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Delva S, Waligora Mendez KJ, Cajita M, Koirala B, Shan R, Wongvibulsin S, Vilarino V, Gilmore DR, Han HR. Efficacy of Mobile Health for Self-management of Cardiometabolic Risk Factors: A Theory-Guided Systematic Review. J Cardiovasc Nurs 2021; 36:34-55. [PMID: 32040072 PMCID: PMC7713761 DOI: 10.1097/jcn.0000000000000659] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although mobile health (mHealth) technologies are burgeoning in the research arena, there is a lack of mHealth interventions focused on improving self-management of individuals with cardiometabolic risk factors (CMRFs). OBJECTIVE The purpose of this article was to critically and systematically review the efficacy of mHealth interventions for self-management of CMRF while evaluating quality, limitations, and issues with disparities using the technology acceptance model as a guiding framework. METHODS PubMed, CINAHL, EMBASE, and Lilacs were searched to identify research articles published between January 2008 and November 2018. Articles were included if they were published in English, included adults, were conducted in the United States, and used mHealth to promote self-care or self-management of CMRFs. A total of 28 articles were included in this review. RESULTS Studies incorporating mHealth have been linked to positive outcomes in self-management of diabetes, physical activity, diet, and weight loss. Most mHealth interventions included modalities such as text messaging, mobile applications, and wearable technologies. There was a lack of studies that are (1) in resource-poor settings, (2) theoretically driven, (3) community-engaged research, (4) measuring digital/health literacy, (5) measuring and evaluating engagement, (6) measuring outcomes related to disease self-management, and (7) focused on vulnerable populations, especially immigrants. CONCLUSION There is still a lack of mHealth interventions created specifically for immigrant populations, especially within the Latino community-the largest growing minority group in the United States. In an effort to meet this challenge, more culturally tailored mHealth interventions are needed.
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Andreozzi F, Candido R, Corrao S, Fornengo R, Giancaterini A, Ponzani P, Ponziani MC, Tuccinardi F, Mannino D. Clinical inertia is the enemy of therapeutic success in the management of diabetes and its complications: a narrative literature review. Diabetol Metab Syndr 2020; 12:52. [PMID: 32565924 PMCID: PMC7301473 DOI: 10.1186/s13098-020-00559-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/08/2020] [Indexed: 12/17/2022] Open
Abstract
Diabetes mellitus is a chronic disease characterized by high social, economic and health burden, mostly due to the high incidence and morbidity of diabetes complications. Numerous studies have shown that optimizing metabolic control may reduce the risk of micro and macrovascular complications related to the disease, and the algorithms suggest that an appropriate and timely step of care intensification should be proposed after 3 months from the failure to achieve metabolic goals. Nonetheless, many population studies show that glycemic control in diabetic patients is often inadequate. The phenomenon of clinical inertia in diabetology, defined as the failure to start a therapy or its intensification/de-intensification when appropriate, has been studied for almost 20 years, and it is not limited to diabetes care, but also affects other specialties. In the present manuscript, we have documented the issue of inertia in its complexity, assessing its dimensions, its epidemiological weight, and its burden over the effectiveness of care. Our main goal is the identification of the causes of clinical inertia in diabetology, and the quantification of its social and health-related consequences through the adoption of appropriate indicators, in an effort to advance possible solutions and proposals to fight and possibly overcome clinical inertia, thus improving health outcomes and quality of care.
