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Wellmann N, Marc MS, Stoicescu ER, Pescaru CC, Trusculescu AA, Martis FG, Ciortea I, Crisan AF, Balica MA, Velescu DR, Fira-Mladinescu O. Enhancing Adult Asthma Management: A Review on the Utility of Remote Home Spirometry and Mobile Applications. J Pers Med 2024; 14:852. [PMID: 39202043 PMCID: PMC11355136 DOI: 10.3390/jpm14080852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/25/2024] [Accepted: 08/09/2024] [Indexed: 09/03/2024] Open
Abstract
Asthma is a prevalent chronic disease, contributing significantly to the global burden of disease and economic costs. Despite advances in treatment, inadequate disease management and reliance on reliever medications lead to preventable deaths. Telemedicine, defined as the use of information and communication technology to improve healthcare access, has gained global attention, especially during the COVID-19 pandemic. This systematic review examines the effectiveness of home monitoring systems in managing severe asthma. A systematic literature search was conducted in PubMed, Web of Science, Scopus, and Cochrane Library, focusing on studies from 2014 to 2024. Fourteen studies involving 9093 patients were analyzed. The results indicate that telemedicine, through tools such as mobile applications and portable spirometers, positively impacts asthma control, self-management, and quality of life. Home spirometry, in particular, shows strong agreement with clinic spirometry, offering a feasible alternative for continuous monitoring. Digital coaching and machine learning-based telemedicine applications also demonstrate significant potential in improving asthma outcomes. However, challenges such as technology accessibility, data privacy, and the need for standardized protocols remain. This review highlights the promise of telemedicine in asthma management and calls for further research to optimize its implementation and address existing barriers.
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Affiliation(s)
- Norbert Wellmann
- Center for Research and Innovation in Personalised Medicine of Respiratory Diseases (CRIPMRD), “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (N.W.); (C.C.P.); (A.A.T.); (F.G.M.); (A.F.C.); (D.R.V.); (O.F.-M.)
- Pulmonology University Clinic, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (E.R.S.); (I.C.); (M.A.B.)
| | - Monica Steluta Marc
- Center for Research and Innovation in Personalised Medicine of Respiratory Diseases (CRIPMRD), “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (N.W.); (C.C.P.); (A.A.T.); (F.G.M.); (A.F.C.); (D.R.V.); (O.F.-M.)
- Pulmonology University Clinic, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Emil Robert Stoicescu
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (E.R.S.); (I.C.); (M.A.B.)
- Research Center for Pharmaco-Toxicological Evaluations, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
- Radiology and Medical Imaging University Clinic, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Camelia Corina Pescaru
- Center for Research and Innovation in Personalised Medicine of Respiratory Diseases (CRIPMRD), “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (N.W.); (C.C.P.); (A.A.T.); (F.G.M.); (A.F.C.); (D.R.V.); (O.F.-M.)
- Pulmonology University Clinic, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Ana Adriana Trusculescu
- Center for Research and Innovation in Personalised Medicine of Respiratory Diseases (CRIPMRD), “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (N.W.); (C.C.P.); (A.A.T.); (F.G.M.); (A.F.C.); (D.R.V.); (O.F.-M.)
- Pulmonology University Clinic, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Flavia Gabriela Martis
- Center for Research and Innovation in Personalised Medicine of Respiratory Diseases (CRIPMRD), “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (N.W.); (C.C.P.); (A.A.T.); (F.G.M.); (A.F.C.); (D.R.V.); (O.F.-M.)
- Pulmonology University Clinic, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (E.R.S.); (I.C.); (M.A.B.)
| | - Ioana Ciortea
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (E.R.S.); (I.C.); (M.A.B.)
| | - Alexandru Florian Crisan
- Center for Research and Innovation in Personalised Medicine of Respiratory Diseases (CRIPMRD), “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (N.W.); (C.C.P.); (A.A.T.); (F.G.M.); (A.F.C.); (D.R.V.); (O.F.-M.)
- Research Center for the Assessment of Human Motion, Functionality and Disability (CEMFD), “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Madalina Alexandra Balica
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (E.R.S.); (I.C.); (M.A.B.)
