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Xie H, Cong S, Wang R, Sun X, Han J, Ni S, Zhang A. Effect of eHealth interventions on perinatal depression: A meta-analysis. J Affect Disord 2024; 354:160-172. [PMID: 38490593 DOI: 10.1016/j.jad.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 02/29/2024] [Accepted: 03/09/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Perinatal depression (PND) is a common mental health problem, and eHealth interventions may provide a strategy for alleviating PND. AIM This meta-analysis aimed to determine the effect of eHealth interventions on PND. METHODS Six databases were searched to retrieve published randomized controlled trials (RCTs) on the effect of eHealth interventions on PND. A meta-analysis was performed on the data of these studies using a random effects model. RESULTS A total of 21 RCTs were included in the meta-analysis, which revealed that eHealth interventions significantly reduced antenatal depression (WMD = -1.64, 95 % CI [-2.92, -0.35], P = .013), postpartum depression (SMD = -0.41, 95 % CI [-0.52, -0.29], P < .001), anxiety (SMD = -0.39, 95 % CI [-0.51, -0.28], P < .001), stress (WMD = -2.93, 95 % CI [-4.58, -1.27], P = .001), and improved self-efficacy (SMD = 0.42, 95 % CI [0.21, 0.63], P < .001) compared with the control group. However, eHealth interventions did not significantly improve social support (SMD = 0.27, 95 % CI [-0.01, 0.56], P = .058). For antenatal depression, significant subgroup differences were observed in the digital platform and material presentation format. In addition, for postpartum depression, significant subgroup differences were found in the type of therapy. CONCLUSIONS The meta-analysis results suggest that eHealth interventions can relieve depression, anxiety, and stress symptoms and improve self-efficacy in perinatal women. However, these interventions did not improve social support. Additional high-quality studies on eHealth interventions in PND are needed to validate these results.
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Affiliation(s)
- Hongyan Xie
- School of Nursing, Nanjing Medical University, Jiangsu, China
| | - Shengnan Cong
- Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Jiangsu, China
| | - Rui Wang
- Central South University Xiangya School of Nursing, Hunan, China
| | - Xiaoqing Sun
- Affiliated Hospital of Xuzhou Medical University, Jiangsu, China
| | - Jingjing Han
- School of Nursing, Suzhou University, Jiangsu, China
| | - Shiqian Ni
- School of Nursing, Nanjing Medical University, Jiangsu, China
| | - Aixia Zhang
- Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Jiangsu, China.
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FarzanehRad A, Allahbakhshian A, Gholizadeh L, Khalili AF, Hasankhani H. Randomized comparison of the effects of tailored text messaging versus pillbox organizers on medication adherence of heart failure patients. BMC Cardiovasc Disord 2024; 24:244. [PMID: 38724943 PMCID: PMC11080170 DOI: 10.1186/s12872-024-03884-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/09/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Heart failure (HF) is a major public health issue worldwide, affecting approximately 64.3 million people in 2017. Non-adherence to medication is a common and serious issue in the management of HF. However, new reminder systems utilizing mobile technology, such as text messaging, have shown promise in improving medication adherence. The purpose of this study was to compare the impact of tailored text messaging (TTM) and pillbox organizers on medication adherence in individuals with HF. METHODS A randomized controlled trial was conducted, involving 189 eligible patients with HF who were randomly assigned to either the TTM, pillbox organizer, or control group. Medication adherence was evaluated using pill counting and the Medication Adherence Rating Scale (MARS) over a period of three months and compared across the groups. The data were analyzed using Kruskal-Wallis, Analysis of Variance (ANOVA), and Repeated Measures ANOVA tests. RESULTS The results indicate that both the TTM and pillbox organizers groups had significantly higher medication adherence compared to the control group, as measured by pill counting (MD = 0.05, 95%CI = 0.03-0.06; p < 0.001 for TTM group, MD = 0.04, 95%CI = 0.03-0.06; p < 0.001 for pillbox organizers group) and the MARS (MD = 1.32, 95%CI = 0.93 to 1.72; p < 0.001 for TTM group, MD = 1.33, 95%CI = 0.95 to 1.72; p < 0.001 for pillbox organizers group). However, there was no statistically significant difference in medication adherence between the two intervention groups using either measurement method. The TTM group exhibited a lower hospitalization rate than the other groups in the first follow up (p = 0.016). CONCLUSIONS Both the TTM and pillbox organizers were shown to be effective in enhancing medication adherence among patients with HF. Therefore, healthcare providers should take into account the patient's condition and preferences when selecting one of these methods to promote medication adherence. Future research should aim to address the limitations of this study, such as controlling for confounding variables, considering long-term effects, and comparing the effectiveness of different interventions.
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Affiliation(s)
- Ameneh FarzanehRad
- Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences Tabriz, Tabriz, East Azerbaijan, Iran
| | - Atefeh Allahbakhshian
- Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences Tabriz, Tabriz, East Azerbaijan, Iran.
- School of Nursing & Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Leila Gholizadeh
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia
| | - Azizeh Farshbaf Khalili
- Physical Medicine and Rehabilitation Research Centre, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran
| | - Hadi Hasankhani
- Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences Tabriz, Tabriz, East Azerbaijan, Iran
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3
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Zhu J, Chen W. Use of aspirin in cardiovascular disease prevention-the role of online information search. Chronic Illn 2024:17423953241241761. [PMID: 38584373 DOI: 10.1177/17423953241241761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
OBJECTIVES This study intends to examine influences of online information search on the use of aspirin in cardiovascular diseases (CVDs) prevention among the applicable adult population in the United States. METHODS We used data of 2018 National Health Interview Survey (NHIS). Our study sample is limited to adults age 40 or older to be consistent with the American Heart Association/American College of Cardiology Foundation (AHA/ACCF) guidelines for aspirin use. Linear probability models were used to test the association between patient's aspirin use behaviors and the variables of interest in four separate models. RESULTS Our results show that the use of aspirin for CVD prevention was associated with online health information seeking in different ways. When patients received doctors' advice to use aspirin, online information seeking has a negative influence, depending on whether the individual has CVD risk factors. However, for patients without recommendations from providers, the effects of online information seeking on self-initiated aspirin use depend on the different types of preventions (primary vs. secondary) and CVD risk factors. CONCLUSION Overall, online health information might lead to both overuse and underuse of aspirin in CVD preventions. Findings in this study may lead to decision-making that is not consistent with advice from healthcare professionals and/or established clinical guidelines.
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Affiliation(s)
- Jingrong Zhu
- School of Economics and Management, Communication University of China, Beijing, China
| | - Wenjia Chen
- School of Economics and Management, Beijing Information Science and Technology University, Beijing, China
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Jeminiwa R, Garza KB, Chou C, Franco-Watkins A, Fox BI. Effects of Framed Mobile Messages on Beliefs, Intentions, Adherence, and Asthma Control: A Randomized Trial. PHARMACY 2024; 12:10. [PMID: 38251404 PMCID: PMC10801554 DOI: 10.3390/pharmacy12010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/19/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
We aimed to examine the effects of framed mobile messages (messages emphasizing losses or gains because of a behavior) on young adults' beliefs about their daily Inhaled Corticosteroids (ICS), intentions to take their ICS, adherence, and asthma control. College students (18-29 years) who owned a mobile phone and had a diagnosis of asthma with a prescription for an ICS were recruited. Participants (n = 43) were randomized to receive either gain- or loss-framed mobile messages three times per week for eight weeks. Engagement rates with messages were calculated. Outcomes included beliefs, intentions, adherence, and asthma control. Data collection was performed at baseline, week 4, and week 8. Mixed-design ANOVA assessed whether outcomes improved differentially from baseline to week eight between gain- and loss-framed groups. Twenty-two participants were randomly assigned to the gain-framed group and 21 to the loss-framed group. There was a 100% retention rate. The engagement rate with the text messages was 85.9%. There was a significant difference in participants' intentions to take medication and asthma control from baseline. There were no significant changes in other outcomes from baseline. There was no difference in changes in all outcomes between participants receiving gain- versus loss-framed messages. Framed mobile messages improved young adults' asthma control and intentions to take their medication as prescribed.
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Affiliation(s)
- Ruth Jeminiwa
- Department of Pharmacy Practice, Thomas Jefferson University, 901 Walnut Street, Philadelphia, PA 19107, USA;
| | - Kimberly B. Garza
- Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL 36849, USA; (K.B.G.)
| | - Chiahung Chou
- Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL 36849, USA; (K.B.G.)
| | - Ana Franco-Watkins
- College of Arts and Sciences, University of Kentucky, 202 Patterson Office Tower, Lexington, KY 40506, USA
| | - Brent I. Fox
- Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL 36849, USA; (K.B.G.)
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Hong CS, Smith TR. Aerobic exercise interventions to address impaired quality of life in patients with pituitary tumors. PLoS One 2023; 18:e0295907. [PMID: 38100429 PMCID: PMC10723697 DOI: 10.1371/journal.pone.0295907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Abstract
Patients with pituitary tumors may experience persistent fatigue and reduced physical activity, based on subjective measures after treatment. These symptoms may persist despite gross total resection of their tumors and biochemical normalization of pituitary function. While reduced quality of life has been commonly acknowledged in pituitary tumor patients, there is a lack of studies on what interventions may be best implemented to ameliorate these issues, particularly when hormonal levels have otherwise normalized. Aerobic exercise programs have been previously described to ameliorate symptoms of chronic fatigue and reduced physical capacity across a variety of pathologies in the literature. As such, a prescribed aerobic exercise program may be an underrecognized but potentially impactful intervention to address quality of life in pituitary tumor patients. This review seeks to summarize the existing literature on aerobic exercise interventions in patients with pituitary tumors. In addition, future areas of study are discussed, including tailoring exercise programs to the hormonal status of the patient and incorporating more objective measures in monitoring response to interventions.
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Affiliation(s)
- Christopher S. Hong
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Computational Neuroscience Outcomes Center (CNOC), Boston, Masachusettts, United States of America
| | - Timothy R. Smith
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Computational Neuroscience Outcomes Center (CNOC), Boston, Masachusettts, United States of America
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Hankins JS, Brambilla D, Potter MB, Kutlar A, Gibson R, King AA, Baumann AA, Melvin C, Gordeuk VR, Hsu LL, Nwosu C, Porter JS, Alberts NM, Badawy SM, Simon J, Glassberg JA, Lottenberg R, DiMartino L, Jacobs S, Fernandez ME, Bosworth HB, Klesges LM, Shah N. A multilevel mHealth intervention boosts adherence to hydroxyurea in individuals with sickle cell disease. Blood Adv 2023; 7:7190-7201. [PMID: 37738155 PMCID: PMC10698253 DOI: 10.1182/bloodadvances.2023010670] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/05/2023] [Accepted: 09/05/2023] [Indexed: 09/24/2023] Open
Abstract
Hydroxyurea reduces sickle cell disease (SCD) complications, but medication adherence is low. We tested 2 mobile health (mHealth) interventions targeting determinants of low adherence among patients (InCharge Health) and low prescribing among providers (HU Toolbox) in a multi-center, non-randomized trial of individuals with SCD ages 15-45. We compared the percentage of days covered (PDC), labs, healthcare utilization, and self-reported pain over 24 weeks of intervention and 12 weeks post-study with a 24-week preintervention interval. We enrolled 293 patients (51% male; median age 27.5 years, 86.8% HbSS/HbSβ0-thalassemia). The mean change in PDC among 235 evaluable subjects increased (39.7% to 56.0%; P < 0.001) and sustained (39.7% to 51.4%, P < 0.001). Mean HbF increased (10.95% to 12.78%; P = 0.03). Self-reported pain frequency reduced (3.54 to 3.35 events/year; P = 0.041). InCharge Health was used ≥1 day by 199 of 235 participants (84.7% implementation; median usage: 17% study days; IQR: 4.8-45.8%). For individuals with ≥1 baseline admission for pain, admissions per 24 weeks declined from baseline through 24 weeks (1.97 to 1.48 events/patient, P = 0.0045) and weeks 25-36 (1.25 events/patient, P = 0.0015). PDC increased with app use (P < 0.001), with the greatest effect in those with private insurance (P = 0.0078), older subjects (P = 0.033), and those with lower pain interference (P = 0.0012). Of the 89 providers (49 hematologists, 36 advanced care providers, 4 unreported), only 11.2% used HU Toolbox ≥1/month on average. This use did not affect change in PDC. Tailoring mHealth solutions to address barriers to hydroxyurea adherence can potentially improve adherence and provide clinical benefits. A definitive randomized study is warranted. This trial was registered at www.clinicaltrials.gov as #NCT04080167.
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Affiliation(s)
- Jane S Hankins
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, TN
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN
| | | | - Michael B Potter
- Department of Family and Community Medicine, University of California San Francisco School of Medicine, San Francisco, CA
| | - Abdullah Kutlar
- Center for Blood Disorders, Medical College of Georgia, Augusta University, Augusta, GA
| | - Robert Gibson
- Center for Blood Disorders, Medical College of Georgia, Augusta University, Augusta, GA
| | - Allison A King
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
- Division of Public Health Sciences, Department of Surgery, Washington University, St. Louis, MO
| | - Ana A Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University, St. Louis, MO
| | - Cathy Melvin
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC
| | - Victor R Gordeuk
- Sickle Cell Center, University of Illinois at Chicago, Chicago, IL
| | - Lewis L Hsu
- Sickle Cell Center, University of Illinois at Chicago, Chicago, IL
| | - Chinonyelum Nwosu
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN
| | - Jerlym S Porter
- Department of Psychology and Biobehavioral Sciences, St. Jude Children's Research Hospital, Memphis, TN
| | - Nicole M Alberts
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | - Sherif M Badawy
- Division of Hematology, Oncology, and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jena Simon
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jeffrey A Glassberg
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - Sara Jacobs
- RTI International, Research Triangle Park, NC
| | - Maria E Fernandez
- Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
| | - Hayden B Bosworth
- Department of Population Health Studies, Duke University, Durham, NC
- Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Affairs Medical Center, Durham, NC
| | - Lisa M Klesges
- Division of Public Health Sciences, Department of Surgery, Washington University, St. Louis, MO
| | - Nirmish Shah
- Department of Pediatric Hematology and Oncology, Duke University, Durham, NC
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Hasan S, AlZubaidi H, Palaian S, AlOmar M, Kheir N, Al Hariri Y, Shanableh S, Gaili A, Kahaleh A. A Telehealth Module and Virtual Objective Structured Clinical Examination of Health Literacy in Pharmacy Education. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:100555. [PMID: 37399897 DOI: 10.1016/j.ajpe.2023.100555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/05/2023] [Accepted: 06/26/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE To implement an online health literacy (HL) module and evaluate its impact through virtual Objective Structured Clinical Examination (OSCE) on students' abilities to manage patients with low HL. METHODS Students virtually engaged in several learning activities related to HL, including practicing using HL assessment tools, designing an information booklet suitable for low HL patients, using readability formulas to lower text readability level to ≤ sixth grade, role-playing scenarios related to HL, and undergoing a virtual OSCE. Student performance on course assessments was tested using Spearman's rank-order. Students evaluated their OSCE experience in terms of case content, virtual assessment, and logistics; and effectiveness of the HL module and confidence related to HL. RESULTS A total of 90 students completed the virtual OSCE; the mean score was 8.8 out of 10 (88%), which correlated with similar course assessments. The average score was 3.46 out of 3.7 for the "gathering information" domain (recognizing risk factors and behaviors, assessing HL and adherence, etc.), and 4.06 out of 4.9 for the "patient management" domain (counseling patients on taking medications, focusing on repeating key messages, offering adherence interventions, etc.). Students responded positively regarding case content and virtual assessment, but less favorably regarding logistics. Feedback on effectiveness of the HL module and confidence in managing patients with low HL was positive. CONCLUSION An HL module delivered online was effective in improving student knowledge, abilities, and confidence related to HL. Students achieved high scores in all items in the virtual OSCE, and considered it a measure of communication and clinical skills that is comparable to traditional in-room assessments.
