/12/2023]
Abstract
The authors examined whether using home BP measurements collected via a custom-built bi-directional-texting platform incorporated into patients' electronic medical records would lead to treatment calibration and improved BP management. Patients were randomized to either the intervention group and collected home measurements based on reminders and reported via bi-directional texting, or to the control group, with home BP measurement reporting via standard practice (eg, phone, electronic medical record portal) and instructed to return 7 morning and 7 evening BP measurements. Outcomes included number of BP measurements submitted, the number of medication changes, reduction in BP, and BP control. 72% of the intervention group submitted at least 14 readings, compared with 45% of the control group. BP control improved in both groups. However, the authors found no statistically significant difference in BP or the number of BP-medication changes at 1, 3, or 6 months compared with the control group.
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Affiliation(s)
- Roula S Zahr
- Department of Internal Medicine, Oregon Health Sciences University, Portland, OR, USA
| | - Chris A Anthony
- Department of Orthopaedic Surgery, University of Iowa, Iowa City, IA, USA
| | - Philip M Polgreen
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA.,Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - Jacob E Simmering
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | | | - Angela B Hoth
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Michelle L Miller
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Manish Suneja
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Alberto M Segre
- Department of Computer Science, University of Iowa, Iowa City, IA, USA
| | - Barry L Carter
- Department of Pharmacy Practice and Science, University of Iowa, Iowa City, IA, USA.,Department of Family Practice, University of Iowa, Iowa City, IA, USA
| | | | - Linnea A Polgreen
- Department of Pharmacy Practice and Science, University of Iowa, Iowa City, IA, USA
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17
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Johnson HM, Sullivan-Vedder L, Kim K, McBride PE, Smith MA, LaMantia JN, Fink JT, Knutson Sinaise MR, Zeller LM, Lauver DR. Rationale and study design of the MyHEART study: A young adult hypertension self-management randomized controlled trial. Contemp Clin Trials 2019; 78:88-100. [PMID: 30677485 PMCID: PMC6387836 DOI: 10.1016/j.cct.2019.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/11/2019] [Accepted: 01/16/2019] [Indexed: 12/25/2022]
Abstract
Young adults (18-39 year-olds) with hypertension have a higher lifetime risk for cardiovascular disease. However, less than 50% of young adults achieve hypertension control in the United States. Hypertension self-management programs are recommended to improve control, but have been targeted to middle-aged and older populations. Young adults need hypertension self-management programs (i.e., home blood pressure monitoring and lifestyle modifications) tailored to their unique needs to lower blood pressure and reduce the risks and medication burden they may face over a lifetime. To address the unmet need in hypertensive care for young adults, we developed MyHEART (My Hypertension Education And Reaching Target), a multi-component, theoretically-based intervention designed to achieve self-management among young adults with uncontrolled hypertension. MyHEART is a patient-centered program, based upon the Self-Determination Theory, that uses evidence-based health behavior approaches to lower blood pressure. Therefore, the objective of this study is to evaluate MyHEART's impact on changes in systolic and diastolic blood pressure compared to usual care after 6 and 12 months in 310 geographically and racially/ethnically diverse young adults with uncontrolled hypertension. Secondary outcomes include MyHEART's impact on behavioral outcomes at 6 and 12 months, compared to usual clinical care (increased physical activity, decreased sodium intake) and to examine whether MyHEART's effects on self-management behavior are mediated through variables of perceived competence, autonomy, motivation, and activation (mediation outcomes). MyHEART is one of the first multicenter, randomized controlled hypertension trials tailored to young adults with primary care. The design and methodology will maximize the generalizability of this study. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03158051.