- Infectious Diseases University Clinic, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Diana Raluca Velescu
- Center for Research and Innovation in Personalised Medicine of Respiratory Diseases (CRIPMRD), “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (N.W.); (C.C.P.); (A.A.T.); (F.G.M.); (A.F.C.); (D.R.V.); (O.F.-M.)
| | - Ovidiu Fira-Mladinescu
- Center for Research and Innovation in Personalised Medicine of Respiratory Diseases (CRIPMRD), “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (N.W.); (C.C.P.); (A.A.T.); (F.G.M.); (A.F.C.); (D.R.V.); (O.F.-M.)
- Pulmonology University Clinic, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
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Kraus B, Lakin A, Sherbrooke N. "The Other Thousand Hours": A Spinal Cord Injury Self-Management Program Qualitative Analysis. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2024:15394492241260648. [PMID: 38910541 DOI: 10.1177/15394492241260648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
People with spinal cord injury experience secondary health conditions (SHCs) at a high rate which impacts life expectancy and functional performance. Self-management (SM) is an evidence-based approach to reduce the negative effects of SHCs, but prior SM programs have not been successful for the spinal cord injury (SCI) population. We sought to describe the experiences of participants completing a group-based telehealth program that is tailored to the SCI population: The Spinal Cord Injury Self-Management (SCISM) Program. We conducted interviews using Interpretive Phenomenological Analysis to examine participants' experiences. Twenty-two participants completed the interviews. Four themes ("A Sense of Community," "Being Held Accountable," "I'm Still Learning," and "Being Proactive Instead of Reactive") emerged. People with SCI require continued support throughout the chronic stage of SCI particularly at the community level to address mental health as well as the learning and application of SM skills through tailored interventions that foster community and accountability.
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Steinman L, Chadwick K, Chavez Santos E, Sravanam S, Johnson SS, Rensema E, Mayotte C, Denison P, Lorig K. Remote Evidence-Based Programs for Health Promotion to Support Older Adults During the COVID-19 Pandemic and Beyond: Mixed Methods Outcome Evaluation. JMIR Aging 2024; 7:e52069. [PMID: 38869932 PMCID: PMC11211707 DOI: 10.2196/52069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 03/28/2024] [Accepted: 04/09/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Evidence-based programs (EBPs) for health promotion were developed to reach older adults where they live, work, pray, and play. When the COVID-19 pandemic placed a disproportionate burden on older adults living with chronic conditions and the community-based organizations that support them, these in-person programs shifted to remote delivery. While EBPs have demonstrated effectiveness when delivered in person, less is known about outcomes when delivered remotely. OBJECTIVE This study evaluated changes in remote EBP participants' health and well-being in a national mixed methods outcome evaluation in January 1, 2021, to March 31, 2022. METHODS We used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) for equity framework to guide the evaluation. We purposively sampled for diverse remote EBP delivery modes and delivery organizations, staff, and traditionally underserved older adults, including people of color and rural dwellers. We included 5 EBPs for self-management, falls prevention, and physical activity: videoconferencing (Chronic Disease Self-Management Program, Diabetes Self-Management Program, and EnhanceFitness), telephone plus mailed materials (Chronic Pain Self-Management Program), and enhanced self-directed mailed materials (Walk With Ease). Participant and provider data included validated surveys, in-depth interviews, and open-ended survey questions. We used descriptive statistics to characterize the sample and the magnitude of change and paired t tests (2-tailed) and the Fisher exact test to test for change in outcomes between enrollment and 6-month follow-up. Thematic analysis was used to identify similarities and differences in outcomes within and across programs. Joint display tables facilitated the integration of quantitative and qualitative findings. RESULTS A total of 586 older adults, 198 providers, and 37 organizations providing EBPs participated in the evaluation. Of the 586 older adults, 289 (49.3%) provided follow-up outcome data. The mean age of the EBP participants was 65.4 (SD 12.0) years. Of the 289 EBP participants, 241 (83.4%) were female, 108 (37.3%) were people of color, 113 (39.1%) lived alone, and 99 (34.3%) were experiencing financial hardship. In addition, the participants reported a mean of 2.5 (SD 1.7) chronic conditions. Overall, the remote EBP participants showed statistically significant improvements in health, energy, sleep quality, loneliness, depressive symptoms, and technology anxiety. Qualitatively, participants shared improvements in knowledge, attitudes, and skills for healthier living; reduced their social isolation and loneliness; and gained better access to programs. Three-fourths of the providers (149/198, 75.2%) felt that effectiveness was maintained when switching from in-person to remote delivery. CONCLUSIONS The findings suggest that participating in remote EBPs can improve health, social, and technological outcomes of interest for older adults and providers, with benefits extending to policy makers. Future policy and practice can better support remote EBP delivery as one model for health promotion, improving access for all older adults.