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Affiliation(s)
- Sanah Hasan
- Ajman University, Department of Clinical Sciences, College of Pharmacy and Health Sciences, Center of Medical and Bio-allied Health Sciences, Ajman, United Arab Emirates.
| | - Hamzah AlZubaidi
- University of Sharjah, Department of Pharmacy practice and Pharmacotherapeutics, Sharjah, United Arab Emirates
| | - Subish Palaian
- Ajman University, Department of Clinical Sciences, College of Pharmacy and Health Sciences, Center of Medical and Bio-allied Health Sciences, Ajman, United Arab Emirates
| | - Muaed AlOmar
- Ajman University, Department of Clinical Sciences, College of Pharmacy and Health Sciences, Center of Medical and Bio-allied Health Sciences, Ajman, United Arab Emirates
| | - Nadir Kheir
- Ajman University, Department of Clinical Sciences, College of Pharmacy and Health Sciences, Center of Medical and Bio-allied Health Sciences, Ajman, United Arab Emirates
| | - Yassin Al Hariri
- Department of Pharmacy, Fatima College of Health Sciences, P.O. Box 42162, Al Maqam, Al Ain, United Arab Emirates
| | - Sawsan Shanableh
- Ajman University, Department of Clinical Sciences, College of Pharmacy and Health Sciences, Center of Medical and Bio-allied Health Sciences, Ajman, United Arab Emirates
| | - Ahmed Gaili
- Ajman University, Department of Clinical Sciences, College of Pharmacy and Health Sciences, Center of Medical and Bio-allied Health Sciences, Ajman, United Arab Emirates
| | - Abby Kahaleh
- Roosevelt University, College of Pharmacy, Schaumburg, IL, USA; American Journal of Pharmaceutical Education, USA
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Wu T, Xiao X, Yan S, Fang Y, Wang M, Zu F, Zhang Y, Qian R. Digital health interventions to improve adherence to oral antipsychotics among patients with schizophrenia: a scoping review. BMJ Open 2023; 13:e071984. [PMID: 37977861 PMCID: PMC10660841 DOI: 10.1136/bmjopen-2023-071984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES To assess the current evidence on the potential of digital health interventions (DHIs) to improve adherence to oral antipsychotics among patients with schizophrenia by assessing the methodologies, feasibility and effectiveness of DHIs as well as the perceptions of relevant stakeholders. DESIGN The scoping review was conducted based on the methodologies outlined by Levac et al and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. DATA SOURCES PubMed, Embase, Web of Science, Scopus, CINAHL, PsycINFO and the Cochrane Library were searched in August 2023 to identify relevant publications from the previous decade. ELIGIBILITY CRITERIA Studies published in English focused on improving medication adherence among adult patients with schizophrenia or schizoaffective disorder via DHIs were selected. Protocols, editorials, comments, perspectives, reviews, correspondence and conference abstracts were excluded. DATA EXTRACTION AND SYNTHESIS The extracted data included general information about the study, framework, participants, features and strategies of DHIs, measurement tools for adherence used, and main findings. RESULTS In total, 64 studies were included in the qualitative synthesis. Features used in DHIs to improve medication adherence included phone calls, text messages, mobile apps, sensors, web-based platforms and electronic devices. Strategies included medication reminders and monitoring, providing medication-related information and suggestions, other illness management suggestions and individual support. Texting and mobile apps were commonly used as medication reminders and monitoring methods. Additionally, the use of sensors combined with other digital technologies has garnered significant attention. All the interventions were considered acceptable and feasible, and several were assessed in pilot trials. Preliminary findings suggest that DHIs could enhance medication adherence in patients with schizophrenia. However, further validation of their effectiveness is required. CONCLUSION DHIs are a promising approach to enhancing medication adherence among patients with schizophrenia. Future interventions should be interactive, focusing on user preference, experience and privacy.
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Affiliation(s)
- Tao Wu
- Department of Nursing, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Xu Xiao
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Shirui Yan
- Department of Nursing, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yuanyuan Fang
- Department of Nursing, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Min Wang
- Department of Adult Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Fengying Zu
- Department of Adult Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yanhong Zhang
- Department of Nursing, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Ruilian Qian
- Department of Nursing, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
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Almutairi M, Marriott JF, Mansur A. Effect of monitoring adherence to regular inhaled corticosteroid (ICS) alone or in combination with a long-acting β2-agonist (LABA) using electronic methods on asthma outcomes: a narrative systematic review. BMJ Open 2023; 13:e074127. [PMID: 37586865 PMCID: PMC10432637 DOI: 10.1136/bmjopen-2023-074127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/28/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVES To evaluate through a systematic review the effectiveness of electronic methods in monitoring adherence to regular inhaled corticosteroids (ICS) alone or in combination with long-acting β2-agonists (LABAs) and their effect on clinical outcomes. DESIGN A narrative systematic review. DATA SOURCES MEDLINE, EMBASE, Cochrane Database of Systematic Reviews and Web of Science were searched through up to 10 July 2022. ELIGIBILITY CRITERIA We included peer-reviewed studies of qualitative and quantitative outcomes that compared the effect of electronic methods to routine non-electronic monitoring intervention or placebo among children and adults with asthma on medication adherence rates to regular ICS alone or in combination with LABA, asthma control and asthma exacerbations. DATA EXTRACTION AND SYNTHESIS Data extraction was performed according to a predetermined sheet specific to the review objectives. The risk of bias was assessed using the Cochrane Risk of Bias Tool for randomised controlled trials and the Risk of Bias in Systematic Reviews tool for systematic reviews. Meta-analysis was not possible based on the findings of the scoping search; however, a narrative review was performed to allow for the grouping of results based on asthma inhaler adherence rates, asthma control and exacerbations. RESULTS Six articles comprising 98 studies published from 1998 to 2022 in the USA, Canada and the UK were included. Compared with the control, electronic monitoring devices (EMDs) showed a 23% adherence improvement, mean difference (MD) of 23%, 95% CI 10.84 to 34.16, p=0.0002. Asthmatic children were 1.5 times more likely to be adherent using EMDs compared with non-EMD users (RR=1.5, 95% CI 1.19 to 1.9) (p<0.001). Mobile devices and text message reminders (MHealth) showed a 12% adherence improvement (MD 12%, 95% CI 6.22 to 18.03) (p<0.0001), alongside a small to medium improvement in asthma control (standardised mean difference (SMD) 0.31, 95% CI 0.17 to 0.44), small improvement in asthma-related quality of life (SMD 0.26) (p=0.007) and variable risk reduction in asthma exacerbations for digital health (risk ratio 0.53, 95% CI 0.32 to 0.91) (p=0.02) compared with EMDs, which showed insignificant differences (risk ratio 0.89, 95% CI 0.45 to 1.75) (p=0.72). Technologies combined yielded variable adherence effects, with an SMD for eHealth of 0.41, 95% CI 0.02 to 0.79, and MD for digital health was 14.66% higher than the control, 95% CI 7.74 to 21.57. Heterogeneity between studies was significant (eHealth I2=98%, digital I2=94%). CONCLUSION Electronic methods improved adherence to inhaled medications in asthma. EMDs appear to be the most effective technology, followed by mHealth. The adherence improvement was associated with a small clinical improvement. There was inconsistent overlapping of terminology describing electronic methods that require standardisation. Data on the cost-effectiveness of electronic devices and their utilisation in severe asthma are lacking and require further research. PROSPERO REGISTRATION NUMBER CRD42022303069.
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Affiliation(s)
- Mohammed Almutairi
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraidah, Saudi Arabia
| | - John F Marriott
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Adel Mansur
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Respiratory Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Lommatzsch M, Criée CP, de Jong CCM, Gappa M, Geßner C, Gerstlauer M, Hämäläinen N, Haidl P, Hamelmann E, Horak F, Idzko M, Ignatov A, Koczulla AR, Korn S, Köhler M, Lex C, Meister J, Milger-Kneidinger K, Nowak D, Pfaar O, Pohl W, Preisser AM, Rabe KF, Riedler J, Schmidt O, Schreiber J, Schuster A, Schuhmann M, Spindler T, Taube C, Christian Virchow J, Vogelberg C, Vogelmeier CF, Wantke F, Windisch W, Worth H, Zacharasiewicz A, Buhl R. [Diagnosis and treatment of asthma: a guideline for respiratory specialists 2023 - published by the German Respiratory Society (DGP) e. V.]. Pneumologie 2023; 77:461-543. [PMID: 37406667 DOI: 10.1055/a-2070-2135] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
The management of asthma has fundamentally changed during the past decades. The present guideline for the diagnosis and treatment of asthma was developed for respiratory specialists who need detailed and evidence-based information on the new diagnostic and therapeutic options in asthma. The guideline shows the new role of biomarkers, especially blood eosinophils and fractional exhaled NO (FeNO), in diagnostic algorithms of asthma. Of note, this guideline is the first worldwide to announce symptom prevention and asthma remission as the ultimate goals of asthma treatment, which can be achieved by using individually tailored, disease-modifying anti-asthmatic drugs such as inhaled steroids, allergen immunotherapy or biologics. In addition, the central role of the treatment of comorbidities is emphasized. Finally, the document addresses several challenges in asthma management, including asthma treatment during pregnancy, treatment of severe asthma or the diagnosis and treatment of work-related asthma.
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Affiliation(s)
- Marek Lommatzsch
- Zentrum für Innere Medizin, Abt. für Pneumologie, Universitätsmedizin Rostock
| | | | - Carmen C M de Jong
- Abteilung für pädiatrische Pneumologie, Abteilung für Pädiatrie, Inselspital, Universitätsspital Bern
| | - Monika Gappa
- Klinik für Kinder und Jugendliche, Evangelisches Krankenhaus Düsseldorf
| | | | | | | | - Peter Haidl
- Abteilung für Pneumologie II, Fachkrankenhaus Kloster Grafschaft GmbH, Schmallenberg
| | - Eckard Hamelmann
- Kinder- und Jugendmedizin, Evangelisches Klinikum Bethel, Bielefeld
| | | | - Marco Idzko
- Abteilung für Pulmologie, Universitätsklinik für Innere Medizin II, Medizinische Universität Wien
| | - Atanas Ignatov
- Universitätsklinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum Magdeburg
| | - Andreas Rembert Koczulla
- Schön-Klinik Berchtesgadener Land, Berchtesgaden
- Klinik für Innere Medizin Schwerpunkt Pneumologie, Universitätsklinikum Marburg
| | - Stephanie Korn
- Pneumologie und Beatmungsmedizin, Thoraxklinik, Universitätsklinikum Heidelberg
| | - Michael Köhler
- Deutsche Patientenliga Atemwegserkrankungen, Gau-Bickelheim
| | - Christiane Lex
- Klinik für Kinder- und Jugendmedizin, Universitätsmedizin Göttingen
| | - Jochen Meister
- Klinik für Kinder- und Jugendmedizin, Helios Klinikum Aue
| | | | - Dennis Nowak
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU München
| | - Oliver Pfaar
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Hals-Chirurgie, Sektion für Rhinologie und Allergie, Universitätsklinikum Marburg, Philipps-Universität Marburg, Marburg
| | - Wolfgang Pohl
- Gesundheitszentrum Althietzing, Karl Landsteiner Institut für klinische und experimentelle Pneumologie, Wien
| | - Alexandra M Preisser
- Zentralinstitut für Arbeitsmedizin und Maritime Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Klaus F Rabe
- Pneumologie, LungenClinic Großhansdorf, UKSH Kiel
| | - Josef Riedler
- Abteilung für Kinder- und Jugendmedizin, Kardinal Schwarzenberg Klinikum Schwarzach
| | | | - Jens Schreiber
- Universitätsklinik für Pneumologie, Universitätsklinikum Magdeburg
| | - Antje Schuster
- Klinik für Allgemeine Pädiatrie, Neonatologie und Kinderkardiologie, Universitätsklinikum Düsseldorf
| | | | | | - Christian Taube
- Klinik für Pneumologie, Universitätsmedizin Essen-Ruhrlandklinik
| | | | - Christian Vogelberg
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, Dresden
| | | | | | - Wolfram Windisch
- Lungenklinik Köln-Merheim, Lehrstuhl für Pneumologie, Universität Witten/Herdecke
| | - Heinrich Worth
- Pneumologische & Kardiologische Gemeinschaftspraxis, Fürth
| | | | - Roland Buhl
- Klinik für Pneumologie, Zentrum für Thoraxerkrankungen, Universitätsmedizin Mainz
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van der Kamp M, Hengeveld V, Willard N, Thio B, de Graaf P, Geven I, Tabak M. Remote Patient Monitoring and Teleconsultation to Improve Health Outcomes and Reduce Health Care Utilization of Pediatric Asthma (ALPACA Study): Protocol for a Randomized Controlled Effectiveness Trial. JMIR Res Protoc 2023; 12:e45585. [PMID: 37399066 PMCID: PMC10365621 DOI: 10.2196/45585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/31/2023] [Accepted: 04/30/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Childhood asthma is imposing a great financial burden on the pediatric health care system. Asthma costs are directly related to the level of asthma control. A substantial part of these costs may be preventable by the timely and adequate assessment of asthma deterioration in daily life and proper asthma management. The use of eHealth technology may assist such timely and targeted medical anticipation. OBJECTIVE This paper describes the Ambulatory Pediatric Asthma Care (ALPACA) study protocol to investigate the effectiveness of an eHealth intervention consisting of remote patient monitoring and teleconsultation integrated into the daily clinical care of pediatric patients with asthma. This intervention aims to reduce health care utilization and costs and improve health outcomes compared to a control group that receives standard care. In addition, this study aims to improve future eHealth pediatric asthma care by gaining insights from home-monitoring data. METHODS This study is a prospective randomized controlled effectiveness trial. A total of 40 participants will be randomized to either 3 months of eHealth care (intervention group) or standard care (control group). The eHealth intervention consists of remote patient monitoring (spirometry, pulse oximetry, electronic medication adherence tracking, and asthma control questionnaire) and web-based teleconsultation (video sharing, messages). All participants will have a 3-month follow-up with standard care to evaluate whether the possible effects of eHealth care are longer lasting. During the entire study and follow-up period, all participants will use blinded observational home monitoring (sleep, cough/wheeze sounds, air quality in bedroom) as well. RESULTS This study was approved by the Medical Research Ethics Committees United. Enrollment began in February 2023, and the results of this study are expected to be submitted for publication in July 2024. CONCLUSIONS This study will contribute to the existing knowledge on the effectiveness of eHealth interventions that combine remote patient monitoring and teleconsultation for health care utilization, costs, and health outcomes. Furthermore, the observational home-monitoring data can contribute to improved identification of early signs of asthma deterioration in pediatric patients. Researchers and technology developers could use this study to guide and improve eHealth development, while health care professionals, health care institutions, and policy makers may employ our results to make informed decisions to steer toward high-quality, efficient pediatric asthma care. TRIAL REGISTRATION ClinicalTrials.gov NCT05517096; https://clinicaltrials.gov/ct2/show/NCT05517096. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/45585.