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Affiliation(s)
- Heather M Johnson
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705-2281, USA; Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 210, Madison, WI 53705, USA.
| | - Lisa Sullivan-Vedder
- Aurora Health Care Department of Family Medicine, Family Care Center, 1020 N 12(th) Street, Milwaukee, WI 53233, USA.
| | - KyungMann Kim
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, K6/420 Clinical Sciences Center, 600 Highland Avenue, Madison, WI 53792-4675, USA.
| | - Patrick E McBride
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705-2281, USA.
| | - Maureen A Smith
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705-2281, USA; Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 210, Madison, WI 53705, USA; Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, 610 Walnut Street, 707 WARF Building, Madison, WI 53726, USA; Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, 1100 Delaplaine Court, Madison, WI 53715-1896, USA.
| | - Jamie N LaMantia
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705-2281, USA; Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 210, Madison, WI 53705, USA.
| | - Jennifer T Fink
- Department of Health Informatics and Administration, University of Wisconsin-Milwaukee College of Health Sciences, NWQ Building B, Suite #6455, 2025 E. Newport Avenue, Milwaukee, WI 53211-2906, USA.
| | - Megan R Knutson Sinaise
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705-2281, USA; Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 210, Madison, WI 53705, USA.
| | - Laura M Zeller
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705-2281, USA; Health Innovation Program, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 210, Madison, WI 53705, USA.
| | - Diane R Lauver
- School of Nursing, University of Wisconsin, Signe Skott Cooper Hall, 701 Highland Avenue, Madison, WI 53705, USA.
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18
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Tofte JN, Anthony CA, Polgreen PM, Buckwalter JA, Caldwell LS, Fowler TP, Ebinger T, Hanley JM, Dowdle SB, Holte AJ, Arpey NC, Lawler EA. Postoperative care via smartphone following carpal tunnel release. J Telemed Telecare 2018; 26:223-231. [PMID: 30428766 DOI: 10.1177/1357633x18807606] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction This study explores a novel smartphone application for postoperative care following carpal tunnel release (CTR). We hypothesized that a software-based ‘virtual visit’ for CTR could be safe, effective and convenient for the patient. Methods Our group developed the software application utilized in this study. Interactive steps with video instructions enabled patients to complete dressing and suture removal, capture a wound photo, answer a question about median nerve symptoms and capture a video of finger range of motion. Adult patients undergoing endoscopic or open CTR were enrolled. Prior to their scheduled postoperative visit, patients received and completed the module using their smartphone. Agreement between findings of the virtual visit and the corresponding in-person clinical visit was assessed using kappa values. Results Twenty-two patients were contacted regarding study enrolment and 17 patients were enrolled (ages 23–63, mean 48.2, 6M, 11F). Of 16 patients who participated, all completed dressing removal. Ten of 16 patients removed their sutures successfully. Fourteen patients captured a clinically adequate wound photo and 15 patients answered a question about median nerve symptoms. Fourteen patients captured a range of motion video. Software assessments of surgical wounds, nerve symptoms and physical exams agreed strongly with clinical assessments. Discussion Most patients were able to respond to a question about their symptoms, provide clinical assessment of their wound via a photo and record a video of their range of motion. Suture removal was the most difficult task. More investigation is needed to determine which patients can reliably remove their sutures.
