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Eilayyan OJ, Arafah AM. Acceptance and Dropout Rates of Individuals with Asthma Approached in Self-management Interventions: A Systematic Review and Meta-analysis. JOURNAL OF HEALTH MANAGEMENT 2023. [DOI: 10.1177/09720634221150970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Objective The objectives of this systematic review were to assess the acceptability of self-management interventions for people with asthma and identify contributing factors. Methods A systematic literature search was conducted using PubMed, MEDLINE, EMBASE (OVIDWEB), CINAHL and Cochrane databases. Clinical trials design was included if they met specified criteria. A random-effect meta-regression analysis was conducted to estimate the overall acceptance and drop-out rates and to assess the potential factors that may influence the outcomes. Results A total of 64 studies were included and 8,092 participants were recruited and participated in the trials. The estimated acceptance rate was 51.1%, while the estimated drop-out rates in the intervention and control groups were 18.2% and 15.6%, respectively. Lack of interest was the main reported reason for refusing to participate and dropping out from the program. Study-related and program-related factors influenced the acceptance and drop-out rates statistically and clinically. Conclusion The acceptance rate of self-management programs among asthmatic people was not high and the dropout rate was somewhat low. The review suggests optimizing the design of self-management studies and modifying the implemented self-management programs to increase the acceptance rate and decrease the dropout rate.
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Affiliation(s)
- Owis J. Eilayyan
- Physical Therapy Department, Faculty of Allied Medical Sciences, Aqaba University of Technology, Aqaba, Jordan
| | - Alaa M. Arafah
- Faculty of Medical Rehabilitation Sciences, Department of Occupational Therapy, King Abdulaziz University, Jeddah, Saudi Arabia
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Suehs CM, Vachier I, Galeazzi D, Vaast F, Cardon F, Molinari N, Bourdin A. Standard patient training versus Vik-Asthme chatbot-guided training: 'AsthmaTrain' - a protocol for a randomised controlled trial for patients with asthma. BMJ Open 2023; 13:e067039. [PMID: 36810168 PMCID: PMC9945055 DOI: 10.1136/bmjopen-2022-067039] [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: 02/24/2023] Open
Abstract
INTRODUCTION Therapeutic education for patients with asthma has been shown to reduce asthma morbidity. The high availability of smart phones provides the opportunity to furnish patient training via specifically designed chatbot applications. The goal of this protocol is to perform a first pilot comparison of traditional face to face versus chatbot-guided patient therapeutic education programmes for patients with asthma. METHODS AND ANALYSIS Eighty adult patients with a physician-confirmed diagnosis of asthma will be enrolled in a two-parallel-arm, randomised (1:1) controlled pilot trial. A single-Zelen consent procedure is deployed to first enrol all participants in the comparator arm, that is, the standard patient therapeutic education programme at the University Hospitals of Montpellier, France. This means of patient therapeutic education is based on reoccurring interviews and discussion with qualified nursing staff as per usual care. Following baseline data acquisition, randomisation will be performed. Those patients randomised to the comparator arm will not be informed of the second arm. Those patients randomised to the experimental arm will be proposed access to a specifically designed chatbot (Vik-Asthme) as the second tested means of patient training (refusals continue with standard training, though analysed as intention to treat). The primary outcome is change in the total Asthma Quality of Life Questionnaire score at the end of follow-up (6 months). Secondary outcomes cover asthma control, spirometry, general health status, programme adherence and burden for medical staff, exacerbations and medical resource use (medications, consults, emergency visits, hospitalisation and intensive care). ETHICS AND DISSEMINATION This study ('AsthmaTrain' protocol version 4-20220330) has been approved by the Committee for the Protection of Persons Ile-de-France VII on 28 March 2022 (reference number 21.03617.000059). Enrolment began on 24 May 2022. Results will be published in international peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05248126.
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Affiliation(s)
- Carey Meredith Suehs
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France
- Department of Medical Information, Univ Montpellier, CHU Montpellier, Montpelier, France
| | - Isabelle Vachier
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France
- Medicine Biology Mediterranee, Department of Respiratory Diseases and Addictology, Arnaud de Villeneuve Hospital, CHRU Montpellier, Montpellier, France
| | - David Galeazzi
- Department of Medical Information, Univ Montpellier, CHU Montpellier, Montpelier, France
| | - François Vaast
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Fanny Cardon
- Department of Research and Innovation, CHU Montpellier, Montpellier, France
| | - Nicolas Molinari
- Department of Medical Information, Univ Montpellier, CHU Montpellier, Montpelier, France
- IMAG, CNRS, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Arnaud Bourdin
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France
- PhyMedExp, CNRS, INSERM, Univ Montpellier, CHU Montpellier, Montpellier, France
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Coker TR, Mitchell SJ, Lowry SJ, Klein EJ, Stout JW, Brown JC, Liljenquist KS, Wingfield E, Horn IB. Text2Breathe: Text-Message Intervention for Parent Communication and Pediatric Asthma. Acad Pediatr 2023; 23:123-129. [PMID: 35577281 PMCID: PMC10650351 DOI: 10.1016/j.acap.2022.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 04/04/2022] [Accepted: 05/07/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Mobile health technology offers promise for reducing disparities in pediatric asthma care and outcomes by helping parents more effectively communicate with their children's primary care providers and manage their children's asthma. This study tested the impact of a text messaging program on emergency department utilization and asthma morbidity. METHODS A randomized controlled trial enrolled 221 parents of Medicaid-insured children visiting the emergency departments of 2 urban children's hospitals in the Pacific Northwest for an asthma-related concern between September 2015 and February 2019. Standardized surveys were administered to parents at baseline and 12 months later to assess the primary outcomes of emergency department utilization and morbidity as well as primary care utilization, parent communication self-efficacy, and asthma self-management knowledge. The intervention group received brief in-person education on partnering with primary care providers, followed by 3 months of educational text messages. RESULTS Participants were mostly female, English speakers, of minority race and ethnicity, and living below 200% of the federal poverty level. Negative binomial and linear regressions indicated no significant group differences in annual number of emergency department visits, morbidity, parent communication self-efficacy, or asthma self-management knowledge at 12 months' follow-up, adjusting for baseline covariates. Average annual rate of primary care visits for asthma was 35% higher in the intervention group compared to control group at follow-up (95% confidence interval 1.03-1.76, P = .03). CONCLUSIONS This parent-focused text message intervention did not impact emergency department utilization or asthma morbidity; however, results suggest its potential for enhancing use of primary care for management of pediatric chronic conditions.
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Affiliation(s)
- Tumaini R Coker
- Division of General Pediatrics, University of Washington School of Medicine (TR Coker, JW Stout, and KS Liljenquist), Seattle, Wash; Seattle Children's Hospital Research Institute (TR Coker, SJ Mitchell, SJ Lowry, EJ Klein, J Brown, KS Liljenquist, E Wingfield, and IB Horn), Seattle, Wash
| | - Stephanie J Mitchell
- Seattle Children's Hospital Research Institute (TR Coker, SJ Mitchell, SJ Lowry, EJ Klein, J Brown, KS Liljenquist, E Wingfield, and IB Horn), Seattle, Wash.
| | - Sarah J Lowry
- Seattle Children's Hospital Research Institute (TR Coker, SJ Mitchell, SJ Lowry, EJ Klein, J Brown, KS Liljenquist, E Wingfield, and IB Horn), Seattle, Wash
| | - Eileen J Klein
- Seattle Children's Hospital Research Institute (TR Coker, SJ Mitchell, SJ Lowry, EJ Klein, J Brown, KS Liljenquist, E Wingfield, and IB Horn), Seattle, Wash; Division of Emergency Medicine, Department of Pediatrics, University of Washington School of Medicine (EJ Klein and J Brown), Seattle, Wash
| | - James W Stout
- Division of General Pediatrics, University of Washington School of Medicine (TR Coker, JW Stout, and KS Liljenquist), Seattle, Wash; Department of Health Services, University of Washington (JW Stout and KS Liljenquist), Seattle, Wash
| | - Julie C Brown
- Seattle Children's Hospital Research Institute (TR Coker, SJ Mitchell, SJ Lowry, EJ Klein, J Brown, KS Liljenquist, E Wingfield, and IB Horn), Seattle, Wash; Division of Emergency Medicine, Department of Pediatrics, University of Washington School of Medicine (EJ Klein and J Brown), Seattle, Wash
| | - Kendra S Liljenquist
- Division of General Pediatrics, University of Washington School of Medicine (TR Coker, JW Stout, and KS Liljenquist), Seattle, Wash; Seattle Children's Hospital Research Institute (TR Coker, SJ Mitchell, SJ Lowry, EJ Klein, J Brown, KS Liljenquist, E Wingfield, and IB Horn), Seattle, Wash; Department of Health Services, University of Washington (JW Stout and KS Liljenquist), Seattle, Wash
| | - Elizabeth Wingfield
- Seattle Children's Hospital Research Institute (TR Coker, SJ Mitchell, SJ Lowry, EJ Klein, J Brown, KS Liljenquist, E Wingfield, and IB Horn), Seattle, Wash
| | - Ivor B Horn
- Seattle Children's Hospital Research Institute (TR Coker, SJ Mitchell, SJ Lowry, EJ Klein, J Brown, KS Liljenquist, E Wingfield, and IB Horn), Seattle, Wash
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Bae WD, Alkobaisi S, Horak M, Park CS, Kim S, Davidson J. Predicting Health Risks of Adult Asthmatics Susceptible to Indoor Air Quality Using Improved Logistic and Quantile Regression Models. Life (Basel) 2022; 12:life12101631. [PMID: 36295066 PMCID: PMC9604638 DOI: 10.3390/life12101631] [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: 08/05/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 11/28/2022] Open
Abstract
The increasing global patterns for asthma disease and its associated fiscal burden to healthcare systems demand a change to healthcare processes and the way asthma risks are managed. Patient-centered health care systems equipped with advanced sensing technologies can empower patients to participate actively in their health risk control, which results in improving health outcomes. Despite having data analytics gradually emerging in health care, the path to well established and successful data driven health care services exhibit some limitations. Low accuracy of existing predictive models causes misclassification and needs improvement. In addition, lack of guidance and explanation of the reasons of a prediction leads to unsuccessful interventions. This paper proposes a modeling framework for an asthma risk management system in which the contributions are three fold: First, the framework uses a deep learning technique to improve the performance of logistic regression classification models. Second, it implements a variable sliding window method considering spatio-temporal properties of the data, which improves the quality of quantile regression models. Lastly, it provides a guidance on how to use the outcomes of the two predictive models in practice. To promote the application of predictive modeling, we present a use case that illustrates the life cycle of the proposed framework. The performance of our proposed framework was extensively evaluated using real datasets in which results showed improvement in the model classification accuracy, approximately 11.5–18.4% in the improved logistic regression classification model and confirmed low relative errors ranging from 0.018 to 0.160 in quantile regression model.
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Affiliation(s)
- Wan D. Bae
- Department of Computer Science, Seattle University, Seattle, WA 98122, USA
| | - Shayma Alkobaisi
- College of Information Technology, United Arab Emirates University, Al Ain 15551, United Arab Emirates
- Correspondence:
| | - Matthew Horak
- Lockheed Martin Space Systems, Denver, CO 80221, USA
| | - Choon-Sik Park
- Department of Internal Medicine, Soonchunhyang Bucheon Hospital, Bucheon 420-767, Korea
| | - Sungroul Kim
- Department of ICT Environmental Health System, Graduate School, Department of Environmental Sciences, Soonchunhyang University, Asan 336-745, Korea
| | - Joel Davidson
- Department of Computer Science, Seattle University, Seattle, WA 98122, USA
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Runsen Z, Yueying X, Tieguang H, Guoan Y, Yuan Z, Li C, Minyi C. Short message service usage may improve the public's self-health management: A community-based randomized controlled study. Health Sci Rep 2022; 5:e850. [PMID: 36189410 PMCID: PMC9498217 DOI: 10.1002/hsr2.850] [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: 11/16/2021] [Revised: 02/28/2022] [Accepted: 06/16/2022] [Indexed: 11/06/2022] Open
Abstract
Background and Aims The last decade has witnessed unprecedented growth in mobile phone use. It links millions of previously unconnected people. The ubiquity of mobile phones, which allows for use of the short message service (SMS), offers new and innovative opportunities for disease prevention and health education. SMS usage appears to be a feasible, popular, and effective way of improving health literacy. This study measured the effect of SMS health education on the improvement of health management in Shenzhen, China. Methods This was a community-based randomized controlled study. A total of 32 communities were randomly chosen out of 320, then about 200 participants were randomly sampled from each selected community. The subjects were equally divided into two groups at random. About half of the participants received health intervention messages via Internet-based SMS for almost a year. The data were analyzed by descriptive and inferential statistical methods. Results The proportion of participants involved in self-health management increased from 30.92% to 38.68% over the year (χ 2 = 42.49, p < 0.001) in the intervention group. People with marginal health literacy reported the highest increase (10.92%), while people with low health literacy reported the smallest (5.25%). The control group showed no difference in baseline and final health management proportions (28.02% and 29.64%, p > 0.05). No statistical difference in the prevalence of chronic disease (15.16% and 13.89%, p > 0.05) was found before and after the intervention in the intervention group. The prevalence in the intervention group was lower after the intervention than it was in the control group (17.33%, χ 2 = 14.45, p < 0.001). Conclusions SMS may be a powerful tool for improving the public's health literacy and health management because it is widely available, popular, affordable, and instant.