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Affiliation(s)
- Mattienne van der Kamp
- Pediatric Department, Medisch Spectrum Twente, Enschede, Netherlands
- Biomedical Signals and Systems Department, University of Twente, Enschede, Netherlands
| | - Vera Hengeveld
- Pediatric Department, Medisch Spectrum Twente, Enschede, Netherlands
| | - Nico Willard
- Remote Patient Management and Chronic Care Department, Philips Research, Eindhoven, Netherlands
| | - Boony Thio
- Pediatric Department, Medisch Spectrum Twente, Enschede, Netherlands
| | - Pascal de Graaf
- Remote Patient Management and Chronic Care Department, Philips Research, Eindhoven, Netherlands
| | - Inge Geven
- Remote Patient Management and Chronic Care Department, Philips Research, Eindhoven, Netherlands
| | - Monique Tabak
- Biomedical Signals and Systems Department, University of Twente, Enschede, Netherlands
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Faiçal AVB, Mota LR, Correia DDA, Monteiro LP, de Souza EL, Terse-Ramos R. Telehealth for children and adolescents with chronic pulmonary disease: systematic review. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2023; 42:e2024111. [PMID: 37194911 PMCID: PMC10185001 DOI: 10.1590/1984-0462/2024/42/2022111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 12/07/2022] [Indexed: 05/18/2023]
Abstract
OBJECTIVE To revise the impact of telehealth on the quality of life, reduction in pulmonary exacerbations, number of days using antibiotics, adherence to treatment, pulmonary function, emergency visits, hospitalizations, and the nutritional status of individuals with asthma and cystic fibrosis. DATA SOURCE Four databases were used, MEDLINE, LILACS, Web of Science and Cochrane, as well as manual searches in English, Portuguese and Spanish. Randomized clinical trials, published between January 2010 and December 2020, with participants aged 0 to 20 years, were included. DATA SYNTHESIS Seventy-one records were identified after the removal of duplicates; however, twelve trials were eligible for synthesis. Included trials utilized: mobile phone applications (n=5), web platforms (n= 4), mobile telemedicine unit (n=1), software with an electronic record (n=1), remote spirometer (n=1), and active video games platform (n=1). Three trials used two tools, including telephone calls. Among the different types of interventions, improvement in adherence, quality of life, and physiologic variables were observed for mobile application interventions and game platforms compared to usual care. Visits to the emergency department, unscheduled medical appointments, and hospitalizations were not reduced. There was considerable heterogeneity among studies. CONCLUSIONS The findings suggest that better control of symptoms, quality of life, and adherence to treatment can be attributed to the technological interventions used. Nevertheless, further research is needed to compare telehealth with face-to-face care and to indicate the most effective tools in the routine care of children with chronic lung diseases.
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13
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Genberg EM, Viitanen HT, Mäkelä MJ, Kautiainen HJ, Kauppi PM. Impact of a digital web-based asthma platform, a real-life study. BMC Pulm Med 2023; 23:165. [PMID: 37173716 PMCID: PMC10177708 DOI: 10.1186/s12890-023-02467-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Digital health technology (DHT) is a growing area in the treatment of chronic diseases. Study results on DHT's effect on asthma control have been mixed, but benefits have been seen for adherence, self-management, symptoms, and quality of life. The aim was to evaluate the impact of an interactive web-based asthma treatment platform on asthma exacerbations and health care visits. METHODS In this real-life study, we retrospectively collected data on adult patients registered on a web-based interactive asthma treatment platform between December 2018 and May 2021. Patients who activated their accounts were active users, and patients who did not were inactive users and considered as controls. We compared the number of exacerbations, total number of exacerbation events defined as the sum of oral corticosteroid (OCS) and antimicrobial courses, emergency room visits, hospitalizations, and asthma-related health care visits before and one year after the registration on the platform. Statistical tests used included the t-test, Pearson's chi-square test and Poisson regression models. RESULTS Of 147 patients registered on the platform, 106 activated their accounts and 41 did not. The active users had significantly fewer total number of exacerbation events (2.56 per person years, relative decline 0.78, 95% CI 0.6 to 1.0) and asthma-related health care visits (2.38 per person years, relative decline 0.84, 95% CI 0.74 to 0.96) than before registration to the platform, whereas the reductions in health care visits and the total number of exacerbation events were not significant in the inactive users. CONCLUSIONS An interactive web-based asthma platform can reduce asthma-related health care visits and exacerbations when used actively.
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Affiliation(s)
- Emma M Genberg
- Allergic Diseases, Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
- Pulmonary Department, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Hilkka T Viitanen
- Allergic Diseases, Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika J Mäkelä
- Allergic Diseases, Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hannu J Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Paula M Kauppi
- Allergic Diseases, Skin and Allergy Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Pulmonary Department, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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14
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Wittwer LH, Walters E, Jordan K. Improving Pediatric Asthma Care Through Asthma Apps: A Narrative Review. J Nurse Pract 2023. [DOI: 10.1016/j.nurpra.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
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15
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Pacheco-Quito EM, Jaramillo J, Sarmiento-Ordoñez J, Cuenca-León K. Drugs Prescribed for Asthma and Their Adverse Effects on Dental Health. Dent J (Basel) 2023; 11:dj11050113. [PMID: 37232764 DOI: 10.3390/dj11050113] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/16/2023] [Accepted: 04/19/2023] [Indexed: 05/27/2023] Open
Abstract
Asthma is a chronic, heterogeneous respiratory pathology characterized by reversible airway inflammation. Therapeutics focus on symptom reduction and control, aimed at preserving normal pulmonary function and inducing bronchodilatation. The objective of this review is to describe the adverse effects produced by anti-asthmatic drugs on dental health, according to the reported scientific evidence. A bibliographic review was carried out on databases, such as Web of science, Scopus, and ScienceDirect. Most anti-asthmatic medications are administered using inhalers or nebulizers, making it impossible to avoid contact of the drug with hard dental tissues and oral mucosa, and thus promoting a greater risk of oral alterations, mainly due to decreases in the salivary flow and pH. Such changes can cause diseases, such as dental caries, dental erosion, tooth loss, periodontal disease, bone resorption, as well as fungal infections, such as oral candidiasis.
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Affiliation(s)
- Edisson-Mauricio Pacheco-Quito
- Academic Unit of Health and Wellness, Faculty of Dentistry, Catholic University of Cuenca, Cuenca 010105, Ecuador
- Innovation and Pharmaceutical Development in Dentistry Research Group, Faculty of Dentistry, Head of Research and Innovation, Catholic University of Cuenca, Cuenca 010105, Ecuador
| | | | - Jéssica Sarmiento-Ordoñez
- Academic Unit of Health and Wellness, Faculty of Dentistry, Catholic University of Cuenca, Cuenca 010105, Ecuador
- Innovation and Pharmaceutical Development in Dentistry Research Group, Faculty of Dentistry, Head of Research and Innovation, Catholic University of Cuenca, Cuenca 010105, Ecuador
| | - Katherine Cuenca-León
- Academic Unit of Health and Wellness, Faculty of Dentistry, Catholic University of Cuenca, Cuenca 010105, Ecuador
- Innovation and Pharmaceutical Development in Dentistry Research Group, Faculty of Dentistry, Head of Research and Innovation, Catholic University of Cuenca, Cuenca 010105, Ecuador
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16
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Uzzaman MN, Hammersley V, McClatchey K, Sheringham J, Habib GMM, Pinnock H. Asynchronous digital health interventions for reviewing asthma: A mixed-methods systematic review protocol. PLoS One 2023; 18:e0281538. [PMID: 36758039 PMCID: PMC9910732 DOI: 10.1371/journal.pone.0281538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/25/2023] [Indexed: 02/10/2023] Open
Abstract
INTRODUCTION People living with asthma require regular reviews to address their concerns and questions, assess control, review medication, and support self-management. However, practical barriers to attending face-to-face consultations might limit routine reviews. Reviewing asthma using asynchronous digital health interventions could be convenient for patients and an efficient way of maintaining communication between patients and healthcare professionals and improving health outcomes. We, therefore, aim to conduct a mixed-methods systematic review to assess the effectiveness of reviewing asthma by asynchronous digital health interventions and explore the views of patients and healthcare professionals about the role of such interventions in delivering asthma care. METHODS We will search MEDLINE, Embase, Scopus, PsycInfo, CINAHL, and Cochrane Library from 2001 to present without imposing any language restrictions. We are interested in studies of asynchronous digital health interventions used either as a single intervention or contributing to mixed modes of review. Two review authors will independently screen titles and abstracts, and retrieve potentially relevant studies for full assessment against the eligibility criteria and extract data. Disagreements will be resolved by discussion with the review team. We will use 'Downs and Black' checklist, 'Critical Appraisal Skills Programme', and 'Mixed Methods Appraisal Tool' to assess methodological quality of quantitative, qualitative, and mixed-methods studies respectively. After synthesising quantitative (narrative synthesis) and qualitative (thematic synthesis) data separately, we will integrate them following methods outlined in the Cochrane Handbook for Systematic Reviews of Interventions. CONCLUSION The findings of this review will provide insights into the role of asynchronous digital health interventions in the routine care of people living with asthma. TRIAL REGISTRATION Systematic review registration: PROSPERO registration number: CRD42022344224.
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Affiliation(s)
- Md. Nazim Uzzaman
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Vicky Hammersley
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Kirstie McClatchey
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Jessica Sheringham
- Institute of Epidemiology & Health, University College London, London, England, United Kingdom
| | - G. M. Monsur Habib
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, Scotland, United Kingdom
- Community Respiratory Centre, Bangladesh Primary Care Respiratory Society, Khulna, Bangladesh
| | - Hilary Pinnock
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, Scotland, United Kingdom
- * E-mail:
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17
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Zhang X, Ding R, Zhang Z, Chen M, Yin Y, Quint JK. Medication Adherence in People with Asthma: A Qualitative Systematic Review of Patient and Health Professional Perspectives. J Asthma Allergy 2023; 16:515-527. [PMID: 37193110 PMCID: PMC10182790 DOI: 10.2147/jaa.s407552] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/03/2023] [Indexed: 05/18/2023] Open
Abstract
Background Increased medication adherence leads to better asthma control and health outcomes. However, many studies have found that patient adherence to maintenance medication is poor. Aim We undertook a meta-synthesis of qualitative studies, to investigate asthma patient and healthcare professionals' perspectives of medication adherence. Methods This systematic review was reported by following the PRISMA guidelines. The Joanna Briggs Institute (JBI) meta-aggregative approach was used for the qualitative synthesis. The protocol was registered in PROSPERO (CRD42022346831). Results In total, 12 articles were included in the review. These articles reported findings from 433 participants in total, which included 315 patients and 118 healthcare professionals. Four synthesised findings with sub-themes were identified from the reviewed studies. These synthesised findings were described as: 1) The role of relationship and communication with/between Healthcare Professionals in medication adherence; 2) Insufficient information from Healthcare Professionals acting as a barrier for adherence; 3) How patient's attitude/beliefs effect their adherence to medication; and 4) Patients' personal behaviour and other relevant barriers. Conclusion The synthesized findings provide a strong evidence-base of patient and health professionals' perspectives and behaviours toward medication adherence, which helps to identify and address non-adherence. Healthcare providers can use these findings to support patients' adherence to asthma medications. The findings suggest that empowering people to make informed decisions around medication adherence rather than "adherence controlling" by health professionals is very important. Effective dialogue and appropriate education are critical approaches to increase medication adherence.
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Affiliation(s)
- Xiubin Zhang
- National Heart and Lung Institute, Imperial College London, London, W12 0BZ, UK
| | - Rong Ding
- School of Health in Social Science, The University of Edinburgh, Edinburgh, Scotland, EH8 9AG, UK
| | - Zhaoxin Zhang
- Medical college, Xijing University, Xi’an, 710123, People’s Republic of China
| | - Mengyun Chen
- School of Nursing, Lanzhou University, Lanzhou, 730000, People’s Republic of China
| | - Yueheng Yin
- School of Nursing, Nanjing Medical University, Nanjing, 210000, People’s Republic of China
| | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, London, W12 0BZ, UK
- Correspondence: Jennifer K Quint, National Heart and Lung Institute, Imperial College London, White City Campus, London, W12 0BZ, UK, Email
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18
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Smith MJ, Gao Z, Chafe R, Alwashmi M. A mobile health intervention for improving the technique of inhaled medications among children with asthma: A pilot study. Digit Health 2023; 9:20552076231216589. [PMID: 38033513 PMCID: PMC10685774 DOI: 10.1177/20552076231216589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2023] [Indexed: 12/02/2023] Open
Abstract
Objective BreatheSuite MDI is a Bluetooth-enabled inhaler attachment and mobile application which aims to improve asthma control. The objective was to compare pressurized metered dose inhaler (pMDI) technique and asthma control test (ACT) scores pre- and post-use of the device and mobile application. Secondary objectives were to assess user satisfaction and therapy adherence. Methods Patients between the ages of 8 and 18 were recruited from several pediatric asthma clinics. Technique and ACT scores were assessed at baseline. Users were given no prompts on technique during the first month of device use. For the subsequent three months, users were given technique scores through the mobile application after each inhaler use and provided weekly performance summaries. At the end of the study, technique and ACT scores were analyzed and an exit survey was completed. Conditional logistic regression was used to examine the association between well-controlled asthma (ACT score > 19) and the intervention. Results 24 patients completed the study. Technique scores improved following the use of Breathesuite (44.19 vs. 62.54; P = 0.01). Well-controlled asthma did not significantly improve (OR = 1.20 [0.4-3.9], P = 0.76). 87% of study subjects agreed or strongly agreed that their asthma control improved while using BreatheSuite; 79% were satisfied with the device and mobile application; and 91% preferred using the device compared to a standard logbook to track inhaler usage. Conclusions In this pilot study, the use of BreatheSuite device was associated with improved technique scores. These results need to be confirmed by a randomized controlled trial. There was high user satisfaction with the BreatheSuite device.
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Affiliation(s)
- Mary Jane Smith
- Faculty of Medicine, Memorial University of Newfoundland, St John’s, Canada
- Janeway Children’s Health and Rehabilitation Centre, Eastern Health, St John’s, Canada
| | - Zhiwei Gao
- Faculty of Medicine, Memorial University of Newfoundland, St John’s, Canada
| | - Roger Chafe
- Faculty of Medicine, Memorial University of Newfoundland, St John’s, Canada
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Molina Paris J, Almonacid Sánchez C, Blanco-Aparicio M, Domínguez-Ortega J, Giner Donaire J, Sánchez Marcos N, Plaza V. Current expert opinion and attitudes to optimize telemedicine and achieve control in patients with asthma in post-pandemic era: The COMETA consensus. Aten Primaria 2022; 54:102492. [PMID: 36272223 PMCID: PMC9589141 DOI: 10.1016/j.aprim.2022.102492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/13/2022] [Accepted: 09/27/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To collect perspectives and explore consensus for expert recommendations related to asthma control and the use of telemedicine among professionals who manage patients with asthma. DESIGN A Delphi-like questionnaire was designed to analyse the level of agreement about several recommendations formulated by an expert scientific committee about asthma control and the use of telemedicine with this purpose. A dedicated scientific committee validated the questionnaire, which included questions about the participants' profile and the use of technological tools at a personal level or in clinical practice. The experts expressed their agreement with a Likert-scale of 9 values: 1-3 was considered no agreement, 4-6 neutral, and 7-9 agreement. A rate ≥70% with the same answer was considered consensus. SITE: The questionnaire was programmed and distributed as an internet-based survey. PARTICIPANTS A pre-selected sample of 75 experts with experience in telemedicine (pulmonology, allergology, family medicine, nursing and community pharmacy) responded to a Delphi-like questionnaire composed by six questions and 52 items. INTERVENTIONS Consultation was performed in two consecutive waves: the first wave was carried out from 12th of July to 8th of September of 2021; the second wave, from 25th of October to 12th of November of 2021. MAIN MEASUREMENTS Three questions about asthma control (actions for achieving or maintaining control of asthma at every visit, current problems that affect asthma control, and potential solutions to offset such problems), and three questions about the impact of telemedicine in asthma control (potential benefits of telemedicine, and potential reticence about telemedicine among both patients and healthcare professionals) were included. RESULTS From the 52 items inquired, 35 were agreed by consensus. The actions for achieving or maintaining control of asthma, the problems that affect asthma control, and their potential solutions were agreed by consensus. The potential benefits of telemedicine were validated by consensus. None of the potential reservations of patients about telemedicine were validated, while five out of 14 potential reservations of healthcare professionals were agreed by consensus. CONCLUSIONS The COMETA consensus provides a current picture of the main problems for achieving asthma control, the benefits and the reservations about the use of telemedicine in the Spanish setting, and offers solutions. A wide interest in implementing telemedicine has been observed, although current limitations need to be overcome.