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Affiliation(s)
- Josef N Tofte
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Christopher A Anthony
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Philip M Polgreen
- Innovation Laboratory, Signal Center, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Joseph A Buckwalter
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Lindsey S Caldwell
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Timothy P Fowler
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, USA
| | | | - Jessica M Hanley
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Spencer B Dowdle
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Andrew J Holte
- Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Nicholas C Arpey
- Department of Orthopaedic Surgery, Northwestern University, Chicago, USA
| | - Ericka A Lawler
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, USA
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19
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Irizarry T, Allen M, Suffoletto BP, Einhorn J, Burke LE, Kamarck TW, Rollman BL, Muldoon MF. Development and Preliminary Feasibility of an Automated Hypertension Self-Management System. Am J Med 2018; 131:1125.e1-1125.e8. [PMID: 29806998 PMCID: PMC6586232 DOI: 10.1016/j.amjmed.2018.04.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 04/19/2018] [Accepted: 04/20/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Uncontrolled hypertension constitutes a significant challenge throughout the world. Blood pressure measurement by patients is informative for both patients and providers but is rarely performed systematically, thereby reducing its utility. Mobile phones can be used to efficiently prompt individuals to measure blood pressure and automate data management while avoiding technology barriers to widespread adoption. Presented is the design and pilot test results of MyBP, an automated texting intervention to support blood pressure self-monitoring and patient self-management. METHODS Three sequential phases are described: (1) stakeholders' needs assessment, (2) preliminary design pilot (n = 10), and (3) a 6-week pilot of the redesigned comprehensive program with hypertensive patients (n = 43) recruited from 3 clinical sites (Emergency Department, Primary Care, Hypertension Center). Outcomes of interest included participant adherence, perceived importance of blood pressure monitoring, and healthy behavior change. RESULTS Median adherence to MyBP prompts over 6 weeks was 79% (72% emergency department, 84% primary care, and 96% hypertension center, H[2] = 5.56, P = .06). Adherence did not vary by age, sex, education, or baseline use of texting but was lowest among patients recruited from the emergency department (χ[2]2 = 6.66, P = .04). In the exit survey, MyBP was associated with increased importance of blood pressure self-monitoring and particularly motivated primary care and emergency department groups to improve dietary habits, increase daily physical activity, and focus on stress reduction. The majority of participants (88%) indicated interest in using the program for 6 months. CONCLUSIONS Automated mobile-phone-based blood pressure self-monitoring using MyBP is feasible, acceptable, and scalable, and may improve self-management and support clinical care.
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Affiliation(s)
- Taya Irizarry
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pa
| | | | - Brian P Suffoletto
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pa
| | - Julian Einhorn
- Department of Psychology, University of Pittsburgh School of Arts and Sciences, Pa
| | - Lora E Burke
- Department of Health & Community Systems, University of Pittsburgh School of Nursing, Pa; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pa
| | - Thomas W Kamarck
- Department of Psychology, University of Pittsburgh School of Arts and Sciences, Pa
| | - Bruce L Rollman
- Division of General Internal Medicine; Center for Behavioral Health and Smart Technology
| | - Matthew F Muldoon
- Division of Cardiology, University of Pittsburgh School of Medicine, Pa; Heart and Vascular Institute Hypertension Center, UPMC Health System, Pittsburgh, Pa.
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20
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Thangada ND, Garg N, Pandey A, Kumar N. The Emerging Role of Mobile-Health Applications in the Management of Hypertension. Curr Cardiol Rep 2018; 20:78. [PMID: 30046971 DOI: 10.1007/s11886-018-1022-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW Mobile-health technology, frequently referred to as m-health, encompasses smartphone, tablet, or personal computer use in the management of chronic disease. There has been a rise in the number of commercially available smartphone applications and website-based platforms which claim to help patients manage hypertension. Very little research has been performed confirming whether or not use of these applications results in improved blood pressure (BP) outcomes. In this paper, we review existing literature on m-health systems and how m-health can affect hypertension management. RECENT FINDINGS M-health systems help patients manage hypertension in the following ways: (1) setting alarms and reminders for patients to take their medications, (2) linking patients' BP reports to their electronic medical record for their physicians to review, (3) providing feedback to patients about their BP trends, and (4) functioning as point-of-care BP sensors. M-health applications with alarms and reminders can increase medication compliance while applications that share ambulatory BP data with patients' physicians can foster improved patient-physician dialog. However, the most influential tool for achieving positive BP outcomes appears to be patient-directed feedback about BP trends. A large number of commercially available m-health applications may facilitate self-management of hypertension by enhancing medication adherence, maintaining a log of blood pressure measurements, and facilitating physician-patient communication. A small number of applications function as BP sensors, thereby transforming the smartphone into a medical device. Such BP sensors often generate unreliable recordings. Patients must be cautioned regarding the use of smartphones for BP measurement at least until these applications have been more extensively validated.