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Affiliation(s)
- Zhuang Runsen
- Shenzhen Health Education and Promotion CenterShenzhenChina
- Department of Public Health and Preventive Medicine, School of MedicineJinan UniversityGuangzhouChina
| | - Xiang Yueying
- 181st Hospital of Chinese People's Liberation ArmyGuilinChina
| | - Han Tieguang
- Shenzhen Health Education and Promotion CenterShenzhenChina
| | - Yang Guoan
- Shenzhen Health Education and Promotion CenterShenzhenChina
| | - Zhang Yuan
- Shenzhen Health Education and Promotion CenterShenzhenChina
| | - Cao Li
- Shenzhen Health Education and Promotion CenterShenzhenChina
| | - Cai Minyi
- Department of Public Health and Preventive Medicine, School of MedicineJinan UniversityGuangzhouChina
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Lee CS, Westland H, Faulkner KM, Iovino P, Thompson JH, Sexton J, Farry E, Jaarsma T, Riegel B. The effectiveness of self-care interventions in chronic illness: a meta-analysis of randomized controlled trials. Int J Nurs Stud 2022; 134:104322. [DOI: 10.1016/j.ijnurstu.2022.104322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 06/21/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022]
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Chan A, De Simoni A, Wileman V, Holliday L, Newby CJ, Chisari C, Ali S, Zhu N, Padakanti P, Pinprachanan V, Ting V, Griffiths CJ. Digital interventions to improve adherence to maintenance medication in asthma. Cochrane Database Syst Rev 2022; 6:CD013030. [PMID: 35691614 PMCID: PMC9188849 DOI: 10.1002/14651858.cd013030.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Asthma is the most common chronic lung condition worldwide, affecting 334 million adults and children globally. Despite the availability of effective treatment, such as inhaled corticosteroids (ICS), adherence to maintenance medication remains suboptimal. Poor ICS adherence leads to increased asthma symptoms, exacerbations, hospitalisations, and healthcare utilisation. Importantly, suboptimal use of asthma medication is a key contributor to asthma deaths. The impact of digital interventions on adherence and asthma outcomes is unknown. OBJECTIVES To determine the effectiveness of digital interventions for improving adherence to maintenance treatments in asthma. SEARCH METHODS We identified trials from the Cochrane Airways Trials Register, which contains studies identified through multiple electronic searches and handsearches of other sources. We also searched trial registries and reference lists of primary studies. We conducted the most recent searches on 1 June 2020, with no restrictions on language of publication. A further search was run in October 2021, but studies were not fully incorporated. SELECTION CRITERIA We included randomised controlled trials (RCTs) including cluster- and quasi-randomised trials of any duration in any setting, comparing a digital adherence intervention with a non-digital adherence intervention or usual care. We included adults and children with a clinical diagnosis of asthma, receiving maintenance treatment. DATA COLLECTION AND ANALYSIS We used standard methodological procedures for data collection. We used GRADE to assess quantitative outcomes where data were available. MAIN RESULTS We included 40 parallel randomised controlled trials (RCTs) involving adults and children with asthma (n = 15,207), of which eight are ongoing studies. Of the included studies, 30 contributed data to at least one meta-analysis. The total number of participants ranged from 18 to 8517 (median 339). Intervention length ranged from two to 104 weeks. Most studies (n = 29) reported adherence to maintenance medication as their primary outcome; other outcomes such as asthma control and quality of life were also commonly reported. Studies had low or unclear risk of selection bias but high risk of performance and detection biases due to inability to blind the participants, personnel, or outcome assessors. A quarter of the studies had high risk of attrition bias and selective outcome reporting. We examined the effect of digital interventions using meta-analysis for the following outcomes: adherence (16 studies); asthma control (16 studies); asthma exacerbations (six studies); unscheduled healthcare utilisation (four studies); lung function (seven studies); and quality of life (10 studies). Pooled results showed that patients receiving digital interventions may have increased adherence (mean difference of 14.66 percentage points, 95% confidence interval (CI) 7.74 to 21.57; low-certainty evidence); this is likely to be clinically significant in those with poor baseline medication adherence. Subgroup analysis by type of intervention was significant (P = 0.001), with better adherence shown with electronic monitoring devices (EMDs) (23 percentage points over control, 95% CI 10.84 to 34.16; seven studies), and with short message services (SMS) (12 percentage points over control, 95% CI 6.22 to 18.03; four studies). No significant subgroup differences were seen for interventions having an in-person component versus fully digital interventions, adherence feedback, one or multiple digital components to the intervention, or participant age. Digital interventions were likely to improve asthma control (standardised mean difference (SMD) 0.31 higher, 95% CI 0.17 to 0.44; moderate-certainty evidence) - a small but likely clinically significant effect. They may reduce asthma exacerbations (risk ratio 0.53, 95% CI 0.32 to 0.91; low-certainty evidence). Digital interventions may result in a slight change in unscheduled healthcare utilisation, although some studies reported no or a worsened effect. School or work absence data could not be included for meta-analysis due to the heterogeneity in reporting and the low number of studies. They may result in little or no difference in lung function (forced expiratory volume in one second (FEV1)): there was an improvement of 3.58% predicted FEV1, 95% CI 1.00% to 6.17%; moderate-certainty evidence); however, this is unlikely to be clinically significant as the FEV1 change is below 12%. Digital interventions likely increase quality of life (SMD 0.26 higher, 95% CI 0.07 to 0.45; moderate-certainty evidence); however, this is a small effect that may not be clinically significant. Acceptability data showed positive attitudes towards digital interventions. There were no data on cost-effectiveness or adverse events. Our confidence in the evidence was reduced by risk of bias and inconsistency. AUTHORS' CONCLUSIONS Overall, digital interventions may result in a large increase in adherence (low-certainty evidence). There is moderate-certainty evidence that digital adherence interventions likely improve asthma control to a degree that is clinically significant, and likely increase quality of life, but there is little or no improvement in lung function. The review found low-certainty evidence that digital interventions may reduce asthma exacerbations. Subgroup analyses show that EMDs may improve adherence by 23% and SMS interventions by 12%, and interventions with an in-person element and adherence feedback may have greater benefits for asthma control and adherence, respectively. Future studies should include percentage adherence as a routine outcome measure to enable comparison between studies and meta-analysis, and use validated questionnaires to assess adherence and outcomes.
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Affiliation(s)
- Amy Chan
- Centre for Behavioural Medicine, Department of Practice and Policy, UCL School of Pharmacy, University College London, London, UK
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
- Asthma UK Centre for Applied Research, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anna De Simoni
- Wolfson Institute of Population Health, Centre for Primary Care Asthma UK Centre for Applied Research, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Vari Wileman
- Centre for Behavioural Medicine, Department of Practice and Policy, UCL School of Pharmacy, University College London, London, UK
| | - Lois Holliday
- Wolfson Institute of Population Health, Centre for Primary Care Asthma UK Centre for Applied Research, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Chris J Newby
- Research Design Service, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Claudia Chisari
- Centre for Behavioural Medicine, Department of Practice and Policy, UCL School of Pharmacy, University College London, London, UK
| | - Sana Ali
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Natalee Zhu
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
| | | | | | - Victoria Ting
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
| | - Chris J Griffiths
- Asthma UK Centre for Applied Research, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Dhippayom T, Wateemongkollert A, Mueangfa K, Im H, Dilokthornsakul P, Devine B. Comparative Efficacy of Strategies to Support Self-Management in Patients with Asthma: A Systematic Review and Network Meta-Analysis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:803-814. [PMID: 34673290 DOI: 10.1016/j.jaip.2021.09.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND There is limited evidence about which composite feature of asthma self-management strategies is the best and should be adopted into practice. OBJECTIVE To compare the efficacy of different strategies to support self-management, based on the newly developed framework, in patients with asthma. METHODS We searched PubMed, EMBASE, CENTRAL, CINAHL, and PsycInfo from 1993 to December 2019. We identified randomized controlled trials that explored effects of strategies to support self-management in adult patients with asthma. We conducted network meta-analyses using a random effects model with usual care as the common comparator. Surface under the cumulative ranking curve methods were used to rank different support strategies. RESULTS Thirty-five trials (5195 patients) were included and classified on the basis of our newly created TIP framework: Theme, Intensity, and Provider/Platform. We identified 6 features from the included trials, each represented by 1 element of the TIP framework: (1) behavioral support more than once a month by e-Health; (2) behavioral support more than once a month by health care personnel (HCP); (3) behavioral support less often than or equal to once a month by HCP; (4) education support less often than or equal to once a month by e-Health; (5) education support less often than or equal to once a month by HCP; and (6) psychosocial support less often than or equal to once a month by HCP. Behavioral support more than once a month by e-Health showed significant improvement in asthma control when compared with the other 2 support strategies, which was confirmed by the highest surface under the cumulative ranking of 97.6%. However, the surface under the cumulative ranking for behavioral support less often than or equal to once a month by HCP suggested that it has the potential to be the best intervention to reduce the risk of hospitalization (89.1%) and emergency department visit (84.2%). CONCLUSIONS Different features of asthma self-management support strategies work best on unique outcomes.
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Affiliation(s)
- Teerapon Dhippayom
- Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, Wash.
| | | | - Kanchana Mueangfa
- Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Haerin Im
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, Wash
| | - Piyameth Dilokthornsakul
- Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Beth Devine
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, Wash
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Lin J, Wang W, Tang H, Huo J, Gu Y, Liu R, Chen P, Yuan Y, Yang X, Xu J, Sun D, Li N, Jiang S, Chen Y, Wang C, Yang L, Liu X, Yang D, Zhang W, Chen Z, Lin Q, Liu C, Zhou J, Zhou X, Hu C, Jiang P, Zhou W, Zhang J, Cai S, Qiu C, Huang M, Huang Y, Liu H. Asthma Management Using the Mobile Asthma Evaluation and Management System in China. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2022; 14:85-98. [PMID: 34983109 PMCID: PMC8724822 DOI: 10.4168/aair.2022.14.1.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/08/2021] [Accepted: 09/01/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE As stated in the Global Initiative for Asthma, there are still some asthmatic patients who have not achieved asthma control. Mobile is a useful tool for asthma management. We aimed to compare the advantages of mobile management with traditional management in improving adherence and control of asthma. METHODS In this prospective, multicentre, randomized, controlled and parallel-group study, we enrolled patients with poor adherence and uncontrolled asthma at 32 hospitals in 28 provinces in China. Patients were randomly assigned to the mobile management or traditional management groups for 12 months. The primary endpoint was the proportion of patients with good adherence (Medication Adherence Report Scale for Asthma [MARS-A] score ≥ 45) for 6 months. This study is registered at ClinicalTrials.gov (NCT02917174). RESULTS Between April 2017 and April 2018, 923 patients were eligible for randomization (mobile group, n = 461; traditional group, n = 462). Dropout was 84 (18.2%) in the mobile management group and 113 (24.4%) patients in the traditional management group. The proportion of patients with good adherence was significantly higher in the mobile management group than in the traditional management group (66.0% vs. 58.99%, P = 0.048). The mobile management group showed higher mean MARS-A score (at 1, 6, 9, and 12 months) and asthma control test scores (at 6 and 9 months), and lower total lost rate to follow-up within 12 months than the traditional management group. CONCLUSIONS Mobile asthma management can improve adherence and asthma control compared to traditional management. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02917174.
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Affiliation(s)
- Jiangtao Lin
- Department of Pulmonary and Critical Care Medicine, National Clinical Research Center of Respiratory Disease, China-Japan Friendship Hospital, Beijing, China.
| | - Wenya Wang
- Department of Pulmonary and Critical Care Medicine, National Clinical Research Center of Respiratory Disease, China-Japan Friendship Hospital, Beijing, China
| | - Huaping Tang
- Department of Pulmonary and Critical Care Medicine, Qingdao Municipal Hospital, Qingdao, China
| | - Jianmin Huo
- Department of Respiratory Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yuhai Gu
- Department of Respiratory Medicine, Qinghai Provincial People's Hospital, Xi'ning, China
| | - Rongyu Liu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ping Chen
- Department of Respiratory Medicine, General Hospital of Northern Theater Command, Shenyang, China
| | - Yadong Yuan
- Department of Respiratory Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaohong Yang
- Department of Pulmonary and Critical Care Medicine, Xinjiang Uiger Municipal People's Hospital, Urumqi, China
| | - Jianying Xu
- Department of Pulmonary and Critical Care Medicine, Shanxi Bethune Hospital, Shanxi, China
| | - Dejun Sun
- Department of Pulmonary and Critical Care Medicine, Inner Mongolia People's Hospital, Hohhot, China
| | - Najia Li
- Department of Respiratory Medicine, Daqing Oilfield General Hospital, Daqing, China
| | - Shujuan Jiang
- Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital, Jinan, China
| | - Yiqiang Chen
- Department of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Changzheng Wang
- Department of Respiratory Medicine, Xinqiao Hospital of Army Medical University, Chongqing, China
| | - Lan Yang
- Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaoju Liu
- Department of Geriatric Respiration, The First Hospital of Lanzhou University, Lanzhou, China
| | - Dong Yang
- Department of Respiration, Zhongshan Hospital Fudan University, Shanghai, China
| | - Wei Zhang
- Department of Respiratory Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhuochang Chen
- Department of Respiratory Medicine, Henan Provincial People's Hospital, Zhengzhou, China
| | - Qichang Lin
- Department of Respiratory Medicine, The First Affiliated Hospital of Fujian Medical University, Xiamen, China
| | - Chuntao Liu
- Department of Respiratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jianying Zhou
- Department of Respiratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, The First Hospital of Zhejiang Province, Hangzhou, China
| | - Xin Zhou
- Department of Respiratory Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Chengping Hu
- Department of Pulmonary and Critical Care Medicine, Xiangya Hospital Central South University, Changsha, China
| | - Ping Jiang
- Department of Respiratory Medicine, Tianjin First Central Hospital, Tianjin, China
| | - Wei Zhou
- Department of Pulmonary and Critical Care Medicine, General Hospital of Ningxia Medical University, Ningxia, China
| | - Jie Zhang
- Department of Pulmonary and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, China
| | - Shaoxi Cai
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern University of Science and Technology, Guangzhou, China
| | - Chen Qiu
- Department of Pulmonary and Critical Care Medicine, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, China
| | - Mao Huang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yijiang Huang
- Department of Pulmonary and Critical Care Medicine, Hainan General Hospital, Hainan, China
| | - Huiguo Liu
- Department of Respiratory Medicine, Tongji Hospital, Tongji Medical college Huazhong University of Science and Technology, Wuhan, China
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10
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Felix SN, Agondi RC, Aun MV, Olivo CR, de Almeida FM, Amorim TS, Cezario JC, Giavina-Bianchi P, Tiberio IDFLC, de Martins MDA, Romanholo BMS. Clinical, functional and inflammatory evaluation in asthmatic patients after a simple short-term educational program: a randomized trial. Sci Rep 2021; 11:18267. [PMID: 34521963 PMCID: PMC8440547 DOI: 10.1038/s41598-021-97846-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/10/2021] [Indexed: 02/08/2023] Open
Abstract
This study aimed to evaluate the clinical evolution, functional parameters and inflammatory activity of asthma in patients who submitted to an educational intervention. 58 adult patients over 18 years of age with partly controlled and uncontrolled asthma were randomized into an intervention group (IG) (N = 32) and a control group (CG) (N = 26) and evaluated for 12 weeks. The Asthma Control Test (ACT), Asthma Control Questionnaire (ACQ), Asthma Quality Life Questionnaire (AQLQ) and Beck Depression Inventory (BDI) questionnaires were applied. Spirometry, exhaled nitric oxide (NO), exhaled breath condensate (EBC) and induced sputum (IS), measurement of the peak flow and symptoms were performed. The IG patients received an educational activity for 30 min applied by a nurse. Statistical analysis: analysis of variance with repeated intragroup measures. IG presented a decreased number of eosinophils in IS and IL-17A in EBC, an increase in the percentage of FEV1 before and after bronchodilator and an improvement in quality of life compared to the CG. There was an improvement in depression levels and a decrease in IL-4 and IL-5 in the IS and in the EBC in both groups. Our results suggest that an educational intervention can bring benefits concerning the control of inflammation, lung function alterations, quality of life and levels of depression in asthmatic patients. Registration: ClinicalTrials.gov; NCT03655392.