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Affiliation(s)
- F. Andreozzi
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Viale Europa, 88100 Catanzaro, Italy
| | - R. Candido
- Diabetes Center District 3, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - S. Corrao
- Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - R. Fornengo
- SSD of Diabetology and Metabolic Diseases, Hospital of Chivasso, Turin, Italy
| | | | - P. Ponzani
- Operative Unit of Diabetology, “La Colletta” Hospital, Genoa, Italy
| | - M. C. Ponziani
- SSD of Diabetology-Azienda Sanitaria Locale Novara, Novara, Italy
| | - F. Tuccinardi
- Diabetology and Endocrinology Unit “Clinica del Sole” Formia, Formia, Italy
| | - D. Mannino
- Section of Endocrinology and Diabetes, Bianchi Melacrino Morelli Hospital, Reggio Calabria, Italy
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Valencia WM, Botros D, Vera-Nunez M, Dang S. Diabetes Treatment in the Elderly: Incorporating Geriatrics, Technology, and Functional Medicine. Curr Diab Rep 2018; 18:95. [PMID: 30187176 DOI: 10.1007/s11892-018-1052-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW The current approach to diabetes in the elderly incorporates components from the comprehensive geriatric approach. The most updated guidelines from the American Diabetes Association reflect influence from the consensus made in 2012 with the American Geriatrics Society. Notably, the framework included the evaluation for geriatric syndromes (falls and urinary incontinence), functional and cognitive abilities. The goal for this review is to provide an updated summary of treatment strategies for community-dwelling older adults. We identified the need to expand our approach by addressing innovative approaches and scientific concepts from telemedicine, functional medicine, and geriatrics. RECENT FINDINGS Findings on cardiovascular protection with sodium-glucose co-transporter 2 inhibitors (SGLT-2i) and some glucagon-like peptide 1 receptor agonists (GLP-1RA) support their use for older patients with diabetes. However, careful consideration for agent selection must incorporate the presence of geriatric issues, such as geriatric syndromes, or functional and cognitive decline, as they could increase the risk and impact adverse reactions. Telemedicine interventions can improve communication and connection between older patients and their providers, and improve glycemic control. Functional medicine concepts can offer additional adjuvant strategies to support the therapeutic interventions and management of diabetes in the elderly. A systematic review confirmed the efficacy and safety of metformin as first-line therapy of type 2 diabetes in the older adult, but multiple reports highlighted the risk for vitamin B12 deficiency. Randomized controlled trials showed the efficacy and safety of antihyperglycemic agents in the elderly, including some with longer duration and lesser risk for hypoglycemia. Randomized clinical trials showed cardiovascular protection with SGLT-2i (empagliflozin, canagliflozin) and GLP-1RA (liraglutide, semaglutide). The most current guidelines recommend addressing for geriatric syndromes, physical and cognitive function in the elderly, in order to individualize targets and therapeutic strategies. Clinicians managing diabetes in the elderly can play a major role for the early detection and evaluation of geriatric issues in their patients. Telemedicine interventions improve glycemic control, and certain functional medicine strategies could be adjuvant interventions to reduce inflammation and stress, but more studies focused on the elderly population are needed.
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Affiliation(s)
- Willy Marcos Valencia
- Geriatric Research, Education and Clinical Center (GRECC), Miami VA Healthcare System, 1201 NW 16th St. (11 GRC), Miami, FL, 33125, USA.
- Department of Humanities, Health and Society, Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA.
