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König L, Grünberg E, Xynogalos P, Thomas D, Rivinius R, Frey N, Ullrich C, Rahm AK. [Acceptance of telemetric care for patients with sICD safety advice : Qualitative interview study in cardiological health services research]. Herzschrittmacherther Elektrophysiol 2023; 34:136-141. [PMID: 37106130 PMCID: PMC10229693 DOI: 10.1007/s00399-023-00938-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/10/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Telemonitoring is used to monitor implantable cardioverter defibrillators (ICDs). Despite the scientifically proven effectiveness and safety of telemetric care, studies show that the offer is not used and accepted by all patients. OBJECTIVES The aim of this study is to investigate the attitudes of ICD patients towards telemonitoring, including which aspects influence attitudes and decision-making. METHODS Data were collected using semi-structured, guideline-based individual interviews. A total of 14 patients with a subcutaneous ICD (sICD) and both primary and secondary prophylactic indications were recruited. Data analysis followed a content-structuring qualitative approach. RESULTS Patients with telemonitoring perceived a high benefit with low concerns about digital technology, while the opposite was observed for patients without telemonitoring. The patients' previous medical experience has a crucial impact on the acceptance of telemonitoring. All age groups reported the technical implementation and practical handling of telemonitoring to be simple and uncomplicated. CONCLUSION The results suggest that the primary and secondary prophylactic indication for ICD implantation have an influence on the attitude towards telemonitoring and, thus, on acceptance. Further qualitative research regarding user acceptance of telemonitoring of other ICD systems is needed.
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Affiliation(s)
- Leonie König
- Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.
- Stabstelle Versorgungsentwicklung und -qualität, kbo - Kliniken des Bezirks Oberbayern, München, Deutschland.
| | - Elisabeth Grünberg
- Kardiologie, Angiologie, Pneumologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
- Heidelberger Zentrum für Herzrhythmusstörungen, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Panagiotis Xynogalos
- Kardiologie, Angiologie, Pneumologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
- Heidelberger Zentrum für Herzrhythmusstörungen, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Dierk Thomas
- Kardiologie, Angiologie, Pneumologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
- Heidelberger Zentrum für Herzrhythmusstörungen, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
- DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partnerstandorte Heidelberg/Mannheim, Heidelberg/Mannheim, Deutschland
| | - Rasmus Rivinius
- Kardiologie, Angiologie, Pneumologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
- Heidelberger Zentrum für Herzrhythmusstörungen, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
- DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partnerstandorte Heidelberg/Mannheim, Heidelberg/Mannheim, Deutschland
| | - Norbert Frey
- Kardiologie, Angiologie, Pneumologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
- Heidelberger Zentrum für Herzrhythmusstörungen, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
- DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partnerstandorte Heidelberg/Mannheim, Heidelberg/Mannheim, Deutschland
| | - Charlotte Ullrich
- Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Ann-Kathrin Rahm
- Kardiologie, Angiologie, Pneumologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
- Heidelberger Zentrum für Herzrhythmusstörungen, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
- DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung), Partnerstandorte Heidelberg/Mannheim, Heidelberg/Mannheim, Deutschland
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Borchers P, Pfisterer D, Scherpf M, Voigt K, Bergmann A. Needs- and user-oriented development of contactless camera-based telemonitoring in heart disease-Results of an acceptance survey from the Home-based Healthcare Project (feasibility project). PLoS One 2023; 18:e0282527. [PMID: 36881604 PMCID: PMC9990940 DOI: 10.1371/journal.pone.0282527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 02/16/2023] [Indexed: 03/08/2023] Open
Abstract
Home-based telemonitoring in heart failure patients can reduce all-cause mortality and the relative risk of heart failure-related hospitalization compared to standard care. However, technology use depends, among other things, on user acceptance, making it important to include potential users early in development. In a home-based healthcare project (a feasibility project) a participatory approach was chosen in preparation for future development of contactless camera-based telemonitoring in heart disease patients. The project study patients (n = 18) were surveyed regarding acceptance and design expectations, and acceptance-enhancing measures and design suggestions were then drawn from the results. The study patients corresponded to the target group of potential future users. 83% of respondents showed high acceptance. 17% of those surveyed were more skeptical with moderate or low acceptance. The latter were female, mostly living alone, and without technical expertise. Low acceptance was associated with a higher expectation of effort and lower perception of self-efficacy and lower integratability into daily rhythms. For the design, the respondents found independent operation of the technology very important. Furthermore, concerns were expressed about the new measuring technology, e.g., anxiety about constant surveillance. The acceptance of a new generation of medical technology (contactless camera-based measuring technology) for telemonitoring is already quite high in the surveyed group of older users (60+). Specific user expectations concerning design should be considered during development to increase acceptance by potential users even more.
