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Wang W, Li M, Loban K, Zhang J, Wei X, Mitchel R. Electronic health record and primary care physician self-reported quality of care: a multilevel study in China. Glob Health Action 2024; 17:2301195. [PMID: 38205626 PMCID: PMC10786430 DOI: 10.1080/16549716.2023.2301195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Health information technology is one of the building blocks of a high-performing health system. However, the evidence regarding the influence of an electronic health record (EHR) on the quality of care remains mixed, especially in low- and middle-income countries. OBJECTIVE This study examines the association between greater EHR functionality and primary care physician self-reported quality of care. METHODS A total of 224 primary care physicians from 38 community health centres (CHCs) in four large Chinese cities participated in a cross-sectional survey to assess CHC care quality. Each CHC director scored their CHC's EHR functionality on the availability of ten typical features covering health information, data, results management, patient access, and clinical decision support. Data analysis utilised hierarchical linear modelling. RESULTS The availability of five EHR features was positively associated with physician self-reported clinical quality: share records online with providers outside the practice (β = 0.276, p = 0.04), access records online by the patient (β = 0.325, p = 0.04), alert provider of potential prescription problems (β = 0.353, p = 0.04), send the patient reminders for care (β = 0.419, p = 0.003), and list patients by diagnosis or health risk (β = 0.282, p = 0.04). However, no association was found between specific features availability or total features score and physician self-reported preventive quality. CONCLUSIONS This study provides evidence that the availability of EHR systems, and specific features of these systems, was positively associated with physician self-reported quality of care in these 38 CHCs. Future longitudinal studies focused on standardised quality metrics, and designed to control known confounding variables, will further inform quality improvement efforts in primary care.
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Affiliation(s)
- Wenhua Wang
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, PR China
| | - Mengyao Li
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, PR China
| | - Katya Loban
- Research Institute of the McGill University Health Centre, McGill University, Montreal, Canada
| | - Jinnan Zhang
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, PR China
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Rebecca Mitchel
- Health and Wellbeing Research Unit (HoWRU), Macquarie Business School, Macquarie University, Sydney, Australia
- Newcastle Business School, University of Newcastle, Newcastle, Australia
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Reyes-Soffer G, Yeang C, Michos ED, Boatwright W, Ballantyne CM. High lipoprotein(a): Actionable strategies for risk assessment and mitigation. Am J Prev Cardiol 2024; 18:100651. [PMID: 38646021 PMCID: PMC11031736 DOI: 10.1016/j.ajpc.2024.100651] [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: 12/08/2023] [Revised: 03/13/2024] [Accepted: 03/17/2024] [Indexed: 04/23/2024] Open
Abstract
High levels of lipoprotein(a) [Lp(a)] are causal for atherosclerotic cardiovascular disease (ASCVD). Lp(a) is the most prevalent inherited dyslipidemia and strongest genetic ASCVD risk factor. This risk persists in the presence of at target, guideline-recommended, LDL-C levels and adherence to lifestyle modifications. Epidemiological and genetic evidence supporting its causal role in ASCVD and calcific aortic stenosis continues to accumulate, although various facets regarding Lp(a) biology (genetics, pathophysiology, and expression across race/ethnic groups) are not yet fully understood. The evolving nature of clinical guidelines and consensus statements recommending universal measurements of Lp(a) and the scientific data supporting its role in multiple disease states reinforce the clinical merit to start population screening for Lp(a) now. There is a current gap in the implementation of recommendations for primary and secondary cardiovascular disease (CVD) prevention in those with high Lp(a), in part due to a lack of protocols for management strategies. Importantly, targeted apolipoprotein(a) [apo(a)]-lowering therapies that reduce Lp(a) levels in patients with high Lp(a) are in phase 3 clinical development. This review focuses on the identification and clinical management of patients with high Lp(a). Specifically, we highlight the clinical value of measuring Lp(a) and its use in determining Lp(a)-associated CVD risk by providing actionable guidance, based on scientific knowledge, that can be utilized now to mitigate risk caused by high Lp(a).
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Affiliation(s)
| | - Calvin Yeang
- Department of Medicine, UC San Diego Health, CA, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, MD, USA
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Vincent W. Willingness to Use Digital Health Screening and Tracking Tools for Public Health in Sexual Minority Populations in a National Probability Sample: Quantitative Intersectional Analysis. J Med Internet Res 2024; 26:e47448. [PMID: 38457790 PMCID: PMC10960216 DOI: 10.2196/47448] [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: 03/20/2023] [Revised: 11/29/2023] [Accepted: 12/20/2023] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Little is known about sexual minority adults' willingness to use digital health tools, such as pandemic-related tools for screening and tracking, outside of HIV prevention and intervention efforts for sexual minority men, specifically. Additionally, given the current cultural climate in the United States, heterosexual and sexual minority adults may differ in their willingness to use digital health tools, and there may be within-group differences among sexual minority adults. OBJECTIVE This study compared sexual minority and heterosexual adults' willingness to use COVID-19-related digital health tools for public health screening and tracking and tested whether sexual minority adults differed from each other by age group, gender, and race or ethnicity. METHODS We analyzed data from a cross-sectional, national probability survey (n=2047) implemented from May 30 to June 8, 2020, in the United States during the height of the public health response to the COVID-19 pandemic. Using latent-variable modeling, heterosexual and sexual minority adults were tested for differences in their willingness to use digital health tools for public health screening and tracking. Among sexual minority adults, specifically, associations with age, gender, and race or ethnicity were assessed. RESULTS On average, sexual minority adults showed greater willingness to use digital health tools for screening and tracking than heterosexual adults (latent factor mean difference 0.46, 95% CI 0.15-0.77). Among sexual minority adults, there were no differences by age group, gender, or race or ethnicity. However, African American (b=0.41, 95% CI 0.19-0.62), Hispanic or Latino (b=0.36, 95% CI 0.18-0.55), and other racial or ethnic minority (b=0.54, 95% CI 0.31-0.77) heterosexual adults showed greater willingness to use digital health tools for screening and tracking than White heterosexual adults. CONCLUSIONS In the United States, sexual minority adults were more willing to use digital health tools for screening and tracking than heterosexual adults. Sexual minority adults did not differ from each other by age, gender, or race or ethnicity in terms of their willingness to use these digital health tools, so no sexual orientation-based or intersectional disparities were identified. Furthermore, White heterosexual adults were less willing to use these tools than racial or ethnic minority heterosexual adults. Findings support the use of digital health tools with sexual minority adults, which could be important for other public health-related concerns (eg, the recent example of mpox). Additional studies are needed regarding the decision-making process of White heterosexual adults regarding the use of digital health tools to address public health crises, including pandemics or outbreaks that disproportionately affect minoritized populations.
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Affiliation(s)
- Wilson Vincent
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, United States
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4
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Chen Y, Xiao X, He Q, Yao RQ, Zhang GY, Fan JR, Xue CX, Huang L. Knowledge mapping of digital medicine in cardiovascular diseases from 2004 to 2022: A bibliometric analysis. Heliyon 2024; 10:e25318. [PMID: 38356571 PMCID: PMC10864893 DOI: 10.1016/j.heliyon.2024.e25318] [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: 09/13/2023] [Revised: 12/22/2023] [Accepted: 01/24/2024] [Indexed: 02/16/2024] Open
Abstract
Objective To review studies on digital medicine in cardiovascular diseases (CVD), discuss its development process, knowledge structure and research hotspots, and provide a perspective for researchers in this field. Methods The relevant literature in recent 20 years (January 2004 to October 2022) were retrieved from the Web of Science Core Collection (WoSCC). CiteSpace was used to demonstrate our knowledge of keywords, co-references and speculative frontiers. VOSviewer was used to chart the contributions of authors, institutions and countries and incorporates their link strength into the table. Results A total of 5265 English articles in set timespan were included. The number of publications increased steadily annually. The United States (US) produced the highest number of publications, followed by England. Most publications were from Harvard Medicine School, followed by Massachusetts General Hospital and Brigham Women's Hospital. The most authoritative academic journal was JMIR mHealth and uHealth. Noseworthy PA may have the highest influence in this intersected field with the highest number of citations and total link strength. The utilization of wearable mobile devices in the context of CVD, encompassing the identification of risk factors, diagnosis and prevention of diseases, as well as early intervention and remote management of diseases, has been widely acknowledged as a knowledge base and an area of current interest. To investigate the impact of various digital medicine interventions on chronic care and assess their clinical effectiveness, examine the potential of machine learning (ML) in delivering clinical care for atrial fibrillation (AF) and identifying early disease risk factors, as well as explore the development of disease prediction models using neural networks (NNs), ML and unsupervised learning in CVD prognosis, may emerge as future trends and areas of focus. Conclusion Recently, there has been a significant surge of interest in the investigation of digital medicine in CVD. This initial bibliometric study offers a comprehensive analysis of the research landscape pertaining to digital medicine in CVD, thereby furnishing related scholars with a dependable reference to facilitate further progress in this domain.