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Affiliation(s)
- Soraia Nogueira Felix
- Instituto de Assistência Médica Ao Servidor Público Estadual (IAMSPE), Sao Paulo, SP, Brazil.
| | - Rosana Câmara Agondi
- Serviço de Imunologia Clínica e Alergia, HCFMUSP, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Marcelo Vivolo Aun
- Serviço de Imunologia Clínica e Alergia, HCFMUSP, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Clarice Rosa Olivo
- Instituto de Assistência Médica Ao Servidor Público Estadual (IAMSPE), Sao Paulo, SP, Brazil
- Universidade Cidade de Sao Paulo (UNICID), Sao Paulo, SP, Brazil
- Laboratório de Terapêutica Experimental (LIM-20), Faculdade de Medicina da USP (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Francine Maria de Almeida
- Laboratório de Terapêutica Experimental (LIM-20), Faculdade de Medicina da USP (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | | | | | - Pedro Giavina-Bianchi
- Serviço de Imunologia Clínica e Alergia, HCFMUSP, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | | | - Milton de Arruda de Martins
- Laboratório de Terapêutica Experimental (LIM-20), Faculdade de Medicina da USP (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Beatriz Mangueira Saraiva Romanholo
- Instituto de Assistência Médica Ao Servidor Público Estadual (IAMSPE), Sao Paulo, SP, Brazil.
- Universidade Cidade de Sao Paulo (UNICID), Sao Paulo, SP, Brazil.
- Laboratório de Terapêutica Experimental (LIM-20), Faculdade de Medicina da USP (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
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11
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Schulte MHJ, Aardoom JJ, Loheide-Niesmann L, Verstraete LLL, Ossebaard HC, Riper H. Effectiveness of eHealth Interventions in Improving Medication Adherence for Patients With Chronic Obstructive Pulmonary Disease or Asthma: Systematic Review. J Med Internet Res 2021; 23:e29475. [PMID: 34313593 PMCID: PMC8403699 DOI: 10.2196/29475] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/12/2021] [Accepted: 06/14/2021] [Indexed: 01/13/2023] Open
Abstract
Background Poor treatment adherence in patients with chronic obstructive pulmonary disease (COPD) or asthma is a global public health concern with severe consequences in terms of patient health and societal costs. A potentially promising tool for addressing poor compliance is eHealth. Objective This review investigates the effects of eHealth interventions on medication adherence in patients with COPD or asthma. Methods A systematic literature search was conducted in the databases of Cochrane Library, PsycINFO, PubMed, and Embase for studies with publication dates between January 1, 2000, and October 29, 2020. We selected randomized controlled trials targeting adult patients with COPD or asthma, which evaluated the effectiveness of an eHealth intervention on medication adherence. The risk of bias in the included studies was examined using the Cochrane Collaboration’s risk of bias tool. The results were narratively reviewed. Results In total, six studies focusing on COPD and seven focusing on asthma were analyzed. Interventions were mostly internet-based or telephone-based, and could entail telemonitoring of symptoms and medication adherence, education, counseling, consultations, and self-support modules. Control groups mostly comprised usual care conditions, whereas a small number of studies used a face-to-face intervention or waiting list as the control condition. For COPD, the majority of eHealth interventions were investigated as an add-on to usual care (5/6 studies), whereas for asthma the majority of interventions were investigated as a standalone intervention (5/7 studies). Regarding eHealth interventions targeting medication adherence for COPD, two studies reported nonsignificant effects, one study found a significant effect in comparison to usual care, and three reported mixed results. Of the seven studies that investigated eHealth interventions targeting medication adherence in asthma, three studies found significant effects, two reported nonsignificant effects, and two reported mixed effects. Conclusions The mixed results on the effectiveness of eHealth interventions in improving treatment adherence for asthma and COPD are presumably related to the type, context, and intensity of the interventions, as well as to differences in the operationalization and measurement of adherence outcomes. Much remains to be learned about the potential of eHealth to optimize treatment adherence in COPD and asthma.
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Affiliation(s)
- Mieke H J Schulte
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
| | - Jiska J Aardoom
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands.,National eHealth Living Lab, Leiden, Netherlands
| | - Lisa Loheide-Niesmann
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands.,Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Leonie L L Verstraete
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
| | | | - Heleen Riper
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam University Medical Center (VUmc), Vrije Universiteit, Amsterdam, Netherlands.,GGZ inGeest Specialized Mental Health Care, Research and Innovation, Amsterdam, Netherlands
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12
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Mosnaim G, Safioti G, Brown R, DePietro M, Szefler SJ, Lang DM, Portnoy JM, Bukstein DA, Bacharier LB, Merchant RK. Digital Health Technology in Asthma: A Comprehensive Scoping Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2377-2398. [PMID: 33652136 DOI: 10.1016/j.jaip.2021.02.028] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND A variety of digital intervention approaches have been investigated for asthma therapy during the past decade, with different levels of interactivity and personalization and a range of impacts on different outcome measurements. OBJECTIVE To assess the effectiveness of digital interventions in asthma with regard to acceptability and outcomes and evaluate the potential of digital initiatives for monitoring or treating patients with asthma. METHODS We evaluated digital interventions using a scoping review methodology through a literature search and review. Of 871 articles identified, 121 were evaluated to explore intervention characteristics, the perception and acceptability of digital interventions to patients and physicians, and effects on asthma outcomes. Interventions were categorized by their level of interactivity with the patient. RESULTS Interventions featuring non-individualized content sent to patients appeared capable of promoting improved adherence to inhaled corticosteroids, but with no identified improvement in asthma burden; and data-gathering interventions appeared to have little effect on adherence or asthma burden. Evidence of improvement in both adherence and patients' impairment due to asthma were seen only with interactive interventions involving two-way responsive patient communication. Digital interventions were generally positively perceived by patients and physicians. Implementation was considered feasible, with certain preferences for design and features important to drive use. CONCLUSIONS Digital health interventions show substantial promise for asthma disease monitoring and personalization of treatment. To be successful, future interventions will need to include both inhaler device and software elements, combining accurate measurement of clinical parameters with careful consideration of ease of use, personalization, and patient engagement aspects.
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Affiliation(s)
- Giselle Mosnaim
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, North Shore University Health System, Evanston, Ill
| | | | - Randall Brown
- Teva Branded Pharmaceutical Products R&D, Inc, West Chester, Pa
| | - Michael DePietro
- Teva Branded Pharmaceutical Products R&D, Inc, West Chester, Pa.
| | - Stanley J Szefler
- The Breathing Institute and Pulmonary Medicine Section, Children's Hospital Colorado and University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
| | - David M Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jay M Portnoy
- Pediatric Allergy and Immunology, Children's Mercy Hospital, Kansas City School of Medicine, Kansas City, Mo
| | - Don A Bukstein
- Allergy, Asthma and Sinus Center, Milwaukee, Greenfield, Wis
| | - Leonard B Bacharier
- Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt University Medical Center, Nashville, Tenn
| | - Rajan K Merchant
- Woodland Clinic Medical Group, Allergy Department, Dignity Health, Woodland, Calif
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13
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Poowuttikul P, Seth D. New Concepts and Technological Resources in Patient Education and Asthma Self-Management. Clin Rev Allergy Immunol 2021; 59:19-37. [PMID: 32215784 DOI: 10.1007/s12016-020-08782-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Asthma is a chronic disease that is associated with significant morbidity and mortality. In general, the use of technology resources or electronic health (e-health) has been shown to have beneficial effects on patients with asthma. E-health can impact a broad section of patients and can be cost-effective and associated with high patient satisfaction. E-health may enable remote delivery of care, as well as timely access to health care, which are some of the common challenges faced by patients with asthma. Web-based asthma self-management systems have been found to improve quality of life, self-reported asthma symptoms, lung function, reduction in asthma symptoms/exacerbations, and self-reported adherence for adults. Social media is commonly being used as a platform to disseminate information on asthma to increase public awareness. It can facilitate asthma self-management in a patient friendly manner and has shown to improve asthma control test scores as well as self-esteem. Text massages reminders can increase awareness regarding asthma treatment and control, thus potentially can improve adherence to medications and asthma outcome. Mobile health applications can support asthma self-management, improve a patient's quality of life, promote medication adherence, and potentially reduce the overall costs for asthma care. Inhaler trackers have shown to be beneficial to asthma outcome in various populations by improving adherence to asthma medications. Barriers such as physician financial reimbursement as well as licensing for rendering tele-healthcare services are important concerns. Other limitations of using technology resources in health care are related to liability, professionalism, and ethical issues such as breach of patient confidentiality and privacy. Additionally, there may be less face-to-face interaction and care of the patient when e-health is used.
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Affiliation(s)
- Pavadee Poowuttikul
- Department of Pediatrics, Division of Allergy/Immunology, Children's Hospital of Michigan, Wayne State University School of Medicine, 3950 Beaubien, 4th Floor, Pediatric Specialty Building, Detroit, MI, 48201, USA.
| | - Divya Seth
- Department of Pediatrics, Division of Allergy/Immunology, Children's Hospital of Michigan, Wayne State University School of Medicine, 3950 Beaubien, 4th Floor, Pediatric Specialty Building, Detroit, MI, 48201, USA
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14
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Chioma Ebuenyi M, Schnoor K, Versluis A, Meijer E, Chavannes NH. Short message services interventions for chronic disease management: A systematic review. CLINICAL EHEALTH 2021. [DOI: 10.1016/j.ceh.2020.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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15
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Bui AAT, Hosseini A, Rocchio R, Jacobs N, Ross MK, Okelo S, Lurmann F, Eckel S, Dzubur E, Dunton G, Gilliland F, Sarrafzadeh M, Habre R. Biomedical REAl-Time Health Evaluation (BREATHE): toward an mHealth informatics platform. JAMIA Open 2020; 3:190-200. [PMID: 32734159 PMCID: PMC7382637 DOI: 10.1093/jamiaopen/ooaa011] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/28/2020] [Accepted: 04/02/2020] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To describe a configurable mobile health (mHealth) framework for integration of physiologic and environmental sensors to be used in studies focusing on the domain of pediatric asthma. MATERIALS AND METHODS The Biomedical REAl-Time Health Evaluation (BREATHE) platform connects different sensors and data streams, contextualizing an individual's symptoms and daily activities over time to understand pediatric asthma's presentation and its management. A smartwatch/smartphone combination serves as a hub for personal/wearable sensing devices collecting data on health (eg, heart rate, spirometry, medications), motion, and personal exposures (eg, particulate matter, ozone); securely transmitting information to BREATHE's servers; and interacting with the user (eg, ecological momentary assessments). Server-side integration of electronic health record data and spatiotemporally correlated information (eg, weather, traffic) elaborates on these observations. An initial panel study involving pediatric asthma patients was conducted to assess BREATHE. RESULTS Twenty subjects were enrolled, during which BREATHE accrued seven consecutive days of continuous data per individual. The data were used to confirm knowledge about asthma (use of controller inhalers, time-activity behaviors, personal air pollution exposure), and additional analyses provided insights into within-day associations of environmental triggers and asthma exacerbations. Exit surveys focusing on mHealth usability, while positive, noted several translational challenges. DISCUSSION Based on these promising results, a longitudinal panel study to evaluate individual microenvironments and exposures is ongoing. Lessons learned thus far reflect the need to address various usability aspects, including convenience and ongoing engagement. CONCLUSION BREATHE enables multi-sensor mHealth studies, capturing new types of information alongside an evolving understanding of personal exposomes.
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Affiliation(s)
- Alex A T Bui
- Medical and Imaging Informatics (MII) Group, Department of Radiological Sciences, UCLA, Los Angeles, California, USA
| | | | - Rose Rocchio
- Mobilize Labs, UCLA, Los Angeles, California, USA
| | - Nate Jacobs
- Mobilize Labs, UCLA, Los Angeles, California, USA
| | - Mindy K Ross
- Department of Pediatrics, UCLA, Los Angeles, California, USA
| | - Sande Okelo
- Department of Pediatrics, UCLA, Los Angeles, California, USA
| | - Fred Lurmann
- Sonoma Technologies, Inc., Petaluma, California, USA
| | - Sandrah Eckel
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Eldin Dzubur
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Genevieve Dunton
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Frank Gilliland
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | | | - Rima Habre
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
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16
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Gambalunga F, Iacorossi L, Notarnicola I, Serra V, Piredda M, De Marinis MG. Mobile Health in Adherence to Oral Anticancer Drugs: A Scoping Review. Comput Inform Nurs 2020; 39:17-23. [PMID: 32568900 DOI: 10.1097/cin.0000000000000643] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In oncology, adherence to oral antineoplastic medication is a key element of treatment, on which the success of any therapeutic intervention depends. Given their widespread use in clinical practice, it is important to identify tools that can facilitate the monitoring and self-management of the patient at home, to avoid the consequences of employing ineffective treatment. One of the tools available today to take action on this phenomenon is mobile health technology. The aim of this review is to describe published studies relating to the use of mobile health to promote adherence to oral antineoplastic medication. This scoping review was conducted using the framework proposed by Arksey and O'Malley, adapted according to Levac et al. Of 1320 articles identified, only seven met the eligibility criteria and therefore were included in the review. All seven articles involved the use of digital means to measure adherence to treatment, patient satisfaction, acceptability and feasibility of the digital means used, and presence of symptoms, but not the effectiveness of the digital instrument used. In conclusion, the use of digital means to assist adherence of cancer patients to oral antineoplastic medication is widely recognized, but its effectiveness in clinical practice is poorly supported by the nature of the published studies.