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Affiliation(s)
- Jesús Molina Paris
- Healthcare Center Francia, Fuenlabrada, Madrid, Spain,Corresponding author.
| | | | | | | | - Jordi Giner Donaire
- Pulmonology and Allergy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Vicente Plaza
- Pulmonology and Allergy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Cen ZF, Tang PK, Hu H, Cavaco AC, Zeng L, Lei SL, Ung COL. Systematic literature review of adopting eHealth in pharmaceutical care during COVID-19 pandemic: recommendations for strengthening pharmacy services. BMJ Open 2022; 12:e066246. [PMID: 36418133 PMCID: PMC9684285 DOI: 10.1136/bmjopen-2022-066246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The study aimed to determine how eHealth was adopted in pharmaceutical care (PC), the outcome reported and the contextual factors. DESIGN Systematic literature review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES Literature was searched in six databases including PubMed, Scopus, Medline, Web of Science, Science Direct and China National Knowledge Infrastructure. ELIGIBILITY CRITERIA Studies which reported the usage experiences of eHealth in any aspects of PC by pharmacists during the COVID-19 pandemic, written in English or Chinese, and published in peer-reviewed journals between December 2019 and March 2022 were included. Opinion articles, conference abstracts, correspondence, letters and editorials were excluded. DATA EXTRACTION AND SYNTHESIS The literature search was completed on 15 April 2022. Two researchers independently conducted the literature search and extracted the data into an Excel table informed by the logic model with the key components of goals, input, activities, output and contextual factors. RESULTS Forty-three studies were included in this review. During the COVID-19 pandemic, hospital pharmacists, community pharmacists and specialist pharmacists in 17 countries continued to educate, consult, monitor and manage the patients and the general public via phone calls, videoconferences, mobile applications, social media, websites and/or enhanced interoperability of electronic medical records. Assuring the continuity of pharmacy care, reduced need for hospital visits, and improved work accuracy and efficiency were the benefits of eHealth mostly reported. Contextual factors affecting the adoption of eHealth were multifaceted, prompting supporting actions at the levels of government, hospital/pharmacy, pharmacists and patients. CONCLUSION This study revealed the wide adoption of eHealth in PC during the pandemic and the emerging evidence for its importance. Proper adoption of eHealth will help reshape the mode of pharmacy services to ensure continuity, quality and efficiency of care amid the challenges of the pandemic. PROSPERO REGISTRATION NUMBER CRD42022299812.
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Affiliation(s)
- Zhi Feng Cen
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao SAR China
| | - Pou Kuan Tang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao SAR China
| | - Hao Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao SAR China
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Taipa, Macao SAR China
| | | | - Luoxin Zeng
- Department of Pharmacy, Kiang Wu Hospital, Macao SAR, China
| | - Sut Leng Lei
- Department of Pharmacy, Kiang Wu Hospital, Macao SAR, China
| | - Carolina Oi Lam Ung
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao SAR China
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Taipa, Macao SAR China
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21
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Hasan S, Zubaidi HA, Saidawi W. Assessing Pharmacy Student Performance and Perceptions on Counseling Skills Through a Simulated Telehealth Encounter. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2022; 86:8619. [PMID: 34507953 PMCID: PMC10159465 DOI: 10.5688/ajpe8619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 09/03/2021] [Indexed: 05/06/2023]
Abstract
Objective. To describe the implementation of a teleconferencing-based patient counseling role play assessment in a newly developed pharmacy communications course, assess student performance on the role play and compare it with other assessments, and measure student perceptions of and satisfaction with the experience.Methods. Eighteen cases were developed, each belonging to one of three interactions in community pharmacy: filling a new prescription, completing a refill, or handling a request for a nonprescription (ie, over-the-counter [OTC]) medication. A rubric was designed to evaluate each type of interaction. Student scores in various course assessments were tested and scores on the three cases were compared. Students also evaluated their experience and satisfaction of the assessment and effectiveness of the course.Results. Seventy-nine students completed the assessment, achieving a mean score of 17.4/20 (87%). Student scores in the counseling role play were similar among case types and positively correlated with other traditional assessments in the course. Despite internet connectivity issues and heightened student anxiety, 71% of students agreed that the assessment did not affect the quality of their counseling, and 74% agreed that the experience was comparable to traditional assessments. The telehealth activity led to enhanced perceived student knowledge and confidence in interviewing and counseling patients.Conclusion. Students attained high scores that were consistent with other assessments in the course. Students reported that the assessment did not affect the quality of their counseling and felt the setting and context were still authentic. The experience required dedicated preparation and organization but was successful in demonstrating overall student satisfaction and positive perceptions.
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Affiliation(s)
- Sanah Hasan
- Ajman University, Center of Medical and Bio-allied Health Sciences, College of Pharmacy and Health Sciences, Ajman, United Arab Emirates
| | - Hamzah Al Zubaidi
- University of Sharjah, College of Pharmacy, Sharjah, United Arab Emirates
| | - Ward Saidawi
- University of Sharjah, College of Pharmacy, Sharjah, United Arab Emirates
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22
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The Future of Telehealth for Allergic Disease. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY: IN PRACTICE 2022; 10:2514-2523. [PMID: 36038132 PMCID: PMC9420069 DOI: 10.1016/j.jaip.2022.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/01/2022] [Accepted: 08/22/2022] [Indexed: 11/24/2022]
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23
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Dauletbaev N, Oftring ZS, Akik W, Michaelis-Braun L, Korel J, Lands LC, Waldmann S, Müller BS, Dreher M, Rohde G, Vogelmeier CF, Kuhn S. A scoping review of mHealth monitoring of pediatric bronchial asthma before and during COVID-19 pandemic. Paediatr Respir Rev 2022; 43:67-77. [PMID: 35131174 PMCID: PMC8761580 DOI: 10.1016/j.prrv.2022.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/10/2022] [Indexed: 12/02/2022]
Abstract
Mobile (m) Health technology is well-suited for Remote Patient Monitoring (RPM) in a patient's habitual environment. In recent years there have been fast-paced developments in mHealth-enabled pediatric RPM, especially during the COVID-19 pandemic, necessitating evidence synthesis. To this end, we conducted a scoping review of clinical trials that had utilized mHealth-enabled RPM of pediatric asthma. MEDLINE, Embase and Web of Science were searched from September 1, 2016 through August 31, 2021. Our scoping review identified 25 publications that utilized synchronous and asynchronous mHealth-enabled RPM in pediatric asthma, either involving mobile applications or via individual devices. The last three years has seen the development of evidence-based, multidisciplinary, and participatory mHealth interventions. The quality of the studies has been improving, such that 40% of included study reports were randomized controlled trials. In conclusion, there exists high-quality evidence on mHealth-enabled RPM in pediatric asthma, warranting future systematic reviews and/or meta-analyses of the benefits of such RPM.
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Affiliation(s)
- Nurlan Dauletbaev
- Department of Internal, Respiratory and Critical Care Medicine, Philipps University of Marburg, Marburg, Germany (Member of the German Center for Lung Research (DZL)), Germany; Department of Pediatrics, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada; The Research Institute of McGill University Health Centre, Montreal, QC, Canada; al-Farabi Kazakh National University, Almaty, Kazakhstan.
| | - Zoe S. Oftring
- Department of Digital Medicine, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany
| | - Wided Akik
- Division of Experimental Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Lukas Michaelis-Braun
- Department of Internal, Respiratory and Critical Care Medicine, Philipps University of Marburg, Marburg, Germany (Member of the German Center for Lung Research (DZL)), Germany
| | - Julia Korel
- Department of Internal, Respiratory and Critical Care Medicine, Philipps University of Marburg, Marburg, Germany (Member of the German Center for Lung Research (DZL)), Germany
| | - Larry C. Lands
- Department of Pediatrics, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada,The Research Institute of McGill University Health Centre, Montreal, QC, Canada
| | - Susanne Waldmann
- Central Medical Library, Philipps University of Marburg, Marburg, Germany
| | - Beate S. Müller
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, University Hospital Aachen, Aachen, Germany
| | - Gernot Rohde
- Medical Clinic 1, Department of Respiratory Medicine, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Claus F. Vogelmeier
- Department of Internal, Respiratory and Critical Care Medicine, Philipps University of Marburg, Marburg, Germany (Member of the German Center for Lung Research (DZL)), Germany
| | - Sebastian Kuhn
- Department of Digital Medicine, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany
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Saukkonen P, Elovainio M, Virtanen L, Kaihlanen AM, Nadav J, Lääveri T, Vänskä J, Viitanen J, Reponen J, Heponiemi T. The Interplay of Work, Digital Health Usage, and the Perceived Effects of Digitalization on Physicians' Work: Network Analysis Approach. J Med Internet Res 2022; 24:e38714. [PMID: 35976692 PMCID: PMC9434392 DOI: 10.2196/38714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/17/2022] [Accepted: 06/24/2022] [Indexed: 11/30/2022] Open
Abstract
Background In health care, the benefits of digitalization need to outweigh the risks, but there is limited knowledge about the factors affecting this balance in the work environment of physicians. To achieve the benefits of digitalization, a more comprehensive understanding of this complex phenomenon related to the digitalization of physicians’ work is needed. Objective The aim of this study was to examine physicians’ perceptions of the effects of health care digitalization on their work and to analyze how these perceptions are associated with multiple factors related to work and digital health usage. Methods A representative sample of 4630 (response rate 24.46%) Finnish physicians (2960/4617, 64.11% women) was used. Statements measuring the perceived effects of digitalization on work included the patients’ active role, preventive work, interprofessional cooperation, decision support, access to patient information, and faster consultations. Network analysis of the perceived effects of digitalization and factors related to work and digital health usage was conducted using mixed graphical modeling. Adjusted and standardized regression coefficients are denoted by b. Centrality statistics were examined to evaluate the relative influence of each variable in terms of node strength. Results Nearly half of physicians considered that digitalization has promoted an active role for patients in their own care (2104/4537, 46.37%) and easier access to patient information (1986/4551, 43.64%), but only 1 in 10 (445/4529, 9.82%) felt that the impact has been positive on consultation times with patients. Almost half of the respondents estimated that digitalization has neither increased nor decreased the possibilities for preventive work (2036/4506, 45.18%) and supportiveness of clinical decision support systems (1941/4458, 43.54%). When all variables were integrated into the network, the most influential variables were purpose of using health information systems, employment sector, and specialization status. However, the grade given to the electronic health record (EHR) system that was primarily used had the strongest direct links to faster consultations (b=0.32) and facilitated access to patient information (b=0.28). At least 6 months of use of the main EHR was associated with facilitated access to patient information (b=0.18). Conclusions The results highlight the complex interdependence of multiple factors associated with the perceived effects of digitalization on physicians’ work. It seems that a high-quality EHR system is critical for promoting smooth clinical practice. In addition, work-related factors may influence other factors that affect digital health success. These factors should be considered when developing and implementing new digital health technologies or services for physicians’ work. The adoption of digital health is not just a technological project but a project that changes existing work practices.
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Affiliation(s)
| | - Marko Elovainio
- Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Lotta Virtanen
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Janna Nadav
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tinja Lääveri
- Infectious Diseases and Meilahti Vaccine Research Center MeVac, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Computer Science, Aalto University, Espoo, Finland
| | | | - Johanna Viitanen
- Department of Computer Science, Aalto University, Espoo, Finland
| | - Jarmo Reponen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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25
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Ni R, Liu M, Huang S, Yang J. Effects of eHealth Interventions on Quality of Life and Psychological Outcomes in Cardiac Surgery Patients: Systematic Review and Meta-analysis. J Med Internet Res 2022; 24:e40090. [PMID: 35972792 PMCID: PMC9428777 DOI: 10.2196/40090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/12/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients undergoing heart surgery may experience a range of physiological changes, and the postoperative recovery time is long. Patients and their families often have concerns about quality of life (QoL) after discharge. eHealth interventions may improve patient participation, ensure positive and effective health management, improve the quality of at-home care and the patient's quality of life, and reduce rates of depression. OBJECTIVE The purpose of this study was to evaluate the effects of eHealth interventions on the physiology, psychology, and compliance of adult patients after cardiac surgery to provide a theoretical basis for clinical practice. METHODS We conducted systematic searches of the following 4 electronic databases: PubMed, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials. Mean (SD) values were used to calculate the pooled effect sizes for all consecutive data, including QoL, anxiety, and depression. Where the same results were obtained using different instruments, we chose the standardized mean difference with a 95% CI to represent the combined effect size; otherwise, the mean difference (MD) with a 95% CI was used. Odds ratios were used to calculate the combined effect size for all dichotomous data. The Cohen Q test for chi-square distribution and an inconsistency index (I2) were used to test for heterogeneity among the studies. We chose a fixed-effects model to estimate the effect size if there was no significant heterogeneity in the data (I2≤50%); otherwise, a random-effects model was used. The quality of the included studies was assessed using the Cochrane risk-of-bias tool for randomized trials (RoB 2). RESULTS The search identified 3632 papers, of which 19 met the inclusion criteria. In terms of physical outcomes, the score of the control group was lower than that of the intervention group (MD 0.15, 95% CI 0.03-0.27, I2=0%, P=.02). There was no significant difference in the mental outcomes between the intervention and control groups (MD 0.10, 95% CI -0.03 to 0.24, I2=46.4%, P=.14). The control group's score was lower than that of the intervention group for the depression outcomes (MD -0.53, 95% CI -0.89 to -0.17, I2=57.1%, P=.004). Compliance outcomes improved in most intervention groups. The results of the sensitivity analysis were robust. Nearly half of the included studies (9/19, 47%) had a moderate to high risk of bias. The quality of the evidence was medium to low. CONCLUSIONS eHealth improved the physical component of quality of life and depression after cardiac surgery; however, there was no statistical difference in the mental component of quality of life. The effectiveness of eHealth on patient compliance has been debated. Further high-quality studies on digital health are required. TRIAL REGISTRATION PROSPERO CRD42022327305; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=327305.