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Affiliation(s)
- Ying Chen
- Beijing University of Chinese Medicine, Beijing, 100029, China
- Department of Integrative Cardiology, China-Japan Friendship Hospital, Beijing, 100029, China
- National Integrative Medicine Center for Cardiovascular Diseases, Beijing, 100029, China
- National Center for Integrative Medicine, Beijing, 100029, China
| | - Xiang Xiao
- Department of Integrative Cardiology, China-Japan Friendship Hospital, Beijing, 100029, China
- National Integrative Medicine Center for Cardiovascular Diseases, Beijing, 100029, China
- National Center for Integrative Medicine, Beijing, 100029, China
| | - Qing He
- Beijing University of Chinese Medicine, Beijing, 100029, China
- Department of Integrative Cardiology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Rui-Qi Yao
- Beijing University of Chinese Medicine, Beijing, 100029, China
- Department of Integrative Cardiology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Gao-Yu Zhang
- Beijing University of Chinese Medicine, Beijing, 100029, China
- Department of Integrative Cardiology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Jia-Rong Fan
- Beijing University of Chinese Medicine, Beijing, 100029, China
- Department of Integrative Cardiology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Chong-Xiang Xue
- Beijing University of Chinese Medicine, Beijing, 100029, China
- National Center for Integrative Medicine, Beijing, 100029, China
- Institute of Metabolic Diseases, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Li Huang
- Department of Integrative Cardiology, China-Japan Friendship Hospital, Beijing, 100029, China
- National Integrative Medicine Center for Cardiovascular Diseases, Beijing, 100029, China
- National Center for Integrative Medicine, Beijing, 100029, China
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Katz ME, Mszar R, Grimshaw AA, Gunderson CG, Onuma OK, Lu Y, Spatz ES. Digital Health Interventions for Hypertension Management in US Populations Experiencing Health Disparities: A Systematic Review and Meta-Analysis. JAMA Netw Open 2024; 7:e2356070. [PMID: 38353950 PMCID: PMC10867699 DOI: 10.1001/jamanetworkopen.2023.56070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/21/2023] [Indexed: 02/16/2024] Open
Abstract
Importance Hypertension remains a leading factor associated with cardiovascular disease, and demographic and socioeconomic disparities in blood pressure (BP) control persist. While advances in digital health technologies have increased individuals' access to care for hypertension, few studies have analyzed the use of digital health interventions in vulnerable populations. Objective To assess the association between digital health interventions and changes in BP and to characterize tailored strategies for populations experiencing health disparities. Data Sources In this systematic review and meta-analysis, a systematic search identified studies evaluating digital health interventions for BP management in the Cochrane Library, Ovid Embase, Google Scholar, Ovid MEDLINE, PubMed, Scopus, and Web of Science databases from inception until October 30, 2023. Study Selection Included studies were randomized clinical trials or cohort studies that investigated digital health interventions for managing hypertension in adults; presented change in systolic BP (SBP) or baseline and follow-up SBP levels; and emphasized social determinants of health and/or health disparities, including a focus on marginalized populations that have historically been underserved or digital health interventions that were culturally or linguistically tailored to a population with health disparities. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Data Extraction and Synthesis Two reviewers extracted and verified data. Mean differences in BP between treatment and control groups were analyzed using a random-effects model. Main Outcomes and Measures Primary outcomes included mean differences (95% CIs) in SBP and diastolic BP (DBP) from baseline to 6 and 12 months of follow-up between digital health intervention and control groups. Shorter- and longer-term follow-up durations were also assessed, and sensitivity analyses accounted for baseline BP levels. Results A total of 28 studies (representing 8257 participants) were included (overall mean participant age, 57.4 years [range, 46-71 years]; 4962 [60.1%], female). Most studies examined multicomponent digital health interventions incorporating remote BP monitoring (18 [64.3%]), community health workers or skilled nurses (13 [46.4%]), and/or cultural tailoring (21 [75.0%]). Sociodemographic characteristics were similar between intervention and control groups. Between the intervention and control groups, there were statistically significant mean differences in SBP at 6 months (-4.24 mm Hg; 95% CI, -7.33 to -1.14 mm Hg; P = .01) and SBP changes at 12 months (-4.30 mm Hg; 95% CI, -8.38 to -0.23 mm Hg; P = .04). Few studies (4 [14.3%]) reported BP changes and hypertension control beyond 1 year. Conclusions and Relevance In this systematic review and meta-analysis of digital health interventions for hypertension management in populations experiencing health disparities, BP reductions were greater in the intervention groups compared with the standard care groups. The findings suggest that tailored initiatives that leverage digital health may have the potential to advance equity in hypertension outcomes.
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Affiliation(s)
| | - Reed Mszar
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Alyssa A. Grimshaw
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, Connecticut
| | - Craig G. Gunderson
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
- VA Connecticut Healthcare System, West Haven
| | - Oyere K. Onuma
- Division of Cardiology, Massachusetts General Hospital, Boston
| | - Yuan Lu
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut
| | - Erica S. Spatz
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut
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6
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Spatz ES, Ginsburg GS, Rumsfeld JS, Turakhia MP. Wearable Digital Health Technologies for Monitoring in Cardiovascular Medicine. N Engl J Med 2024; 390:346-356. [PMID: 38265646 DOI: 10.1056/nejmra2301903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Affiliation(s)
- Erica S Spatz
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (E.S.S.); the National Institutes of Health, Bethesda, MD (G.S.G.); the University of Colorado School of Medicine, Aurora (J.S.R.); and Meta Platforms, Menlo Park (J.S.R.), the Stanford Center for Digital Health, Stanford University School of Medicine, Stanford (M.P.T.), and iRhythm Technologies, San Francisco (M.P.T.) - all in California
| | - Geoffrey S Ginsburg
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (E.S.S.); the National Institutes of Health, Bethesda, MD (G.S.G.); the University of Colorado School of Medicine, Aurora (J.S.R.); and Meta Platforms, Menlo Park (J.S.R.), the Stanford Center for Digital Health, Stanford University School of Medicine, Stanford (M.P.T.), and iRhythm Technologies, San Francisco (M.P.T.) - all in California
| | - John S Rumsfeld
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (E.S.S.); the National Institutes of Health, Bethesda, MD (G.S.G.); the University of Colorado School of Medicine, Aurora (J.S.R.); and Meta Platforms, Menlo Park (J.S.R.), the Stanford Center for Digital Health, Stanford University School of Medicine, Stanford (M.P.T.), and iRhythm Technologies, San Francisco (M.P.T.) - all in California
| | - Mintu P Turakhia
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (E.S.S.); the National Institutes of Health, Bethesda, MD (G.S.G.); the University of Colorado School of Medicine, Aurora (J.S.R.); and Meta Platforms, Menlo Park (J.S.R.), the Stanford Center for Digital Health, Stanford University School of Medicine, Stanford (M.P.T.), and iRhythm Technologies, San Francisco (M.P.T.) - all in California
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7
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Bakhit M, Fien S, Abukmail E, Jones M, Clark J, Scott AM, Glasziou P, Cardona M. Cardiovascular disease risk communication and prevention: a meta-analysis. Eur Heart J 2024:ehae002. [PMID: 38243824 DOI: 10.1093/eurheartj/ehae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND AND AIMS Knowledge of quantifiable cardiovascular disease (CVD) risk may improve health outcomes and trigger behavioural change in patients or clinicians. This review aimed to investigate the impact of CVD risk communication on patient-perceived CVD risk and changes in CVD risk factors. METHODS PubMed, Embase, and PsycINFO databases were searched from inception to 6 June 2023, supplemented by citation analysis. Randomized trials that compared any CVD risk communication strategy versus usual care were included. Paired reviewers independently screened the identified records and extracted the data; disagreements were resolved by a third author. The primary outcome was the accuracy of risk perception. Secondary outcomes were clinician-reported changes in CVD risk, psychological responses, intention to modify lifestyle, and self-reported changes in risk factors and clinician prescribing of preventive medicines. RESULTS Sixty-two trials were included. Accuracy of risk perception was higher among intervention participants (odds ratio = 2.31, 95% confidence interval = 1.63 to 3.27). A statistically significant improvement in overall CVD risk scores was found at 6-12 months (mean difference = -0.27, 95% confidence interval = -0.45 to -0.09). For primary prevention, risk communication significantly increased self-reported dietary modification (odds ratio = 1.50, 95% confidence interval = 1.21 to 1.86) with no increase in intention or actual changes in smoking cessation or physical activity. A significant impact on patients' intention to start preventive medication was found for primary and secondary prevention, with changes at follow-up for the primary prevention group. CONCLUSIONS In this systematic review and meta-analysis, communicating CVD risk information, regardless of the method, reduced the overall risk factors and enhanced patients' self-perceived risk. Communication of CVD risk to patients should be considered in routine consultations.
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Affiliation(s)
- Mina Bakhit
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | - Samantha Fien
- School of Health, Medical and Applied Sciences, Central Queensland University, Mackay, QLD, Australia
| | - Eman Abukmail
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | - Mark Jones
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | - Anna Mae Scott
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | - Magnolia Cardona
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
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8
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Park Y, Kim SH, Yoon HJ. Quality controlled YouTube content intervention for enhancing health literacy and health behavioural intention: A randomized controlled study. Digit Health 2024; 10:20552076241263691. [PMID: 38894944 PMCID: PMC11185003 DOI: 10.1177/20552076241263691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 06/05/2024] [Indexed: 06/21/2024] Open
Abstract
Background Individuals increasingly turn to the Internet for health information, with YouTube being a prominent source. However, the quality and reliability of the health information vary widely, potentially affecting health literacy and behavioural intentions. Methods To analyse the impact of health information quality on health literacy and behavioural intention, we conducted a randomized controlled trial using a quality-controlled YouTube intervention. Health information quality on YouTube was evaluated using the Global Quality Score and DISCERN. We randomly allocated (1 : 1) to the intervention group to watch the highest quality-evaluated content and to the control group to watch the lowest quality-evaluated content. Health literacy and health behavioural intention were assessed before and after watching YouTube. The trial was set for two different topics: interpreting laboratory test results from health check-up and information about inflammatory bowel disease (IBD). Results From 8 April 2022 to 15 April 2022, 505 participants were randomly assigned to watch either high-quality content (intervention group, n = 255) or low-quality content (control group, n = 250). Health literacy significantly improved in the intervention group (28.1 before and 31.8 after; p < 0.01 for health check-up; 28.3 before and 31.3 after; p < 0.01 for IBD). Health behavioural intention significantly improved in the intervention group (3.5 before and 4.1 after; p < 0.01 for health check-up; 3.6 before and 4.0 after; p < 0.01 for IBD). Control groups had no such effect. Conclusion High-quality health information can enhance health literacy and behavioural intention in both healthy individuals and those with specific conditions like IBD. It stresses the significance of ensuring reliable health information online and calls for future efforts to curate and provide access to high-quality health content.
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Affiliation(s)
- Yujin Park
- Healthcare Data Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Su Hwan Kim
- Department of Information Statistics, Gyeongsang National University, Jinju, Gyeongsangnam-do, South Korea
| | - Hyung-Jin Yoon
- Medical Big Data Research Center, Seoul National University College of Medicine, Seoul, South Korea
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Liquori G, Pio Posa V, De Leo A, Giannetta N, Di Simone E, Di Muzio M, Dionisi S. The Use of mHealth in Promoting Therapeutic Adherence: A Scoping Review. Comput Inform Nurs 2024; 42:71-79. [PMID: 37769234 DOI: 10.1097/cin.0000000000001062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Nonadherence to therapy negatively impacts mortality and quality of life and results in suboptimal efficacy of treatment regimens, threats to patient safety, and increased healthcare costs for disease management. Mobile health solutions can offer users instruments that can promote therapeutic adherence. The objective of this review is to investigate the impact mobile health systems have on therapeutic adherence. Specifically, we want to map the main systems used, the functions implemented, and the different methods of adherence detection used. For this purpose, a scoping review was conducted. The following databases were consulted: PubMed, Cochrane Library, EBSCO (including APA PsycINFO, CINAHL Plus with Full Text, ERIC), including English-language studies published in the last 10 years (2012-2022). The main mobile health systems used are as follows: applications, automated messaging, interactive voice response, and mobile video games. The main features implemented to support medication management were as follows: reminders, self-monitoring instruments, educational support, and caregiver involvement. In conclusion, the use of interactive mobile health instruments intended for use by the patient and/or caregiver can improve objectively and subjectively detected therapeutic adherence. The use of these systems in the therapeutic pathway of users, with a special focus on people with comorbidities and in polypharmacy treatment, represents a challenge to improve caregiver health.