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Affiliation(s)
- Francesca Gambalunga
- Author Affiliations: Department of Health Professions (DAPS), University Hospital "Policlinico Umberto I" (Ms Gambalunga); IRCCS "Regina Elena" National Cancer Institute (Dr Iacorossi and Ms Serra); Centre of Excellence for Nursing Scholarship OPI Rome Italy (Dr Notarnicola); and Research Unit Nursing Science, Campus Bio-Medico of Rome University (Drs Piredda and De Marinis), Rome, Italy
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17
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Portnoy JM, Wu AC. Is Telemedicine as Effective as Usual Care? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:217-218. [PMID: 30598177 DOI: 10.1016/j.jaip.2018.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 01/19/2023]
Affiliation(s)
- Jay M Portnoy
- Division of Medical Informatics and Telemedicine, Children's Mercy Hospital, Kansas City, Mo
| | - Ann Chen Wu
- Center for Health Care Research in Pediatrics (CHeRP), Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass.
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18
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Huang X, Matricardi PM. Allergy and Asthma Care in the Mobile Phone Era. Clin Rev Allergy Immunol 2019; 56:161-173. [PMID: 27209270 DOI: 10.1007/s12016-016-8542-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Strategies to improve patients' adherence to treatment are essential to reduce the great health and economic burden of allergic rhinitis and asthma. Mobile phone applications (apps) for a better management of allergic diseases are growing in number, but their usefulness for doctors and patients is still debated. Controlled trials have investigated the feasibility, cost-effectiveness, security, and perspectives of the use of tele-medicine in the self-management of asthma. These studies focused on different tools or devices, such as SMS, telephone calls, automatic voice response system, mobile applications, speech recognition system, or cloud-computing systems. While some trials concluded that m-Health can improve asthma control and the patient's quality of life, others did not show any advantage in relation to usual care. The only controlled study on allergic rhinitis showed an improvement of adherence to treatment among tele-monitored patients compared to those managed with usual care. Most studies have also highlighted a few shortcomings and limitations of tele-medicine, mainly concerning security and cost-efficiency. The use of smartphones and apps for a personalized asthma and allergy care needs to be further evaluated and optimized before conclusions on its usefulness can be drawn.
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Affiliation(s)
- Xinyuan Huang
- Department of Pediatric Pneumology and Immunology, Charité Medical University, Augustenburgerplatz, 1, 13353, Berlin, Germany.,Department of Pediatric, Shengzhou People's Hospital, Zhejiang, China
| | - Paolo Maria Matricardi
- Department of Pediatric Pneumology and Immunology, Charité Medical University, Augustenburgerplatz, 1, 13353, Berlin, Germany.
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19
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Hearn J, Ssinabulya I, Schwartz JI, Akiteng AR, Ross HJ, Cafazzo JA. Self-management of non-communicable diseases in low- and middle-income countries: A scoping review. PLoS One 2019; 14:e0219141. [PMID: 31269070 PMCID: PMC6608949 DOI: 10.1371/journal.pone.0219141] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 06/17/2019] [Indexed: 12/30/2022] Open
Abstract
Background The prevalence of non-communicable diseases (NCDs) is rising in low- and middle-income countries (LMICs). Self-management, which enables patients to better manage their health, presents a potentially-scalable means of mitigating the growing burden of NCDs in LMICs. Though the effectiveness of self-management interventions in high-income countries is well-documented, the use of these strategies in LMICs has yet to be thoroughly summarized. Objective The purpose of this scoping review is to summarize the nature and effectiveness of past interventions that have enabled the self-management of NCDs in LMICs. Methods Using the scoping review methodology proposed by Arksey and O’Malley, PubMed was searched for relevant articles published between January 2007 and December 2018. The implemented search strategy comprised three major themes: self-management, NCDs and LMICs. Results Thirty-six original research articles were selected for inclusion. The selected studies largely focused on the self-management of diabetes (N = 21), hypertension (N = 7) and heart failure (N = 5). Most interventions involved the use of short message service (SMS, N = 17) or phone calls (N = 12), while others incorporated educational sessions (N = 10) or the deployment of medical devices (N = 4). The interventions were generally effective and often led to improvements in physiologic indicators, patient self-care and/or patient quality of life. However, the studies emphasized results in small populations, with little indication of future scaling of the intervention. Furthermore, the results indicate a need for further research into the self-management of cardiovascular diseases, as well as for the co-management of diabetes and cardiovascular disease. Conclusions Self-management appears to be an effective means of improving health outcomes in LMICs. Future strategies should include patients and clinicians in all stages of design and development, allowing for a focus on long-term sustainability, scalability and interoperability of the intervention in the target setting.
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Affiliation(s)
- Jason Hearn
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Isaac Ssinabulya
- Uganda Heart Institute, Mulago Hospital, Kampala, Uganda
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Jeremy I. Schwartz
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT, United States of America
| | - Ann R. Akiteng
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Heather J. Ross
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Joseph A. Cafazzo
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- * E-mail:
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20
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Tan X, Xiong H, Gui S, Wan Y, Yan W, Wang D, Tong L, Zeng G. Effects of cognitive education on the perceived control and symptom distress of lung cancer patients receiving chemotherapy: A randomised controlled trial. Eur J Cancer Care (Engl) 2019; 28:e13120. [PMID: 31184792 DOI: 10.1111/ecc.13120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 04/28/2019] [Accepted: 05/14/2019] [Indexed: 11/26/2022]
Abstract
AIM A randomised controlled trial (RCT) was implemented to verify the feasibility and acceptability of cognitive education in the format of mind maps for increasing perceived control and decreasing the symptom distress of lung cancer patients who were receiving chemotherapy. METHODS A total of 136 lung cancer patients who were receiving chemotherapy were randomised using stratified blocks (1:1 ratio, from March 2016 to April 2017). The intervention group was given cognitive education in the format of mind maps. The control group was provided conventional education. The primary outcomes were perceived control, including cancer experience and cancer efficacy; the secondary outcomes included symptom distress (arising from fatigue, distress, sleep disturbance, poor appetite, drowsiness, shortness of breath, etc.). The Mann-Whitney U test, chi-squared test, two-sample t test and repeated measurement analysis of variance were used. RESULTS Ninety-four patients completed the final study. The results of the repeated measurement analysis of variance indicated that at the 8th or 12th week following cognitive education intervention in the format of mind maps, the cancer experience, cancer efficacy (except personal efficacy) and symptom distress (arising from fatigue, distress, sleep disturbance, and sadness and its total scores) of the patients in the intervention group were considerably improved compared with those of the control group (p < 0.05). The longer the intervention was, the higher the level of the patients' perceived control was and the lower the degree of patient symptom distress was (p < 0.05). CONCLUSIONS Our findings suggest that cognitive education in the format of mind maps could improve perceived control and decrease the symptom distress of lung cancer patients who were receiving chemotherapy and that it was feasible and acceptable. Cognitive education in the format of mind maps was found to be an effective teaching tool for lung cancer patients who were receiving chemotherapy.
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Affiliation(s)
- Xing Tan
- School of Nursing, University of South China, Hengyang, China.,People's Hospital of Longhua District, Shenzhen, China
| | - Haihan Xiong
- People's Hospital of Longhua District, Shenzhen, China
| | - Sijie Gui
- Queen Mary School, Nanchang University, Nanchang, China
| | - Yanping Wan
- School of Nursing, University of South China, Hengyang, China
| | - Wenjing Yan
- School of Nursing, University of South China, Hengyang, China
| | - Dian Wang
- School of Nursing, University of South China, Hengyang, China
| | - Lingling Tong
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, China
| | - Guqing Zeng
- School of Nursing, University of South China, Hengyang, China
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Mikalsen IB, Nassehi D, Øymar K. Vortex Whistle and Smart Phone Application for Peak Flow Recordings in Asthmatic Children: A Feasibility Study. Telemed J E Health 2018; 25:1077-1082. [PMID: 30570372 PMCID: PMC6842893 DOI: 10.1089/tmj.2018.0270] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Variable airflow obstruction that can be confirmed by diurnal variability of peak expiratory flow (PEF) >13% is an important characteristic of asthma. Home monitoring of PEF may be helpful to diagnose and monitor asthma. In this feasibility study, we aimed to study if asthmatic children can measure PEF at home twice daily during a 4-week period using a device designed as a "whistle" and a smart phone software application. Materials and Methods: Twice daily during 4 weeks, children aged 5-12 years with current asthma rated their asthma condition electronically on the smart phone application Blowfish before inhaling deeply then exhaling into the device to produce a high-pitched sound recorded by the application. Through mathematical algorithms, the sound was transferred to PEF, which was uploaded to a server. At inclusion, the Pediatric Asthma Quality of Life Questionnaire and the Childhood Asthma Control Test were answered. At the end, the parents graded the device and application. Results: One child did not manage to upload PEF. For the remaining 21 children, the median (quartiles) days with at least one measurement during the period were 27 (21-29.5), and on median 18 (9-24) days PEF was recorded twice daily. The median parental score (potential score 0-20) of the application was 18 (15-20). Discussion/Conclusion: The study shows promising results for home monitoring of PEF by an electronic device with automatic teletransmission. The high rate of successful recordings and parental satisfaction suggests that the clinical utility of the solution should be further studied.
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Affiliation(s)
- Ingvild Bruun Mikalsen
- Department of Pediatrics, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Knut Øymar
- Department of Pediatrics, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
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Blakey JD, Bender BG, Dima AL, Weinman J, Safioti G, Costello RW. Digital technologies and adherence in respiratory diseases: the road ahead. Eur Respir J 2018; 52:1801147. [PMID: 30409819 PMCID: PMC6364097 DOI: 10.1183/13993003.01147-2018] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 09/25/2018] [Indexed: 01/09/2023]
Abstract
Outcomes for patients with chronic respiratory diseases remain poor despite the development of novel therapies. In part, this reflects the fact that adherence to therapy is low and clinicians lack accurate methods to assess this issue. Digital technologies hold promise to overcome these barriers to care. For example, algorithmic analysis of large amounts of information collected on health status and treatment use, along with other disease relevant information such as environmental data, can be used to help guide personalised interventions that may have a positive health impact, such as establishing habitual and correct inhaler use. Novel approaches to data analysis also offer the possibility of statistical algorithms that are better able to predict exacerbations, thereby creating opportunities for preventive interventions that may adapt therapy as disease activity changes. To realise these possibilities, digital approaches to disease management should be supported by strong evidence, have a solid infrastructure, be designed collaboratively as clinically effective and cost-effective systems, and reflect the needs of patients and healthcare providers. Regulatory standards for digital interventions and strategies to handle the large amounts of data generated are also needed. This review highlights the opportunities provided by digital technologies for managing patients with respiratory diseases.
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Affiliation(s)
- John D Blakey
- Respiratory Medicine, Royal Liverpool Hospital and Health Services Research, University of Liverpool, Liverpool, UK
| | - Bruce G Bender
- Dept of Pediatrics, National Jewish Health, Denver, CO, USA
| | - Alexandra L Dima
- Health Services and Performance Research, Université Claude Bernard Lyon 1, Lyon, France
| | - John Weinman
- Institute of Pharmaceutical Science and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Richard W Costello
- RCSI Education and Research Centre, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
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23
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Unni E, Gabriel S, Ariely R. A review of the use and effectiveness of digital health technologies in patients with asthma. Ann Allergy Asthma Immunol 2018; 121:680-691.e1. [PMID: 30352288 DOI: 10.1016/j.anai.2018.10.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/12/2018] [Accepted: 10/16/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE A new generation of digital health technologies (DHT) offers the opportunity to improve adherence and asthma control. Recent literature was reviewed to summarize the use of technological aids and evaluate their impact on health outcomes in patients with asthma. DATA SOURCES PubMed and Embase were searched to identify articles published over the past 5 years (2013 to 2017). STUDY SELECTIONS All records were judged for eligibility by 2 independent reviewers; 28 articles met the inclusion criteria. RESULTS Interactive websites were the most frequently evaluated type of DHT (50% of all studies), followed by mobile apps in adult patient cohorts. Relatively few studies assessed electronic monitoring devices, phone calls, or text messaging. Among the 16 studies that focused on children, most interventions that used interactive websites (n = 8) showed at least some benefit, although results varied based on the specific outcome. Twelve studies focused on adults, with interventions using interactive websites (n = 6) reporting results that were generally less consistent compared with the pediatric studies. The 6 studies that assessed mobile apps with adult patients reported consistent benefits across a range of outcomes, including medication adherence and asthma control. CONCLUSION Most interventions reported at least some benefit, although results varied based on the specific outcome. Overall, technology that included more interactive features, such as website-based daily diary entries and apps that provided real-time feedback, was associated with increased asthma control, as was the case for multidimensional interventions that combined the use of several complementary types of DHT.
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Affiliation(s)
- Elizabeth Unni
- Roseman University of Health Sciences, South Jordan, Utah
| | - Susan Gabriel
- Global Health Economics and Outcomes Research, Teva Pharmaceuticals, Frazer, Pennsylvania
| | - Rinat Ariely
- Global Health Economics and Outcomes Research, Teva Pharmaceuticals, Frazer, Pennsylvania.