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Affiliation(s)
- Peggy Borchers
- Faculty of Medicine Carl Gustav Carus, Department of General Practice, Medical Clinic III, Technische Universität Dresden, Dresden, Germany
- * E-mail:
| | - David Pfisterer
- Faculty of Medicine Carl Gustav Carus, Department of General Practice, Medical Clinic III, Technische Universität Dresden, Dresden, Germany
| | - Matthieu Scherpf
- Institute for Biomedical Engineering, Technische Universität Dresden, Dresden, Germany
| | - Karen Voigt
- Faculty of Medicine Carl Gustav Carus, Department of General Practice, Medical Clinic III, Technische Universität Dresden, Dresden, Germany
| | - Antje Bergmann
- Faculty of Medicine Carl Gustav Carus, Department of General Practice, Medical Clinic III, Technische Universität Dresden, Dresden, Germany
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Barriers and Supports in eHealth Implementation among People with Chronic Cardiovascular Ailments: Integrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148296. [PMID: 35886149 PMCID: PMC9318125 DOI: 10.3390/ijerph19148296] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 02/01/2023]
Abstract
eHealth interventions use information technology to provide attention to patients with chronic cardiovascular conditions, thereby supporting their self-management abilities. OBJECTIVE Identify barriers and aids to the implementation of eHealth interventions in people with chronic cardiovascular conditions from the perspectives of users, health professionals and institutions. METHOD An integrative database review of WoS, Scopus, PubMed and Scielo of publications between 2016 and 2020 reporting eHealth interventions in people with chronic cardiovascular diseases. Keywords used were eHealth and chronic disease. Following inclusion and exclusion criteria application, 14 articles were identified. RESULTS Barriers and aids were identified from the viewpoints of users, health professionals and health institutions. Some notable barriers include users' age and low technological literacy, perceived depersonalization in attention, limitations in technology access and usability, and associated costs. Aids included digital education and support from significant others. CONCLUSIONS eHealth interventions are an alternative with wide potentiality for chronic disease management; however, their implementation must be actively managed.
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Göbl L, Weis A, Hoffmann M, Wiezorreck L, Wensing M, Szecsenyi J, Litke N. [An exploratory cross-sectional study on technical affinity and smartphone use among practice staff and patients: development of an app for multimorbid patients in general practice]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 169:39-47. [PMID: 35058166 DOI: 10.1016/j.zefq.2021.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/30/2021] [Accepted: 11/03/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Due to individual care needs, the provision of care to patients with two or more chronic diseases (multimorbidity) is described as complex. In addition, the number of chronically ill people is increasing, due in part to demographic changes which pose a challenge, especially for outpatient primary care. In order to fulfil patients' needs and to promote self-management as a central care element of chronically ill patients, the use of eHealth applications increases. TelePraCMan will be developed as one of these applications and includes a symptom-based electronic diary, which will be implemented in the established German disease management programme 'PraCMan'. This study is conducted as a part of the TelePraCMan project and aims to detect the needs of potential end users (physicians, medical assistants, patients). METHODS In the TelePraCMan development phase, an explorative cross-sectional study was conducted with potential end users of the TelePraCMan app (patients, physicians and medical assistants). For this purpose, a written survey was conducted in Baden-Wurttemberg between April 2019 and March 2020. The survey covered smartphone usage behaviour, technology affinity using the standardised questionnaire TA-EG, support network for technical questions and sociodemographic data. RESULTS A total of n=202 patients (n=98), physicians (n=58) and medical assistants (n=43) participated in the survey. Concerning smartphone use, 78.2 % of the participants stated that the function used most frequently was writing short messages. Health apps were the least used function (9.6 %). Furthermore, patients (12.6 %) use health apps more often than medical assistants (10.3%) and doctors (4.4 %). Participants aged 50 and younger were found to have a higher affinity for technology (mean=3.20, SD=0.51) than participants over 50 years of age (mean=2.98, SD=0.67). Older, multimorbid respondents had a particularly low affinity for technology (mean=2.52, SD=0.69). 10.9 % of the over-fifties and 12.5 % of the multimorbid persons felt able to fix any technical problems on their own without help. Multimorbid participants over the age of 50 were observed to prefer personal support over internet-based support. DISCUSSION On average, multimorbid respondents in the age group over 50 have a lower affinity for technology than respondents aged under 50 without multimorbidity. The most frequent negative attitude towards electronic devices is also found among patients over 50 years of age, who are expected to be the main target group of the TelePraCMan app. These findings can be used to derive requirements for the design and development of functions of the app, as well as accompanying measures, such as intuitive and simple user interface, a telephone hotline to support users, close consultation with users on the planned functions, and more. CONCLUSION Based on this survey, we were able to determine the needs of the future target group of the TelePraCMan app. This is seen as a starting point for the development of an implementation strategy and the pilot testing of the app in primary care.