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Affiliation(s)
- Gloria Liquori
- Author Affiliations: Department of Biomedicine and Prevention, University of Rome Tor Vergata (Drs Liquori and De Leo); Department of Clinical and Molecular Medicine, Sapienza University of Rome (Mr Pio Posa, Dr Di Muzio and Di Simone); Nursing, Technical, Rehabilitation, Assistance and Research Department, IRCCS Istituti Fisioterapici Ospitalieri (Drs De Leo); UniCamillus-Saint Camillus International University of Health and Medical Sciences (Dr Giannetta), Rome; and Nursing, Technical and Rehabilitation, Department, DaTeR Azienda Unità Sanitaria Locale di Bologna (Dr Dionisi)
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10
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Reimer LM, Nissen L, von Scheidt M, Perl B, Wiehler J, Najem SA, Limbourg FP, Tacke T, Müller A, Jonas S, Schunkert H, Starnecker F. User-centered development of an mHealth app for cardiovascular prevention. Digit Health 2024; 10:20552076241249269. [PMID: 38774157 PMCID: PMC11107323 DOI: 10.1177/20552076241249269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 04/08/2024] [Indexed: 05/24/2024] Open
Abstract
Background Mobile health (mHealth) apps can be used for cardiovascular disease (CVD) prevention. User-centered design, evidence-based content and user testing can be applied to ensure a high level of usability and adequate app access. Objective To develop and evaluate an mHealth app (HerzFit) for CVD prevention. Methods HerzFit´s development included a user-centered design approach and guideline-based content creation based on the identified requirements of the target group. Beta testing and a preliminary usability evaluation of the HerzFit prototype were performed. For evaluation, German versions of the System Usability Scale (SUS) and the mHealth App Usability Questionnaire (GER-MAUQ) as well as free text feedback were applied. Results User-centered design thinking led to the definition of four personas. Based on their requirements, HerzFit enables users to individually assess, monitor, and optimize their cardiovascular risk profile. Users are also provided with a variety of evidence-based information on CVD and their risk factors. The user interface and system design followed the identified functional requirements. Beta-testers provided feedback on the structure and functionality and rated the usability of HerzFit´s prototype as slightly above average both in SUS and GER-MAUQ rating. Participants positively noted the variety of functions and information presented in HerzFit, while negative feedback mostly concerned wearable synchronization. Conclusions The present study demonstrates the user-centered development of a guideline-based mHealth app for CVD prevention. Beta-testing and a preliminary usability study were used to further improve the HerzFit app until its official release.
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Affiliation(s)
- Lara Marie Reimer
- School for Computation, Information and Technology, Technical University Munich, Munich, Germany
- Institute for Digital Medicine, University Hospital Bonn, Bonn, Germany
| | - Leon Nissen
- Institute for Digital Medicine, University Hospital Bonn, Bonn, Germany
| | - Moritz von Scheidt
- Department of Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
- German Center for Cardiovascular Disease (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Benedikt Perl
- Department of Sport and Health Sciences, Technical University Munich, Munich, Germany
| | - Jens Wiehler
- BioM Biotech Cluster Development GmbH – BioM, Planegg, Germany
| | - Sinann Al Najem
- Deutsche Herzstiftung e.V. (German Heart Foundation), Frankfurt, Germany
| | - Florian P. Limbourg
- Vascular Medicine Research, Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
- Deutsche Hochdruckliga e.V. (German Hypertension League), Heidelberg, Germany
| | - Theodora Tacke
- Institute of General Practice, Goethe University Frankfurt, Frankfurt, Germany
| | - Angelina Müller
- Institute of General Practice, Goethe University Frankfurt, Frankfurt, Germany
| | - Stephan Jonas
- Institute for Digital Medicine, University Hospital Bonn, Bonn, Germany
| | - Heribert Schunkert
- Department of Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
- German Center for Cardiovascular Disease (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
- Deutsche Herzstiftung e.V. (German Heart Foundation), Frankfurt, Germany
- Medical Graduate Center, Technical University Munich, Munich, Germany
| | - Fabian Starnecker
- Department of Cardiology, German Heart Center Munich, Technical University Munich, Munich, Germany
- German Center for Cardiovascular Disease (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
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11
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McLaughlin MM, Hsue PY, Lowe DA, Olgin JE, Beatty AL. Development of text messages for primary prevention of cardiovascular disease in persons with HIV. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2023; 4:191-197. [PMID: 38222100 PMCID: PMC10787147 DOI: 10.1016/j.cvdhj.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
Objective Persons with HIV (PWH) have increased risk for atherosclerotic cardiovascular disease (CVD). Despite this increased risk, perceived cardiovascular risk among PWH is low, and interventions that are known to be beneficial in the general population, such as statins, have low uptake in this population. We sought to develop a bank of text messages about (1) the association between HIV and CVD and (2) advice on reducing cardiovascular risk. Methods We developed an initial bank of 162 messages. We solicited feedback from 29 PWH recruited from outpatient clinics providing HIV care at a large urban tertiary medical center and a public hospital in San Francisco, California. Participants reviewed 7-10 messages each and rated message usefulness, readability, and potential impact on behavior on a scale from 1 (least) to 5 (most). We also collected open-ended feedback on the messages and data on preferences about message timing. Results The average score for the messages was 4.4/5 for usefulness, 4.4/5 for readability, and 4.0/5 for potential impact on behavior. The text messages were iteratively revised based on participant feedback, and lowest-rated messages were removed from the message bank. The final message bank included 116 messages on diet (30.2%), physical activity (24.8%), tobacco (11.2%), the association between HIV and cardiovascular disease (9.5%), general heart health (6.9%), cholesterol (5.2%), blood pressure (4.3%), blood sugar (2.6%), sleep (2.6%), and weight (2.6%). Conclusion We describe an approach for developing educational text messages on primary prevention of cardiovascular disease among PWH.
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Affiliation(s)
- Megan M. McLaughlin
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Priscilla Y. Hsue
- Division of Cardiology, Department of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Dylan A. Lowe
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Jeffrey E. Olgin
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California
- Cardiovascular Research Institute, University of California San Francisco, San Francisco, California
| | - Alexis L. Beatty
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
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McNeill E, Lindenfeld Z, Mostafa L, Zein D, Silver D, Pagán J, Weeks WB, Aerts A, Des Rosiers S, Boch J, Chang JE. Uses of Social Determinants of Health Data to Address Cardiovascular Disease and Health Equity: A Scoping Review. J Am Heart Assoc 2023; 12:e030571. [PMID: 37929716 PMCID: PMC10727404 DOI: 10.1161/jaha.123.030571] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 09/06/2023] [Indexed: 11/07/2023]
Abstract
Background Cardiovascular disease is the leading cause of morbidity and mortality worldwide. Prior research suggests that social determinants of health have a compounding effect on health and are associated with cardiovascular disease. This scoping review explores what and how social determinants of health data are being used to address cardiovascular disease and improve health equity. Methods and Results After removing duplicate citations, the initial search yielded 4110 articles for screening, and 50 studies were identified for data extraction. Most studies relied on similar data sources for social determinants of health, including geocoded electronic health record data, national survey responses, and census data, and largely focused on health care access and quality, and the neighborhood and built environment. Most focused on developing interventions to improve health care access and quality or characterizing neighborhood risk and individual risk. Conclusions Given that few interventions addressed economic stability, education access and quality, or community context and social risk, the potential for harnessing social determinants of health data to reduce the burden of cardiovascular disease remains unrealized.
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Affiliation(s)
- Elizabeth McNeill
- Department of Public Health Policy and ManagementNew York University School of Global Public HealthNew YorkNYUSA
| | - Zoe Lindenfeld
- Department of Public Health Policy and ManagementNew York University School of Global Public HealthNew YorkNYUSA
| | - Logina Mostafa
- Department of Public Health Policy and ManagementNew York University School of Global Public HealthNew YorkNYUSA
| | - Dina Zein
- Department of Public Health Policy and ManagementNew York University School of Global Public HealthNew YorkNYUSA
| | - Diana Silver
- Department of Public Health Policy and ManagementNew York University School of Global Public HealthNew YorkNYUSA
| | - José Pagán
- Department of Public Health Policy and ManagementNew York University School of Global Public HealthNew YorkNYUSA
| | - William B. Weeks
- Microsoft Corporation, Precision Population Health, Microsoft ResearchRedmondWAUSA
| | - Ann Aerts
- The Novartis FoundationBaselSwitzerland
| | | | | | - Ji Eun Chang
- Department of Public Health Policy and ManagementNew York University School of Global Public HealthNew YorkNYUSA
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Azizi Z, Adedinsewo D, Rodriguez F, Lewey J, Merchant RM, Brewer LC. Leveraging Digital Health to Improve the Cardiovascular Health of Women. CURRENT CARDIOVASCULAR RISK REPORTS 2023; 17:205-214. [PMID: 37868625 PMCID: PMC10587029 DOI: 10.1007/s12170-023-00728-z] [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: 08/29/2023] [Indexed: 10/24/2023]
Abstract
Purpose of Review In this review, we present a comprehensive discussion on the population-level implications of digital health interventions (DHIs) to improve cardiovascular health (CVH) through sex- and gender-specific prevention strategies among women. Recent Findings Over the past 30 years, there have been significant advancements in the diagnosis and treatment of cardiovascular diseases, a leading cause of morbidity and mortality among men and women worldwide. However, women are often underdiagnosed, undertreated, and underrepresented in cardiovascular clinical trials, which all contribute to disparities within this population. One approach to address this is through DHIs, particularly among racial and ethnic minoritized groups. Implementation of telemedicine has shown promise in increasing adherence to healthcare visits, improving BP monitoring, weight control, physical activity, and the adoption of healthy behaviors. Furthermore, the use of mobile health applications facilitated by smart devices, wearables, and other eHealth (defined as electronically delivered health services) modalities has also promoted CVH among women in general, as well as during pregnancy and the postpartum period. Overall, utilizing a digital health approach for healthcare delivery, decentralized clinical trials, and incorporation into daily lifestyle activities has the potential to improve CVH among women by mitigating geographical, structural, and financial barriers to care. Summary Leveraging digital technologies and strategies introduces novel methods to address sex- and gender-specific health and healthcare disparities and improve the quality of care provided to women. However, it is imperative to be mindful of the digital divide in specific populations, which may hinder accessibility to these novel technologies and inadvertently widen preexisting inequities.