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Affiliation(s)
- Ruping Ni
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China
- College of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Maobai Liu
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China
- College of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Shunmin Huang
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China
- College of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Jing Yang
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China
- College of Pharmacy, Fujian Medical University, Fuzhou, China
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Kardas P, Bago M, Barnestein-Fonseca P, Garuolienė K, Granas AG, Gregório J, Hadžiabdić MO, Kostalova B, Leiva-Fernández F, Lewek P, Mala-Ladova K, Schneider MP, van Boven JFM, Volmer D, Ziampara I, Ágh T. Reimbursed medication adherence enhancing interventions in 12 european countries: Current state of the art and future challenges. Front Pharmacol 2022; 13:944829. [PMID: 36034792 PMCID: PMC9403510 DOI: 10.3389/fphar.2022.944829] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 07/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Medication non-adherence jeopardises the effectiveness of chronic therapies and negatively affects financial sustainability of healthcare systems. Available medication adherence-enhancing interventions (MAEIs) are utilised infrequently, and even more rarely reimbursed. The aim of this paper was to review reimbursed MAEIs across selected European countries.Methods: Data on reimbursed MAEIs were collected from European countries at the ENABLE Cost Action expert meeting in September 2021. The identified MAEIs were analysed and clustered according to their characteristics, direct vs. indirect relation to adherence, and the targeted adherence phase.Results: Out of 12 contributing countries, 10 reported reimbursed MAEIs, 28 in total, of which 20 were identified as MAEIs targeting adherence directly. Reimbursed MAEIs were most often performed by either doctors (n = 6), nurses (n = 6), or pharmacists (n = 3). The most common types of MAEIs were education (n = 6), medication regimen management (n = 5), and adherence monitoring feedback (n = 4). Only seven reimbursed MAEIs were technology-mediated, whereas 11 addressed two interlinked phases of medication adherence, i.e., implementation and persistence.Conclusion: Our review highlights the scarcity of reimbursed MAEIs across the selected European countries, and calls for their more frequent use and reimbursement.
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Affiliation(s)
- Przemysław Kardas
- Medication Adherence Research Centre, Department of Family Medicine, Medical University of Lodz, Lodz, Poland
- *Correspondence: Przemysław Kardas,
| | - Martina Bago
- Reference Center of Pharmacoepidemiology, Research and Teaching Department, Andrija Stampar Teaching Institute of Public Health, Zagreb, Croatia
| | - Pilar Barnestein-Fonseca
- CUDECA Institute for Training and Research in Palliative Care, CUDECA Hospice Foundation, Málaga, Spain; Instituto de Investigación Biomédica de Málaga-IBIMA Group C08: Pharma Economy: Clinical and Economic Evaluation of Medication and Palliative Care, Málaga, Spain
| | - Kristina Garuolienė
- Pharmacy Center, Institute of Biomedical Science, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Anne Gerd Granas
- Section for Pharmaceutics and Social Pharmacy, Department of Pharmacy, University of Oslo, Oslo, Norway
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - João Gregório
- CBIOS – Universidade Lusófona’s Research Center for Biosciences and Health Technologies, Lisbon, Portugal
| | - Maja Ortner Hadžiabdić
- Centre for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Barbora Kostalova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Francisca Leiva-Fernández
- Multiprofessional Teaching Unit of Community and Family Care Primary Care District Málaga-Guadalhorce, Andalusian Health Service (SAS), Instituto de Investigación Biomédica de Málaga-IBIMA Group C08, Málaga, Spain
| | - Pawel Lewek
- Medication Adherence Research Centre, Department of Family Medicine, Medical University of Lodz, Lodz, Poland
| | - Katerina Mala-Ladova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Marie Paule Schneider
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Job F. M. van Boven
- Department of Clinical Pharmacy and Pharmacology, Medication Adherence Expertise Center of the Northern Netherlands (MAECON), University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Daisy Volmer
- Faculty of Medicine, Institute of Pharmacy, University of Tartu, Tartu, Estonia
| | - Ioli Ziampara
- Health Insurance Organization, National Health Insurance System, Nicosia, Cyprus
| | - Tamás Ágh
- Syreon Research Institute, Budapest, Hungary
- Center for Health Technology Assessment and Pharmacoeconomic Research, University of Pécs, Pécs, Hungary
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27
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Murphy J, Molloy GJ, Hynes L, McSharry J. Young adult preferences for digital health interventions to support adherence to inhaled corticosteroids in asthma: a qualitative study. Health Psychol Behav Med 2022; 10:557-578. [PMID: 35756333 PMCID: PMC9225781 DOI: 10.1080/21642850.2022.2085709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objective: Adherence to inhaled corticosteroids (ICS) among young adults living with asthma is low and in need of appropriate intervention. Digital health interventions (DHIs) have demonstrated potential to improve ICS adherence; however, young adult preferences for these DHIs and how their use could support adherence in this population remain understudied. Therefore, this study aimed to explore young adult preferences for ICS adherence supports and potential DHI features to deliver these supports, in order to improve adherence behaviour throughout this critical developmental stage of the lifespan. Methods: Qualitative, semi-structured interviews were conducted with 13 young adults living with asthma. Analysis followed an inductive, reflexive thematic approach. Results: Participant’s age ranged from 18 to 30 years (M = 24.7; 8 female). Three themes were developed from the analysis: ‘Enabling young adults to find their ‘own way of knowing', ‘Support for making a habit of adherence’, and ‘Providing accessible information’ which included the sub-themes: ‘Education on asthma self-management and medication’, ‘Self-monitoring information’ and ‘Personal feedback on outcomes of adherence’. Suggested features to deliver these supports included a medication and prescription refill reminder, adherence charts, symptom and trigger monitoring, rewards for adherence, visual representations of lungs demonstrating the impact of adherence and lung function monitoring. Conclusion: DHIs may offer an appropriate solution to improve suboptimal adherence to ICS in young adults. However, it is crucial that young adult preferences for adherence supports and features are integrated into these interventions in order to optimise engagement and support adherence behaviour in this population.
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Affiliation(s)
- Jane Murphy
- Medication Adherence Across the Lifespan Research Group, School of Psychology, National University of Ireland, Galway, Ireland
| | - Gerard J Molloy
- Medication Adherence Across the Lifespan Research Group, School of Psychology, National University of Ireland, Galway, Ireland
| | - Lisa Hynes
- Croí, The West of Ireland Cardiac Foundation, Galway, Ireland
| | - Jenny McSharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
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Chan A, De Simoni A, Wileman V, Holliday L, Newby CJ, Chisari C, Ali S, Zhu N, Padakanti P, Pinprachanan V, Ting V, Griffiths CJ. Digital interventions to improve adherence to maintenance medication in asthma. Cochrane Database Syst Rev 2022; 6:CD013030. [PMID: 35691614 PMCID: PMC9188849 DOI: 10.1002/14651858.cd013030.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Asthma is the most common chronic lung condition worldwide, affecting 334 million adults and children globally. Despite the availability of effective treatment, such as inhaled corticosteroids (ICS), adherence to maintenance medication remains suboptimal. Poor ICS adherence leads to increased asthma symptoms, exacerbations, hospitalisations, and healthcare utilisation. Importantly, suboptimal use of asthma medication is a key contributor to asthma deaths. The impact of digital interventions on adherence and asthma outcomes is unknown. OBJECTIVES To determine the effectiveness of digital interventions for improving adherence to maintenance treatments in asthma. SEARCH METHODS We identified trials from the Cochrane Airways Trials Register, which contains studies identified through multiple electronic searches and handsearches of other sources. We also searched trial registries and reference lists of primary studies. We conducted the most recent searches on 1 June 2020, with no restrictions on language of publication. A further search was run in October 2021, but studies were not fully incorporated. SELECTION CRITERIA We included randomised controlled trials (RCTs) including cluster- and quasi-randomised trials of any duration in any setting, comparing a digital adherence intervention with a non-digital adherence intervention or usual care. We included adults and children with a clinical diagnosis of asthma, receiving maintenance treatment. DATA COLLECTION AND ANALYSIS We used standard methodological procedures for data collection. We used GRADE to assess quantitative outcomes where data were available. MAIN RESULTS We included 40 parallel randomised controlled trials (RCTs) involving adults and children with asthma (n = 15,207), of which eight are ongoing studies. Of the included studies, 30 contributed data to at least one meta-analysis. The total number of participants ranged from 18 to 8517 (median 339). Intervention length ranged from two to 104 weeks. Most studies (n = 29) reported adherence to maintenance medication as their primary outcome; other outcomes such as asthma control and quality of life were also commonly reported. Studies had low or unclear risk of selection bias but high risk of performance and detection biases due to inability to blind the participants, personnel, or outcome assessors. A quarter of the studies had high risk of attrition bias and selective outcome reporting. We examined the effect of digital interventions using meta-analysis for the following outcomes: adherence (16 studies); asthma control (16 studies); asthma exacerbations (six studies); unscheduled healthcare utilisation (four studies); lung function (seven studies); and quality of life (10 studies). Pooled results showed that patients receiving digital interventions may have increased adherence (mean difference of 14.66 percentage points, 95% confidence interval (CI) 7.74 to 21.57; low-certainty evidence); this is likely to be clinically significant in those with poor baseline medication adherence. Subgroup analysis by type of intervention was significant (P = 0.001), with better adherence shown with electronic monitoring devices (EMDs) (23 percentage points over control, 95% CI 10.84 to 34.16; seven studies), and with short message services (SMS) (12 percentage points over control, 95% CI 6.22 to 18.03; four studies). No significant subgroup differences were seen for interventions having an in-person component versus fully digital interventions, adherence feedback, one or multiple digital components to the intervention, or participant age. Digital interventions were likely to improve asthma control (standardised mean difference (SMD) 0.31 higher, 95% CI 0.17 to 0.44; moderate-certainty evidence) - a small but likely clinically significant effect. They may reduce asthma exacerbations (risk ratio 0.53, 95% CI 0.32 to 0.91; low-certainty evidence). Digital interventions may result in a slight change in unscheduled healthcare utilisation, although some studies reported no or a worsened effect. School or work absence data could not be included for meta-analysis due to the heterogeneity in reporting and the low number of studies. They may result in little or no difference in lung function (forced expiratory volume in one second (FEV1)): there was an improvement of 3.58% predicted FEV1, 95% CI 1.00% to 6.17%; moderate-certainty evidence); however, this is unlikely to be clinically significant as the FEV1 change is below 12%. Digital interventions likely increase quality of life (SMD 0.26 higher, 95% CI 0.07 to 0.45; moderate-certainty evidence); however, this is a small effect that may not be clinically significant. Acceptability data showed positive attitudes towards digital interventions. There were no data on cost-effectiveness or adverse events. Our confidence in the evidence was reduced by risk of bias and inconsistency. AUTHORS' CONCLUSIONS Overall, digital interventions may result in a large increase in adherence (low-certainty evidence). There is moderate-certainty evidence that digital adherence interventions likely improve asthma control to a degree that is clinically significant, and likely increase quality of life, but there is little or no improvement in lung function. The review found low-certainty evidence that digital interventions may reduce asthma exacerbations. Subgroup analyses show that EMDs may improve adherence by 23% and SMS interventions by 12%, and interventions with an in-person element and adherence feedback may have greater benefits for asthma control and adherence, respectively. Future studies should include percentage adherence as a routine outcome measure to enable comparison between studies and meta-analysis, and use validated questionnaires to assess adherence and outcomes.
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Affiliation(s)
- Amy Chan
- Centre for Behavioural Medicine, Department of Practice and Policy, UCL School of Pharmacy, University College London, London, UK
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
- Asthma UK Centre for Applied Research, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anna De Simoni
- Wolfson Institute of Population Health, Centre for Primary Care Asthma UK Centre for Applied Research, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Vari Wileman
- Centre for Behavioural Medicine, Department of Practice and Policy, UCL School of Pharmacy, University College London, London, UK
| | - Lois Holliday
- Wolfson Institute of Population Health, Centre for Primary Care Asthma UK Centre for Applied Research, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Chris J Newby
- Research Design Service, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Claudia Chisari
- Centre for Behavioural Medicine, Department of Practice and Policy, UCL School of Pharmacy, University College London, London, UK
| | - Sana Ali
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Natalee Zhu
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
| | | | | | - Victoria Ting
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
| | - Chris J Griffiths
- Asthma UK Centre for Applied Research, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Schnoor K, Versluis A, Bakema R, van Luenen S, Kooij MJ, van den Heuvel JM, Teichert M, Honkoop PJ, van Boven JFM, Chavannes NH, Aardoom JJ. A Pharmacy-Based eHealth Intervention Promoting Correct Use of Medication in Patients With Asthma and COPD: Nonrandomized Pre-Post Study. J Med Internet Res 2022; 24:e32396. [PMID: 35675120 PMCID: PMC9218880 DOI: 10.2196/32396] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 02/10/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Asthma and chronic obstructive pulmonary disease (COPD) affect millions of people worldwide. While medication can control and improve disease symptoms, incorrect use of medication is a common problem. The eHealth intervention SARA (Service Apothecary Respiratory Advice) aims to improve participants' correct use of inhalation medication by providing information and as-needed tailored follow-up support by a pharmacist. OBJECTIVE The primary aim of this study was to investigate the effect of SARA on exacerbation rates in participants with asthma and COPD. Secondary aims were to investigate its effects in terms of adherence to maintenance medication and antimycotic treatment. METHODS In this nonrandomized pre-post study, medication dispensing data from 382 Dutch community pharmacies were included. Exacerbation rates were assessed with dispensed short-course oral corticosteroids. Medication adherence between new and chronic users was assessed by calculating the proportion of days covered from dispensed inhalation maintenance medication. Antimycotic treatment was investigated from dispensed oral antimycotics in participants who were also dispensed inhaled corticosteroids (ICS). Outcomes were assessed 1 year before and 1 year after implementation of SARA and were compared between SARA participants and control participants. More specifically, for exacerbation rates and medication adherence, a difference score was calculated (ie, 1 year after SARA minus 1 year before SARA) and was subsequently compared between the study groups with independent-samples t tests. For antimycotics, the relative number of participants who were dispensed antimycotics was calculated and subsequently analyzed with a mixed-effects logistic regression. RESULTS The study population comprised 9452 participants, of whom 2400 (25.39%) were SARA participants. The mean age of the population was 60.8 (15.0) years, and approximately two-thirds (n=5677, 60.06%) were female. The results showed an increase in mean exacerbation rates over time for both study groups (SARA: 0.05; control: 0.15). However, this increase in exacerbation rates was significantly lower for SARA participants (t9450=3.10, 95% CI 0.04-0.16; P=.002; Cohen d=0.06). Chronic users of inhalation medication in both study groups showed an increase in mean medication adherence over time (SARA: 6.73; control: 4.48); however, this increase was significantly higher for SARA participants (t5886=-2.74, 95% CI -3.86 to -0.84; P=.01; Cohen d=-0.07). Among new users of inhalation medication, results showed no significant difference in medication adherence between SARA and control participants in the year after implementation of SARA (t1434=-1.85, 95% CI -5.60 to 0.16; P=.06; Cohen d=-0.10). Among ICS users, no significant differences between the study groups were found over time in terms of the proportion of participants who were dispensed antimycotics (t5654=0.29, 95% CI -0.40 to 0.54; P=.76; Cohen d=0). CONCLUSIONS This study provides preliminary evidence that the SARA eHealth intervention might have the potential to decrease exacerbation rates and improve medication adherence among patients with asthma and COPD.