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Affiliation(s)
- Neela D Thangada
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Neetika Garg
- Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ambarish Pandey
- Division of Cardiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Nilay Kumar
- Division of Hospital Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53703, USA.
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21
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Schwebel FJ, Larimer ME. Using text message reminders in health care services: A narrative literature review. Internet Interv 2018; 13:82-104. [PMID: 30206523 PMCID: PMC6112101 DOI: 10.1016/j.invent.2018.06.002] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 06/19/2018] [Accepted: 06/19/2018] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Despite the extensive use of mHealth behavior change interventions, questions remain about the use of technology-based reminders in delivering health care services. Text messaging, or short message service (SMS), is one reminder method that has been extensively researched. Most SMS-reminder research is distributed across a range of health care outcomes. The aim of this article is to systematically review the aggregate impact of these reminders on overall health care outcomes. METHODS A systematic literature review was conducted and yielded 2316 articles. Studies were included if they used SMS reminders to support patient health care outcomes. Study methodology was aligned with the PRISMA guidelines for systematic reviews. RESULTS Following screening, 162 articles met inclusion criteria. Of these studies, 93 investigated medical compliance reminders and 56 investigated appointment reminders. The review found that nearly all the SMS-reminder studies helped improve patient medical compliance and appointment reminders. Additionally, researchers reported numerous benefits from using SMS reminders, including ease of use, relative inexpensiveness, and rapid and automated message delivery. Minimal risks were reported and most participants found the reminders to be acceptable. DISCUSSION Text messages appear to be an effective reminder mechanism to promote improved patient appointment and medical compliance. Reminders should continue to be evaluated and improved to determine the most effective timing and frequency of messages for improving outcomes.
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Affiliation(s)
- Frank J. Schwebel
- University of Washington, Department of Psychology, 119A Guthrie Hall Box 351525, Seattle, WA 98195-1525, United States of America,Corresponding author.
| | - Mary E. Larimer
- University of Washington, Department of Psychology, 119A Guthrie Hall Box 351525, Seattle, WA 98195-1525, United States of America,University of Washington, Department of Psychiatry and Behavioral Sciences, 1100 NE 45th, Suite 300, Office 312, Box 354944, Seattle, WA 98105, United States of America
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Polgreen LA, Anthony C, Carr L, Simmering JE, Evans NJ, Foster ED, Segre AM, Cremer JF, Polgreen PM. The effect of automated text messaging and goal setting on pedometer adherence and physical activity in patients with diabetes: A randomized controlled trial. PLoS One 2018; 13:e0195797. [PMID: 29718931 PMCID: PMC5931450 DOI: 10.1371/journal.pone.0195797] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 03/29/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Activity-monitoring devices may increase activity, but their effectiveness in sedentary, diseased, and less-motivated populations is unknown. METHODS Subjects with diabetes or pre-diabetes were given a Fitbit and randomized into three groups: Fitbit only, Fitbit with reminders, and Fitbit with both reminders and goal setting. Subjects in the reminders group were sent text-message reminders to wear their Fitbit. The goal-setting group was sent a daily text message asking for a step goal. All subjects had three in-person visits (baseline, 3 and 6 months). We modelled daily steps and goal setting using linear mixed-effects models. RESULTS 138 subjects participated with 48 in the Fitbit-only, 44 in the reminders, and 46 in the goal-setting groups. Daily steps decreased for all groups during the study. Average daily steps were 7123, 6906, and 6854 for the Fitbit-only, the goal-setting, and the reminders groups, respectively. The reminders group was 17.2 percentage points more likely to wear their Fitbit than the Fitbit-only group. Setting a goal was associated with a significant increase of 791 daily steps, but setting more goals did not lead to step increases. CONCLUSION In a population of patients with diabetes or pre-diabetes, individualized reminders to wear their Fitbit and elicit personal step goals did not lead to increases in daily steps, although daily steps were higher on days when goals were set. Our intervention improved engagement and data collection, important goals for activity surveillance. This study demonstrates that new, more-effective interventions for increasing activity in patients with pre-diabetes and diabetes are needed.