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Affiliation(s)
- Zahra Azizi
- Center for Digital Health, Stanford University, Stanford, CA USA
- Department of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University, Stanford, CA USA
| | | | - Fatima Rodriguez
- Department of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University, Stanford, CA USA
| | - Jennifer Lewey
- Department of Medicine, Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Raina M. Merchant
- Center for Digital Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - LaPrincess C. Brewer
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN USA
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN USA
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14
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Bakema R, Smirnova D, Biri D, Kocks JWH, Postma MJ, de Jong LA. The Use of eHealth for Pharmacotherapy Management With Patients With Respiratory Disease, Cardiovascular Disease, or Diabetes: Scoping Review. J Med Internet Res 2023; 25:e42474. [PMID: 37751232 PMCID: PMC10565624 DOI: 10.2196/42474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 07/22/2023] [Accepted: 07/27/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND eHealth is increasingly considered an important tool for supporting pharmacotherapy management. OBJECTIVE We aimed to assess the (1) use of eHealth in pharmacotherapy management with patients with asthma or chronic obstructive pulmonary disease (COPD), diabetes, or cardiovascular disease (CVD); (2) effectiveness of these interventions on pharmacotherapy management and clinical outcomes; and (3) key factors contributing to the success of eHealth interventions for pharmacotherapy management. METHODS We conducted a scoping review following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review) statement. Databases searched included Embase, MEDLINE (PubMed), and Cochrane Library. Screening was conducted by 2 independent researchers. Eligible articles were randomized controlled trials and cohort studies assessing the effect of an eHealth intervention for pharmacotherapy management compared with usual care on pharmacotherapy management or clinical outcomes in patients with asthma or COPD, CVD, or diabetes. The interventions were categorized by the type of device, pharmacotherapy management, mode of delivery, features, and domains described in the conceptual model for eHealth by Shaw at al (Health in our Hands, Interacting for Health, Data Enabling Health). The effectiveness on pharmacotherapy management outcomes and patient- and clinician-reported clinical outcomes was analyzed per type of intervention categorized by number of domains and features to identify trends. RESULTS Of 63 studies, 16 (25%), 31 (49%), 13 (21%), and 3 (5%) included patients with asthma or COPD, CVD, diabetes, or CVD and diabetes, respectively. Most (38/63, 60%) interventions targeted improving medication adherence, often combined for treatment plan optimization. Of the 16 asthma or COPD interventions, 6 aimed to improve inhaled medication use. The majority (48/63, 76%) of the studies provided an option for patient feedback. Most (20/63, 32%) eHealth interventions combined all 3 domains by Shaw et al, while 25% (16/63) combined Interacting for Health with Data Enabling Health. Two-thirds (42/63, 67%) of the studies showed a positive overall effect. Respectively, 48% (23/48), 57% (28/49), and 39% (12/31) reported a positive effect on pharmacotherapy management and clinician- and patient-reported clinical outcomes. Pharmacotherapy management and patient-reported clinical outcomes, but not clinician-reported clinical outcomes, were more often positive in interventions with ≥3 features. There was a trend toward more studies reporting a positive effect on all 3 outcomes with more domains by Shaw et al. Of the studies with interventions providing patient feedback, more showed a positive clinical outcome, compared with studies with interventions without feedback. This effect was not seen for pharmacotherapy management outcomes. CONCLUSIONS There is a wide variety of eHealth interventions combining various domains and features to target pharmacotherapy management in asthma or COPD, CVD, and diabetes. Results suggest feedback is key for a positive effect on clinician-reported clinical outcomes. eHealth interventions become more impactful when combining domains.
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Affiliation(s)
- Robbert Bakema
- Nederlandse Service Apotheek Beheer BV, 's-Hertogenbosch, Netherlands
| | - Daria Smirnova
- Asc Academics, Groningen, Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Despina Biri
- Asc Academics, Groningen, Netherlands
- Victoria Hospital, Kirkcaldy, United Kingdom
| | - Janwillem W H Kocks
- General Practitioners Research Institute, Groningen, Netherlands
- Groningen Research Institute Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Department of Pulmonology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Maarten J Postma
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Economics, Econometrics and Finance, University of Groningen, Groningen, Netherlands
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Padjadjaran University, Bandung, Indonesia
| | - Lisa A de Jong
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Verweel L, Newman A, Michaelchuk W, Packham T, Goldstein R, Brooks D. The effect of digital interventions on related health literacy and skills for individuals living with chronic diseases: A systematic review and meta-analysis. Int J Med Inform 2023; 177:105114. [PMID: 37329765 DOI: 10.1016/j.ijmedinf.2023.105114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Chronic diseases are a leading cause of death and disease burden globally. Digital interventions could be an approach to improve patients' ability to find, evaluate, and use health information. OBJECTIVES The main objective was to conduct a systematic review to determine the effect of digital interventions on digital health literacy for patients living with chronic disease. Secondary objectives were to provide an overviewof the design and delivery characteristics of interventions that impact digital health literacy in people with chronic disease. METHODS Randomized controlled trials examining digital health literacy (and related components) for individuals with cardiovascular disease, chronic lung disease, osteoarthritis, diabetes, chronic kidney disease, and HIV were identified. This review was conducted following the PRIMSA guidelines. Certainty was assessed using GRADE and the Cochrane risk of bias tool. Meta-analyses were conducted using Review Manager 5.1. The protocol was registered on PROSPERO (CRD42022375967). RESULTS 9386 articles were identified and 17 articles representing 16 unique trials were included. Studies evaluated 5138 individuals with one or more chronic conditions (50% women, ages 42 ± 7-71 ± 12 years). The most targeted conditions were cancer, diabetes, cardiovascular disease, and HIV. Interventions included: skills training, websites, electronic personal health records, remote patient monitoring, and education. The effects of the interventions were related to: (i) digital health literacy, (ii) health literacy, (iii) health information skills, (iv) technology skills and access, and (v) self-management and participation in care. A meta-analysis of three studies identified the effect of digital interventions was better than usual care for eHealth literacy (1.22 [CI 0.55, 1.89], p < 0.001). CONCLUSIONS The evidence of the effects of digital interventions on related health literacy is limited. Existing studies reflect the heterogeneity in study design, population, and outcome measures. There is a need for further studies on the effects of digital interventions on related health literacy for individuals with chronic conditions.
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Affiliation(s)
- L Verweel
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada; West Park Healthcare Centre, Toronto, Canada.
| | - A Newman
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada; West Park Healthcare Centre, Toronto, Canada
| | - W Michaelchuk
- West Park Healthcare Centre, Toronto, Canada; Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - T Packham
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada
| | - R Goldstein
- West Park Healthcare Centre, Toronto, Canada; Department of Physical Therapy, University of Toronto, Toronto, Canada
| | - D Brooks
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada; West Park Healthcare Centre, Toronto, Canada
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16
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Morgan TL, Faught E, Ross-White A, Fortier MS, Duggan M, Jain R, Lane KN, Lorbergs A, Maclaren K, McFadden T, Tomasone JR. Tools to guide clinical discussions on physical activity, sedentary behaviour, and/or sleep for health promotion between primary care providers and adults accessing care: a scoping review. BMC PRIMARY CARE 2023; 24:140. [PMID: 37420229 PMCID: PMC10326959 DOI: 10.1186/s12875-023-02091-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 06/22/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Health care providers have reported low knowledge, skill, and confidence for discussing movement behaviours (i.e., physical activity, sedentary behaviour, and sleep), which may be improved with the use of tools to guide movement behaviour discussions in their practice. Past reviews have examined the psychometric properties, scoring, and behavioural outcomes of physical activity discussion tools. However, the features, perceptions, and effectiveness of discussion tools for physical activity, sedentary behaviour, and/or sleep have not yet been synthesized. The aim of this review was to report and appraise tools for movement behaviour discussions between health care providers and adults 18 + years in a primary care context within Canada or analogous countries. METHODS An integrated knowledge translation approach guided this review, whereby a working group of experts in medicine, knowledge translation, communications, kinesiology, and health promotion was engaged from research question formation to interpretation of findings. Three search approaches were used (i.e., peer-reviewed, grey literature, and forward searches) to identify studies reporting on perceptions and/or effectiveness of tools for physical activity, sedentary behaviour, and/or sleep. The quality of included studies was assessed using the Mixed Methods Appraisal Tool. RESULTS In total, 135 studies reporting on 61 tools (i.e., 51 on physical activity, one on sleep, and nine combining two movement behaviours) met inclusion criteria. Included tools served the purposes of assessment (n = 57), counselling (n = 50), prescription (n = 18), and/or referral (n = 12) of one or more movement behaviour. Most tools were used or intended for use by physicians, followed by nurses/nurse practitioners (n = 11), and adults accessing care (n = 10). Most tools were also used or intended to be used with adults without chronic conditions aged 18-64 years (n = 34), followed by adults with chronic conditions (n = 18). The quality of the 116 studies that evaluated tool effectiveness varied. CONCLUSIONS Many tools were positively perceived and were deemed effective at enhancing knowledge of, confidence for, ability in, and frequency of movement behaviour discussions. Future tools should guide discussions of all movement behaviours in an integrated manner in line with the 24-Hour Movement Guidelines. Practically, this review offers seven evidence-based recommendations that may guide future tool development and implementation.
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Affiliation(s)
- Tamara L Morgan
- School of Kinesiology and Health Studies, Queen's University, 28 Division Street, Kingston, ON, K7L 3N6, Canada.
| | - Emma Faught
- School of Medicine, Queen's University, Kingston, ON, Canada
| | - Amanda Ross-White
- Bracken Health Sciences Library, Queen's University, Kingston, ON, Canada
| | | | - Mary Duggan
- Canadian Society for Exercise Physiology, Ottawa, ON, Canada
| | - Rahul Jain
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kirstin N Lane
- Canadian Society for Exercise Physiology, Ottawa, ON, Canada
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | | | | | - Taylor McFadden
- School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
- Canadian Medical Association, Ottawa, ON, Canada
| | - Jennifer R Tomasone
- School of Kinesiology and Health Studies, Queen's University, 28 Division Street, Kingston, ON, K7L 3N6, Canada
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Coorey G, Campain A, Mulley J, Usherwood T, Redfern J, Harris M, Zwar N, Peiris D. Management of cardiovascular disease risk in people with comorbid mental illness: A cross sectional study in Australian general practice. Aust N Z J Psychiatry 2023; 57:613-615. [PMID: 36314767 DOI: 10.1177/00048674221133043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Genevieve Coorey
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Anna Campain
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - John Mulley
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Tim Usherwood
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Julie Redfern
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia
| | - Nicholas Zwar
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, QLD, Australia
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - David Peiris
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
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Brørs G, Dalen H, Allore H, Deaton C, Fridlund B, Norman CD, Palm P, Wentzel-Larsen T, Norekvål TM. The association of electronic health literacy with behavioural and psychological coronary artery disease risk factors in patients after percutaneous coronary intervention: a 12-month follow-up study. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2023; 4:125-135. [PMID: 36974270 PMCID: PMC10039428 DOI: 10.1093/ehjdh/ztad010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 01/15/2023] [Indexed: 02/10/2023]
Abstract
Aims Fundamental roadblocks, such as non-use and low electronic health (eHealth) literacy, prevent the implementation of eHealth resources. The aims were to study internet usage for health information and eHealth literacy in patients after percutaneous coronary intervention (PCI). Further, we aimed to evaluate temporal changes and determine whether the use of the internet to find health information and eHealth literacy were associated with coronary artery disease (CAD) risk factors at the index admission and 12-month follow-up of the same population. Methods and results This prospective longitudinal study recruited 2924 adult patients with internet access treated by PCI in two Nordic countries. Assessments were made at baseline and 12-month follow-up, including a de novo question Have you used the internet to find information about health?, the eHealth literacy scale, and assessment of clinical, behavioural, and psychological CAD risk factors. Regression analyses were used. Patients' use of the internet for health information and their eHealth literacy were moderate at baseline but significantly lower at 12-month follow-up. Non-users of the internet for health information were more often smokers and had a lower burden of anxiety symptoms. Lower eHealth literacy was associated with a higher burden of depression symptoms at baseline and lower physical activity and being a smoker at baseline and at 12-month follow-up. Conclusion Non-use of the internet and lower eHealth literacy need to be considered when implementing eHealth resources, as they are associated with behavioural and psychological CAD risk factors. eHealth should therefore be designed and implemented with high-risk CAD patients in mind. Clinical trial registration ClinicalTrials.gov NCT03810612 https://clinicaltrials.gov/ct2/show/NCT03810612.