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Affiliation(s)
- Kyma Schnoor
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands.,National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Anke Versluis
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands.,National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Robbert Bakema
- Nederlandse Service Apotheek Beheer, 's Hertogenbosch, Netherlands
| | - Sanne van Luenen
- Department of Clinical Psychology, Leiden University, Leiden, Netherlands
| | | | - J Maurik van den Heuvel
- Department of Respiratory Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Martina Teichert
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, Netherlands
| | - Persijn J Honkoop
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Job F M van Boven
- Department of Clinical Pharmacy and Pharmacology, Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands.,National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
| | - Jiska J Aardoom
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands.,National eHealth Living Lab, Leiden University Medical Center, Leiden, Netherlands
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Utilization and Effectiveness of eHealth Technology in the Follow-up of Celiac Disease: A Systematic Review. J Pediatr Gastroenterol Nutr 2022; 74:812-818. [PMID: 35849504 DOI: 10.1097/mpg.0000000000003423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES To systematically review the literature on the utilization and effectiveness of electronic-health technologies (eHealth), such as smartphone applications, in managing patients with celiac disease (CD). METHODS PubMed, Scopus, and the Cochrane Library were all searched (until February 2021). Inclusion criteria were full-text English articles reporting original data on the use of eHealth technologies in the follow-up of CD patients, with no age restriction. Exclusion criteria were studies only using non-interactive websites and phone consultation as the primary eHealth method. The results were summarized narratively. RESULTS Using identified keywords, 926 unique studies were identified. After title and abstract screening by two independent reviewers, 26 studies were reviewed in full text. Finally, eight studies were included in this systematic review, and their quality appraised using standardized forms. Of the eight studies, six were randomized-controlled trials, one mixed-methods study, and one cross-sectional, observational study. Studies were assessed to be of "low" to "moderate" methodological quality. Studied eHealth technologies included web-based interventions, smartphone applications, text messaging, and online consultations. The most consistently reported effects related to improved quality of life (number of studies = 4), knowledge on CD (n = 3), and dietary adherence (n = 2); notably, only one study reported reduced costs of eHealth vs. standard (in-office) care. CONCLUSIONS Although eHealth has the potential to improve the management of CD, so far, the research in the field is scarce and generally of low-moderate methodological quality. Hence, the effectiveness of eHealth in CD management remains uncertain, and more high-quality evidence is required before its utility is known.
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Barbosa MT, Sousa CS, Morais-Almeida M. Telemedicine in the Management of Chronic Obstructive Respiratory Diseases: An Overview. Digit Health 2022. [DOI: 10.36255/exon-publications-digital-health-respiratory-diseases] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Oomen L, Bootsma-Robroeks C, Cornelissen E, de Wall L, Feitz W. Pearls and Pitfalls in Pediatric Kidney Transplantation After 5 Decades. Front Pediatr 2022; 10:856630. [PMID: 35463874 PMCID: PMC9024248 DOI: 10.3389/fped.2022.856630] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
Worldwide, over 1,300 pediatric kidney transplantations are performed every year. Since the first transplantation in 1959, healthcare has evolved dramatically. Pre-emptive transplantations with grafts from living donors have become more common. Despite a subsequent improvement in graft survival, there are still challenges to face. This study attempts to summarize how our understanding of pediatric kidney transplantation has developed and improved since its beginnings, whilst also highlighting those areas where future research should concentrate in order to help resolve as yet unanswered questions. Existing literature was compared to our own data of 411 single-center pediatric kidney transplantations between 1968 and 2020, in order to find discrepancies and allow identification of future challenges. Important issues for future care are innovations in immunosuppressive medication, improving medication adherence, careful donor selection with regard to characteristics of both donor and recipient, improvement of surgical techniques and increased attention for lower urinary tract dysfunction and voiding behavior in all patients.
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Affiliation(s)
- Loes Oomen
- Division of Pediatric Urology, Department of Urology, Radboudumc Amalia Children's Hospital, Nijmegen, Netherlands
| | - Charlotte Bootsma-Robroeks
- Department of Pediatric Nephrology, Radboudumc Amalia Children's Hospital, Nijmegen, Netherlands
- Department of Pediatrics, Pediatric Nephrology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Elisabeth Cornelissen
- Department of Pediatric Nephrology, Radboudumc Amalia Children's Hospital, Nijmegen, Netherlands
| | - Liesbeth de Wall
- Division of Pediatric Urology, Department of Urology, Radboudumc Amalia Children's Hospital, Nijmegen, Netherlands
| | - Wout Feitz
- Division of Pediatric Urology, Department of Urology, Radboudumc Amalia Children's Hospital, Nijmegen, Netherlands
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Lung Function Tests, Quality of Life and Telemedicine: Three Windows on the Multifaceted World of Asthma in Adolescents. CHILDREN 2022; 9:children9040476. [PMID: 35455520 PMCID: PMC9026868 DOI: 10.3390/children9040476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/15/2022] [Accepted: 03/28/2022] [Indexed: 11/17/2022]
Abstract
Asthma is a heterogeneous disease usually characterized by chronic airway inflammation and recognized as the most prevalent chronic illness among children. Despite this, the knowledge as to how asthma affects adolescents is still scarce. One of the main management problems of asthmatic adolescents is the poor adherence to pharmacological and non-pharmacological treatments. The assessment of respiratory function and the impact on quality of life are still two crucial challenges in the management of asthmatic adolescents. Additionally, the COVID-19 pandemic has prompted physicians to explore complementary management strategies including telemedicine technologies. This review aims to provide an update on the contribution of respiratory functional tests, how asthma affects quality of life of adolescents and, finally, how telemedicine contributes to the management of adolescent asthmatics during the COVID-19 pandemic.
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Johnson EL, Miller E. Remote Patient Monitoring in Diabetes: How to Acquire, Manage, and Use All of the Data. Diabetes Spectr 2022; 35:43-56. [PMID: 35308161 PMCID: PMC8914599 DOI: 10.2337/dsi21-0015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The ability of patients and health care providers to use various forms of technology for general health has significantly increased in the past several years with the expansion of telehealth, digital applications, personal digital devices, smartphones, and other internet-connected platforms and devices. For individuals with diabetes, this also includes connected blood glucose meters, continuous glucose monitoring devices, and insulin delivery systems. In this article, the authors outline several steps to facilitate the acquisition, management, and meaningful use of digital diabetes data that can enable successful implementation of both diabetes technology and telehealth services in primary care clinics.
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Affiliation(s)
- Eric L. Johnson
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND
- Diabetes Center – Altru Health System, Grand Forks, ND
- Corresponding author: Eric L. Johnson,
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Jarva E, Oikarinen A, Andersson J, Tuomikoski A, Kääriäinen M, Meriläinen M, Mikkonen K. Healthcare professionals' perceptions of digital health competence: A qualitative descriptive study. Nurs Open 2022; 9:1379-1393. [PMID: 35094493 PMCID: PMC8859079 DOI: 10.1002/nop2.1184] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/26/2021] [Accepted: 01/09/2022] [Indexed: 01/15/2023] Open
Abstract
Aims and objectives This study aims to provide insight into healthcare professionals' lived experiences of digital health competence with the objective of improving the knowledge of how digital health competence is perceived by healthcare professionals. Background Healthcare professionals need to adjust to the digital era to provide quality and ethical care. Previous research has rarely adopted a healthcare professional's standpoint to describe their perceptions of digital health competence, even though their perspective in how new care practices are designed and implemented is vital. Design A qualitative descriptive study. Methods Healthcare professionals (nurses and allied health professionals) from versatile healthcare settings were recruited for individual semi‐structured interviews in Sweden (n = 5) and Finland (n = 15) (spring 2019‐summer 2020). Purposive and convenience sampling was used. Participants' backgrounds were in the public and private sectors. The interviews were transcribed for inductive content analysis. The SRQR guideline guided the study process. Results Healthcare professionals' perceptions of digital health competence are connected to competence to provide patient‐centric care through digital channels, using technology and digital health systems, interacting with the patient through digital means, evaluating what digital health is and combining digital and traditional methods. Professionals' perceptions of their own digital health competence were divided, with the participants either reporting sufficient competence or perceiving a lack of skills in some specific areas. Conclusions Healthcare professionals' perceptions of digital health competence focus on the ability to provide patient‐centric care by evaluating the need and possibilities for using digital health services jointly with more traditional methods. This study provides a sound basis for digital health research, but future studies should focus on elucidating factors which affect digital health competence and competence development. Relevance to clinical practice The results of this study can guide healthcare practices and digital health implementation, as well as function as a basis for instrument or theory development. Health care and nursing leaders should enable the resources to hybrid practices in patient‐centric care provision.
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Affiliation(s)
- Erika Jarva
- Research Unit of Nursing Science and Health Management University of Oulu Oulu Finland
| | - Anne Oikarinen
- Research Unit of Nursing Science and Health Management University of Oulu Oulu Finland
| | - Janicke Andersson
- Center for Research on Welfare, Health and Sports Academy of Health and WelfareHalmstad University Halmstad Sweden
| | - Anna‐Maria Tuomikoski
- Oulu University of Applied Sciences Oulu Finland
- The Finnish Centre for Evidence‐Based Health Care: A Joanna Briggs Institute Centre of Excellence Oulu Finland
| | - Maria Kääriäinen
- Research Unit of Nursing Science and Health Management University of Oulu Oulu Finland
- The Finnish Centre for Evidence‐Based Health Care: A Joanna Briggs Institute Centre of Excellence Oulu Finland
- Medical Research Center Oulu Oulu University Hospital and University of Oulu Oulu Finland
| | - Merja Meriläinen
- Medical Research Center Oulu Oulu University Hospital and University of Oulu Oulu Finland
| | - Kristina Mikkonen
- Research Unit of Nursing Science and Health Management University of Oulu Oulu Finland
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Sánchez-Nieto JM, Bernabeu-Mora R, Fernández-Muñoz I, Carrillo-Alcaraz A, Alcántara-Fructuoso J, Fernández-Alvarez J, Vera-Olmos JC, Martínez-Ferre MJ, Olea MGV, Valenciano MJC, Martínez DS. Effectiveness of individualized inhaler technique training on low adherence (LowAd) in ambulatory patients with COPD and asthma. NPJ Prim Care Respir Med 2022; 32:1. [PMID: 35013343 PMCID: PMC8748930 DOI: 10.1038/s41533-021-00262-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 11/12/2021] [Indexed: 11/09/2022] Open
Abstract
To analyze whether there is improvement in adherence to inhaled treatment in patients with COPD and asthma after an educational intervention based on the teach-to-goal method. This is a prospective, non-randomized, single-group study, with intervention and before-after evaluation. The study population included 120 patients (67 females and 53 males) diagnosed with asthma (70.8%) and COPD (29.1%). The level of adherence (low and optimal) and the noncompliance behavior pattern (erratic, deliberate and unwitting) were determined by the Test of the adherence to Inhalers (TAI). This questionnaire allows you to determine the level of adherence and the types of noncompliance. Low Adherence (LowAd) was defined as a score less than 49 points. All patients received individualized educational inhaler technique intervention (IEITI). Before the IEITI, 67.5% of the patients had LowAd. Following IEITI, on week 24, LowAd was 55% (p = 0.024). Each patient can present one or more types of noncompliance. The most frequent type was forgetting to use the inhaler (erratic), 65.8%. The other types were deliberate: 43.3%, and unwitting: 57.5%. All of them had decreased on the final visit: 51.7% (p = 0.009), 25.8% (p = 0.002), 39.2% (p = 0.002). There were no significant differences in adherence between asthma and COPD patients at the start of the study. The only predicting factor of LowAd was the female gender. An individualized educational intervention, in ambulatory patients with COPD and asthma, in real-world clinical practice conditions, improves adherence to the inhaled treatment.
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Affiliation(s)
- Juan Miguel Sánchez-Nieto
- Division of Pneumology, Morales Meseguer General University Hospital, 30008, Murcia, Spain.,Institute for Bio-health Research of Murcia (IMIB-Arrixaca), El Palmar, 30120, Murcia, Spain.,Department of Internal Medicine, University of Murcia, El Palmar, 30120, Murcia, Spain
| | - Roberto Bernabeu-Mora
- Division of Pneumology, Morales Meseguer General University Hospital, 30008, Murcia, Spain. .,Institute for Bio-health Research of Murcia (IMIB-Arrixaca), El Palmar, 30120, Murcia, Spain. .,Department of Internal Medicine, University of Murcia, El Palmar, 30120, Murcia, Spain.
| | - Irene Fernández-Muñoz
- Division of Pneumology, Morales Meseguer General University Hospital, 30008, Murcia, Spain
| | - Andrés Carrillo-Alcaraz
- Division of Intensive Care Unit, Morales Meseguer General University Hospital, 30008, Murcia, Spain
| | | | | | - Juan Carlos Vera-Olmos
- Division of Pneumology, Morales Meseguer General University Hospital, 30008, Murcia, Spain
| | | | | | | | - Diego Salmerón Martínez
- Institute for Bio-health Research of Murcia (IMIB-Arrixaca), El Palmar, 30120, Murcia, Spain.,Department of Health and Social Sciences, Murcia University, Murcia, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Poureslami I, FitzGerald JM, Tregobov N, Goldstein RS, Lougheed MD, Gupta S. Health literacy in asthma and chronic obstructive pulmonary disease (COPD) care: a narrative review and future directions. Respir Res 2022; 23:361. [PMID: 36529734 PMCID: PMC9760543 DOI: 10.1186/s12931-022-02290-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
Respiratory self-care places considerable demands on patients with chronic airways disease (AD), as they must obtain, understand and apply information required to follow their complex treatment plans. If clinical and lifestyle information overwhelms patients' HL capacities, it reduces their ability to self-manage. This review outlines important societal, individual, and healthcare system factors that influence disease management and outcomes among patients with asthma and chronic obstructive pulmonary disease (COPD)-the two most common ADs. For this review, we undertook a comprehensive literature search, conducted reference list searches from prior HL-related publications, and added insights from international researchers and scientists with an interest in HL. We identified methodological limitations in currently available HL measurement tools in respiratory care. We also summarized the issues contributing to low HL and system-level cultural incompetency that continue to be under-recognized in AD management and contribute to suboptimal patient outcomes. Given that impaired HL is not commonly recognized as an important factor in AD care, we propose a three-level patient-centered model (strategies) designed to integrate HL considerations, with the goal of enabling health systems to enhance service delivery to meet the needs of all AD patients.
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Affiliation(s)
- Iraj Poureslami
- grid.417243.70000 0004 0384 4428Division of Respiratory Medicine, Centre for Lung Health, Vancouver Coastal Health Research Institute, University of British Columbia, 716-828 West 10th Avenue, Vancouver, BC V5Z 1M9 Canada ,Canadian Multicultural Health Promotion Society (CMHPS), Vancouver, BC Canada
| | - J. Mark FitzGerald
- grid.417243.70000 0004 0384 4428Division of Respiratory Medicine, Centre for Lung Health, Vancouver Coastal Health Research Institute, University of British Columbia, 716-828 West 10th Avenue, Vancouver, BC V5Z 1M9 Canada
| | - Noah Tregobov
- grid.417243.70000 0004 0384 4428Division of Respiratory Medicine, Centre for Lung Health, Vancouver Coastal Health Research Institute, University of British Columbia, 716-828 West 10th Avenue, Vancouver, BC V5Z 1M9 Canada ,grid.17091.3e0000 0001 2288 9830Faculty of Medicine, Vancouver-Fraser Medical Program, University of British Columbia, Vancouver, BC Canada
| | - Roger S. Goldstein
- grid.17063.330000 0001 2157 2938Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada ,Respiratory Medicine, Westpark Healthcare Centre, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - M. Diane Lougheed
- grid.410356.50000 0004 1936 8331Asthma Research Unit, Department of Medicine, Kingston Health Sciences Centre, Queen’s University, Kingston, ON Canada ,grid.418647.80000 0000 8849 1617Institute for Clinical Evaluative Sciences, Toronto, ON Canada
| | - Samir Gupta
- grid.415502.7Unity Health, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON Canada
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Li J, Zhu C, Liu C, Su Y, Peng X, Hu X. Effectiveness of eHealth interventions for cancer-related pain, fatigue, and sleep disorders in cancer survivors: A systematic review and meta-analysis of randomized controlled trials. J Nurs Scholarsh 2021; 54:184-190. [PMID: 34791779 DOI: 10.1111/jnu.12729] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 09/13/2021] [Accepted: 10/15/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE To systematically evaluate the effects of Electronic health (eHealth) interventions on fatigue, pain, and sleep disorders in cancer survivors. DESIGN A systematic review and meta-analysis was conducted. METHODS Relevant studies were searched from five databases (MEDLINE, Embase, the Cochrane Central Register of Controlled trials, CINAHL, and PsycINFO). The comprehensive literature search was done in December 2020. Only randomized controlled trials (RCTs) that examined the effects of eHealth interventions among cancer survivors were included. FINDINGS Twenty-five RCTs were included. The meta-analysis showed that eHealth interventions had a positive impact on pain interference (SMD = -0.37, 95% CI: -0.54 to -0.20, p = 0.0001) and sleep disorders (SMD = -0.43, 95% CI: -0.77 to -0.08, p = 0.02) but not on pain severity or fatigue in cancer survivors. The sensitivity and subgroup analyses indicated that the pooled results were robust and reliable. CONCLUSION eHealth interventions are effective in improving pain interference and sleep disorders in cancer survivors. Additional high-quality RCTs are needed to test the effectiveness of eHealth interventions on fatigue, pain, and sleep disorders in cancer survivors. CLINICAL RELEVANCE This systematic review and meta-analysis provides evidence to offer effective and sustainable eHealth care for symptom management among cancer survivors.