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Affiliation(s)
- Linda Göbl
- Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Aline Weis
- Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Mariell Hoffmann
- Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Lars Wiezorreck
- Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Michel Wensing
- Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Joachim Szecsenyi
- Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Nicola Litke
- Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.
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Borchers P, Piller S, Böhme M, Voigt K, Bergmann A. Need-based care of multi-morbid patients - supporting general practitioners with algorithm-generated recommendations of healthcare services (telemedicine-project ATMoSPHÄRE). BMC FAMILY PRACTICE 2021; 22:198. [PMID: 34625053 PMCID: PMC8499564 DOI: 10.1186/s12875-021-01537-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/07/2021] [Indexed: 11/23/2022]
Abstract
Background The patient-oriented and need-based care of multi-morbid patients with healthcare services and assistive products can be a highly complex task for the general practitioners (GPs). An algorithm-based digital recommendation system (DRS) for healthcare services was developed within the context of the telemedicine research project ATMoSPHÄRE. The plausibility of the DRS was tested and the results used to examine if, and to what degree, the DRS provides useful assistance to GPs. Methods The plausibility of the recommendations of the DRS were tested with the Delphi procedure (n = 8) and Interviews (n = 4) in collaboration with the GPs. They proposed services and assistive products they considered appropriate for two multi-morbid patients. Furthermore, GPs had to report whether, and to what degree they deemed the algorithm-generated recommendations appropriate. Significant quantitative differences between the GPs’, and the algorithm-generated, recommendations were evaluated with paired-samples-Wilcoxon-test. Results The first Delphi round revealed a high variability regarding the amount and character of services recommended by the physicians (1 to 10 recommendations, mean = 5.6, sd = 2.8). These professional recommendations converged after consideration of the algorithm-generated recommendations. The number of algorithm-generated recommendations which were judged as appropriate ranged between 7 and 17 of a total of 20 (mean = 11.9, sd = 2.5). The interviews revealed that the additional algorithm-generated recommendations which were judged appropriate contained mainly social care services. Conlusion The DRS provides GPs with additional appropriate recommendations for the need-based care of patients, which may not have been previously considered. It can therefore be assessed as a helpful complement in the primary care of multi-morbid patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01537-2.
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Affiliation(s)
- Peggy Borchers
- Department of General Practice, Medical Clinic III, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| | | | - Mandy Böhme
- Department of General Practice, Medical Clinic III, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Karen Voigt
- Department of General Practice, Medical Clinic III, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Antje Bergmann
- Department of General Practice, Medical Clinic III, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
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Hertling S, Hertling D, Martin D, Graul I. Acceptance, Use and Barriers of Telemedicine in times of SARS-CoV-2 in Transgender Health Care: Results of a nationwide cross-sectional survey. JMIR Public Health Surveill 2021; 7:e30278. [PMID: 34591783 PMCID: PMC8647970 DOI: 10.2196/30278] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/02/2021] [Accepted: 09/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background The global incidence in the treatment of transgender people is increasing. During the COVID-19 pandemic, many consultations had to be cancelled, postponed, or converted to a virtual format. Telemedicine in the management of transgender health care could support physicians. Objective The aim of this study was to analyze the acceptance, use, and barriers of telemedicine in transgender health care in times of SARS-CoV-2 in Germany. Methods This prospective cross-sectional study was based on a survey of gynecological endocrinologists and transgender patients undergoing gender-affirming hormone treatment in Germany during the COVID-19 pandemic. Descriptive statistics were calculated, and regression analyses were performed to show correlations. Results We analyzed responses of 269 transgender patients and 202 gynecological endocrinologists treating transgender patients. Most believed that telemedicine was useful. Physicians and patients rated their knowledge of telemedicine as unsatisfactory. The majority of respondents said they did not currently use telemedicine, although they would like to do so. Patients and physicians reported that their attitudes toward telemedicine had changed positively and that their use of telemedicine had increased due to COVID-19. The majority in both groups agreed on the implementation of virtual visits in the context of stable disease conditions. In the treatment phases, 74.3% (150/202) of the physicians said they would use telemedicine during follow-ups. Half of the physicians said they would choose tele-counseling as a specific approach to improving care (128/202, 63.4%). Obstacles to the introduction of telemedicine among physicians included the purchase of technical equipment (132/202, 65.3%), administration (124/202, 61.4%), and poor reimbursement (106/202, 52.5%). Conclusions Telemedicine in transgender health care found limited use but high acceptance among doctors and patients alike. The absence of a structured framework is an obstacle for effective implementation. Training courses should be introduced to improve the limited knowledge of physicians in the use of telemedicine. More research in tele-endogynecology is needed. Future studies should include large-scale randomized controlled trials, economic analyses, and the exploration of user preferences.