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24
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Donevant SB, Estrada RD, Culley JM, Habing B, Adams SA. Exploring app features with outcomes in mHealth studies involving chronic respiratory diseases, diabetes, and hypertension: a targeted exploration of the literature. J Am Med Inform Assoc 2018; 25:1407-1418. [PMID: 30137383 PMCID: PMC6188510 DOI: 10.1093/jamia/ocy104] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 06/29/2018] [Accepted: 07/10/2018] [Indexed: 01/06/2023] Open
Abstract
Objectives Limited data are available on the correlation of mHealth features and statistically significant outcomes. We sought to identify and analyze: types and categories of features; frequency and number of features; and relationship of statistically significant outcomes by type, frequency, and number of features. Materials and Methods This search included primary articles focused on app-based interventions in managing chronic respiratory diseases, diabetes, and hypertension. The initial search yielded 3622 studies with 70 studies meeting the inclusion criteria. We used thematic analysis to identify 9 features within the studies. Results Employing existing terminology, we classified the 9 features as passive or interactive. Passive features included: 1) one-way communication; 2) mobile diary; 3) Bluetooth technology; and 4) reminders. Interactive features included: 1) interactive prompts; 2) upload of biometric measurements; 3) action treatment plan/personalized health goals; 4) 2-way communication; and 5) clinical decision support system. Discussion Each feature was included in only one-third of the studies with a mean of 2.6 mHealth features per study. Studies with statistically significant outcomes used a higher combination of passive and interactive features (69%). In contrast, studies without statistically significant outcomes exclusively used a higher frequency of passive features (46%). Inclusion of behavior change features (ie, plan/goals and mobile diary) were correlated with a higher incident of statistically significant outcomes (100%, 77%). Conclusion This exploration is the first step in identifying how types and categories of features impact outcomes. While the findings are inconclusive due to lack of homogeneity, this provides a foundation for future feature analysis.
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Affiliation(s)
- Sara Belle Donevant
- College of Nursing, University of South Carolina, Columbia, South Carolina, USA
| | | | - Joan Marie Culley
- College of Nursing, University of South Carolina, Columbia, South Carolina, USA
| | - Brian Habing
- Department of Statistics, University of South Carolina, Columbia, South Carolina, USA
| | - Swann Arp Adams
- College of Nursing/Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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25
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Nemanic T, Sarc I, Skrgat S, Flezar M, Cukjati I, Marc Malovrh M. Telemonitoring in asthma control: a randomized controlled trial. J Asthma 2018; 56:782-790. [PMID: 30063840 DOI: 10.1080/02770903.2018.1493599] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Telemonitoring seems to be a useful tool for patients' management. The aim of our project was to test the applicability and potential effects of a 12-month telemonitoring of patients with asthma supported by information and communication technologies. METHODS We included 100 patients with asthma followed in the outpatient pulmonary clinic in a randomized controlled clinical trial. The patients' data were collected by study questionnaires and lung function tests at the inclusion and at the end of interventional period. In the interventional group, asthma control test (ACT) and peak expiratory flow measurements (PEF) were stimulated to be regularly reported by Short Message Service (SMS). As a response to reported values, the patients automatically received a preformed text or a call from a study nurse in case of detected predefined critical values. RESULTS The compliance of reporting PEF and ACT values was higher than 80% in 96% of patients. Although we did not detect significant differences in ACT score improvement between the two study groups, we found more prominent improvement of ACT score in the subgroup of patients with two or more exacerbations prior to inclusion in the interventional group, compared to the control group. 40 (78%) patients in the interventional group listed at least one positive effect of telemonitoring on management of asthma. CONCLUSIONS The developed program for home monitoring of patients with asthma was applicable and offered the patients support in managing their disease. Further studies with more selected patients are needed to confirm its usefulness in improving asthma control.
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Affiliation(s)
- Tiva Nemanic
- a University Clinic of Pulmonary and Allergic Diseases Golnik , Golnik , Slovenia
| | - Irena Sarc
- a University Clinic of Pulmonary and Allergic Diseases Golnik , Golnik , Slovenia
| | - Sabina Skrgat
- a University Clinic of Pulmonary and Allergic Diseases Golnik , Golnik , Slovenia
| | - Matjaz Flezar
- a University Clinic of Pulmonary and Allergic Diseases Golnik , Golnik , Slovenia
| | - Iztok Cukjati
- b Faculty of Medicine , University of Ljubljana , Ljubljana , Slovenia.,c AdriaData d.o.o. , Ljubljana , Slovenia
| | - Mateja Marc Malovrh
- a University Clinic of Pulmonary and Allergic Diseases Golnik , Golnik , Slovenia
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26
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Deng Z, Hong Z, Ren C, Zhang W, Xiang F. What Predicts Patients' Adoption Intention Toward mHealth Services in China: Empirical Study. JMIR Mhealth Uhealth 2018; 6:e172. [PMID: 30158101 PMCID: PMC6135967 DOI: 10.2196/mhealth.9316] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 05/08/2018] [Accepted: 06/21/2018] [Indexed: 12/24/2022] Open
Abstract
Background With the increasing concerns about the health of individuals in China and the development of information technology, mHealth enables patients to access health information and interact with doctors anytime and anywhere. Examining patients’ willingness to use mHealth is considered critical because its success depends on the adoption of patients. Objective The objective of our study was to explore the determinants of mHealth service adoption among Chinese patients using an extended technology acceptance model (TAM) with trust and perceived risks. Methods We conducted a questionnaire-based survey in 3 large hospitals in China and analyzed the data using structural equation modeling. Results The results corroborated that the proposed model fits well. Trust, perceived usefulness, and perceived ease of use positively correlated with mHealth service adoption. Privacy and performance risks negatively correlated with the patients’ trust and adoption intention toward mHealth services. In addition, patients’ age and chronic diseases can help predict their trust level and adoption intention toward mHealth, respectively. Conclusions We concluded that the TAM generally works in the context of mHealth adoption, although its significance has declined. In addition to technical factors, trust and perceived risks are critical for explaining mHealth service adoption among Chinese patients.
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Affiliation(s)
- Zhaohua Deng
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China
| | - Ziying Hong
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China
| | - Cong Ren
- Department of Medical Records Room, Affiliated Central Hospital of Zhengzhou University, Zhengzhou, China
| | - Wei Zhang
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China
| | - Fei Xiang
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China
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27
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Chongmelaxme B, Lee S, Dhippayom T, Saokaew S, Chaiyakunapruk N, Dilokthornsakul P. The Effects of Telemedicine on Asthma Control and Patients' Quality of Life in Adults: A Systematic Review and Meta-analysis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 7:199-216.e11. [PMID: 30055283 DOI: 10.1016/j.jaip.2018.07.015] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 07/06/2018] [Accepted: 07/16/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Telemedicine is increasingly used to improve health outcomes in asthma. However, it is still inconclusive which telemedicine works effectively. OBJECTIVE This study aimed to determine the effects of telemedicine on asthma control and the quality of life in adults. METHODS An electronic search was performed from the inception to March 2018 on the following databases: Cochrane CENTRAL, CINAHL, ClinicalTrials.gov, EMBASE, PubMed, and Scopus. Randomized controlled trials that assessed the effects of telemedicine in adults with asthma were included in this analysis, and the outcomes of interest were levels of asthma control and quality of life. Random-effects model meta-analyses were performed. RESULTS A total of 22 studies (10,281 participants) were included. Each of 11 studies investigated the effects of single-telemedicine and combined-telemedicine (combinations of telemedicine approaches), and the meta-analyses showed that combined tele-case management could significantly improve asthma control compared with usual care (standardized mean difference [SMD] = 0.78; 95% confidence interval [CI]: 0.56, 1.01). Combined tele-case management and tele-consultation (SMD = 0.52 [95% CI: 0.13, 0.91]) and combined tele-consultation (SMD = 0.28 [95% CI: 0.13, 0.44]) also significantly improved asthma outcomes, but to a lesser degree. In addition, combined tele-case management (SMD = 0.59 [95% CI: 0.31, 0.88]) was the most effective telemedicine for improving quality of life, followed by combined tele-case management and tele-consultation (SMD = 0.31 [95% CI: 0.03, 0.59]), tele-case management (SMD = 0.30 [95% CI: 0.05, 0.55]), and combined tele-consultation (SMD = 0.27 [95% CI: 0.11, 0.43]), respectively. CONCLUSIONS Combined-telemedicine involving tele-case management or tele-consultation appear to be effective telemedicine interventions to improve asthma control and quality of life in adults. Our findings are expected to provide health care professionals with current evidence of the effects of telemedicine on asthma control and patients' quality of life.
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Affiliation(s)
- Bunchai Chongmelaxme
- Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Shaun Lee
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia; Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Teerapon Dhippayom
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Surasak Saokaew
- Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; School of Pharmacy, Monash University Malaysia, Selangor, Malaysia; Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
| | - Nathorn Chaiyakunapruk
- Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; School of Pharmacy, Monash University Malaysia, Selangor, Malaysia; Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia; Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; School of Pharmacy, University of Wisconsin, Madison, Wis
| | - Piyameth Dilokthornsakul
- Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.
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28
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Schwebel FJ, Larimer ME. Using text message reminders in health care services: A narrative literature review. Internet Interv 2018; 13:82-104. [PMID: 30206523 PMCID: PMC6112101 DOI: 10.1016/j.invent.2018.06.002] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 06/19/2018] [Accepted: 06/19/2018] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Despite the extensive use of mHealth behavior change interventions, questions remain about the use of technology-based reminders in delivering health care services. Text messaging, or short message service (SMS), is one reminder method that has been extensively researched. Most SMS-reminder research is distributed across a range of health care outcomes. The aim of this article is to systematically review the aggregate impact of these reminders on overall health care outcomes. METHODS A systematic literature review was conducted and yielded 2316 articles. Studies were included if they used SMS reminders to support patient health care outcomes. Study methodology was aligned with the PRISMA guidelines for systematic reviews. RESULTS Following screening, 162 articles met inclusion criteria. Of these studies, 93 investigated medical compliance reminders and 56 investigated appointment reminders. The review found that nearly all the SMS-reminder studies helped improve patient medical compliance and appointment reminders. Additionally, researchers reported numerous benefits from using SMS reminders, including ease of use, relative inexpensiveness, and rapid and automated message delivery. Minimal risks were reported and most participants found the reminders to be acceptable. DISCUSSION Text messages appear to be an effective reminder mechanism to promote improved patient appointment and medical compliance. Reminders should continue to be evaluated and improved to determine the most effective timing and frequency of messages for improving outcomes.
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Affiliation(s)
- Frank J. Schwebel
- University of Washington, Department of Psychology, 119A Guthrie Hall Box 351525, Seattle, WA 98195-1525, United States of America,Corresponding author.
| | - Mary E. Larimer
- University of Washington, Department of Psychology, 119A Guthrie Hall Box 351525, Seattle, WA 98195-1525, United States of America,University of Washington, Department of Psychiatry and Behavioral Sciences, 1100 NE 45th, Suite 300, Office 312, Box 354944, Seattle, WA 98105, United States of America
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29
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Pirożyński M, Hantulik P, Almgren-Rachtan A, Chudek J. Evaluation of the Efficiency of Single-Inhaler Combination Therapy with Budesonide/Formoterol Fumarate in Patients with Bronchial Asthma in Daily Clinical Practice. Adv Ther 2017; 34:2648-2660. [PMID: 29119403 PMCID: PMC5709454 DOI: 10.1007/s12325-017-0641-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Indexed: 11/02/2022]
Abstract
INTRODUCTION The effectiveness of single-inhaler budesonide/formoterol fumarate combination therapy for asthma has been previously shown for the original product. The aim of this nonrandomized, open-label, postauthorization efficacy study (PAES) real-life clinical assessment was to evaluate the clinical effectiveness of a second product (Bufomix Easyhaler®) in the daily clinical practice of asthma therapy. METHODS This multicenter PAES was conducted by 220 unselected allergologists and pulmonologists who enrolled 2200 adult outpatients (age 49.8 ± 17.9 years) with asthma treated with Bufomix Easyhaler® for at least 14 days before enrolment. Asthma control was assessed during three subsequent visits with 8-12-week intervals on the basis of the Asthma Control Test (ACT). Adherence was assessed with the Medication Adherence Questionnaire. In addition, patient satisfaction with Bufomix Easyhaler® was scored, and adverse drug reactions were recorded. RESULTS The percentage of patients with well-controlled asthma or total control of asthma (ACT score 20-25 points) increased from 46.6% at the first visit to 90.8% at the third visit (p < 0.001). In addition, the percentage of patients with poor control of asthma (ACT score less than 15 points) decreased from 14.9% to 1.2% (p < 0.001). The adherence rate increased from 88% at the first visit to 95.3% at the third visit. Patient satisfaction with the use of this dry powder inhaler increased with the duration of its use. Only one adverse drug reaction was reported. CONCLUSION The results obtained confirm the effectiveness of Bufomix Easyhaler® in the treatment of asthma in outpatient adults in daily clinical practice. FUNDING Orion Corporation.
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Affiliation(s)
- Michał Pirożyński
- Department of Allergology and Pulmonology, Postgraduate Centre for Medical Education, Warsaw, Poland
| | - Piotr Hantulik
- Medical Affairs, Orion Pharma Poland Co. Ltd, Warsaw, Poland
| | | | - Jerzy Chudek
- Department of Internal Medicine and Oncological Chemotherapy, Medical Faculty in Katowice, Medical University of Silesia, Katowice, Poland.
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Hui CY, Walton R, McKinstry B, Jackson T, Parker R, Pinnock H. The use of mobile applications to support self-management for people with asthma: a systematic review of controlled studies to identify features associated with clinical effectiveness and adherence. J Am Med Inform Assoc 2017; 24:619-632. [PMID: 27694279 DOI: 10.1093/jamia/ocw143] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 08/28/2016] [Indexed: 01/28/2023] Open
Abstract
Objectives Telehealth is promoted as a strategy to support self-management of long-term conditions. The aim of this systematic review is to identify which information and communication technology features implemented in mobile apps to support asthma self-management are associated with adoption, adherence to usage, and clinical effectiveness. Methods We systematically searched 9 databases, scanned reference lists, and undertook manual searches (January 2000 to April 2016). We include randomized controlled trials (RCTs) and quasiexperimental studies with adults. All eligible papers were assessed for quality, and we extracted data on the features included, health-related outcomes (asthma control, exacerbation rate), process/intermediate outcomes (adherence to monitoring or treatment, self-efficacy), and level of adoption of and adherence to use of technology. Meta-analysis and narrative synthesis were used. Results We included 12 RCTs employing a range of technologies. A meta-analysis (n = 3) showed improved asthma control (mean difference -0.25 [95% CI, -0.37 to -0.12]). Included studies incorporated 10 features grouped into 7 categories (education, monitoring/electronic diary, action plans, medication reminders/prompts, facilitating professional support, raising patient awareness of asthma control, and decision support for professionals). The most successful interventions included multiple features, but effects on health-related outcomes were inconsistent. No studies explicitly reported adoption of and adherence to the technology system. Conclusion Meta-analysis of data from 3 trials showed improved asthma control, though overall the clinical effectiveness of apps, typically incorporating multiple features, varied. Further studies are needed to identify the features that are associated with adoption of and adherence to use of the mobile app and those that improve health outcomes.