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Affiliation(s)
- Gunhild Brørs
- Department of Clinical Science, University of Bergen, PO Box 7804, Bergen 5020, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway
| | - Håvard Dalen
- Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Heather Allore
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Christi Deaton
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Bengt Fridlund
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Cameron D Norman
- Cense Ltd. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Pernille Palm
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Tore Wentzel-Larsen
- Centre for Child and Adolescent Mental Health, Region East and South, Oslo, Norway
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Tone M Norekvål
- Department of Clinical Science, University of Bergen, PO Box 7804, Bergen 5020, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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Xu L, Tong Q, Zhang X, Yu T, Lian X, Yu T, Falter M, Scherrenberg M, Kaihara T, Kizilkilic SE, Kindermans H, Dendale P, Li F. Smartphone-based gamification intervention to increase physical activity participation among patients with coronary heart disease: A randomized controlled trial. J Telemed Telecare 2023:1357633X221150943. [PMID: 36794484 DOI: 10.1177/1357633x221150943] [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: 02/17/2023]
Abstract
INTRODUCTION Despite proven benefits, patients with coronary heart disease (CHD) typically fail to participate in sufficient physical activity (PA). Effective interventions should be implemented to help patients maintain a healthy lifestyle and modify their present behavior. Gamification is the use of game design features (such as points, leaderboards, and progress bars) to improve motivation and engagement. It shows the potential for encouraging patients to engage in PA. However, empirical evidence on the efficacy of such interventions among patients with CHD is still emerging. PURPOSE The aim of the study is to explore whether a smartphone-based gamification intervention could increase PA participation and other physical and psychological outcomes in CHD patients. METHODS Participants with CHD were randomly assigned to three groups (control group, individual group, and team group). The individual and team groups received gamified behavior intervention based on behavioral economics. The team group combined gamified intervention with social interaction. The intervention lasted for 12 weeks, and the follow-up was12 weeks. The primary outcomes included the change in daily steps and the proportion of patient days that step goals were achieved. The secondary outcomes included competence, autonomy, relatedness, and autonomous motivation. RESULTS For the individual group, smartphone-based gamification intervention significantly increased PA among CHD patients over the 12-week period (step count difference 988; 95% CI 259-1717; p < 0.01) and had a good maintenance effect during the follow-up period (step count difference 819; 95% CI 24-1613; p < 0.01). There are also significant differences in competence, autonomous motivation, body mass index (BMI), and waist circumference in 12 weeks between the control group and individual group. For the team group, gamification intervention with collaboration didn't result in significant increases in PA. But patients in this group had a significant increase in competence, relatedness, and autonomous motivation. CONCLUSION A smartphone-based gamification intervention was proven to be an effective way to increase motivation and PA engagement, with a substantial maintenance impact (Chinese Clinical Trial Registry Identifier: ChiCTR2100044879).
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Affiliation(s)
- Linqi Xu
- School of Nursing, 12510Jilin University, Changchun, China
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, 54496UHasselt, Diepenbeek, Belgium
| | - Qian Tong
- Department of Cardiology, First Hospital of Jilin University, Changchun, China
| | - Xin Zhang
- School of Nursing, 12510Jilin University, Changchun, China
| | - Tianzhuo Yu
- School of Nursing, 12510Jilin University, Changchun, China
| | - Xiaoqian Lian
- School of Nursing, 12510Jilin University, Changchun, China
| | - Tianyue Yu
- School of Nursing, 12510Jilin University, Changchun, China
| | - Maarten Falter
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, 54496UHasselt, Diepenbeek, Belgium
- Faculty of Medicine, Department of Cardiology, KU Leuven, Leuven, Belgium
| | - Martijn Scherrenberg
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, 54496UHasselt, Diepenbeek, Belgium
- Faculty of Medicine and Health Sciences, Antwerp University, Leuven, Belgium
| | - Toshiki Kaihara
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, 54496UHasselt, Diepenbeek, Belgium
- Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Japan
| | - Sevda Ece Kizilkilic
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, 54496UHasselt, Diepenbeek, Belgium
| | - Hanne Kindermans
- Faculty of Medicine and Life Sciences, 54496UHasselt, Diepenbeek, Belgium
| | - Paul Dendale
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, 54496UHasselt, Diepenbeek, Belgium
| | - Feng Li
- School of Nursing, 12510Jilin University, Changchun, China
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20
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Xiong S, Lu H, Peoples N, Duman EK, Najarro A, Ni Z, Gong E, Yin R, Ostbye T, Palileo-Villanueva LM, Doma R, Kafle S, Tian M, Yan LL. Digital health interventions for non-communicable disease management in primary health care in low-and middle-income countries. NPJ Digit Med 2023; 6:12. [PMID: 36725977 PMCID: PMC9889958 DOI: 10.1038/s41746-023-00764-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 01/21/2023] [Indexed: 02/03/2023] Open
Abstract
Current evidence on digital health interventions is disproportionately concerned with high-income countries and hospital settings. This scoping review evaluates the extent of use and effectiveness of digital health interventions for non-communicable disease (NCD) management in primary healthcare settings of low- and middle-income countries (LMICs) and identifies factors influencing digital health interventions' uptake. We use PubMed, Embase, and Web of Science search results from January 2010 to 2021. Of 8866 results, 52 met eligibility criteria (31 reviews, 21 trials). Benchmarked against World Health Organization's digital health classifications, only 14 out of 28 digital health intervention categories are found, suggesting critical under-use and lagging innovation. Digital health interventions' effectiveness vary across outcomes: clinical (mixed), behavioral (positively inclined), and service implementation outcomes (clear effectiveness). We further identify multiple factors influencing digital health intervention uptake, including political commitment, interactivity, user-centered design, and integration with existing systems, which points to future research and practices to invigorate digital health interventions for NCD management in primary health care of LMICs.
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Affiliation(s)
- Shangzhi Xiong
- The George Institute for Global Health, Faulty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.
- Global Health Research Centre, Duke Kunshan University, Kunshan, China.
| | - Hongsheng Lu
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Ege K Duman
- Global Health Research Centre, Duke Kunshan University, Kunshan, China
- School of Anthropology and Museum Ethnography, Oxford University, Oxford, UK
| | - Alberto Najarro
- Global Health Research Centre, Duke Kunshan University, Kunshan, China
- The Yenching Academy of Peking University, Beijing, China
| | - Zhao Ni
- School of Nursing, Yale University, New Haven, CT, USA
| | - Enying Gong
- School of Population Medicine and Public Health, China Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ruoyu Yin
- Department of Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Truls Ostbye
- Global Health Research Centre, Duke Kunshan University, Kunshan, China
| | | | - Rinchen Doma
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Sweta Kafle
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Maoyi Tian
- The George Institute for Global Health, Faulty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- School of Public Health, Harbin Medical University, Harbin, China
| | - Lijing L Yan
- Global Health Research Centre, Duke Kunshan University, Kunshan, China.
- Duke Global Health Institute, Duke University, Durham, NC, USA.
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- The George Institute for Global Health, Beijing, China.
- School of Health Sciences, Wuhan University, Wuhan, China.
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21
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Zwack CC, Smith C, Poulsen V, Raffoul N, Redfern J. Information Needs and Communication Strategies for People with Coronary Heart Disease: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1723. [PMID: 36767091 PMCID: PMC9914653 DOI: 10.3390/ijerph20031723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/13/2023] [Accepted: 01/13/2023] [Indexed: 06/18/2023]
Abstract
A critical aspect of coronary heart disease (CHD) care and secondary prevention is ensuring patients have access to evidence-based information. The purpose of this review is to summarise the guiding principles, content, context and timing of information and education that is beneficial for supporting people with CHD and potential communication strategies, including digital interventions. We conducted a scoping review involving a search of four databases (Web of Science, PubMed, CINAHL, Medline) for articles published from January 2000 to August 2022. Literature was identified through title and abstract screening by expert reviewers. Evidence was synthesised according to the review aims. Results demonstrated that information-sharing, decision-making, goal-setting, positivity and practicality are important aspects of secondary prevention and should be patient-centred and evidenced based with consideration of patient need and preference. Initiation and duration of education is highly variable between and within people, hence communication and support should be regular and ongoing. In conclusion, text messaging programs, smartphone applications and wearable devices are examples of digital health strategies that facilitate education and support for patients with heart disease. There is no one size fits all approach that suits all patients at all stages, hence flexibility and a suite of resources and strategies is optimal.