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Affiliation(s)
- Stefan Hertling
- Department of Obstetrics and Gynaecology, University Hospital Jena, Am Klinikum 1, Jena, DE.,Orthopaedic Department, Campus Eisenberg, University Hospital Jena, Eisenberg, Germany, Eisenberg, DE.,Fakultät für Gesundheit (Department für Humanmedizin), Lehrstuhl für Medizintheorie, Integrative und Anthroposophische Medizin, Witten/Herdecke, DE
| | - Doreen Hertling
- Department of Gynaecology, Hospital Rummelsberg, University Hospital Erlangen, Rummelsberg, DE
| | - David Martin
- Fakultät für Gesundheit (Department für Humanmedizin), Lehrstuhl für Medizintheorie, Integrative und Anthroposophische Medizin, Witten/Herdecke, DE
| | - Isabel Graul
- Department of trauma, hand and reconstructive surgery, University hospital Jena, Jena, Germany, Jena, DE.,Orthopaedic Department, Campus Eisenberg, University Hospital Jena, Eisenberg, Germany, Eisenberg, DE.,Department für Orthopädie, Unfall - Universitätsklinikum Halle, Halle, DE
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Yue J, Yang X, Wang B, Hu H, Fu H, Gao Y, Sun G. Home blood pressure telemonitoring for improving blood pressure control in middle-aged and elderly patients with hypertension. J Clin Hypertens (Greenwich) 2021; 23:1744-1751. [PMID: 34350677 PMCID: PMC8678721 DOI: 10.1111/jch.14341] [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] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/10/2021] [Accepted: 07/19/2021] [Indexed: 01/16/2023]
Abstract
The blood pressure (BP) control rate among treated hypertensives in China remains low at 37.5%. The relationship between home blood pressure telemonitoring (HBPT) and BP control is controversial. The authors aimed to investigate the relationship between HBPT and BP control in middle‐aged and elderly hypertensives. In total, 252 hypertension patients aged between 60 and 79 years were enrolled. The patients were given either HBPT through interactive platforms between physicians and patients (telemonitoring group, n = 126) or conventional management (routine management group, n = 126). All patients were followed‐up for 15 months. BP control was defined as home systolic blood pressure < 135 mm Hg and home diastolic blood pressure < 85 mm Hg. At baseline, there were no significant differences in the baseline BP control rate (p = .083). However, after 15 months, the BP control rate improved in both groups, and the telemonitoring group (71.3%) had a significantly higher BP control than the routine management group (49.8%) (p < .001). The change of BP control rate from baseline in the routine management group increased by 26.1%, and that of the telemonitoring group increased by 35.4%. The results of the fully adjusted binary logistic regression showed that HBPT was positively associated with BP control after adjusting for confounders (OR = 4.15, 95% CI 2.05–8.39). Similar results were observed after 3, 9, and 12 months. The association of HBPT with BP control was similar in subgroups. In conclusions, HBPT is recommended for BP control in middle‐aged and elderly hypertensives in the community setting.