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Affiliation(s)
- Chi Yan Hui
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Robert Walton
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, London, UK
| | - Brian McKinstry
- Primary Care eHealth, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Tracy Jackson
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Richard Parker
- Health Services Research Unit, University of Edinburgh, Edinburgh, UK
| | - Hilary Pinnock
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
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Abaza H, Marschollek M. mHealth Application Areas and Technology Combinations*. A Comparison of Literature from High and Low/Middle Income Countries. Methods Inf Med 2017; 56:e105-e122. [PMID: 28925418 PMCID: PMC6291822 DOI: 10.3414/me17-05-0003] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 05/25/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND With the continuous and enormous spread of mobile technologies, mHealth has evolved as a new subfield of eHealth. While eHealth is broadly focused on information and communication technologies, mHealth seeks to explore more into mobile devices and wireless communication. Since mobile phone penetration has exceeded other infrastructure in low and middle-income countries (LMICs), mHealth is seen as a promising component to provide pervasive and patient-centered care. OBJECTIVES The aim of our research work for this paper is to examine the mHealth literature to identify application areas, target diseases, and mHealth service and technology types that are most appropriate for LMICs. METHODS Based on the 2011 WHO mHealth report, a combination of search terms, all including the word "mHealth", was identified. A literature review was conducted by searching the PubMed and IEEE Xplore databases. Articles were included if they were published in English, covered an mHealth solution/ intervention, involved the use of a mobile communication device, and included a pilot evaluation study. Articles were excluded if they did not provide sufficient detail on the solution covered or did not focus on clinical efficacy/effectiveness. Cross-referencing was also performed on included articles. RESULTS 842 articles were retrieved and analyzed, 255 of which met the inclusion criteria. North America had the highest number of applications (n=74) followed by Europe (n=50), Asia (n=44), Africa (n=25), and Australia (n=9). The Middle East (n=5) and South America (n=3) had the least number of studies. The majority of solutions addressed diabetes (n=51), obesity (n=25), CVDs (n=24), HIV (n=18), mental health (n=16), health behaviors (n=16), and maternal and child's health (MCH) (n=11). Fewer solutions addressed asthma (n=7), cancer (n=5), family health planning (n=5), TB (n=3), malaria (n=2), chronic obtrusive pulmonary disease (COPD) (n=2), vision care (n=2), and dermatology (n=2). Other solutions targeted stroke, dental health, hepatitis vaccination, cold and flu, ED prescribed antibiotics, iodine deficiency, and liver transplantation (n=1 each). The remainder of solutions (n=14) did not focus on a certain disease. Most applications fell in the areas of health monitoring and surveillance (n=93) and health promotion and raising awareness (n=88). Fewer solutions addressed the areas of communication and reporting (n=11), data collection (n=6), telemedicine (n=5), emergency medical care (n=3), point of care support (n=2), and decision support (n=2). The majority of solutions used SMS messaging (n=94) or mobile apps (n=71). Fewer used IVR/phone calls (n=8), mobile website/email (n=5), videoconferencing (n=2), MMS (n=2), or video (n=1) or voice messages (n=1). Studies were mostly RCTs, with the majority suffering from small sample sizes and short study durations. Problems addressed by solutions included travel distance for reporting, self-management and disease monitoring, and treatment/medication adherence. CONCLUSIONS SMS and app solutions are the most common forms of mHealth applications. SMS solutions are prevalent in both high and LMICs while app solutions are mostly used in high income countries. Common application areas include health promotion and raising awareness using SMS and health monitoring and surveillance using mobile apps. Remaining application areas are rarely addressed. Diabetes is the most commonly targeted medical condition, yet remains deficient in LMICs.
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Affiliation(s)
- Haitham Abaza
- Peter L. Reichertz Institute for Medical Informatics, Hannover Medical School, Hannover, Germany
| | - Michael Marschollek
- Peter L. Reichertz Institute for Medical Informatics, Hannover Medical School, Hannover, Germany
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Haas K, Martin A, Park KT. Text Message Intervention (TEACH) Improves Quality of Life and Patient Activation in Celiac Disease: A Randomized Clinical Trial. J Pediatr 2017; 185:62-67.e2. [PMID: 28343658 PMCID: PMC5637528 DOI: 10.1016/j.jpeds.2017.02.062] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/20/2017] [Accepted: 02/23/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine the impact of the Text Message Educational Automated Compliance Help (TEACH) text message intervention as a pragmatic approach for patient engagement among adolescents with celiac disease (CD) as measured by gluten-free diet (GFD) adherence, patient activation, and quality of life (QOL). STUDY DESIGN Randomized controlled trial with patient recruitment at a pediatric, university-based hospital and through social media; 61 participants ages 12-24 years with CD diagnosed at least 1 year were enrolled. The TEACH intervention cohort received 45 unique text messages over a 3-month study period while the control group received standard of care treatment. Primary outcome measures included objective markers of GFD adherence included serum tissue transglutaminase IgA and deamidated gliadin peptide IgA levels. Secondary patient-reported outcomes collected via online survey included the Celiac Dietary Adherence Test, National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System (PROMIS) Global Short Form measure of QOL, Celiac Symptom Index, and Patient Activation Measure. All measures were assessed at enrollment and after the 3-month study period. Statistical analysis performed using the 2-tailed paired Student t test. RESULTS Among the TEACH intervention group, there was significant improvement comparing enrollment scores with 3-month follow-up scores in patient activation (Patient Activation Measure score 63.1 vs 72.5, P?=?.01) and QOL (NIH PROMIS Global Mental Health 50.8 vs 53.3, P?=?.01 and NIH PROMIS Global Physical Health 50.8 vs 57.7, P?=?.03). There was no statistically significant difference in patient-reported or objectively measured GFD adherence. CONCLUSIONS TEACH is an effective intervention among patients with CD to improve patient activation and QOL, even among a cohort with GFD adherence at baseline. TRIAL REGISTRATION ClinicalTrials.gov: NCT02458898.
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Affiliation(s)
- Kelly Haas
- Department of Pediatrics, Division of Gastroenterology, Stanford University School of Medicine, Stanford University, Palo Alto, CA.
| | - Andrew Martin
- Center for Clinical Informatics, Stanford University School of Medicine, Stanford University, Palo Alto, CA
| | - KT Park
- Department of Pediatrics, Division of Gastroenterology, Stanford University School of Medicine, Stanford University, Palo Alto, CA
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Pernell BM, DeBaun MR, Becker K, Rodeghier M, Bryant V, Cronin RM. Improving Medication Adherence with Two-way Short Message Service Reminders in Sickle Cell Disease and Asthma. A feasibility randomized controlled trial. Appl Clin Inform 2017; 8:541-559. [PMID: 28536723 PMCID: PMC6241750 DOI: 10.4338/aci-2016-12-ra-0203] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 03/08/2017] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Sickle cell disease (SCD) is a childhood and adult disease that primarily affects African Americans, characterized by life threatening sequelae mitigated by medications. One-way and two-way short message service (SMS) medication reminders have differing efficacy in chronic diseases. There is limited literature about SMS medication reminders in SCD. OBJECTIVE The goal of this study was to test the feasibility, defined by recruitment/acceptance, retention/attrition, and technology utilization, of two-way SMS medication reminders in individuals with SCD with and without asthma. MATERIALS AND METHODS Participants were randomly allocated to standard care or reminders. Two-way SMS reminders were automated using Research Electronic Data Capture (REDCap) for hydroxyurea, fluticasone, budesonide and montelukast. Adherence was measured using the Morisky Medication Adherence Scale-8 (MMAS-8). Asthma control was assessed using the Childhood and Adult-Asthma Control Tests (ACT). Participants were enrolled 28 to 60 days with a common termination date. RESULTS The recruitment rate was 95% (47/49) and 82.9% completed the study. Among the 47 study participants enrolled, 51.1% were male, 61.7% were adults, median age was 20 (range: 3 to 59), and 98% were African Americans. Of the 26 participants receiving messages, 20% responded on over 95% of the days and usage varied with an average response rate of 33%, ranging from 21% to 46%. Medication adherence scores improved significantly in the intervention group (3.42 before, 5.46 after; p=0.002), but not in the control group (3.90 before, 4.75 after; p=0.080). Childhood-ACT scores improved in the intervention group (19.20 before, 24.25 after). Adult-ACT scores within the intervention arm were unchanged (21.0 before, 22.0 after. ACT scores did not improve significantly. CONCLUSION This study demonstrated the feasibility for two-way SMS medication reminders to improve medication adherence in a high-risk population where daily medication adherence is critical to health outcomes and quality of life.
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Affiliation(s)
- Brandi M. Pernell
- Vanderbilt-Meharry-Matthew Walker Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville TN
- University of Alabama at Birmingham, Department of Pediatrics, Division of Hematology, Birmingham, AL
| | - Michael R. DeBaun
- Vanderbilt-Meharry-Matthew Walker Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville TN
| | | | | | - Valencia Bryant
- Vanderbilt-Meharry-Matthew Walker Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville TN
| | - Robert M. Cronin
- Vanderbilt University Medical Center, Departments of Biomedical Informatics, Internal Medicine, and Pediatrics, Nashville, TN
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Miller L, Schüz B, Walters J, Walters EH. Mobile Technology Interventions for Asthma Self-Management: Systematic Review and Meta-Analysis. JMIR Mhealth Uhealth 2017; 5:e57. [PMID: 28465281 PMCID: PMC5434254 DOI: 10.2196/mhealth.7168] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/01/2017] [Accepted: 03/17/2017] [Indexed: 12/31/2022] Open
Abstract
Background Mobile technology interventions (MTI) are becoming increasingly popular in the management of chronic health behaviors. Most MTI allow individuals to monitor medication use, record symptoms, or store and activate disease-management action plans. Therefore, MTI may have the potential to improve low adherence to medication and action plans for individuals with asthma, which is associated with poor clinical outcomes. Objective A systematic review and meta-analysis were conducted to evaluate the efficacy of MTI on clinical outcomes as well as adherence in individuals with asthma. As the use of evidence-based behavior change techniques (BCT) has been shown to improve intervention effects, we also conducted exploratory analyses to determine the role of BCT and engagement with MTI as moderators of MTI efficacy. Methods We searched electronic databases for randomized controlled trials up until June 2016. Random effect models were used to assess the effect of MTI on clinical outcomes as well as adherence to preventer medication or symptom monitoring. Mixed effects models assessed whether the features of the MTI (ie, use of BCT) and how often a person engaged with MTI moderated the effects of MTI. Results The literature search located 11 studies meeting the inclusion criteria, with 9 providing satisfactory data for meta-analysis. Compared with standard treatment, MTI had moderate to large effect sizes (Hedges g) on medication adherence and clinical outcomes. MTI had no additional effects on adherence or clinical outcomes when compared with paper-based monitoring. No moderator effects were found, and the number of studies was small. A narrative review of the two studies, which are not included in the meta-analysis, found similar results. Conclusions This review indicated the efficacy of MTI for self-management in individuals with asthma and also indicated that MTI appears to be as efficacious as paper-based monitoring. This review also suggested a need for robust studies to examine the effects of BCT use and engagement on MTI efficacy to inform the evidence base for MTI in individuals with asthma.
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Affiliation(s)
- Lisa Miller
- School of Medicine, Psychology, University of Tasmania, Hobart, Australia
| | - Benjamin Schüz
- School of Medicine, Psychology, University of Tasmania, Hobart, Australia
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The potential of eHealth in otorhinolaryngology-head and neck surgery: patients' perspectives. Eur Arch Otorhinolaryngol 2017; 274:2933-2943. [PMID: 28444458 DOI: 10.1007/s00405-017-4567-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 04/13/2017] [Indexed: 10/19/2022]
Abstract
The use of modern information and communication technologies (ICT) in daily life has significantly increased during the last several years. These essential online technologies have also found their way into the healthcare system. The use of modern ICT for health reasons can be summarized by the term 'eHealth'. Despite the potential importance of eHealth in the field of otorhinolaryngology (ORL), there is little understanding of patients' attitudes towards the deeper integration of these technologies into intersectoral care. The aim of this study was to gain a better understanding of patients' attitudes towards the use of modern ICT for intersectoral communication and information transfer in the field of ORL. Therefore, a structured interview was developed by an interdisciplinary team of otorhinolaryngologists, public health researchers, and information technology (IT) specialists. Overall, 211 ORL patients were interviewed at the Department of Otorhinolaryngology-Head and Neck Surgery, Tuebingen University Hospital, Germany, and 203 of these patients completed the interview. This study revealed ORL patients' perspectives on the potential of eHealth, especially for appointment scheduling, appointment reminders, and intersectoral communication of personal medical information. Furthermore, this study provides evidence that data security and the impacts of eHealth on the physician-patient relationship and on treatment quality warrant special attention in future research.
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Dayer LE, Shilling R, Van Valkenburg M, Martin BC, Gubbins PO, Hadden K, Heldenbrand S. Assessing the Medication Adherence App Marketplace From the Health Professional and Consumer Vantage Points. JMIR Mhealth Uhealth 2017; 5:e45. [PMID: 28428169 PMCID: PMC5415657 DOI: 10.2196/mhealth.6582] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 02/07/2017] [Accepted: 03/02/2017] [Indexed: 01/10/2023] Open
Abstract
Background Nonadherence produces considerable health consequences and economic burden to patients and payers. One approach to improve medication nonadherence that has gained interest in recent years is the use of smartphone adherence apps. The development of smartphone adherence apps has increased rapidly since 2012; however, literature evaluating the clinical app and effectiveness of smartphone adherence apps to improve medication adherence is generally lacking. Objective The aims of this study were to (1) provide an updated evaluation and comparison of medication adherence apps in the marketplace by assessing the features, functionality, and health literacy (HL) of the highest-ranking adherence apps and (2) indirectly measure the validity of our rating methodology by determining the relationship between our app evaluations and Web-based consumer ratings. Methods Two independent reviewers assessed the features and functionality using a 4-domain rating tool of all adherence apps identified based on developer claims. The same reviewers downloaded and tested the 100 highest-ranking apps including an additional domain for assessment of HL. Pearson product correlations were estimated between the consumer ratings and our domain and total scores. Results A total of 824 adherence apps were identified; of these, 645 unique apps were evaluated after applying exclusion criteria. The median initial score based on descriptions was 14 (max of 68; range 0-60). As a result, 100 of the highest-scoring unique apps underwent user testing. The median overall user-tested score was 31.5 (max of 73; range 0-60). The majority of the user tested the adherence apps that underwent user testing reported a consumer rating score in their respective online marketplace. The mean consumer rating was 3.93 (SD 0.84). The total user-tested score was positively correlated with consumer ratings (r=.1969, P=.04). Conclusions More adherence apps are available in the Web-based marketplace, and the quality of these apps varies considerably. Consumer ratings are positively but weakly correlated with user-testing scores suggesting that our rating tool has some validity but that consumers and clinicians may assess adherence app quality differently.