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Affiliation(s)
- Linnea A. Polgreen
- Department of Pharmacy Practice and Science, University of Iowa, Iowa City, Iowa, United States of America
- * E-mail:
| | - Christopher Anthony
- Department of Orthopedic Surgery, University of Iowa, Iowa City, Iowa, United States of America
| | - Lucas Carr
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa, United States of America
| | - Jacob E. Simmering
- Signal Center for Healthcare Innovation, University of Iowa Health Systems, Iowa City, Iowa, United States of America
| | - Nicholas J. Evans
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa, United States of America
| | - Eric D. Foster
- Department of Biostatistics, University of Iowa, Iowa City, Iowa, United States of America
| | - Alberto M. Segre
- Department of Computer Science, University of Iowa, Iowa City, Iowa, United States of America
| | - James F. Cremer
- Department of Computer Science, University of Iowa, Iowa City, Iowa, United States of America
| | - Philip M. Polgreen
- Signal Center for Healthcare Innovation, University of Iowa Health Systems, Iowa City, Iowa, United States of America
- Departments of Internal Medicine and Epidemiology, University of Iowa, Iowa City, Iowa, United States of America
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Day MA, Anthony CA, Bedard NA, Glass NA, Clark CR, Callaghan JJ, Noiseux NO. Increasing Perioperative Communication With Automated Mobile Phone Messaging in Total Joint Arthroplasty. J Arthroplasty 2018; 33:19-24. [PMID: 29017803 DOI: 10.1016/j.arth.2017.08.046] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 08/26/2017] [Accepted: 08/31/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Automated mobile phone messaging has not been reported in total joint arthroplasty (TJA). Our purpose was to compare Press Ganey (PG) and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores between TJA patients who did and did not receive perioperative automated mobile phone messages. METHODS Patients were prospectively enrolled and received messages for 1 week prior until 2 weeks after TJA. Message content included reminders, activity, and pain control. Patients answered select PG/HCAHPS and questions regarding their experience with the automated communication platform. Average PG/HCAHPS scores were compared to historical TJA patients in the 3-year window prior (control group) with significance P < .05. RESULTS Thirty-seven consecutive patients were approached and 92% (n = 34) were enrolled. The experimental group was 47% male, with 80% patients between 51 and 75 years. The experimental (n = 30) and control groups (n = 26) were similar. Patients receiving messages were more likely to have a good understanding of health responsibilities (P = .024) and feel that the care team demonstrated shared decision-making (P = .024). Of patients enrolled, 87% felt messages helped them be more prepared for surgery, 100% felt messages kept them better informed, and 97% would participate again. CONCLUSION TJA patients who received perioperative communication via automated mobile phone messaging had improved patient satisfaction scores postoperatively. Patients perceived this form of communication was useful and kept them better informed. Automated mobile phone messaging can be an easily integrated, helpful adjunct to surgeons, healthcare systems, and case managers to more effectively communicate with patients undergoing TJA in this era of value-based care.