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Affiliation(s)
- Jianwei Yue
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, P.R. China.,Research Institute of Hypertension, Department of Cardiovascular Medicine, The Second Affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia, P.R. China
| | - Xiaomin Yang
- Research Institute of Hypertension, Department of Cardiovascular Medicine, The Second Affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia, P.R. China
| | - Bin Wang
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Han Hu
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Haiming Fu
- Department of Clinical Laboratory, Baotou Maternal and Child Health Center, Baotou, Inner Mongolia Autonomous Region, P.R. China
| | - Yuxia Gao
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Gang Sun
- Research Institute of Hypertension, Department of Cardiovascular Medicine, The Second Affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia, P.R. China
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Dennett EJ, Janjua S, Stovold E, Harrison SL, McDonnell MJ, Holland AE. Tailored or adapted interventions for adults with chronic obstructive pulmonary disease and at least one other long-term condition: a mixed methods review. Cochrane Database Syst Rev 2021; 7:CD013384. [PMID: 34309831 PMCID: PMC8407330 DOI: 10.1002/14651858.cd013384.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a chronic respiratory condition characterised by shortness of breath, cough and recurrent exacerbations. People with COPD often live with one or more co-existing long-term health conditions (comorbidities). People with more severe COPD often have a higher number of comorbidities, putting them at greater risk of morbidity and mortality. OBJECTIVES To assess the effectiveness of any single intervention for COPD adapted or tailored to their comorbidity(s) compared to any other intervention for people with COPD and one or more common comorbidities (quantitative data, RCTs) in terms of the following outcomes: Quality of life, exacerbations, functional status, all-cause and respiratory-related hospital admissions, mortality, pain, and depression and anxiety. To assess the effectiveness of an adapted or tailored single COPD intervention (simple or complex) that is aimed at changing the management of people with COPD and one or more common comorbidities (quantitative data, RCTs) compared to usual care in terms of the following outcomes: Quality of life, exacerbations, functional status, all-cause and respiratory-related hospital admissions, mortality, pain, and depression and anxiety. To identify emerging themes that describe the views and experiences of patients, carers and healthcare professionals when receiving or providing care to manage multimorbidities (qualitative data). SEARCH METHODS We searched multiple databases including the Cochrane Airways Trials Register, CENTRAL, MEDLINE, Embase, and CINAHL, to identify relevant randomised and qualitative studies. We also searched trial registries and conducted citation searches. The latest search was conducted in January 2021. SELECTION CRITERIA Eligible randomised controlled trials (RCTs) compared a) any single intervention for COPD adapted or tailored to their comorbidity(s) compared to any other intervention, or b) any adapted or tailored single COPD intervention (simple or complex) that is aimed at changing the management of people with COPD and one or more comorbidities, compared to usual care. We included qualitative studies or mixed-methods studies to identify themes. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods for analysis of the RCTs. We used Cochrane's risk of bias tool for the RCTs and the CASP checklist for the qualitative studies. We planned to use the Mixed Methods Appraisal tool (MMAT) to assess the risk of bias in mixed-methods studies, but we found none. We used GRADE and CERQual to assess the quality of the quantitative and qualitative evidence respectively. The primary outcome measures for this review were quality of life and exacerbations. MAIN RESULTS Quantitative studies We included seven studies (1197 participants) in the quantitative analyses, with interventions including telemonitoring, pulmonary rehabilitation, treatment optimisation, water-based exercise training and case management. Interventions were either compared with usual care or with an active comparator (such as land-based exercise training). Duration of trials ranged from 4 to 52 weeks. Mean age of participants ranged from 64 to 72 years and COPD severity ranged from mild to very severe. Trials included either people with COPD and a specific comorbidity (including cardiovascular disease, metabolic syndrome, lung cancer, head or neck cancer, and musculoskeletal conditions), or with one or more comorbidities of any type. Overall, we judged the evidence presented to be of moderate to very low certainty (GRADE), mainly due to the methodological quality of included trials and imprecision of effect estimates. Intervention versus usual care Quality of life as measured by the St George's Respiratory Questionnaire (SGRQ) total score may improve with tailored pulmonary rehabilitation compared to usual care at 52 weeks (mean difference (MD) -10.85, 95% confidence interval (CI) -12.66 to -9.04; 1 study, 70 participants; low-certainty evidence). Tailored pulmonary rehabilitation is likely to improve COPD assessment test (CAT) scores compared with usual care at 52 weeks (MD -8.02, 95% CI -9.44 to -6.60; 1 study, 70 participants, moderate-certainty evidence) and with a multicomponent telehealth intervention at 52 weeks (MD -6.90, 95% CI -9.56 to -4.24; moderate-certainty evidence). Evidence is uncertain about effects of pharmacotherapy optimisation or telemonitoring interventions on CAT improvement compared with usual care. There may be little to no difference in the number of people experiencing exacerbations, or mean exacerbations with case management compared with usual care (OR 1.09, 95% CI 0.75 to 1.57; 1 study, 470 participants; very low-certainty evidence). For secondary outcomes, six-minute walk distance (6MWD) may improve with pulmonary