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Affiliation(s)
- Lindsey E Dayer
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences College of Pharmacy, Little Rock, AR, United States
| | - Rebecca Shilling
- University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | | | - Bradley C Martin
- Division of Pharmaceutical Evaluation and Policy, Department of Pharmacy Practice, University of Arkansas for Medical Sciences College of Pharmacy, Little Rock, AR, United States
| | - Paul O Gubbins
- Division of Pharmacy Practice and Administration, University of Missouri-Kansas City School of Pharmacy, Springfield, MO, United States
| | - Kristie Hadden
- UAMS Regional Programs, Center for Health Literacy, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Seth Heldenbrand
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences College of Pharmacy, Little Rock, AR, United States
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Tian M, Zhang J, Luo R, Chen S, Petrovic D, Redfern J, Xu DR, Patel A. mHealth Interventions for Health System Strengthening in China: A Systematic Review. JMIR Mhealth Uhealth 2017; 5:e32. [PMID: 28302597 PMCID: PMC5374274 DOI: 10.2196/mhealth.6889] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 01/26/2017] [Accepted: 02/10/2017] [Indexed: 01/20/2023] Open
Abstract
Background With rapidly expanding infrastructure in China, mobile technology has been deemed to have the potential to revolutionize health care delivery. There is particular promise for mobile health (mHealth) to positively influence health system reform and confront the new challenges of chronic diseases. Objective The aim of this study was to systematically review existing mHealth initiatives in China, characterize them, and examine the extent to which mHealth contributes toward the health system strengthening in China. Furthermore, we also aimed to identify gaps in mHealth development and evaluation. Methods We systematically reviewed the literature from English and Chinese electronic database and trial registries, including PubMed, EMBASE, Cochrane, China National Knowledge of Infrastructure (CNKI), and World Health Organization (WHO) International Clinical Trials Registry Platform. We used the English keywords of mHealth, eHealth, telemedicine, telehealth, mobile phone, cell phone, text messaging, and China, as well as their corresponding Chinese keywords. All articles using mobile technology for health care management were included in the study. Results A total of 1704 articles were found using the search terms, and eventually 72 were included. Overall, few high quality interventions were identified. Most interventions were found to be insufficient in scope, and their evaluation was of inadequate rigor to generate scalable solutions and provide reliable evidence of effectiveness. Most interventions focused on text messaging for consumer education and behavior change. There were a limited number of interventions that addressed health information management, health workforce issues, use of medicines and technologies, or leadership and governance from a health system perspective. Conclusions We provide four recommendations for future mHealth interventions in China that include the need for the development, evaluation and trials examining integrated mHealth interventions to guide the development of future mHealth interventions, target disadvantaged populations with mHealth interventions, and generate appropriate evidence for scalable and sustainable models of care.
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Affiliation(s)
- Maoyi Tian
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China.,Sydney Medical School, The George Institute for Global Health, Australia, University of Sydney, Sydney, Australia
| | - Jing Zhang
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Rong Luo
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Shi Chen
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Djordje Petrovic
- Medical School, University of Michigan, Ann Arbor, MI, United States
| | - Julie Redfern
- Sydney Medical School, The George Institute for Global Health, Australia, University of Sydney, Sydney, Australia
| | - Dong Roman Xu
- Sun Yat-sen Global Health Institute, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Anushka Patel
- Sydney Medical School, The George Institute for Global Health, Australia, University of Sydney, Sydney, Australia
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Beratarrechea A, Moyano D, Irazola V, Rubinstein A. mHealth Interventions to Counter Noncommunicable Diseases in Developing Countries: Still an Uncertain Promise. Cardiol Clin 2017; 35:13-30. [PMID: 27886783 DOI: 10.1016/j.ccl.2016.08.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
mHealth constitutes a promise for health care delivery in low- and middle-income countries (LMICs) where health care systems are unprepared to combat the threat of noncommunicable diseases (NCDs). This article assesses the impact of mHealth on NCD outcomes in LMICs. A systematic review identified controlled studies evaluating mHealth interventions that addressed NCDs in LMICs. From the 1274 abstracts retrieved, 108 articles were selected for full text review and 20 randomized controlled trials were included from 14 LMICs. One-way SMS was the most commonly used mobile function to deliver reminders, health education, and information. mHealth interventions in LMICs have positive but modest effects on chronic disease outcomes.
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Affiliation(s)
- Andrea Beratarrechea
- South American Center of Excellence for Cardiovascular Health, Institute for Clinical Effectiveness and Health Policy, Ravignani 2024, Buenos Aires C1414CPV, Argentina.
| | - Daniela Moyano
- South American Center of Excellence for Cardiovascular Health, Institute for Clinical Effectiveness and Health Policy, Ravignani 2024, Buenos Aires C1414CPV, Argentina
| | - Vilma Irazola
- South American Center of Excellence for Cardiovascular Health, Institute for Clinical Effectiveness and Health Policy, Ravignani 2024, Buenos Aires C1414CPV, Argentina
| | - Adolfo Rubinstein
- South American Center of Excellence for Cardiovascular Health, Institute for Clinical Effectiveness and Health Policy, Ravignani 2024, Buenos Aires C1414CPV, Argentina
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Feng S, Liang Z, Zhang R, Liao W, Chen Y, Fan Y, Li H. Effects of mobile phone WeChat services improve adherence to corticosteroid nasal spray treatment for chronic rhinosinusitis after functional endoscopic sinus surgery: a 3-month follow-up study. Eur Arch Otorhinolaryngol 2016; 274:1477-1485. [DOI: 10.1007/s00405-016-4371-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 11/03/2016] [Indexed: 11/29/2022]
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Kashgary A, Alsolaimani R, Mosli M, Faraj S. The role of mobile devices in doctor-patient communication: A systematic review and meta-analysis. J Telemed Telecare 2016; 23:693-700. [PMID: 27632990 DOI: 10.1177/1357633x16661604] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction In the last few years, the use of telecommunication and mobile technology has grown significantly. This has led to a notable increase in the utilization of this telecommunication in healthcare, namely phone calls and text messaging (SMS). However, evaluating its global impact on improving healthcare processes and outcomes demands a more comprehensive assessment. In this study, we focused on the role of mobile devices via phone calls and SMS in patient-doctor communication, and aimed to assess its impact on various health outcomes. Methods Major databases, including MEDLINE, EMBASE, PsycINFO, Global Health, and Cochrane CENTRAL, were searched for clinical trials that investigated mobile-device technology in any facet of doctor-patient communication published between 1990 and April 2015. A meta-analysis was performed where appropriate. Results Sixty-two articles met our inclusion criteria. Of those, 23 articles investigated mobile appointment reminder technologies, 19 investigated medication adherence, 20 investigated disease-control interventions, and two investigated test-result reporting. Patients who received an appointment reminder were 10% less likely to miss an appointment (relative risk [RR] = 1.11, 95% confidence interval [CI] 1.08-1.15). Mobile interventions increased medication adherence by 22% (RR = 1.22, 95% CI 1.09-1.36). Ten of 20 studies examining disease control reported statistically significant reductions in clinically meaningful endpoints. The use of mobile-device interventions improved forced expiratory volume in one second and hemoglobin A1c percentage in meta-analyses. Conclusion The use of mobile-device technologies exerted modest improvements in communication and health outcomes. Further research is needed to determine the true effect of these technologies on doctor-patient communication.
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Affiliation(s)
- Abdullah Kashgary
- 1 Department of Medicine, King Abdulaziz University, Saudi Arabia.,2 Faculty of Management, McGill University, Canada
| | - Roaa Alsolaimani
- 1 Department of Medicine, King Abdulaziz University, Saudi Arabia
| | - Mahmoud Mosli
- 1 Department of Medicine, King Abdulaziz University, Saudi Arabia
| | - Samer Faraj
- 2 Faculty of Management, McGill University, Canada
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Cook KA, Modena BD, Simon RA. Improvement in Asthma Control Using a Minimally Burdensome and Proactive Smartphone Application. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2016; 4:730-737.e1. [PMID: 27107690 PMCID: PMC5501988 DOI: 10.1016/j.jaip.2016.03.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 03/02/2016] [Accepted: 03/11/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Integrated chronic disease treatment models that enable patient self-care and shared treatment decision making have recently been shown to improve medication adherence and outcomes. Smartphone applications (apps) are a readily available means to enable this model, although sustained user engagement remains a challenge. OBJECTIVE To assess the efficacy of improving asthma control using a proactive smartphone app without required regular inputs. METHODS We designed a minimally intrusive smartphone app to provide individualized and timely support to patients with asthma based on the National Asthma Education and Prevention Program guidelines and Scripps management pathways. In this proof-of-concept study, we enrolled 60 adults with poorly controlled asthma to test the usability and effectiveness of this app over a 4-month period. The Asthma Control Test survey was used to assess control before, during, and after app use. As a corollary, a retrospective chart review was also used to assess changes in lung function and prescribed courses of systemic corticosteroids. RESULTS Our patients, with a mean age of 50 years, reported an improvement in Asthma Control Test scores from 16.6 (inadequate to poor) to 20.5 (controlled) over the study period. Concurrently, there was a 7.9% absolute increase in FEV1, while courses of systemic corticosteroids decreased from 0.5 to 0.3 courses per 6-month period. Fifty-eight of 60 patients completed the final survey, with high satisfaction reported. CONCLUSIONS This app improved asthma control in a cohort of patients with uncontrolled asthma (age range, 17-82 years), while minimizing burdensome inputs and proactively providing individualized teaching and treatment support. The app and treatment model are scalable to cost-effectively manage chronic disease.
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Affiliation(s)
- Kevin A Cook
- Division of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, Calif.
| | - Brian D Modena
- Division of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, Calif
| | - Ronald A Simon
- Division of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, Calif
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Ershad Sarabi R, Sadoughi F, Jamshidi Orak R, Bahaadinbeigy K. The Effectiveness of Mobile Phone Text Messaging in Improving Medication Adherence for Patients with Chronic Diseases: A Systematic Review. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e25183. [PMID: 27437126 PMCID: PMC4939231 DOI: 10.5812/ircmj.25183] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 12/08/2014] [Accepted: 12/15/2014] [Indexed: 12/15/2022]
Abstract
Context Medication non-adherence is a commonly observed problem in the self-administration of treatment, regardless of the disease type. Text messaging reminders, as electronic reminders, provide an opportunity to improve medication adherence. In this study, we aimed to provide evidence addressing the question of whether text message reminders were effective in improving patients’ adherence to medication. Evidence Acquisition We carried out a systematic literature search, using the five electronic bibliographic databases: PubMed, Embase, PsycINFO, CINAHL, and the Cochrane central register of controlled trials. Studies were included on the basis of whether they examined the benefits and effects of short-message service (SMS) interventions on medication adherence. Results The results of this systematic review indicated that text messaging interventions have improved patients’ medication adherence rate (85%, 29.34). Included in the review, those who had problems with adherence, or those whom text messaging was most helpful had HIV, asthma, diabetes, schizophrenia and heart disease (73.5%). The period of intervention varied from 1 week to 14 months. The most common study design was randomized controlled trials (RCTs) (66%) carried out in the developed countries. Conclusions This study demonstrated the potential of mobile phone text messaging for medication non-adherence problem solving.
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Affiliation(s)
- Roghayeh Ershad Sarabi
- Health Information Management Department, School of Management and Medical Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran
| | - Farahnaz Sadoughi
- Health Information Management Department, School of Management and Medical Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Farahnaz Sadoughi, Health Information Management Department, School of Management and Medical Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2188794302, Fax: +98-2188883334, E-mail:
| | - Roohangiz Jamshidi Orak
- Health Information Management Department, School of Management and Medical Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute of Futures Studies in Health, Kerman University of Medical Sciences, Kerman, IR Iran
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Abstract
Recently, several technological advances have been introduced to mobile phones leading some people to refer to them as "smartphones." These changes have led to widespread consumer adoption. A similar adoption has occurred within the medical field and this revolution is changing the practice of medicine, including pathology. Several mobile applications have been published for dermatology, orthopedics, ophthalmology, neurosurgery, and clinical pathology. The applications are wide ranging, including mobile technology to increase patient engagement, self-monitoring by patients, clinical algorithm calculation, facilitation between experts to resource-poor environments. These advances have been received with mixed reviews. For anatomic pathology, mobile technology applications can be broken into 4 broad categories: (a) educational uses, (b) microscope with mobile phone, (c) mobile phone as microscope/acquisition device, and (d) miscellaneous. Using a mobile phone as an acquisition device paired with a microscope seems to be the most interesting current application because of the need for expert consultation with resource-poor environments. However, several emerging uses for mobile technology may become more prominent as the technology matures including image analysis, alternative light sources, and increased opportunities for clinician and patient engagement. The flexibility represented by mobile technology represents a burgeoning field in pathology informatics.