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Affiliation(s)
- Clara C. Zwack
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Carlie Smith
- National Heart Foundation of Australia, Brisbane, QLD 4006, Australia
| | - Vanessa Poulsen
- National Heart Foundation of Australia, Adelaide, SA 5000, Australia
| | - Natalie Raffoul
- National Heart Foundation Australia, Sydney, NSW 2011, Australia
| | - Julie Redfern
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
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22
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Krychtiuk KA, Ahrens I, Drexel H, Halvorsen S, Hassager C, Huber K, Kurpas D, Niessner A, Schiele F, Semb AG, Sionis A, Claeys MJ, Barrabes J, Montero S, Sinnaeve P, Pedretti R, Catapano A. Acute LDL-C reduction post ACS: strike early and strike strong: from evidence to clinical practice. A clinical consensus statement of the Association for Acute CardioVascular Care (ACVC), in collaboration with the European Association of Preventive Cardiology (EAPC) and the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2022; 11:939-949. [PMID: 36574353 DOI: 10.1093/ehjacc/zuac123] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/02/2022] [Indexed: 12/28/2022]
Abstract
After experiencing an acute coronary syndrome (ACS), patients are at a high risk of suffering from recurrent ischaemic cardiovascular events, especially in the very early phase. Low density lipoprotein-cholesterol (LDL-C) is causally involved in atherosclerosis and a clear, monotonic relationship between pharmacologic LDL-C lowering and a reduction in cardiovascular events post-ACS has been shown, a concept termed 'the lower, the better'. Current ESC guidelines suggest an LDL-C guided, step-wise initiation and escalation of lipid-lowering therapy (LLT). Observational studies consistently show low rates of guideline-recommended LLT adaptions and concomitant low rates of LDL-C target goal achievement, leaving patients at residual risk, especially in the vulnerable post-ACS phase. In addition to the well-established 'the lower, the better' approach, a 'strike early and strike strong' approach in the early post-ACS phase with upfront initiation of a combined lipid-lowering approach using high-intensity statins and ezetimibe seems reasonable. We discuss the rationale, clinical trial evidence and experience for such an approach and highlight existing knowledge gaps. In addition, the concept of acute initiation of PCSK9 inhibition in the early phase is reviewed. Ultimately, we focus on hurdles and solutions to provide high-quality, evidence-based follow-up care in post-ACS patients.
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Affiliation(s)
- Konstantin A Krychtiuk
- Department of Internal Medicine II-Division of Cardiology, Medical University of Vienna, 1180 Vienna, Austria.,Duke Clinical Research Institute, Durham, NC 27701, USA
| | - Ingo Ahrens
- Department of Cardiology and Medical Intensive Care, Augustinerinnen Hospital Cologne, Academic Teaching Hospital University of Cologne, 50678 Cologne, Germany
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Carinagasse 47, AT-6800 Feldkirch, Austria.,Private University of the Principality of Liechtenstein, Dorfstrasse 24, FL-9495 Triesen, Liechtenstein.,Department of Medicine I, Academic Teaching Hospital Feldkirch, Carinagasse 47, AT-6800 Feldkirch, Austria
| | - Sigrun Halvorsen
- Institute of Clinical Medicine, University of Oslo, 0372 Oslo, Norway.,Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet and Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Kurt Huber
- 3rd Department of Internal Medicine, Cardiology and Intensive Care Unit, Wilhelminenhospital, 1160 Vienna, Austria.,Ludwig Boltzmann Institute for Cardiovascular Research, 1090 Vienna, Austria.,Medical School, Sigmund Freud University, 1020 Vienna, Austria
| | - Donata Kurpas
- Family Medicine Department, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Alexander Niessner
- Department of Internal Medicine II-Division of Cardiology, Medical University of Vienna, 1180 Vienna, Austria
| | - Francois Schiele
- Department of Cardiology, University Hospital Besancon, University of Franche-Comté, France and EA3920, Besancon, France
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Division of Innovation and Research, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de Sant Pau, IIB-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBER-CV, Centro de investigación Biomédica en Red de Enfermedades Cardiovasculares, 28029 Madrid, Spain
| | - Marc J Claeys
- Department of Cardiology, Antwerp University Hospital, 2650 Edegem, Belgium
| | - José Barrabes
- Acute Cardiac Care Unit, Cardiology Service, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBERC-V, Centro de investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Santiago Montero
- Acute Cardiovascular Care Unit, Cardiology, Hospital Germans Trias i Pujol. Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Peter Sinnaeve
- Department of Cardiology, University Hospital Leuven, Leuven, Belgium
| | - Roberto Pedretti
- Director of Cardiovascular Department, Head of Cardiology Unit, IRCCS MultiMedica, Milan, Italy
| | - Alberico Catapano
- Professor of Pharmacology, Director Center of Epidemiology and Preventive Pharmacology, Director Laboratory of Lipoproteins, Immunity and Atherosclerosis Department of Pharmacological and Biomolecular Sciences Director Center for the Study of Atherosclerosis at Bassini Hospital University of Milan, Milan, Italy
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23
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Reif S, Schubert S, Stiefel J, Husri F, Fischlein T, Pauschinger M, Klucken J. Supporting patients with heart failure with digital therapeutics-A pilot study in Germany. Digit Health 2022; 8:20552076221143899. [PMID: 36583086 PMCID: PMC9793018 DOI: 10.1177/20552076221143899] [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] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 11/18/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Continuous monitoring and targeted behavioral interventions have been shown to improve health status and quality of life for heart failure patients. Digital therapeutics offer the possibility to make more frequent monitoring and targeted behavioral interventions available for more people. Methods We conduct a pilot study with 71 patients who were given a smartphone app and wearables for a 3-month period. Clinical indicators as well as patient-reported outcomes were collected at entry and exit examinations. Results The New York Heart Association class remained stable or improved. Most quantitative outcome measures improved (6-minute walk test distance + 21 m, Kansas City Cardiomyopathy Questionnaire summary score + 6.0 points, European Heard Failure Self-care Behavior Scale summary score + 6.6 points, correct answers in the Atlanta Heart Failure Knowledge Test + 2.1), although the changes were mainly not significantly different from zero. There was no change in EQ-5D weight and 9-item Shared Decision-Making Questionnaire summary score. Conclusions This before-after comparison shows that an app-based intervention can work as a digital therapeutic for heart failure patients.
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Affiliation(s)
- S. Reif
- ZEW – Leibniz Centre for European Economic Research, Mannheim,
Germany,S. Reif, ZEW - Leibniz Centre for European
Economic Research, L7 1, 68161 Mannheim, Germany.
| | - S. Schubert
- ZEW – Leibniz Centre for European Economic Research, Mannheim,
Germany,FAU University Erlangen-Nurnberg, Nürnberg, Germany
| | - J. Stiefel
- dmac – Medical Valley Digital Health Application Center, Bamberg,
Germany
| | - F. Husri
- Department of Cardiac Surgery, Klinikum Nürnberg (Cardiovascular
Center), Paracelsus Medical University, Nürnberg, Germany
| | - T. Fischlein
- Department of Cardiac Surgery, Klinikum Nürnberg (Cardiovascular
Center), Paracelsus Medical University, Nürnberg, Germany
| | - M. Pauschinger
- Department of Cardiology, Klinikum Nürnberg (Cardiovascular Center),
Paracelsus Medical University, Nürnberg, Germany
| | - J. Klucken
- Digital Medicine Group, Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg,Medicine Group, Department of Precision Health, Luxembourg Institute
of Health (LIH), Strassen, Luxembourg,Digital Medicine Group, Centre Hospitalier de Luxembourg (CHL),
Luxembourg
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24
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Coorey G, Campain A, Mulley J, Usherwood T, Redfern J, Harris M, Zwar N, Parker S, Coiera E, Peiris D. Utilisation of government-subsidised chronic disease management plans and cardiovascular care in Australian general practices. BMC PRIMARY CARE 2022; 23:157. [PMID: 35729493 PMCID: PMC9210726 DOI: 10.1186/s12875-022-01763-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/06/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Government-subsidised general practice management plans (GPMPs) facilitate chronic disease management; however, impact on cardiovascular disease (CVD) is unknown. We aimed to determine utilisation and impact of GPMPs for people with or at elevated risk of CVD.
Methods
Secondary analysis of baseline data from the CONNECT randomised controlled trial linked to Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) claims. Multivariate regression examining the association of GPMP receipt and review with: (1) ≥ 1 MBS-subsidised allied health visit in the previous 24 months; (2) adherence to dual cardioprotective medication (≥ 80% of days covered with a dispensed PBS prescription); and (3) meeting recommended LDL-cholesterol and blood pressure (BP) targets concurrently.
Results
Overall, 905 trial participants from 24 primary health care services consented to data linkage. Participants with a GPMP (46.6%, 422/905) were older (69.4 vs 66.0 years), had lower education (32.3% vs 24.7% high school or lower), lower household income (27.5% vs 17.0% in lowest bracket), and more comorbidities, particularly diabetes (42.2% vs 17.6%) compared to those without a GPMP. After adjustment, a GPMP was strongly associated with allied health visits (odds ratio (OR) 14.80, 95% CI: 9.08–24.11) but not higher medication adherence rates (OR 0.82, 95% CI: 0.52–1.29) nor meeting combined LDL and BP targets (OR 1.31, 95% CI: 0.72–2.38). Minor differences in significant covariates were noted in models using GPMP review versus GPMP initiation.
Conclusions
In people with or at elevated risk of CVD, GPMPs are under-utilised overall. They are targeting high-needs populations and facilitate allied health access, but are not associated with improved CVD risk management, which represents an opportunity for enhancing their value in supporting guideline-recommended care.
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25
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Kuan PX, Chan WK, Fern Ying DK, Rahman MAA, Peariasamy KM, Lai NM, Mills NL, Anand A. Efficacy of telemedicine for the management of cardiovascular disease: a systematic review and meta-analysis. Lancet Digit Health 2022; 4:e676-e691. [PMID: 36028290 PMCID: PMC9398212 DOI: 10.1016/s2589-7500(22)00124-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 06/13/2022] [Accepted: 06/21/2022] [Indexed: 10/29/2022]
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26
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Emadi F, Ghanbarzadegan A, Ghahramani S, Bastani P, Baysari MT. Factors affecting medication adherence among older adults using tele-pharmacy services: a scoping review. Arch Public Health 2022; 80:199. [PMID: 36042508 PMCID: PMC9429665 DOI: 10.1186/s13690-022-00960-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/22/2022] [Indexed: 11/21/2022] Open
Abstract
Background Medication adherence among older adults (aged 60 and above), particularly those with chronic conditions who take several medications, is critical, and tele-pharmacy services are a way to improve medication adherence. This study sought to determine the factors influencing medication adherence (MA) in older adults using tele-pharmacy services. Method The Joana Briggs Institute scoping review methodology was implemented. Searches were conducted in databases PubMed, Scopus, ProQuest, Web of Science, and Embase from 2000 to the present day, to identify both qualitative and quantitative studies focusing on the use of tele-pharmacy by older people. Factors impacting MA were extracted and analyzed into themes using a qualitative approach. A concept map was also designed summarising these factors. Results Of 7495 articles obtained in the initial search, 52 articles met the inclusion criteria. The analysis resulted in 5 themes and 21 sub-themes representing factors that impacted MA with tele-pharmacy. These themes are divided broadly into technology and user related factors. Technology factors included design of the tele-pharmacy intervention, commercial aspects, and adherence measurement method. User factors included user-health constraints, behaviors and perceptions. Conclusion Industry, policymakers, and stakeholders should consider using tele-pharmacy services for improving medication adherence among older adults; however, ensuring interventions facilitate communication between patients and health care teams, and are accompanied by user training and support, is essential for technology uptake and effectiveness. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-022-00960-w.