rehabilitation, water-based exercise or multicomponent interventions at 38 to 52 weeks (low-certainty evidence). A multicomponent intervention may result in fewer people being admitted to hospital at 17 weeks, although there may be little to no difference in a telemonitoring intervention. There may be little to no difference between intervention and usual care for mortality. Intervention versus active comparator We included one study comparing water-based and land-based exercise (30 participants). We found no evidence for quality of life or exacerbations. There may be little to no difference between water- and land-based exercise for 6MWD (MD 5 metres, 95% CI -22 to 32; 38 participants; very low-certainty evidence). Qualitative studies One nested qualitative study (21 participants) explored perceptions and experiences of people with COPD and long-term conditions, and of researchers and health professionals who were involved in an RCT of telemonitoring equipment. Several themes were identified, including health status, beliefs and concerns, reliability of equipment, self-efficacy, perceived ease of use, factors affecting usefulness and perceived usefulness, attitudes and intention, self-management and changes in healthcare use. We judged the qualitative evidence presented as of very low certainty overall. AUTHORS' CONCLUSIONS Owing to a paucity of eligible trials, as well as diversity in the intervention type, comorbidities and the outcome measures reported, we were unable to provide a robust synthesis of data. Pulmonary rehabilitation or multicomponent interventions may improve quality of life and functional status (6MWD), but the evidence is too limited to draw a robust conclusion. The key take-home message from this review is the lack of data from RCTs on treatments for people living with COPD and comorbidities. Given the variation in number and type of comorbidity(s) an individual may have, and severity of COPD, larger studies reporting individual patient data are required to determine these effects.
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Affiliation(s)
- Emma J Dennett
- Cochrane Airways, Population Health Research Institute, St George's, University of London, London, UK
| | - Sadia Janjua
- Cochrane Airways, Population Health Research Institute, St George's, University of London, London, UK
| | - Elizabeth Stovold
- Cochrane Airways, Population Health Research Institute, St George's, University of London, London, UK
| | | | - Melissa J McDonnell
- Department of Respiratory Medicine, Galway University Hospital, Galway, Ireland
| | - Anne E Holland
- Physiotherapy, Alfred Health, Melbourne, Australia
- Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
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Scheibe M, Lang C, Druschke D, Arnold K, Luntz E, Schmitt J, Holthoff-Detto V. Independent Use of a Home-Based Telemonitoring App by Older Patients With Multimorbidity and Mild Cognitive Impairment: Qualitative Study. JMIR Hum Factors 2021; 8:e27156. [PMID: 34255664 PMCID: PMC8314150 DOI: 10.2196/27156] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/16/2021] [Accepted: 05/03/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The management of multimorbidity is complex and patients have a high burden of disease. When symptoms of dementia also appear, it becomes even more difficult for patients to cope with their everyday lives and manage their diseases. Home-based telemonitoring may support older patients with multimorbidity and mild cognitive impairment (MCI) in their regular monitoring and self-management. However, to date, there has been no investigation into whether patients with MCI are able to operate a telemonitoring app independently to manage their own diseases. This question has become even more important during the current COVID-19 pandemic to maintain high-quality medical care for this patient group. OBJECTIVE We examined the following research questions: (1) How do patients with MCI assess the usability of the telemonitoring app? (2) How do patients with MCI assess the range of functions offered by the telemonitoring app? (3) Was there an additional benefit for the patients with MCI in using the telemonitoring app? (4) Were patients with MCI able to use the telemonitoring app independently and without restrictions? (5) To what extent does previous experience with smartphones, tablets, or computers influence the perceived ease of use of the telemonitoring app? METHODS We performed a formative evaluation of a telemonitoring app. Therefore, we carried out a qualitative study and conducted guided interviews. All interviews were audio-recorded, transcribed verbatim, and analyzed using the Mayring method of structured content analysis. RESULTS Twelve patients (8 women, 4 men) were interviewed; they had an average age of 78.7 years (SD 5.6) and an average Mini-Mental State Examination score of 24.5 (SD 1.6). The interviews lasted between 17 and 75 minutes (mean 41.8 minutes, SD 19.4). Nine patients reported that the telemonitoring app was easy to use. All respondents assessed the range of functions as good or adequate. Desired functionalities mainly included more innovative and varied educational material, better fit of the telemonitoring app for specific needs of patients with MCI, and a more individually tailored content. Ten of the 12 patients stated that the telemonitoring app had an additional benefit for them. Most frequently reported benefits included increased feeling of security, appreciation of regular monitoring of vital parameters, and increased independence due to telemonitoring. Eight patients were able to operate the app independently. Participants found the app easy to use regardless of whether they had prior experience with smartphones, tablets, or computers. CONCLUSIONS The majority of examined patients with MCI were capable of operating the telemonitoring app independently. Crucial components in attaining independent use were comprehensive personal support from the start of use and appropriate design features. This study provides initial evidence that patients with MCI could increasingly be considered as a relevant user group of telemonitoring apps.