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44
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Johnson KB, Patterson BL, Ho YX, Chen Q, Nian H, Davison CL, Slagle J, Mulvaney SA. The feasibility of text reminders to improve medication adherence in adolescents with asthma. J Am Med Inform Assoc 2015; 23:449-55. [PMID: 26661717 DOI: 10.1093/jamia/ocv158] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 09/20/2015] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Personal health applications have the potential to help patients with chronic disease by improving medication adherence, self-efficacy, and quality of life. The goal of this study was to assess the impact of MyMediHealth (MMH) - a website and a short messaging service (SMS)-based reminder system - on medication adherence and perceived self-efficacy in adolescents with asthma. METHODS We conducted a block-randomized controlled study in academic pediatric outpatient settings. There were 98 adolescents enrolled. Subjects who were randomized to use MMH were asked to create a medication schedule and receive SMS reminders at designated medication administration times for 3 weeks. Control subjects received action lists as a part of their usual care. Primary outcome measures included MMH usage patterns and self-reports of system usability, medication adherence, asthma control, self-efficacy, and quality of life. RESULTS Eighty-nine subjects completed the study, of whom 46 were randomized to the intervention arm. Compared to controls, we found improvements in self-reported medication adherence (P = .011), quality of life (P = .037), and self-efficacy (P = .016). Subjects reported high satisfaction with MMH; however, the level of system usage varied widely, with lower use among African American patients. CONCLUSIONS MMH was associated with improved medication adherence, perceived quality of life, and self-efficacy.Trial Registration This project was registered under http://clinicaltrials.gov/ identifier NCT01730235.
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Affiliation(s)
- Kevin B Johnson
- Department of Biomedical Informatics at Vanderbilt University School of Medicine, Nashville, TN, USA Department of Pediatrics at Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Barron L Patterson
- Department of Pediatrics at Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Yun-Xian Ho
- Department of Biomedical Informatics at Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Qingxia Chen
- Department of Biomedical Informatics at Vanderbilt University School of Medicine, Nashville, TN, USA Department of Biostatistics at Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Hui Nian
- Department of Biostatistics at Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Coda L Davison
- Department of Biomedical Informatics at Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Jason Slagle
- Department of Anesthesiology at Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Shelagh A Mulvaney
- Department of Biomedical Informatics at Vanderbilt University School of Medicine, Nashville, TN, USA School of Nursing at Vanderbilt University School of Medicine, Nashville, TN, USA
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45
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Pizzulli A, Perna S, Florack J, Pizzulli A, Giordani P, Tripodi S, Pelosi S, Matricardi PM. The impact of telemonitoring on adherence to nasal corticosteroid treatment in children with seasonal allergic rhinoconjunctivitis. Clin Exp Allergy 2015; 44:1246-54. [PMID: 25109375 DOI: 10.1111/cea.12386] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 06/05/2014] [Accepted: 07/01/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND Adherence to controller therapy in allergic diseases is low. Telemonitoring has been proposed to improve adherence to treatment in chronic diseases. However, this strategy has never been tested in allergic rhinoconjunctivitis. OBJECTIVE To test whether Internet-based telemonitoring during the grass-pollen season of children with allergic rhinoconjunctivitis may enhance adherence to treatment. METHODS Children and adolescents, 5-18 years old, with moderate-to-severe seasonal allergic rhinoconjunctivitis to grass pollen requiring daily administration of nasal corticosteroid (NCS) (mometasone) were recruited (April 2013) in a paediatric allergy practice. Participants were randomized to Internet-based monitoring (AllergyMonitor(™) , AM) or to usual care (no diary at all, controls) and followed from 13 May (T0) to 15 June 2013 (T2). An intermediate visit (T1) was performed between 31 May and 2 June. Optimal adherence to therapy was expressed as the use of at least 0.190 g/day of mometasone, corresponding to 1 puff/nostril/day, and it was measured by canister weights during (T1) and at the end (T2) of the study period. Main secondary outcomes included the reported disease severity (validated self-questionnaire) and quality of life (AdoIRQLQ questionnaire), disease knowledge (multiple-choice questionnaire), nasal flow and resistance at baseline and at T2. RESULTS The use of mometasone, expressed as both optimal adherence rate (48.4% vs. 12.5%; P = 0.002) and average daily use (0.20 ± 0.12 g/day vs. 0.15 ± 0.07 g/day; P = 0.037), was higher in the AM group (n = 31) than among controls (n = 32). Disease knowledge improved among the patients using AM (83.3% vs. 68.3%; P < 0.001) but not among controls (68.2% vs. 67.7% right answers; P > 0.05). No differences were observed in the reported severity of disease, nasal flow and resistance and quality of life both at baseline and at follow-up visits. CONCLUSIONS Internet-based telemonitoring improves adherence to NCS treatment and disease knowledge among children and adolescents with seasonal allergic rhinoconjunctivitis.
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Affiliation(s)
- A Pizzulli
- Department of Paediatric Pneumology and Immunology, Charité Medical University, Berlin, Germany; Practice for Pediatric Allergy and Pneumology, Berlin, Germany
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46
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Khan NUZ, Rasheed S, Sharmin T, Ahmed T, Mahmood SS, Khatun F, Hanifi S, Hoque S, Iqbal M, Bhuiya A. Experience of using mHealth to link village doctors with physicians: lessons from Chakaria, Bangladesh. BMC Med Inform Decis Mak 2015; 15:62. [PMID: 26242574 PMCID: PMC4526289 DOI: 10.1186/s12911-015-0188-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 07/20/2015] [Indexed: 12/04/2022] Open
Abstract
Background Bangladesh is facing serious shortage of trained health professionals. In the pluralistic healthcare system of Bangladesh, formal health care providers constitute only 5 % of the total workforce; the rest are informal health care providers. Information Communication Technologies (ICTs) are increasingly seen as a powerful tool for linking the community with formal healthcare providers. Our study assesses an intervention that linked village doctors (a cadre of informal health care providers practising modern medicine) to formal doctors through call centres from the perspective of the village doctors who participated in the intervention. Methods The study was conducted in Chakaria, a remote rural area in south-eastern Bangladesh during April–May 2013. Twelve village doctors were selected purposively from a pool of 55 village doctors who participated in the mobile health (mHealth) intervention. In depth interviews were conducted to collect data. The data were manually analysed using themes that emerged. Result The village doctors talked about both business benefits (access to formal doctors, getting support for decision making, and being entitled to call trained doctors) and personal benefits (both financial and non-financial). Some of the major barriers mentioned were technical problems related to accessing the call centre, charging consultation fees, and unfamiliarity with the call centre physicians. Conclusion Village doctors saw many benefits to having a business relationship with the trained doctors that the mHealth intervention provided. mHealth through call centres has the potential to ensure consultation services to populations through existing informal healthcare providers in settings with a shortage of qualified healthcare providers.
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Affiliation(s)
- Nazib Uz Zaman Khan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Sabrina Rasheed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Tamanna Sharmin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Tanvir Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.,Institute of Development Studies (IDS), University of Sussex, Library Road, Brighton, BN1 9RE, UK
| | - Shehrin Shaila Mahmood
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Fatema Khatun
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.,School of Public Health and Community Medicine, The University of New South Wales, Kensington, NSW, 2052, Australia
| | - Sma Hanifi
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Shahidul Hoque
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Mohammad Iqbal
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Abbas Bhuiya
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
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47
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Abstract
Recent advances in hardware and computing power contained within mobile devices have made it possible to use these devices to improve and enhance pathologist workflow. This article discusses the possible uses ranging from basic functions to intermediate functions to advanced functions. Barriers to implementation are also discussed.
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Affiliation(s)
- Douglas J Hartman
- Department of Anatomic Pathology, University of Pittsburgh Medical Center, 200 Lothrop Street, A-607, Pittsburgh, PA 15213, USA.
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48
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Hamine S, Gerth-Guyette E, Faulx D, Green BB, Ginsburg AS. Impact of mHealth chronic disease management on treatment adherence and patient outcomes: a systematic review. J Med Internet Res 2015; 17:e52. [PMID: 25803266 PMCID: PMC4376208 DOI: 10.2196/jmir.3951] [Citation(s) in RCA: 638] [Impact Index Per Article: 70.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 01/21/2015] [Accepted: 01/21/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Adherence to chronic disease management is critical to achieving improved health outcomes, quality of life, and cost-effective health care. As the burden of chronic diseases continues to grow globally, so does the impact of non-adherence. Mobile technologies are increasingly being used in health care and public health practice (mHealth) for patient communication, monitoring, and education, and to facilitate adherence to chronic diseases management. OBJECTIVE We conducted a systematic review of the literature to evaluate the effectiveness of mHealth in supporting the adherence of patients to chronic diseases management ("mAdherence"), and the usability, feasibility, and acceptability of mAdherence tools and platforms in chronic disease management among patients and health care providers. METHODS We searched PubMed, Embase, and EBSCO databases for studies that assessed the role of mAdherence in chronic disease management of diabetes mellitus, cardiovascular disease, and chronic lung diseases from 1980 through May 2014. Outcomes of interest included effect of mHealth on patient adherence to chronic diseases management, disease-specific clinical outcomes after intervention, and the usability, feasibility, and acceptability of mAdherence tools and platforms in chronic disease management among target end-users. RESULTS In all, 107 articles met all inclusion criteria. Short message service was the most commonly used mAdherence tool in 40.2% (43/107) of studies. Usability, feasibility, and acceptability or patient preferences for mAdherence interventions were assessed in 57.9% (62/107) of studies and found to be generally high. A total of 27 studies employed randomized controlled trial (RCT) methods to assess impact on adherence behaviors, and significant improvements were observed in 15 of those studies (56%). Of the 41 RCTs that measured effects on disease-specific clinical outcomes, significant improvements between groups were reported in 16 studies (39%). CONCLUSIONS There is potential for mHealth tools to better facilitate adherence to chronic disease management, but the evidence supporting its current effectiveness is mixed. Further research should focus on understanding and improving how mHealth tools can overcome specific barriers to adherence.
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Affiliation(s)
- Saee Hamine
- University of Washington, Seattle, WA, United States
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49
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Morowatisharifabad MA, Karimiankakolaki Z, Bokaie M, Fallahzadeh H, Gerayllo S. The effects of training married men about premenstrual syndrome by pamphlets and short messages on marital satisfaction. HEALTH EDUCATION RESEARCH 2014; 29:1005-1014. [PMID: 25214514 DOI: 10.1093/her/cyu052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Premenstrual syndrome (PMS), which includes physical, psychological and emotional symptoms that occur during the luteal phase of the menstrual cycle, has a negative impact on the quality of the relationship among married couples. The purpose of the study was to examine the effects of educating married men by two methods, pamphlet and short messages (SMS), on marital satisfaction of the couples. The study was experimental in nature. The sample consisted of 80 couples who had visited health centers in Yazd, Iran. The subjects were randomly assigned to the two training methods and pretested and post-tested on the outcome measures. The before to after the training increase in knowledge and practice in men and marital satisfaction of couples were statistically significant. The differences between the two training methods were not statistically significant. Pamphlets and SMS, if designed properly and based on the principles of psychology, can act as influential and almost equally effective educational tools in the context of PMS.
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Affiliation(s)
- Mohammad Ali Morowatisharifabad
- Department of Health Education and Promotion, Shahid Sadoughi University of Medical Sciences, Yazd, Iran, Department of Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran and Department of Biostatistics and Epidemiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Zohreh Karimiankakolaki
- Department of Health Education and Promotion, Shahid Sadoughi University of Medical Sciences, Yazd, Iran, Department of Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran and Department of Biostatistics and Epidemiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mahshid Bokaie
- Department of Health Education and Promotion, Shahid Sadoughi University of Medical Sciences, Yazd, Iran, Department of Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran and Department of Biostatistics and Epidemiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Fallahzadeh
- Department of Health Education and Promotion, Shahid Sadoughi University of Medical Sciences, Yazd, Iran, Department of Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran and Department of Biostatistics and Epidemiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Sakineh Gerayllo
- Department of Health Education and Promotion, Shahid Sadoughi University of Medical Sciences, Yazd, Iran, Department of Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran and Department of Biostatistics and Epidemiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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50
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Kannisto KA, Koivunen MH, Välimäki MA. Use of mobile phone text message reminders in health care services: a narrative literature review. J Med Internet Res 2014; 16:e222. [PMID: 25326646 PMCID: PMC4211035 DOI: 10.2196/jmir.3442] [Citation(s) in RCA: 188] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 07/30/2014] [Accepted: 08/25/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mobile text messages are a widely recognized communication method in societies, as the global penetration of the technology approaches 100% worldwide. Systematic knowledge is still lacking on how the mobile telephone text messaging (short message service, SMS) has been used in health care services. OBJECTIVE This study aims to review the literature on the use of mobile phone text message reminders in health care. METHODS We conducted a systematic literature review of studies on mobile telephone text message reminders. The data sources used were PubMed (MEDLINE), CINAHL, Proquest Databases/ PsycINFO, EMBASE, Cochrane Library, Scopus, and hand searching since 2003. Studies reporting the use of SMS intended to remind patients in health services were included. Given the heterogeneity in the studies, descriptive characteristics, purpose of the study, response rates, description of the intervention, dose and timing, instruments, outcome measures, and outcome data from the studies were synthesized using a narrative approach. RESULTS From 911 initial citations, 60 studies were included in the review. The studies reported a variety of use for SMS. Mobile telephone text message reminders were used as the only intervention in 73% (44/60) of the studies, and in 27% (16/60) of the remaining studies, SMS was connected to another comprehensive health intervention system. SMS reminders were sent to different patient groups: patients with HIV/AIDS (15%, 9/60) and diabetes (13%, 8/60) being the most common groups. The response rates of the studies varied from 22-100%. Typically, the text message reminders were sent daily. The time before the specific intervention to be rendered varied from 10 minutes (eg, medication taken) to 2 weeks (eg, scheduled appointment). A wide range of different evaluation methods and outcomes were used to assess the impact of SMS varying from existing databases (eg, attendance rate based on medical records), questionnaires, and physiological measures. About three quarters of the studies (77%, 46/60) reported improved outcomes: adherence to medication or to treatment reportedly improved in 40% (24/60) of the studies, appointment attendance in 18% (11/60) of the studies, and non-attendance rates decreased in 18% (11/60) of the studies. Other positive impacts were decreased amount of missed medication doses, more positive attitudes towards medication, and reductions in treatment interruptions. CONCLUSIONS We can conclude that although SMS reminders are used with different patient groups in health care, SMS is less systematically studied with randomized controlled trial study design. Although the amount of evidence for SMS application recommendations is still limited, having 77% (46/60) of the studies showing improved outcomes may indicate its use in health care settings. However, more well-conducted SMS studies are still needed.
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