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Diana Botros
- Jackson Memorial Hospital, University of Miami Miller School of Medicine, 1611 NW 12th Ave, Miami, FL, 33136, USA
| | - Maria Vera-Nunez
- Institute for NeuroImmune Medicine (INIM), Nova Southeastern University College of Osteopathic Medicine, 3301 College Ave, CCR 4th Floor, Fort Lauderdale, FL, 33314, USA
| | - Stuti Dang
- Geriatric Research, Education and Clinical Center (GRECC), Miami VA Healthcare System, 1201 NW 16th St. (11 GRC), Miami, FL, 33125, USA
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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Reach G, Pechtner V, Gentilella R, Corcos A, Ceriello A. Clinical inertia and its impact on treatment intensification in people with type 2 diabetes mellitus. DIABETES & METABOLISM 2017; 43:501-511. [PMID: 28754263 DOI: 10.1016/j.diabet.2017.06.003] [Citation(s) in RCA: 158] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/24/2017] [Accepted: 06/14/2017] [Indexed: 12/13/2022]
Abstract
Many people with type 2 diabetes mellitus (T2DM) fail to achieve glycaemic control promptly after diagnosis and do not receive timely treatment intensification. This may be in part due to 'clinical inertia', defined as the failure of healthcare providers to initiate or intensify therapy when indicated. Physician-, patient- and healthcare-system-related factors all contribute to clinical inertia. However, decisions that appear to be clinical inertia may, in fact, be only 'apparent' clinical inertia and may reflect good clinical practice on behalf of the physician for a specific patient. Delay in treatment intensification can happen at all stages of treatment for people with T2DM, including prescription of lifestyle changes after diagnosis, introduction of pharmacological therapy, use of combination therapy where needed and initiation of insulin. Clinical inertia may contribute to people with T2DM living with suboptimal glycaemic control for many years, with dramatic consequences for the patient in terms of quality of life, morbidity and mortality, and for public health because of the huge costs associated with uncontrolled T2DM. Because multiple factors can lead to clinical inertia, potential solutions most likely require a combination of approaches involving fundamental changes in medical care. These could include the adoption of a person-centred model of care to account for the complex considerations influencing treatment decisions by patients and physicians. Better patient education about the progressive nature of T2DM and the risks inherent in long-term poor glycaemic control may also reinforce the need for regular treatment reviews, with intensification when required.
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Affiliation(s)
- G Reach
- Department of Endocrinology, Diabetes and Metabolic Diseases, Avicenne Hospital APHP and EA 3412, CRNH-IdF, Paris 13 University, 93017 Bobigny, France.
| | - V Pechtner
- Lilly Diabetes, Eli Lilly & Company, 92521 Neuilly-sur-Seine, France
| | - R Gentilella
- Eli Lilly Italia, Sesto Fiorentino, 50019 Florence, Italy
| | - A Corcos
- Eli Lilly Italia, Sesto Fiorentino, 50019 Florence, Italy
| | - A Ceriello
- U.O. Diabetologia e Malattie Metaboliche, Multimedica IRCCS Sesto San Giovanni, 20099 Milan, Italy
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Alvarado MM, Kum HC, Gonzalez Coronado K, Foster MJ, Ortega P, Lawley MA. Barriers to Remote Health Interventions for Type 2 Diabetes: A Systematic Review and Proposed Classification Scheme. J Med Internet Res 2017; 19:e28. [PMID: 28193598 PMCID: PMC5329647 DOI: 10.2196/jmir.6382] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 11/05/2016] [Accepted: 11/23/2016] [Indexed: 01/17/2023] Open
Abstract
Background Diabetes self-management involves adherence to healthy daily habits typically involving blood glucose monitoring, medication, exercise, and diet. To support self-management, some providers have begun testing remote interventions for monitoring and assisting patients between clinic visits. Although some studies have shown success, there are barriers to widespread adoption. Objective The objective of our study was to identify and classify barriers to adoption of remote health for management of type 2 diabetes. Methods The following 6 electronic databases were searched for articles published from 2010 to 2015: MEDLINE (Ovid), Embase (Ovid), CINAHL, Cochrane Central, Northern Light Life Sciences Conference Abstracts, and Scopus (Elsevier). The search identified studies involving remote technologies for type 2 diabetes self-management. Reviewers worked in teams of 2 to review and extract data from identified papers. Information collected included study characteristics, outcomes, dropout rates, technologies used, and barriers identified. Results A total of 53 publications on 41 studies met the specified criteria. Lack of data accuracy due to input bias (32%, 13/41), limitations on scalability (24%, 10/41), and technology illiteracy (24%, 10/41) were the most commonly cited barriers. Technology illiteracy was most prominent in low-income populations, whereas limitations on scalability were more prominent in mid-income populations. Barriers identified were applied to a conceptual model of successful remote health, which includes patient engagement, patient technology accessibility, quality of care, system technology cost, and provider productivity. In total, 40.5% (60/148) of identified barrier instances impeded patient engagement, which is manifest in the large dropout rates cited (up to 57%). Conclusions The barriers identified represent major challenges in the design of remote health interventions for diabetes. Breakthrough technologies and systems are needed to alleviate the barriers identified so far, particularly those associated with patient engagement. Monitoring devices that provide objective and reliable data streams on medication, exercise, diet, and glucose monitoring will be essential for widespread effectiveness. Additional work is needed to understand root causes of high dropout rates, and new interventions are needed to identify and assist those at the greatest risk of dropout. Finally, future studies must quantify costs and benefits to determine financial sustainability.