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Affiliation(s)
- Molly A Day
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Christopher A Anthony
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Nicholas A Bedard
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Natalie A Glass
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Charles R Clark
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - John J Callaghan
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Nicolas O Noiseux
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Anthony CA, Volkmar AJ, Shah AS, Willey M, Karam M, Marsh JL. Communication with Orthopedic Trauma Patients via an Automated Mobile Phone Messaging Robot. Telemed J E Health 2017; 24:504-509. [PMID: 29261036 DOI: 10.1089/tmj.2017.0188] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Communication with orthopedic trauma patients is traditionally problematic with low response rates (RRs). The purpose of this investigation was to (1) evaluate the feasibility of communicating with orthopedic trauma patients postoperatively, utilizing an automated mobile phone messaging platform; and (2) assess the first 2 weeks of postoperative patient-reported pain and opioid use after lower extremity orthopedic trauma procedures. MATERIALS AND METHODS This was a prospective investigation at a Level 1 trauma center in the United States. Adult patients who were capable of mobile phone messaging and were undergoing common, lower extremity orthopedic trauma procedures were enrolled in the study. Patients received a daily mobile phone message protocol inquiring about their current pain level and amount of opioid medication they had taken in the past 24 h starting on postoperative day (POD) 3 and continuing through POD 17. Our analysis considered (1) Patient completion rate of mobile phone questions, (2) Patient-reported pain level (0-10 scale), and (3) Number and percentage of daily prescribed opioid medication patients reported taking. RESULTS Twenty-five patients were enrolled in this investigation. Patients responded to 87.5% of the pain and opioid medication inquiries they received over the 2-week study period. There were no differences in RRs by patient age, sex, or educational attainment. Patient-reported pain decreased over the initial 2-week study period from an average of 4.9 ± 1.7 on POD 3 to 3 ± 2.2 on POD 16-17. Patients took an average of 68% of their maximum daily narcotic prescription on POD 3 compared with 35% of their prescribed pain medication on POD 16-17. CONCLUSIONS We found that in orthopedic trauma patients, an automated mobile phone messaging platform elicited a high patient RR that improved upon prior methods in the literature. This method may be used to reliably obtain pain and medication utilization data after trauma procedures.
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Affiliation(s)
- Chris A Anthony
- 1 Department of Orthopedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics , Iowa City, Iowa
| | - Alexander J Volkmar
- 1 Department of Orthopedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics , Iowa City, Iowa
| | - Apurva S Shah
- 2 Division of Orthopedic Surgery, The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania
| | - Mike Willey
- 1 Department of Orthopedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics , Iowa City, Iowa
| | - Matt Karam
- 1 Department of Orthopedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics , Iowa City, Iowa
| | - J Lawrence Marsh
- 1 Department of Orthopedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics , Iowa City, Iowa
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Anthony CA, Lawler EA, Glass NA, McDonald K, Shah AS. Delivery of Patient-Reported Outcome Instruments by Automated Mobile Phone Text Messaging. Hand (N Y) 2017; 12:614-621. [PMID: 29091492 PMCID: PMC5669321 DOI: 10.1177/1558944716672201] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patient-reported outcome (PRO) instruments allow patients to interpret their health and are integral in evaluating orthopedic treatments and outcomes. The purpose of this study was to define: (1) correlation between PROs collected by automated delivery of text messages on mobile phones compared with paper delivery; and (2) patient use characteristics of a technology platform utilizing automated delivery of text messages on mobile phones. METHODS Paper versions of the 12-Item Short Form Health Survey (SF-12) and the short form of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) were completed by patients in orthopedic hand and upper extremity clinics. Over the next 48 hours, the same patients also completed the mobile phone portion of the study outside of the clinic which included text message delivery of the SF-12 and QuickDASH, assigned in a random order. Correlations between paper and text message delivery of the 2 PROs were assessed. RESULTS Among 72 patients, the intraclass correlation coefficient (ICC) between the written and mobile phone delivery of QuickDASH was 0.91 (95% confidence interval [CI], 0.85-0.95). The ICC between the paper and mobile phone delivery of the SF-12 physical health composite score was 0.88 (95% CI, 0.79-0.93) and 0.86 (95% CI, 0.75-0.92) for the SF-12 mental health composite score. CONCLUSIONS We find that text message delivery using mobile phones permits valid assessment of SF-12 and QuickDASH scores. The findings suggest that software-driven automated delivery of text communication to patients via mobile phones may be a valid method to obtain other PRO scores in orthopedic patients.