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Affiliation(s)
- Madlen Scheibe
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Caroline Lang
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Diana Druschke
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Katrin Arnold
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Edwin Luntz
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Vjera Holthoff-Detto
- Department of Psychiatry, Psychotherapy and Psychosomatics, Alexianer Hospital Hedwigshöhe, St Hedwig Hospital Berlin, Berlin, Germany
- Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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Bolzani A, Ramsenthaler C, Hodiamont F, Burner-Fritsch IS, Bausewein C. Monitoring of Palliative Care Symptoms and Concerns in Specialized Palliative Home Care Using an Electronic Version of the Integrated Palliative care Outcome Scale (Palli-MONITOR): protocol for a mixed-methods study. BMJ Open 2021; 11:e042266. [PMID: 34078632 PMCID: PMC8173291 DOI: 10.1136/bmjopen-2020-042266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Over the last decades, patient-reported outcome (PRO) measures have been developed to better understand the patient's perspective and enable patient-centred care. In palliative care, the Integrated Palliative care Outcome Scale (IPOS) is recommended as a PRO tool. Its implementation in specialised palliative home care (SPHC) would benefit from an electronic version validated for the setting.Following the Medical Research Council (MRC) guidance, the study Palli-MONITOR is developing (phase 1) and testing the feasibility (phase 2) of implementing the electronic version of IPOS (eIPOS) in the SPHC setting to inform a cluster-randomised phase 3 trial. METHODS AND ANALYSIS Palli-MONITOR is a multicentre, sequential mixed-methods, two-phase development and feasibility study. The study consists of four substudies. In phase 1 (MRC development phase), qualitative patient interviews and focus groups with SPHC professionals are used to identify barriers and facilitators of eIPOS (substudy I). Substudy II tests the equivalence of eIPOS and IPOS in a crossover randomised controlled trial. Phase 2 (MRC feasibility/piloting phase) includes a quasi-experimental study with two control groups (substudy III), and qualitative interviews as well as focus groups to explore the feasibility and acceptability of the developed intervention (substudy IV).Qualitative data will be analysed with thematic analysis following the framework approach. Quantitative analysis uses a two-way intraclass correlation coefficients model for the equivalence testing. Quantitative analysis of the quasi-experimental study will focus on the primary outcomes, recruitment rates and completeness of eIPOS. Secondary outcomes will include intraindividual change in palliative symptoms and concerns, quality of life and symptom burden. ETHICS AND DISSEMINATION Approval of the ethics committee of the Ludwig Maximilian University Munich was received for all study parts. Results and experiences will be presented at congresses and in written form. Additionally, participating SPHC teams will receive summarised results. TRIAL REGISTRATION NUMBER NCT03879668.
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Affiliation(s)
- Anna Bolzani
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Christina Ramsenthaler
- Department of Palliative Medicine, Albert Ludwig University of Freiburg, Freiburg im Breisgau, Germany
- Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Farina Hodiamont
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
| | | | - Claudia Bausewein
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
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Lang C, Roessler M, Schmitt J, Bergmann A, Holthoff-Detto V. Health-related quality of life in elderly, multimorbid individuals with and without depression and/or mild cognitive impairment using a telemonitoring application. Qual Life Res 2021; 30:2829-2841. [PMID: 33983617 PMCID: PMC8481145 DOI: 10.1007/s11136-021-02848-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Multimorbidity leads to decreasing health-related quality of life (HRQoL). Telemedicine may help to improve HRQoL. The present study was conducted to show (I) differences in HRQoL and changes in HRQoL over time in elderly, multimorbid individuals with and without depression and/or mild cognitive impairment (MCI) using a telemonitoring application (TMA) and (II) associations between engagement with measurements by study participants using a TMA and changes in their HRQoL. METHODS The present feasibility study was part of a longitudinal intervention study. Recruited general practitioners (GPs) enrolled individuals and assigned them to risk groups according to absence/presence of depression and/or MCI. Depression was assessed using the Geriatric Depression Scale (GDS-15), MCI using the Mini-Mental State Examination (MMSE), and HRQoL using the SF-12. The TMA consisted of tablets, software, and measuring devices. Measured vital data were transferred to a care and case manager for monitoring and possible intervention. RESULTS Nine GPs recruited 177 individuals, 97 of whom were included in the HRQoL analysis. Significantly lower physical and mental component summary (PCS/MCS) scores were revealed in study participants with depression, and with both depression and MCI, compared to participants with no mental disorders. PCS scores did not differ between study dates, but MCS scores had significantly increased over time. Participants' engagement with measurements was significantly associated with an increased MCS score, but not with the PCS score. DISCUSSION Depression and/or MCI are negatively associated with the HRQoL of elderly, multimorbid people using a TMA. Engagement of individuals with vital data measurements via a TMA may increase their mental HRQoL. Mentally impaired people should be closely involved as co-designers and experts in development processes of TMAs to benefit from tailored solutions. An individual's increased mental HRQoL can be a decisive factor in their engagement with a GP treatment regimen and telemonitoring processes.