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Affiliation(s)
- Michelle M Alvarado
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
| | - Hye-Chung Kum
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States.,Department of Health Policy and Management, School of Public Health, Texas A&M Health Science Center, College Station, TX, United States
| | - Karla Gonzalez Coronado
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
| | - Margaret J Foster
- Medical Sciences Library, Texas A&M University, College Station, TX, United States
| | - Pearl Ortega
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
| | - Mark A Lawley
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
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Dang S, Karanam C, Gómez-Orozco C, Gómez-Marín O. Mobile Phone Intervention for Heart Failure in a Minority Urban County Hospital Population: Usability and Patient Perspectives. Telemed J E Health 2017; 23:544-554. [PMID: 28051761 DOI: 10.1089/tmj.2016.0224] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Chronic heart failure (HF) is a complex and costly disease. Daily weight and symptom monitoring is the cornerstone of HF management. Little information exists about feasibility of a mobile monitoring intervention among minority patients with HF. METHODS We developed and tested usability of a mobile-monitoring system in minority patients with HF in a 2:1 randomized controlled trial. We tracked usage and obtained feedback on usability and the system overall at 1, 2, and 3 months. RESULTS Forty-two participants aged 53.0 ± 9.4 years (mean ± standard deviation) were randomized to the mobile-monitoring intervention group. They included the following: 67% males, 76% White Hispanics, 21% African Americans, and 52% with high school education or less. Over the 3-month intervention period, 26 (62%) participants used the system over 50% of the time. Overall, on a 1.0-7.0 scale for both, program satisfaction scores were excellent (mean 6.84 ± 0.46), and the usability ratings were all above 6.0. Comparing 1- to 3-month responses, there was a substantial increase in the percentage of participants who felt the system was easy to use after they had gotten used to it (84% vs. 94%) and that navigating the system was not complicated (78% vs. 84%). Almost all participants said that the program made them feel more secure about their health and that they would stay enrolled in a program like this. None of them had used a similar system before. CONCLUSIONS A mobile phone-based disease management program is feasible in a minority county hospital population and offers a modality to help reduce ethnic disparity.