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27
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Smart Home Technology Solutions for Cardiovascular Diseases: A Systematic Review. APPLIED SYSTEM INNOVATION 2022. [DOI: 10.3390/asi5030051] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Cardiovascular diseases (CVD) are the leading cause of mortality globally. Despite improvement in therapies, people with CVD lack support for monitoring and managing their condition at home and out of hospital settings. Smart Home Technologies have potential to monitor health status and support people with CVD in their homes. We explored the Smart Home Technologies available for CVD monitoring and management in people with CVD and acceptance of the available technologies to end-users. We systematically searched four databases, namely Medline, Web of Science, Embase, and IEEE, from 1990 to 2020 (search date 18 March 2020). “Smart-Home” was defined as a system using integrated sensor technologies. We included studies using sensors, such as wearable and non-wearable devices, to capture vital signs relevant to CVD at home settings and to transfer the data using communication systems, including the gateway. We categorised the articles for parameters monitored, communication systems and data sharing, end-user applications, regulations, and user acceptance. The initial search yielded 2462 articles, and the elimination of duplicates resulted in 1760 articles. Of the 36 articles eligible for full-text screening, we selected five Smart Home Technology studies for CVD management with sensor devices connected to a gateway and having a web-based user interface. We observed that the participants of all the studies were people with heart failure. A total of three main categories—Smart Home Technology for CVD management, user acceptance, and the role of regulatory agencies—were developed and discussed. There is an imperative need to monitor CVD patients’ vital parameters regularly. However, limited Smart Home Technology is available to address CVD patients’ needs and monitor health risks. Our review suggests the need to develop and test Smart Home Technology for people with CVD. Our findings provide insights and guidelines into critical issues, including Smart Home Technology for CVD management, user acceptance, and regulatory agency’s role to be followed when designing, developing, and deploying Smart Home Technology for CVD.
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28
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Buss VH, Varnfield M, Harris M, Barr M. A Mobile App for Prevention of Cardiovascular Disease and Type 2 Diabetes Mellitus: Development and Usability Study. JMIR Hum Factors 2022; 9:e35065. [PMID: 35536603 PMCID: PMC9131155 DOI: 10.2196/35065] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/26/2022] [Accepted: 03/26/2022] [Indexed: 01/16/2023] Open
Abstract
Background Cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) are posing a huge burden on health care systems worldwide. Mobile apps can deliver behavior change interventions for chronic disease prevention on a large scale, but current evidence for their effectiveness is limited. Objective This paper reported on the development and user testing of a mobile app that aims at increasing risk awareness and engaging users in behavior change. It would form part of an intervention for primary prevention of CVD and T2DM. Methods The theoretical framework of the app design was based on the Behaviour Change Wheel, combined with the capability, opportunity, and motivation for behavior change system and the behavior change techniques from the Behavior Change Technique Taxonomy (version 1). In addition, evidence from scientific literature has guided the development process. The prototype was tested for user-friendliness via an iterative approach. We conducted semistructured interviews with individuals in the target populations, which included the System Usability Scale. We transcribed and analyzed the interviews using descriptive statistics for the System Usability Scale and thematic analysis to identify app features that improved utility and usability. Results The target population was Australians aged ≥45 years. The app included 4 core modules (risk score, goal setting, health measures, and education). In these modules, users learned about their risk for CVD and T2DM; set goals for smoking, alcohol consumption, diet, and physical activity; and tracked them. In total, we included 12 behavior change techniques. We conducted 2 rounds of usability testing, each involving 5 participants. The average age of the participants was 58 (SD 8) years. Totally, 60% (6/10) of the participants owned iPhone Operating System phones, and 40% (4/10) of them owned Android phones. In the first round, we identified a technical issue that prevented 30% (3/10) of the participants from completing the registration process. Among the 70% (7/10) of participants who were able to complete the registration process, 71% (5/7) rated the app above average, based on the System Usability Scale. During the interviews, we identified some issues related to functionality, content, and language and clarity. We used the participants’ feedback to improve these aspects. Conclusions We developed the app using behavior change theory and scientific evidence. The user testing allowed us to identify and remove technical errors and integrate additional functions into the app, which the participants had requested. Next, we will evaluate the feasibility of the revised version of the app developed through this design process and usability testing.
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Affiliation(s)
- Vera Helen Buss
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Herston, Australia.,Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Marlien Varnfield
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Herston, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Margo Barr
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
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29
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Redfern J, Gallagher R, O’Neil A, Grace SL, Bauman A, Jennings G, Brieger D, Briffa T. Historical Context of Cardiac Rehabilitation: Learning From the Past to Move to the Future. Front Cardiovasc Med 2022; 9:842567. [PMID: 35571195 PMCID: PMC9091441 DOI: 10.3389/fcvm.2022.842567] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/18/2022] [Indexed: 12/12/2022] Open
Abstract
Contemporary myocardial infarction (MI) care and management has evolved dramatically since the 1950's; yet outpatient rehabilitation remains underutilized. Deepening our understanding of the origins and history of cardiac rehabilitation highlights a contemporary shift required for policy and practice related to secondary prevention of coronary disease in light of societal changes as well as medical, digital and surgical advancements. Contemporary "cardiac rehabilitation" began when bed rest and physical inactivity was recommended and commonplace for MI survivors. Today, most patients who survive an MI, undergo reperfusion therapy, a short inpatient stay and are discharged with minimal physical morbidity. Despite this, the majority of modern day programs continue to be structured in the same way they have been for the past 50 years and this model has become incongruent with the contemporary context, especially in the COVID-19 era. This review aims to describe the historical foundations of cardiac rehabilitation to inform solutions and meet the demands of contemporary MI management. Delivering health systems reform to address modernization is current healthcare challenge where a united and interdisciplinary effort is needed.
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Affiliation(s)
- Julie Redfern
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Robyn Gallagher
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Adrienne O’Neil
- School of Medicine, IMPACT Institute, Deakin University, Geelong, VIC, Australia
| | - Sherry L. Grace
- Faculty of Health, York University, Toronto, ON, Canada
- KITE Toronto Rehabilitation Institute and Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Adrian Bauman
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Garry Jennings
- National Heart Foundation of Australia, Melbourne, VIC, Australia
| | - David Brieger
- Department of Cardiology, Concord Hospital, Sydney, NSW, Australia
| | - Tom Briffa
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
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30
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Wong BLH, Maaß L, Vodden A, van Kessel R, Sorbello S, Buttigieg S, Odone A. The dawn of digital public health in Europe: Implications for public health policy and practice. Lancet Reg Health Eur 2022; 14:100316. [PMID: 35132399 PMCID: PMC8811486 DOI: 10.1016/j.lanepe.2022.100316] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The COVID-19 pandemic has highlighted the importance of digital health technologies and the role of effective surveillance systems. While recent events have accelerated progress towards the expansion of digital public health (DPH), there remains significant untapped potential in harnessing, leveraging, and repurposing digital technologies for public health. There is a particularly growing need for comprehensive action to prepare citizens for DPH, to regulate and effectively evaluate DPH, and adopt DPH strategies as part of health policy and services to optimise health systems improvement. As representatives of the European Public Health Association's (EUPHA) Digital Health Section, we reflect on the current state of DPH, share our understanding at the European level, and determine how the application of DPH has developed during the COVID-19 pandemic. We also discuss the opportunities, challenges, and implications of the increasing digitalisation of public health in Europe.
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31
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Using clinical prediction models to personalise lifestyle interventions for cardiovascular disease prevention: A systematic literature review. Prev Med Rep 2022; 25:101672. [PMID: 35127352 PMCID: PMC8800044 DOI: 10.1016/j.pmedr.2021.101672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 12/09/2021] [Accepted: 12/12/2021] [Indexed: 11/23/2022] Open
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32
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Xu L, Li J, Zhang X, Pang Y, Yu T, Lian X, Yu T, Zhu L, Tong Q, Li F. Mobile health-based gamification intervention to increase physical activity participation among patients with coronary heart disease: study protocol of a randomised controlled trial. BMJ Open 2022; 12:e054623. [PMID: 35105640 PMCID: PMC8808393 DOI: 10.1136/bmjopen-2021-054623] [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: 11/19/2022] Open
Abstract
INTRODUCTION Despite proven benefits, physical activity participation remains low in patients with coronary heart disease (CHD). Scientific evidence suggests that mobile health (mHealth)-based gamification interventions could increase physical activity levels. However, several systematic reviews demonstrated that most gamification intervention designs do not appropriately leverage theories from health behaviour models, and empirical evidence on the efficacy of such interventions among patients with CHD is still emerging. This study embeds the principles of behavioural economics into a gamification intervention based on a smartphone app (WeChat applet) to explore whether a mHealth-based gamification intervention can improve participation in physical activity and other related physical and psychological outcomes in patients with CHD. METHODS We propose a single-blinded three-arm randomised controlled trial with 108 patients with CHD, who will be randomly divided into three groups (Control group: WeChat applet+step goal setting; Individual group: WeChat applet+step goal setting+gamification; Team group: WeChat applet+step goal setting+gamification+collaboration). The interventions will last for 12 weeks and follow-up for 12 weeks. All patients will receive only WeChat applet-based step goal setting in the follow-up period. The primary outcome is physical activity participation, which includes a change in daily steps and self-reported physical activity from the baseline to 12 and 24 weeks, and the proportion of patient-days that step goals achieved in 12 and 24 weeks. The secondary outcomes include biomedical and lifestyle-related risk factors, intrinsic motivation, enjoyment, competence, autonomy and relatedness, social support and mental health and patients' satisfaction, perceptions and intervention experience. ETHICS AND DISSEMINATION The Human Research Ethics Committee of the School of Nursing, Jilin University (HREC 2020122401) approved this. The results will be published in peer-reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER ChiCTR2100044879; Pre-results.