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Affiliation(s)
- Caroline Lang
- Center for Evidence-Based Healthcare, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Martin Roessler
- Center for Evidence-Based Healthcare, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Antje Bergmann
- Department of General Practice, Medical Clinic III, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Vjera Holthoff-Detto
- Department of Psychiatry, Psychotherapy and Psychosomatics, Alexianer Hospital Hedwigshöhe, St. Hedwig Hospital Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Teleassistance for frail elderly people: A usability and customer satisfaction study. Geriatr Nurs 2020; 41:463-467. [DOI: 10.1016/j.gerinurse.2020.01.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/21/2020] [Accepted: 01/23/2020] [Indexed: 12/31/2022]
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Lang C, Voigt K, Neumann R, Bergmann A, Holthoff-Detto V. Adherence and acceptance of a home-based telemonitoring application used by multi-morbid patients aged 65 years and older. J Telemed Telecare 2020; 28:37-51. [PMID: 32009577 PMCID: PMC8721554 DOI: 10.1177/1357633x20901400] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Currently, there are only a small number of comprehensive study results on adherence and acceptance of telemonitoring applications (TMAs) regarding multi-morbid older patients. The ATMoSPHAERE study aimed to develop an information and communication platform for an intersectoral networking of, for example, general practitioners, therapists, social services and the multi-morbid older patient. Methods The study presented was designed as a longitudinal bicentric intervention study which focused on multi-morbid patients aged ≥65 years using home-based telemedical measurement and input devices. The development and testing of this TMA aimed to optimise patients’ health care through intersectoral networking of all treating actors. Quantitative methods of data collection and analysis were used. Results Patients who completed the study were significantly younger than drop-outs and non-participants. The mental health of study patients significantly improved between the beginning and end of TMA use. The main reason for non-participation in the study was the high time expenditure when participating in the study. No perceived (information) benefits for health and insufficient content variety were the main reasons for drop-out. Appropriateness and handling of TMAs must be aligned with the needs of the heterogeneous user group of multi-morbid patients in order to increase acceptance and the added value of TMAs. Telemonitoring hardware should be oriented on functional capabilities of the older target group. Telemonitoring software content requires an individual, disease-specific approach for patients. The TMA should be unobtrusively integrated into usual daily life and be used to an appropriate extent according to the underlying disease in order to avoid stressing patients. With regard to adherence concerning TMAs, it is crucial to provide a contact person who is always available for patients having problems handling TMAs. Health concerns and questions can thus be addressed early, providing a feeling of safety in the care process. Discussion User acceptance of TMAs is an essential indicator and driver for use and for future implementation efforts in health care. In order to achieve maximum user centricity in development processes, patients must be involved as experts, co-designers and future users, considering their needs and perceptions.
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Affiliation(s)
- Caroline Lang
- Department of General Practice, Medical Clinic III, Medical Faculty, Technische Universität Dresden, Germany.,Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Germany
| | - Karen Voigt
- Department of General Practice, Medical Clinic III, Medical Faculty, Technische Universität Dresden, Germany
| | - Robert Neumann
- Institute of Sociology, Philosophical Faculty, Technische Universität Dresden, Germany
| | - Antje Bergmann
- Department of General Practice, Medical Clinic III, Medical Faculty, Technische Universität Dresden, Germany
| | - Vjera Holthoff-Detto
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, Alexianer Hospital Hedwigshöhe, St. Hedwig Hospital Berlin, Germany
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[Not Available]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2019; 141-142:74-75. [PMID: 31047826 DOI: 10.1016/j.zefq.2019.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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