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Affiliation(s)
| | | | | | | | - Apurva S. Shah
- The Children’s Hospital of Philadelphia, PA, USA,Apurva S. Shah, Division of Orthopedic Surgery, The Children’s Hospital of Philadelphia, 2nd Floor Wood Center, 34th & Civic Center Boulevard, Philadelphia, PA 19104, USA.
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Niznik JD, He H, Kane-Gill SL. Impact of clinical pharmacist services delivered via telemedicine in the outpatient or ambulatory care setting: A systematic review. Res Social Adm Pharm 2017; 14:707-717. [PMID: 29100941 DOI: 10.1016/j.sapharm.2017.10.011] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 10/25/2017] [Accepted: 10/25/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Utilization of telemedicine allows pharmacists to extend the reach of clinical interventions, connecting them with patients and providers, but the overall impact of these services is under-studied. OBJECTIVE Identify the impact of clinical pharmacist telemedicine interventions on clinical outcomes, subsequently defined as clinical disease management, patient self-management, and adherence, in outpatient or ambulatory settings. METHODS A literature search was conducted from database inception through May 2016 in Medline, SCOPUS, and EMBASE. Broad terms "telemedicine", "telehealth", and "telephone" were used in combination with "pharmacist" or "pharmacy" and "telepharmacy". The search and extraction process followed PRISMA guidelines. Results were screened for pharmacist interventions and reviewed to identify studies in outpatient our ambulatory settings. Studies of non-clinical outcomes (i.e. dispensing or product preparation) and with no comparator were excluded. The final studies were categorized by types of outcomes reported: clinical disease management, patient self-management, and adherence. RESULTS Only 34 studies measured clinical outcomes against a comparator, consistent with the research question. The majority utilized scheduled models of care (n = 29). Telephone was the most common communication method (n = 25). The most utilized interventions were pharmacist-led telephonic clinics (n = 10). Most studies focused on chronic disease management in adults including hypertension, diabetes, anticoagulation, depression, hyperlipidemia, asthma, heart failure, HIV, PTSD, CKD, stroke, COPD and smoking cessation. Twenty-three studies had a positive impact with one reporting negative results. Higher positive impact rate was observed for scheduled (72.4%, 21/29) and continuous (100%, 2/2) models compared to responsive/reactive (25%, 1/4). CONCLUSIONS Clinical pharmacy telemedicine interventions in the outpatient or ambulatory setting, primarily via phone, have an overall positive impact on outcomes related to clinical disease management, patient self-management, and adherence in the management of chronic diseases. Commonalities among studies with positive impact included utilization of continuous or scheduled models via telephone, with frequent monitoring and interventions. Studies identified did not evaluate benefits of video capability over telephone or cost-effectiveness, both of which are useful directions for future study.
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Affiliation(s)
- Joshua D Niznik
- School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, United States; VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, Pittsburgh, PA, United States; Magee-Women's Hospital of UPMC, Pittsburgh, PA, United States.
| | - Harvey He
- School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, United States
| | - Sandra L Kane-Gill
- School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, United States; Critical Care Medicine, Biomedical Informatics and Clinical Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, United States; UPMC, Pittsburgh, PA, United States
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Grutzmacher SK, Munger AL, Speirs KE, Zemeir LA, Richard KC, Worthington L. Feasibility of bidirectional text messages in evaluating a text-based nutrition education program for low-income parents: Results from the Text2BHealthy program. EVALUATION AND PROGRAM PLANNING 2017; 64:90-94. [PMID: 28578291 DOI: 10.1016/j.evalprogplan.2017.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 03/14/2017] [Accepted: 04/13/2017] [Indexed: 06/07/2023]
Abstract
Text messages are increasingly used in the delivery of health education programs. One appealing aspect of this approach is the possibility of remotely collecting participant data to use in program tailoring or evaluation. The purpose of the present study is to test the feasibility of using text messages to collect participant data. Using data from 33 texted evaluation questions sent through the Text2BHealthy nutrition education program for low-income parents (n=108-1521) response rates under different incentive and prompting strategies were examined. Response rates are generally low across a pilot year and three program years, ranging from 10-55%. While incentives seemed to be ineffective at improving response rates, results indicate that prompting participants to respond may increase response rates. Individuals who respond to an initial question are highly likely to respond to a follow-up question (88-99%) and to report positive behaviors (68-100%). Responses received through text may be unrepresentative and positively biased. Text messages may be a supplemental data collection strategy in nutrition education programs, but low response rates and response bias undermine data quality.