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Affiliation(s)
- Juejin Li
- West China School of Nursing, Sichuan University/Department of Nursing, West China Hospital, Sichuan University, Chengdu, PR China
| | - Chuanmei Zhu
- Outpatient Department, West China Hospital, Sichuan University, Chengdu, PR China
| | - Chunhua Liu
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, PR China
| | - Yonglin Su
- Department of Rehabilitation/Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, PR China
| | - Xingchen Peng
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, PR China
| | - Xiaolin Hu
- West China School of Nursing, Sichuan University/Department of Nursing, West China Hospital, Sichuan University, Chengdu, PR China
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Alwashmi MF, Mugford G, Vokey B, Abu-Ashour W, Hawboldt J. Effectiveness of the BreatheSuite Device in Assessing the Technique of Metered-Dose Inhalers: Validation Study. JMIR BIOMEDICAL ENGINEERING 2021; 6:e26556. [PMID: 38907373 PMCID: PMC11041462 DOI: 10.2196/26556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/11/2021] [Accepted: 10/03/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The majority of medications used in treating asthma and chronic obstructive pulmonary disease (COPD) are taken through metered-dose inhalers (MDIs). Studies have reported that most patients demonstrate poor inhaler technique, which has resulted in poor disease control. Digital Health applications have the potential to improve the technique and adherence of inhaled medications. OBJECTIVE This study aimed to validate the effectiveness of the BreatheSuite MDI device in assessing the technique of taking a dose via an MDI. METHODS The study was a validation study. Thirty participants who self-reported a diagnosis of asthma or COPD were recruited from community pharmacies in Newfoundland and Labrador, Canada. Participants used a BreatheSuite MDI device attached to a placebo MDI and resembled taking 3 doses. Pharmacists used a scoring sheet to evaluate the technique of using the MDI. An independent researcher compared the results of the pharmacist's scoring sheet with the results of the BreatheSuite device. RESULTS This study found that the BreatheSuite MDI can objectively detect several errors in the MDI technique. The data recorded by the BreatheSuite MDI device showed that all participants performed at least one error in using the MDI. The BreatheSuite device captured approximately 40% (143/360) more errors compared to observation alone. The distribution of participants who performed errors in MDI steps as recorded by BreatheSuite compared to errors reported by observation alone were as follows: shaking before actuation, 33.3% (30/90) versus 25.5% (23/90); upright orientation of the inhaler during actuation, 66.7% (60/90) versus 18.87% (17/90); coordination (actuating after the start of inhalation), 76.6% (69/90) versus 35.5% (32/90); and duration of inspiration, 96.7% (87/90) versus 34.4% (31/90). CONCLUSIONS The BreatheSuite MDI can objectively detect several errors in the MDI technique, which were missed by observation alone. It has the potential to enhance treatment outcomes among patients with chronic lung diseases.
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McIntire K, Weis B, Litwin Ye L, Krugman SD. Feasibility of video observed therapy to support controller inhaler use among children in West Baltimore. J Asthma 2021; 59:1961-1972. [PMID: 34550849 DOI: 10.1080/02770903.2021.1984525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess feasibility of a novel video directly observed therapy (DOT)-based digital asthma program intended to support correct inhaled corticosteroid (ICS) use among children. METHODS We conducted a 60-day pilot study among patients 2-18 years attending a primary care clinic with prescribed ICS and sub-optimally controlled asthma (recent hospitalization, ICS nonadherence, frequent rescue inhaler use, therapy escalation, or Asthma Control Test <20). Participants used a mobile application to receive reminders, submit videos of ICS doses (video DOT), and receive asynchronous feedback on adherence and inhaler technique. We assessed enrollment, engagement, program metrics, and user experience; adherence and inhaler errors were secondary outcomes. RESULTS Of 26 eligible patients, 21 (81%) enrolled and submitted ≥1 video; median age was 11 years (8-15), 71% were male, 90% had Medicaid, and 62% experienced ≥1 exacerbation in the previous 6 months. Retention was 57% and 52% at week 5 and 8, respectively. Participants submitted 810 videos. Missed doses, inhaler errors (n = 247) and adherence issues (n = 107) prompted 543 communications; inadequate inspiration or holding breath were most common. Among 16 patients with engagement >7 days and >4 videos, median inhaler error rate (proportion of videos with ≥1 error) decreased from week 1 to week 2 (73% vs 8%, p ≤ 0.05) with median adherence >80%. Participants experienced the program as long, but easy to use; benefits included building routines, skill, and independence. CONCLUSIONS This pilot study suggests high program acceptability among our cohort. High engagement with improved inhaler technique over the first 14 days suggests shorter implementation.
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Affiliation(s)
- K McIntire
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - B Weis
- Department of Pediatrics, Herman and Walter Samuelson Children's Hospital of Sinai, Baltimore, MD, USA
| | - L Litwin Ye
- emocha Mobile Health Inc, Baltimore, MD, USA
| | - S D Krugman
- Department of Pediatrics, Herman and Walter Samuelson Children's Hospital of Sinai, Baltimore, MD, USA
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Samal L, Fu HN, Camara DS, Wang J, Bierman AS, Dorr DA. Health information technology to improve care for people with multiple chronic conditions. Health Serv Res 2021; 56 Suppl 1:1006-1036. [PMID: 34363220 PMCID: PMC8515226 DOI: 10.1111/1475-6773.13860] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To review evidence regarding the use of Health Information Technology (health IT) interventions aimed at improving care for people living with multiple chronic conditions (PLWMCC) in order to identify critical knowledge gaps. DATA SOURCES We searched MEDLINE, CINAHL, PsycINFO, EMBASE, Compendex, and IEEE Xplore databases for studies published in English between 2010 and 2020. STUDY DESIGN We identified studies of health IT interventions for PLWMCC across three domains as follows: self-management support, care coordination, and algorithms to support clinical decision making. DATA COLLECTION/EXTRACTION METHODS Structured search queries were created and validated. Abstracts were reviewed iteratively to refine inclusion and exclusion criteria. The search was supplemented by manually searching the bibliographic sections of the included studies. The search included a forward citation search of studies nested within a clinical trial to identify the clinical trial protocol and published clinical trial results. Data were extracted independently by two reviewers. PRINCIPAL FINDINGS The search yielded 1907 articles; 44 were included. Nine randomized controlled trials (RCTs) and 35 other studies including quasi-experimental, usability, feasibility, qualitative studies, or development/validation studies of analytic models were included. Five RCTs had positive results, and the remaining four RCTs showed that the interventions had no effect. The studies address individual patient engagement and assess patient-centered outcomes such as quality of life. Few RCTs assess outcomes such as disability and none assess mortality. CONCLUSIONS Despite a growing body of literature on health IT interventions or multicomponent interventions including a health IT component for chronic disease management, current evidence for applying health IT solutions to improve care for PLWMCC is limited. The body of literature included in this review provides critical information on the state of the science as well as the many gaps that need to be filled for digital health to fulfill its promise in supporting care delivery that meets the needs of PLWMCC.
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Affiliation(s)
- Lipika Samal
- Brigham and Women's HospitalBostonMAUSA
- Harvard Medical SchoolBostonMAUSA
| | - Helen N. Fu
- Indiana University Richard M. Fairbanks School of Public HealthIndianapolisINUSA
- Regenstrief InstituteCenter for Biomedical InformaticsIndianapolisINUSA
| | - Djibril S. Camara
- Center for Disease Control and Prevention, Center for Surveillance, Epidemiology, and Laboratory Services (CSELS) Division of Scientific Education and Professional Development, Public Health Informatics Fellowship ProgramAtlantaGeorgiaUSA
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and QualityRockvilleMDUSA
| | - Jing Wang
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and QualityRockvilleMDUSA
- Florida State University College of NursingTallahasseeFloridaUSA
- Health and Aging Policy Fellows Program at Columbia UniversityNew YorkNYUSA
| | - Arlene S. Bierman
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and QualityRockvilleMDUSA
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42
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Milne-Ives M, Lam C, Meinert E. Digital Technologies for Monitoring and Improving Treatment Adherence in Children and Adolescents With Asthma: Scoping Review of Randomized Controlled Trials. JMIR Pediatr Parent 2021; 4:e27999. [PMID: 34533463 PMCID: PMC8486994 DOI: 10.2196/27999] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/28/2021] [Accepted: 06/03/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Inadequate pediatric asthma care has resulted in potentially avoidable unplanned hospital admissions and morbidity. A wide variety of digital technologies have been developed to monitor and support treatment adherence in children and adolescents with asthma. However, existing reviews need to be updated and expanded to provide an overview of the current state of research on these technologies and how they are being integrated into existing health care services and care pathways. OBJECTIVE This study aims to provide an overview of the current research landscape and knowledge gaps regarding the use of digital technologies to support the care of children and adolescents with asthma. METHODS This study was structured according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) and Population, Intervention, Comparator, Outcome, and Study frameworks. Five databases (PubMed, the Cochrane Central Register of Controlled Trials, Web of Science, Embase, and PsycINFO) were systematically searched for studies published in English from 2014 onward. Two reviewers independently screened the references and selected studies for inclusion based on the eligibility criteria. Data were systematically extracted per research question, which were synthesized in a descriptive analysis. RESULTS A wide variety of study characteristics, including the number and age of participants, study duration, and type of digital intervention, were identified. There was mixed evidence for the effectiveness of the interventions. Of the 10 studies that evaluated treatment adherence, 7 (70%) found improvements, but the evidence was inconsistent for asthma control (6/9, 67% of studies reported improvement or maintenance, but only 1 was significantly different between groups) and health outcome variables (5/9, 56% of studies found no evidence of effectiveness). The 6 studies that examined patient perceptions and assessments of acceptability and usability generally had positive findings. CONCLUSIONS A wide range of digital interventions are being developed and evaluated to support the monitoring and treatment adherence of children and adolescents with asthma. Meta-analyses are inhibited by the use of samples with a variety of overlapping age ranges; a theoretical framework for evaluating specific age groups would aid comparison between studies. Most studies found significant evidence for improved adherence to treatment or medications, but there was mixed evidence of the impact of the digital interventions on asthma control and other health outcomes. There are gaps in the literature relating to cost-effectiveness and integration with existing clinical care pathways. This study will be necessary to determine which digital interventions for children and young people with asthma are worth supporting and adopting in the clinical care pathways.
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Affiliation(s)
- Madison Milne-Ives
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | - Ching Lam
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Edward Meinert
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom.,Department of Primary Care and Public Health, Imperial College London, London, United Kingdom.,Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
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43
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O’Connor A, Tai A, Carson-Chahhoud K. Isn't There an App for That? The Role of Smartphone and Tablet Applications for Asthma Education and Self-Management in Adolescents. CHILDREN (BASEL, SWITZERLAND) 2021; 8:786. [PMID: 34572218 PMCID: PMC8467082 DOI: 10.3390/children8090786] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 01/03/2023]
Abstract
Asthma is one of the most common chronic diseases worldwide, with a substantial proportion of the asthma population being children and adolescents. Self-management is recognized as a key component to asthma management, with multiple international guidelines emphasizing the need for adequate self-management skills for good asthma control. Unfortunately, the uptake amongst young people and adolescents is low, with often suboptimal engagement to self-management education and skills contributing to poor adherence to medication as well as poor perception of asthma symptoms. Innovative solutions to deliver education and self-management to adolescents are clearly needed. mHealth is the use of mobile devices such as smartphones and tablet devices to improve healthcare and has been used in multiple chronic diseases. This review articles explores the current use of mHealth in asthma, specifically smartphone and tablet applications as a generation-appropriate, accessible delivery modality for provision of asthma education and self-management interventions in adolescents. Current evidence gaps are also highlighted, which should be addressed in future research.
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Affiliation(s)
- Antonia O’Connor
- Respiratory and Sleep Department, Women’s and Children’s Hospital, 72 King Williams Road, North Adelaide, SA 5006, Australia;
| | - Andrew Tai
- Respiratory and Sleep Department, Women’s and Children’s Hospital, 72 King Williams Road, North Adelaide, SA 5006, Australia;
- Robinson Research Institute, University of Adelaide, Ground Floor, Norwich Centre, 55 King William Road, North Adelaide, SA 5006, Australia
| | - Kristin Carson-Chahhoud
- Adelaide Medical School, University of Adelaide, Adelaide Health and Medical Sciences Building, Corner of North Terrace & George Street, Adelaide, SA 5000, Australia;
- Translational Medicine and Technology Group, Australian Centre for Precision Health, University of South Australia, Level 8 South SAHMRI Building, North Terrace, Adelaide, SA 5000, Australia
- Australian Centre for Precision Health, South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA 5000, Australia
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44
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Schulte MHJ, Aardoom JJ, Loheide-Niesmann L, Verstraete LLL, Ossebaard HC, Riper H. Effectiveness of eHealth Interventions in Improving Medication Adherence for Patients With Chronic Obstructive Pulmonary Disease or Asthma: Systematic Review. J Med Internet Res 2021; 23:e29475. [PMID: 34313593 PMCID: PMC8403699 DOI: 10.2196/29475] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/12/2021] [Accepted: 06/14/2021] [Indexed: 01/13/2023] Open
Abstract
Background Poor treatment adherence in patients with chronic obstructive pulmonary disease (COPD) or asthma is a global public health concern with severe consequences in terms of patient health and societal costs. A potentially promising tool for addressing poor compliance is eHealth. Objective This review investigates the effects of eHealth interventions on medication adherence in patients with COPD or asthma. Methods A systematic literature search was conducted in the databases of Cochrane Library, PsycINFO, PubMed, and Embase for studies with publication dates between January 1, 2000, and October 29, 2020. We selected randomized controlled trials targeting adult patients with COPD or asthma, which evaluated the effectiveness of an eHealth intervention on medication adherence. The risk of bias in the included studies was examined using the Cochrane Collaboration’s risk of bias tool. The results were narratively reviewed. Results In total, six studies focusing on COPD and seven focusing on asthma were analyzed. Interventions were mostly internet-based or telephone-based, and could entail telemonitoring of symptoms and medication adherence, education, counseling, consultations, and self-support modules. Control groups mostly comprised usual care conditions, whereas a small number of studies used a face-to-face intervention or waiting list as the control condition. For COPD, the majority of eHealth interventions were investigated as an add-on to usual care (5/6 studies), whereas for asthma the majority of interventions were investigated as a standalone intervention (5/7 studies). Regarding eHealth interventions targeting medication adherence for COPD, two studies reported nonsignificant effects, one study found a significant effect in comparison to usual care, and three reported mixed results. Of the seven studies that investigated eHealth interventions targeting medication adherence in asthma, three studies found significant effects, two reported nonsignificant effects, and two reported mixed effects. Conclusions The mixed results on the effectiveness of eHealth interventions in improving treatment adherence for asthma and COPD are presumably related to the type, context, and intensity of the interventions, as well as to differences in the operationalization and measurement of adherence outcomes. Much remains to be learned about the potential of eHealth to optimize treatment adherence in COPD and asthma.