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Affiliation(s)
- Stuti Dang
- 1 Bruce W. Carter Department of Veterans Affairs Medical Center, Miami Veterans Affairs Healthcare System, Miami, Florida.,2 Geriatric Research Education and Clinical Center, Miami Veterans Affairs Healthcare System; Miami, Florida.,3 Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Chandana Karanam
- 1 Bruce W. Carter Department of Veterans Affairs Medical Center, Miami Veterans Affairs Healthcare System, Miami, Florida.,2 Geriatric Research Education and Clinical Center, Miami Veterans Affairs Healthcare System; Miami, Florida
| | - Carlos Gómez-Orozco
- 4 South Florida Veterans Affairs Foundation for Research and Education, Inc., Miami, Florida
| | - Orlando Gómez-Marín
- 2 Geriatric Research Education and Clinical Center, Miami Veterans Affairs Healthcare System; Miami, Florida.,5 Division of Biostatistics, Departments of Public Health Sciences, Medicine, and Pediatrics, University of Miami Miller School of Medicine, Miami, Florida
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Nicolucci A, Cercone S, Chiriatti A, Muscas F, Gensini G. A Randomized Trial on Home Telemonitoring for the Management of Metabolic and Cardiovascular Risk in Patients with Type 2 Diabetes. Diabetes Technol Ther 2015; 17:563-70. [PMID: 26154338 DOI: 10.1089/dia.2014.0355] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND This study evaluated whether a home telehealth (HT) system enabling the patient to monitor body weight, blood glucose values, and blood pressure values, associated with remote educational support and feedback to the general practitioner, can improve metabolic control and overall cardiovascular risk in individuals with type 2 diabetes mellitus, compared with usual practice. MATERIALS AND METHODS This was a randomized, parallel-group (1:1), open-label, multicenter study conducted in general practice. Follow-up was for 12 months. RESULTS Overall, 29 general practitioners enrolled 302 patients (153 assigned to the HT group and 149 to the control group). Use of the HT system was associated with a statistically significant reduction in glycated hemoglobin (HbA1c) levels compared with the control group (estimated mean difference, 0.33±0.1; P=0.001). No difference emerged as for body weight, blood pressure, and lipid profile. The proportion of patients reaching the target of HbA1c <7.0% was higher in the HT group than in the control group after 6 months (33.0% vs. 18.7%; P=0.009) and 12 months (28.1% vs. 18.5%; P=0.07). As for quality of life (evaluated with the 36-item Short Form health survey), significant differences in favor of the HT group were detected as for physical functioning (P=0.01), role limitations due to emotional problems (P=0.02), mental health (P=0.005), and mental component summary (P=0.03) scores. A lower number of specialist visits was reported in the telemedicine group (incidence rate ratio, 0.72; 95% confidence interval, 0.51-1.01; P=0.06). CONCLUSIONS Use of the HT system was associated with better metabolic control and quality of life; a marginally nonsignificant lower resource utilization was also documented. No impact was documented on blood pressure, lipid profile, and body weight.
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Affiliation(s)
- Antonio Nicolucci
- 1 Center for Outcomes Research and Clinical Epidemiology , Pescara, Italy
| | | | | | | | - Gianfranco Gensini
- 5 Cardiology and Internal Medicine, University of Florence , Florence, Italy
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Mignerat M, Lapointe L, Vedel I. Using telecare for diabetic patients: A mixed systematic review. HEALTH POLICY AND TECHNOLOGY 2014. [DOI: 10.1016/j.hlpt.2014.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Demiris G, Thompson H, Boquet J, Le T, Chaudhuri S, Chung J. Older adults' acceptance of a community-based telehealth wellness system. Inform Health Soc Care 2012; 38:27-36. [PMID: 22571733 DOI: 10.3109/17538157.2011.647938] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The development of ongoing assessment tools to monitor older adult health and wellness can support improved quality of life and independence. These technologies have often been employed within private residences. Our work describes a telehealth kiosk system implemented within a community setting, which reduces the costs of installing and maintaining individual systems. Though user acceptance of telehealth systems has been studied within the context of home residences, this has yet to be addressed for community-based systems. Older adults in a retirement community were recruited to use a telehealth system including assessment of vital signs and cognitive performance. With a series of focus groups (N = 12, average age 79.3 years), we examined user perceptions of the telehealth kiosk, addressing issues of usability, effectiveness and privacy. Older adults were favorable towards the collection of health monitoring information, recognizing the utility of these data sources. There were issues of usability, especially regarding ergonomics of the telehealth kiosk. We found no concerns over privacy, with some participants expressing increased preference for the social interactions afforded through the community setting. Understanding the social, technical and human factors involved with a community-based telehealth system can inform the design of cost-effective health monitoring systems.
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Optimizing diabetes self-care in low literacy and minority populations--problem-solving, empowerment, peer support and technology-based approaches. J Gen Intern Med 2011; 26:953-5. [PMID: 21647745 PMCID: PMC3157538 DOI: 10.1007/s11606-011-1759-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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