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Affiliation(s)
| | - Ashley L Munger
- California State University, Los Angeles, Los Angeles, CA, United States.
| | | | - Lindsey A Zemeir
- University of Maryland, College Park, Columbia, MD, United States.
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Anthony CA, Lawler EA, Ward CM, Lin IC, Shah AS. Use of an Automated Mobile Phone Messaging Robot in Postoperative Patient Monitoring. Telemed J E Health 2017. [PMID: 28622079 DOI: 10.1089/tmj.2017.0055] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Mobile phone messaging software robots allow clinicians and healthcare systems to communicate with patients without the need for human intervention. The purpose of this study was to (1) describe a method for communicating with patients postoperatively outside of the traditional healthcare setting by utilizing an automated software and mobile phone messaging platform and to (2) evaluate the first week of postoperative pain and opioid use after common ambulatory hand surgery procedures. MATERIALS AND METHODS The investigation was a prospective, multicenter investigation of patient-reported pain and opioid usage after ambulatory hand surgery. Inclusion criteria included any adult with a mobile phone capable of text messaging, who was undergoing a common ambulatory hand surgical procedure at one of three tertiary care institutions. Participants received daily, automated text messages inquiring about their pain level and how many tablets of prescription pain medication they had taken in the past 24 h. Initial 1-week response rate was assessed and compared between different patient demographics. Patient-reported pain and opioid use were also quantified for the first postoperative week. Statistical significance was set as p < 0.05. RESULTS Forty-seven (n = 47) patients were enrolled in this investigation. Total response rate of both pain and opioid medication questions through 7 days was 88.3%. Pain trended down on a daily basis for the first postoperative week, with the highest levels of pain being reported in the first 48 h after surgery. Patients reported an average use of 15.9 ± 14.8 tablets of prescription opioid pain medication. CONCLUSIONS We find that a mobile phone messaging software robot allows for effective data collection of postoperative pain and pain medication use. Patients undergoing common ambulatory hand procedures utilized an average of 16 tablets of opioid medication in the first postoperative week.
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Affiliation(s)
- Chris A Anthony
- 1 Department of Orthopedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics , Iowa City, Iowa
| | - Ericka A Lawler
- 1 Department of Orthopedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics , Iowa City, Iowa
| | - Christina M Ward
- 2 Department of Orthopedic Surgery, Health Partners/Regions Hospital , St. Paul, Minnesota
| | - Ines C Lin
- 3 Department of Plastic Surgery, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Apurva S Shah
- 4 Department of Orthopedic Surgery, Children's Hospital of Philadelphia , Philadelphia, Pennsylvania
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Menéndez Villalva C, Luis Muiño López-Alvarez X, Menéndez Rodríguez M, José Modroño Freire M, Quintairos Veloso O, Conde Guede L, Vilchez Dosantos S, Blanco Ramos M. Blood Pressure Monitoring in Cardiovascular Disease. AIMS MEDICAL SCIENCE 2017. [DOI: 10.3934/medsci.2017.2.164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Mendu ML, Waikar SS. Electronic Health Record Patient Portals in CKD and Hypertension Management: Meaningfully Used? Clin J Am Soc Nephrol 2015; 10:1897-9. [PMID: 26493243 DOI: 10.2215/cjn.10070915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Mallika L Mendu
- Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sushrut S Waikar
- Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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