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Affiliation(s)
- Mieke H J Schulte
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
| | - Jiska J Aardoom
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands.,National eHealth Living Lab, Leiden, Netherlands
| | - Lisa Loheide-Niesmann
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands.,Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Leonie L L Verstraete
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
| | | | - Heleen Riper
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam University Medical Center (VUmc), Vrije Universiteit, Amsterdam, Netherlands.,GGZ inGeest Specialized Mental Health Care, Research and Innovation, Amsterdam, Netherlands
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45
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van der Kamp M, Reimering Hartgerink P, Driessen J, Thio B, Hermens H, Tabak M. Feasibility, Efficacy, and Efficiency of eHealth-Supported Pediatric Asthma Care: Six-Month Quasi-Experimental Single-Arm Pretest-Posttest Study. JMIR Form Res 2021; 5:e24634. [PMID: 34309568 PMCID: PMC8367169 DOI: 10.2196/24634] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/28/2020] [Accepted: 05/16/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Early detection of loss of asthma control can effectively reduce the burden of the disease. However, broad implementation in clinical practice has not been accomplished so far. We are in need of research investigating the operationalization of eHealth pediatric asthma care in practice, which can provide the most potential benefits in terms of adoption, efficiency, and effectiveness. OBJECTIVE The aim of this study was to investigate the technical and clinical feasibility, including an exploration of the efficacy and cost-efficiency, of an eHealth program implemented in daily clinical pediatric asthma practice. METHODS We designed an eHealth-supported pediatric asthma program facilitating early detection of loss of asthma control while increasing symptom awareness and self-management. In the 6-month program, asthma control was monitored by 4 health care professionals (HCPs) by using objective home measurements and the web-based Puffer app to allow timely medical anticipation and prevent treatment delay. Technical feasibility was assessed by technology use, system usability, and technology acceptance. Clinical feasibility was assessed by participation and patient-reported health and care outcomes and via a focus group with HCPs regarding their experiences of implementing eHealth in daily practice. The efficacy and cost-efficiency were explored by comparing pretest-posttest program differences in asthma outcomes (asthma control, lung function, and therapy adherence) and medical consumption. RESULTS Of 41 children, 35 children with moderate-to-severe asthma volunteered for participation. With regard to technical feasibility, the Puffer app scored a good usability score of 78 on the System Usability Scale and a score of 70 for technology acceptance on a scale of 1 to 100. Approximately 75% (18/24) of the children indicated that eHealth helped them to control their asthma during the program. HCPs indicated that home measurements and real time communication enabled them to make safe and substantiated medical decisions during symptom manifestations. With an average time commitment of 15 minutes by patients, eHealth care led to a 80% gross reduction (from €71,784 to €14,018, US $1=€0.85) in health care utilization, 8.6% increase (from 18.6 to 20.2, P=.40) in asthma control, 25.0% increase (from 2.8 to 3.5, P=.04) in the self-management level, and 20.4% improved (from 71.2 to 76.8, P=.02) therapy adherence. CONCLUSIONS eHealth asthma care seems to be technically and clinically feasible, enables safe remote care, and seems to be beneficial for pediatric asthma care in terms of health outcomes and health care utilization. Follow-up research should focus on targeted effectiveness studies with the lessons learned, while also enabling individualization of eHealth for personalized health care.
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Affiliation(s)
- Mattienne van der Kamp
- Department of Pediatrics, Medisch Spectrum Twente, Enschede, Netherlands.,Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
| | | | - Jean Driessen
- Department of Pediatrics, Medisch Spectrum Twente, Enschede, Netherlands.,Department of Sports Medicine, Orthopedisch Centrum Oost Nederland, Hengelo, Netherlands
| | - Bernard Thio
- Department of Pediatrics, Medisch Spectrum Twente, Enschede, Netherlands
| | - Hermie Hermens
- Biomedical Signals and Systems, University of Twente, Enschede, Netherlands.,Department of eHealth, Roessingh Research and Development, Enschede, Netherlands
| | - Monique Tabak
- Biomedical Signals and Systems, University of Twente, Enschede, Netherlands.,Department of eHealth, Roessingh Research and Development, Enschede, Netherlands
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46
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Davies B, Kenia P, Nagakumar P, Gupta A. Paediatric and adolescent asthma: A narrative review of telemedicine and emerging technologies for the post-COVID-19 era. Clin Exp Allergy 2021; 51:393-401. [PMID: 33527625 PMCID: PMC8013619 DOI: 10.1111/cea.13836] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/22/2020] [Accepted: 01/16/2021] [Indexed: 01/25/2023]
Abstract
Children and young people with asthma need regular monitoring to maintain good asthma control, prevent asthma attacks and manage comorbidities. The COVID‐19 pandemic has resulted in healthcare professionals making fundamental changes to the way healthcare is delivered and for patients and families adapting to these changes. Comprehensive remotely delivered, technology‐based healthcare, closer to the patients home (reducing hospital footfall and possibly reducing carbon footprint) is likely to be one of the important collateral effects of the pandemic. Telemedicine is anticipated to impact everyone involved in healthcare ‐ providers and patients alike. It is going to bring changes to organization, work areas and work culture in healthcare. Healthcare providers, policymakers and those accessing healthcare services will experience the impact of technology‐based healthcare delivery. Telemedicine can play an exciting role in the management of childhood asthma by delivering high‐quality care closer to the child's home. However, unlike adults, children still need to be accompanied by their carers for virtual care. Policymakers will need to take into account potential additional costs as well as the legal, ethical and cultural implications of large scale use of telemedicine. In this narrative review, we review evidence regarding the role of telemedicine and related emerging technologies in paediatric and adolescent asthma. Although there are gaps in the current knowledge, there is evidence demonstrating the important role of telemedicine in management of childhood and adolescent asthma. However, there is an urgent need for healthcare researchers and policymakers to focus on improving the technologies and address the disparities in accessing novel technology‐based management strategies to improve asthma care.
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Affiliation(s)
- Benjamin Davies
- Department of Paediatric Respiratory Medicine, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK.,Birmingham Acute Care Research, University of Birmingham, Birmingham, UK
| | - Priti Kenia
- Department of Paediatric Respiratory Medicine, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Prasad Nagakumar
- Department of Paediatric Respiratory Medicine, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK.,Birmingham Acute Care Research, University of Birmingham, Birmingham, UK
| | - Atul Gupta
- Department of Paediatric Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, UK
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47
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Sinha IP, Brown L, Fulton O, Gait L, Grime C, Hepworth C, Lilley A, Murray M, Simba J. Empowering children and young people who have asthma. Arch Dis Child 2021; 106:125-129. [PMID: 32709687 DOI: 10.1136/archdischild-2020-318788] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/16/2020] [Accepted: 06/30/2020] [Indexed: 12/18/2022]
Abstract
Asthma is the most common chronic condition of childhood. In this review, we discuss an overview of strategies to empower children and young people with asthma. The key aspects of empowerment are to enable shared decision making and self-management, and help children minimise the impact of asthma on their life. The evidence behind these strategies is either sparse or heterogenous, and it is difficult to identify which interventions are most likely to improve clinical outcomes. Wider determinants of health, in high-resource and low-resource settings, can be disempowering for children with asthma. New approaches to technology could help empower young people with asthma and other chronic health conditions.
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Affiliation(s)
- Ian P Sinha
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK .,Division of Child Health, University of Liverpool, Liverpool, UK
| | - Lynsey Brown
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Olivia Fulton
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Lucy Gait
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | | | | | - Andrew Lilley
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Morgan Murray
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Justus Simba
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,Child Health and Paediatrics, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
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Pouls BPH, Vriezekolk JE, Bekker CL, Linn AJ, van Onzenoort HAW, Vervloet M, van Dulmen S, van den Bemt BJF. Effect of Interactive eHealth Interventions on Improving Medication Adherence in Adults With Long-Term Medication: Systematic Review. J Med Internet Res 2021; 23:e18901. [PMID: 33416501 PMCID: PMC7822716 DOI: 10.2196/18901] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/06/2020] [Accepted: 10/30/2020] [Indexed: 12/15/2022] Open
Abstract
Background Medication nonadherence leads to suboptimal treatment outcomes, making it a major priority in health care. eHealth provides an opportunity to offer medication adherence interventions with minimal effort from health care providers whose time and resources are limited. Objective The aim of this systematic review is twofold: (1) to evaluate effectiveness of recently developed and tested interactive eHealth (including mHealth) interventions on medication adherence in adult patients using long-term medication and (2) to describe strategies among effective interventions. Methods MEDLINE, EMBASE, Cochrane Library, PsycINFO, and Web of Science were systematically searched from January 2014 to July 2019 as well as reference lists and citations of included articles. Eligible studies fulfilled the following inclusion criteria: (1) randomized controlled trial with a usual care control group; (2) a total sample size of at least 50 adult patients using long-term medication; (3) applying an interactive eHealth intervention aimed at the patient or patient’s caregiver; and (4) medication adherence as primary outcome. Methodologic quality was assessed using the Cochrane risk of bias tool. Selection and quality assessment of studies were performed by 2 researchers (BP and BvdB or JV) independently. A best evidence synthesis was performed according to the Cochrane Back Review Group. Results Of the 9047 records screened, 22 randomized clinical trials were included reporting on 29 interventions. Most (21/29, 72%) interventions specified using a (mobile) phone for calling, SMS text messaging, or mobile apps. A majority of all interactive interventions (17/29) had a statistically significant effect on medication adherence (P<.05). Of these interventions, 9 had at least a small effect size (Cohen d ≥ 0.2) and 3 showed strong odds for becoming adherent in the intervention group (odds ratio > 2.0). Our best evidence synthesis provided strong evidence for a positive effect of interventions using SMS text messages or interactive voice response, mobile app, and calls as mode of providing adherence tele-feedback. Intervention strategies “to teach medication management skills,” “to improve health care quality by coordinating medication adherence care between professionals,” and “to facilitate communication or decision making between patients and health care providers” also showed strong evidence for a positive effect. Conclusions Overall, this review supports the hypothesis that interactive eHealth interventions can be effective in improving medication adherence. Intervention strategies that improve patients’ treatment involvement and their medication management skills are most promising and should be considered for implementation in practice.
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Affiliation(s)
- Bart P H Pouls
- Department of Rheumatology Research, Sint Maartenskliniek, Nijmegen, Netherlands.,Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Johanna E Vriezekolk
- Department of Rheumatology Research, Sint Maartenskliniek, Nijmegen, Netherlands
| | - Charlotte L Bekker
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Annemiek J Linn
- Amsterdam School of Communication Research, University of Amsterdam,, Amsterdam, Netherlands
| | - Hein A W van Onzenoort
- Department of Clinical Pharmacy, Amphia Hospital, Breda, Netherlands.,Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Marcia Vervloet
- Nivel (Netherlands Institute for Health Services Research), Utrecht, Netherlands
| | - Sandra van Dulmen
- Nivel (Netherlands Institute for Health Services Research), Utrecht, Netherlands.,Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands.,Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Bart J F van den Bemt
- Department of Rheumatology Research, Sint Maartenskliniek, Nijmegen, Netherlands.,Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
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Mendes NF, Jara CP, Mansour E, Araújo EP, Velloso LA. Asthma and COVID-19: a systematic review. Allergy Asthma Clin Immunol 2021; 17:5. [PMID: 33407838 PMCID: PMC7787409 DOI: 10.1186/s13223-020-00509-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/21/2020] [Indexed: 12/19/2022] Open
Abstract
Background Severe coronavirus disease-19 (COVID-19) presents with progressive dyspnea, which results from acute lung inflammatory edema leading to hypoxia. As with other infectious diseases that affect the respiratory tract, asthma has been cited as a potential risk factor for severe COVID-19. However, conflicting results have been published over the last few months and the putative association between these two diseases is still unproven. Methods Here, we systematically reviewed all reports on COVID-19 published since its emergence in December 2019 to June 30, 2020, looking into the description of asthma as a premorbid condition, which could indicate its potential involvement in disease progression. Results We found 372 articles describing the underlying diseases of 161,271 patients diagnosed with COVID-19. Asthma was reported as a premorbid condition in only 2623 patients accounting for 1.6% of all patients. Conclusions As the global prevalence of asthma is 4.4%, we conclude that either asthma is not a premorbid condition that contributes to the development of COVID-19 or clinicians and researchers are not accurately describing the premorbidities in COVID-19 patients.
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Affiliation(s)
- Natália F Mendes
- School of Nursing, State University of Campinas, Campinas, Brazil.,Laboratory of Cell Signaling, Obesity and Comorbidities Research Center, State University of Campinas, Rua Carl Von Lineaus s/n, Instituto de Biologia, Bloco Z. Campus Universitário Zeferino Vaz, Barão Geraldo, Campinas, SP, 13083-864, Brazil
| | - Carlos P Jara
- School of Nursing, State University of Campinas, Campinas, Brazil.,Laboratory of Cell Signaling, Obesity and Comorbidities Research Center, State University of Campinas, Rua Carl Von Lineaus s/n, Instituto de Biologia, Bloco Z. Campus Universitário Zeferino Vaz, Barão Geraldo, Campinas, SP, 13083-864, Brazil
| | - Eli Mansour
- Clinical Immunology and Allergy, Department of Internal Medicine, State University of Campinas, Campinas, Brazil
| | - Eliana P Araújo
- School of Nursing, State University of Campinas, Campinas, Brazil.,Laboratory of Cell Signaling, Obesity and Comorbidities Research Center, State University of Campinas, Rua Carl Von Lineaus s/n, Instituto de Biologia, Bloco Z. Campus Universitário Zeferino Vaz, Barão Geraldo, Campinas, SP, 13083-864, Brazil
| | - Licio A Velloso
- Laboratory of Cell Signaling, Obesity and Comorbidities Research Center, State University of Campinas, Rua Carl Von Lineaus s/n, Instituto de Biologia, Bloco Z. Campus Universitário Zeferino Vaz, Barão Geraldo, Campinas, SP, 13083-864, Brazil. .,Clinical Immunology and Allergy, Department of Internal Medicine, State University of Campinas, Campinas, Brazil.
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Abstract
PURPOSE OF REVIEW Telemedicine, defined as synchronous video visits between a provider and a child with asthma, often takes place in the school setting. This review examines the new electronic sensors for adherence monitoring and studies that used telemedicine in the school setting to improve asthma outcomes. RECENT FINDINGS School-based telemedicine provides an important service to families of school-aged children who have difficulty due to time and distance in planning and keeping in-person appointments with primary or specialty providers. Significant improvements in objective measures of asthma control are inconsistently observed although caregiver and parent quality of life and child self-management behaviors are improved and satisfaction is high. Assessment and outcomes related to adherence are mentioned in studies but results are not often reported. However, it appears that adherence interventions are beneficial while maintained but the effects are not sustained upon intervention discontinuation. SUMMARY The school setting provides a convenient and suitable environment to conduct telemedicine visits between school-aged children and their primary care or specialty provider. Electronic adherence sensors allow review of controller and rescue medication use through a cloud-based dashboard and provides an opportunity for real-time assessment and intervention by providers to improve asthma outcomes.
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Affiliation(s)
- Kathryn V Blake
- Biomedical Research Department, Center for Pharmacogenomics and Translational Research, Nemours Children's Specialty Care, Jacksonville, Florida, USA
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