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Affiliation(s)
- Linqi Xu
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Jinwei Li
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Xin Zhang
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Yue Pang
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Tianzhuo Yu
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Xiaoqian Lian
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Tianyue Yu
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Lanyu Zhu
- School of Nursing, Jilin University, Changchun, Jilin, China
- School of Nursing, Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Qian Tong
- Department of Cardiology, Bethune First Hospital Of Jilin University, Changchun, Jilin, China
| | - Feng Li
- School of Nursing, Jilin University, Changchun, Jilin, China
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Castela Forte J, Gannamani R, Folkertsma P, Kumaraswamy S, Mount S, van Dam S, Hoogsteen J. Changes in blood lipid levels after a digitally-enabled, cardiometabolic preventive health program: a pre-post study in an adult, Dutch general population cohort (Preprint). JMIR Cardio 2021; 6:e34946. [PMID: 35319473 PMCID: PMC8987960 DOI: 10.2196/34946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/12/2022] [Accepted: 03/05/2022] [Indexed: 01/17/2023] Open
Abstract
Background Despite widespread education, many individuals fail to follow basic health behaviors such as consuming a healthy diet and exercising. Positive changes in lifestyle habits are associated with improvements in multiple cardiometabolic health risk factors, including lipid levels. Digital lifestyle interventions have been suggested as a viable complement or potential alternative to conventional health behavior change strategies. However, the benefit of digital preventive interventions for lipid levels in a preventive health context remains unclear. Objective This observational study aimed to determine how the levels of lipids, namely total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, non-HDL cholesterol, and triglycerides, changed over time in a Dutch general population cohort undergoing a digital preventive health program. Moreover, we looked to establish associations between lifestyle factors at baseline and lipid levels. Methods We included 348 adults from the Dutch general population who underwent a digitally enabled preventive health program at Ancora Health between January 2020 and October 2021. Upon enrollment, participants underwent a baseline assessment involving a comprehensive lifestyle questionnaire, a blood biochemistry panel, physical measurements, and cardiopulmonary fitness measurements. Thereafter, users underwent a lifestyle coaching program and could access the digital application to register and track health behaviors, weight, and anthropometric data at any time. Lipid levels were categorized as normal, elevated, high, and clinical dyslipidemia according to accepted international standards. If at least one lipid marker was high or HDL was low, participants received specific coaching and advice for cardiometabolic health. We retrospectively analyzed the mean and percentage changes in lipid markers in users who were remeasured after a cardiometabolic health–focused intervention, and studied the association between baseline user lifestyle characteristics and having normal lipid levels. Results In our cohort, 199 (57.2%) participants had dyslipidemia at baseline, of which 104 participants were advised to follow a cardiometabolic health–focused intervention. Eating more amounts of favorable food groups and being more active were associated with normal lipid profiles. Among the participants who underwent remeasurement 9 months after intervention completion, 57% (17/30), 61% (19/31), 56% (15/27), 82% (9/11), and 100% (8/8) showed improvements at remeasurement for total, LDL, HDL, and non-HDL cholesterol, and triglycerides, respectively. Moreover, between 35.3% and 77.8% showed a return to normal levels. In those with high lipid levels at baseline, total cholesterol decreased by 0.5 mmol/L (7.5%), LDL cholesterol decreased by 0.39 mmol/L (10.0%), non-HDL cholesterol decreased by 0.44 mmol/L (8.3%), triglycerides decreased by 0.97 mmol/L (32.0%), and HDL increased by 0.17 mmol/L (15.6%), after the intervention. Conclusions A cardiometabolic screening program in a general population cohort identified a significant portion of individuals with subclinical and clinical lipid levels. Individuals who, after screening, actively engaged in a cardiometabolic health–focused lifestyle program improved their lipid levels.
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Affiliation(s)
- José Castela Forte
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, Groningen, Netherlands
- Ancora Health BV, Groningen, Netherlands
| | - Rahul Gannamani
- Ancora Health BV, Groningen, Netherlands
- Department of Neurology, University Medical Centre Groningen, Groningen, Netherlands
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Management of cardiovascular disease using an mHealth tool: a randomized clinical trial. NPJ Digit Med 2021; 4:165. [PMID: 34862449 PMCID: PMC8642390 DOI: 10.1038/s41746-021-00535-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/26/2021] [Indexed: 01/02/2023] Open
Abstract
Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of death and morbidity worldwide. This randomized controlled, single-center, open-label trial tested the impact of a mobile health (mHealth) service tool optimized for ASCVD patient care. Patients with clinical ASCVD were enrolled and randomly assigned to the intervention or control group. Participants in the intervention group were provided with a smartphone application named HEART4U, while a dedicated interface integrated into the electronic healthcare record system was provided to the treating physicians. A total of 666 patients with ASCVD were enrolled, with 333 patients in each group. The estimated baseline 10-year risk of cardiovascular disease was 9.5% and 10.8% in the intervention and control groups, respectively, as assessed by the pooled cohort risk equations. The primary study endpoint was the change in the estimated risk at six months. The estimated risk increased by 1.3% and 1.1%, respectively, which did not differ significantly (P = 0.821). None of the secondary study endpoints showed significant differences between the groups. A post-hoc subgroup analysis showed the benefit was greater if a participant in the intervention group accessed the application more frequently. The present study demonstrated no significant benefits associated with the use of the mHealth tool in terms of the predefined study endpoints in stable patients with ASCVD. However, it also suggested that motivating patients to use the mHealth tool more frequently may lead to greater clinical benefit. Better design with a positive user experience needs to be considered for developing future mHealth tools for ASCVD patient care.Trial Registration: ClinicalTrials.gov NCT03392259.
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Qiu Y, Asselin CY, Kallas D, Adreak N, Armstrong K, Colella TJ, Sharma A, Avram R, Gravel GM, Randhawa VK. The Emerging Role of Digital Health Technology in Cardiovascular Care. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Coorey G, Peiris D, Scaria A, Mulley J, Neubeck L, Hafiz N, Redfern J. An Internet-Based Intervention for Cardiovascular Disease Management Integrated With Primary Care Electronic Health Records: Mixed Methods Evaluation of Implementation Fidelity and User Engagement. J Med Internet Res 2021; 23:e25333. [PMID: 33900204 PMCID: PMC8111511 DOI: 10.2196/25333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/21/2020] [Accepted: 03/16/2021] [Indexed: 12/02/2022] Open
Abstract
Background Growing evidence supports the benefits of eHealth interventions to increase patient engagement and improve outcomes for a range of conditions. However, ineffective program delivery and usage attrition limit exposure to these interventions and may reduce their effectiveness. Objective This study aims to evaluate the delivery fidelity of an eHealth intervention, describe use patterns, compare outcomes between low and high users, and identify mediating factors on intervention delivery and receipt. Methods This is a mixed methods study of an internet-based intervention being evaluated for effectiveness in a randomized controlled trial (RCT). The intervention comprised medication and cardiovascular disease (CVD) risk data uploaded from the primary care electronic health record (EHR); interactive, personalized CVD risk score estimation; goal setting and self-monitoring; an interactive social forum; and optional receipt of heart health messages. Fidelity was assessed over 12 months. Trial outcomes were compared between low and high users. Data sources included program delivery records, web log data, trial data, and thematic analysis of communication records. Results Most participants in the intervention group (451/486, 93%) had an initial training session conducted by telephone (413/447, 92.4% of participants trained), with a mean duration of 44 minutes (range 10-90 minutes). Staff conducted 98.45% (1776/1804) of the expected follow-ups, mostly by telephone or email. Of the 451 participants who commenced log-ins, 46.8% (211) were categorized as low users (defined as at least one log-in in 3 or fewer months of follow-up), 40.4% (182) were categorized as high users (at least one log-in in more than 3 months of follow-up), and 12.8% (58) were nonadopters (no log-ins after their training session). The mean log-in frequency was 3-4 per month in ongoing users. There was no significant difference between the groups in the primary trial outcome of adherence to guideline-recommended medications (P=.44). In unadjusted analyses, high users had significantly greater eHealth literacy scores (P=.003) and were more likely to meet recommended weekly targets for fruit (P=.03) and fish (P=.004) servings; however, the adjusted findings were not significant. Interactive screen use was highest for goal tracking and lowest for the chat forum. Screens with EHR-derived data held only an early interest for most users. Fidelity measures (reach, content, dose delivered, and dose received) were influenced by the facilitation strategies used by staff, invisible qualities of staff-participant communication, and participants’ responsiveness to intervention attributes. Conclusions A multifeature internet-based intervention was delivered with high fidelity to the RCT protocol and was regularly used by 40.4% (182/451) of users over 12 months. Higher log-in frequency as an indicator of greater intervention exposure was not associated with statistically significant improvements in eHealth literacy scores, lifestyle changes, or clinical outcomes. Attributes of the intervention and individualized support influenced initial and ongoing use.
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Affiliation(s)
- Genevieve Coorey
- The George Institute for Global Health, Sydney, Australia, Sydney, Australia.,School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Peiris
- The George Institute for Global Health, Sydney, Australia, Sydney, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, Australia
| | - Anish Scaria
- The George Institute for Global Health, Sydney, Australia, Sydney, Australia
| | - John Mulley
- The George Institute for Global Health, Sydney, Australia, Sydney, Australia
| | - Lis Neubeck
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, United Kingdom.,Susan Wakil School for Nursing and Midwifery, The University of Sydney, Sydney, Australia
| | - Nashid Hafiz
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Julie Redfern
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Makris E, Hu L, Jones GB, Wright JM. Moving the Dial on Heart Failure Patient Adherence Rates. Patient Prefer Adherence 2020; 14:2407-2418. [PMID: 33324042 PMCID: PMC7733338 DOI: 10.2147/ppa.s283277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/20/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Heart failure remains a substantive contributor to patient morbidity and mortality rates worldwide and represents a significant burden on the healthcare ecosystem. Faced with persistent physical symptoms and debilitating social consequences, patients follow complex treatment regimens and often have difficulty adhering to them. PURPOSE In this manuscript, we review factors which contribute to low adherence rates and advance potential single- and multi-factor-based interventions. It is hoped that these observations can lead to improvements in managed care of this vulnerable population of patients. METHODS A narrative review of the primary literature was performed on contributing factors with primary focus on the period 2015-2020 using available databases and search engines. Adherence pain points identified were mapped against a series of potential solutions which are presented. RESULTS Enhancement of treatment adherence relies on two approaches viz. single-factor and multi-factor solutions. Single factors identified include electronic reminders, enhanced health education, financial incentives, gamification strategies, community drivers, persona-based modeling, and burden relief of poly pharmacy. Multi-factor solutions combine two or more of the seven approaches offering the potential for flexible interventions tailored to the individual. DISCUSSION AND CONCLUSION Heart failure patients with poor adherence have increased mortality, hospitalization needs, and healthcare costs. This review highlights current single-factor and multi-factor adherence methods. Against a backdrop of diversity of approaches, multi-factor solutions cast the widest net for positively influencing adherent behaviors. A key enabler lies in the development and leveraging of patient personas in the synthesis of successful intervention methods. Deployable solutions can also be envisioned in clinical trials where adherence tracking represents an essential component.
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Affiliation(s)
- Eleanna Makris
- TRD Innovation Group, Novartis Pharmaceuticals, East Hanover, NJ07936, USA
| | - Lucy Hu
- TRD Innovation Group, Novartis Pharmaceuticals, East Hanover, NJ07936, USA
| | - Graham B Jones
- TRD Innovation Group, Novartis Pharmaceuticals, East Hanover, NJ07936, USA
- Clinical and Translational Science Institute, Tufts University Medical Center, Boston, MA02111, USA
- Correspondence: Graham B Jones Email
| | - Justin M Wright
- TRD Innovation Group, Novartis Pharmaceuticals, East Hanover, NJ07936, USA
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