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Affiliation(s)
- Lesley Steinman
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, United States
| | - Kelly Chadwick
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, United States
| | - Erica Chavez Santos
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, United States
| | - Sruthi Sravanam
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, United States
| | - Selisha Snowy Johnson
- Office of Community Outreach and Engagement, Fred Hutch Cancer Center, Seattle, WA, United States
| | - Elspeth Rensema
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Caitlin Mayotte
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, United States
| | | | - Kate Lorig
- Self Management Resource Center, Aptos, CA, United States
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Van Damme J, Dal Bello-Haas V, Strachan P, Kuspinar A, Kalu M, Zaide M. Client and clinician perspectives about a virtual education and exercise chronic disease management programme for people with hip and knee osteoarthritis. Musculoskeletal Care 2024; 22:e1881. [PMID: 38588022 DOI: 10.1002/msc.1881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION Osteoarthritis (OA) is one of the most prevalent chronic conditions in Canada. Despite the established benefits of non-pharmacological management (education, exercise) for people with OA, many do not receive treatment, resulting in pain, decreased physical function, and poorer quality of life. Virtual programme options grew significantly during the recent pandemic and may provide longer-term opportunities for increased uptake by reaching individuals otherwise unable to participate. This study explored the experiences and perspectives of clients participating in and clinicians providing the Good Life with osteoArthritis: Denmark (GLA:DTM) Canada remote programme. METHODS This qualitative descriptive study recruited 10 clients with hip and/or knee OA and 11 clinicians across Canada using purposive sampling. An online pre-interview survey was completed, and individual interviews were conducted, audio-recorded, transcribed verbatim and analysed independently by two researchers using inductive thematic analysis. Coding and analyses were initially conducted separately by group and then compared and combined. RESULTS Four overarching themes (and 11 subthemes) were identified: (1) Expected and unexpected benefits of virtual programs; (2) Drawbacks to virtual programs; (3) Programme delivery in a virtual world; (4) Shifting and non-shifting perspectives. Although initially sceptical, after completion of the programme, clients were in favour of virtual delivery with many benefits described. Clinicians' perspectives varied about feedback aimed to correct client movement patterns. CONCLUSIONS Clients and clinicians identified important experiential and procedural elements for virtual chronic disease management programs that include education and exercise. Additional work is needed to understand if the GLA:DTM remote outcomes are equivalent to the in-person programme.
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Affiliation(s)
- Jill Van Damme
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Ayse Kuspinar
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Michael Kalu
- School of Kinesiology and Health Sciences, York University, Toronto, Ontario, Canada
| | - Mashal Zaide
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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Freer CL, George ES, Tan SY, Abbott G, Daly RM. Delivery of a telehealth supported home exercise program with dietary advice to increase plant-based protein intake in people with non-alcoholic fatty liver disease: a 12-week randomised controlled feasibility trial. Br J Nutr 2024; 131:1709-1719. [PMID: 38268105 PMCID: PMC11063658 DOI: 10.1017/s0007114524000242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/20/2023] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
This study evaluated the feasibility and safety of a telehealth delivered exercise plus plant-based protein diet in adults with non-alcoholic fatty liver disease (NAFLD). This was a 12-week, randomised controlled feasibility trial including twenty-eight adults aged > 45 years with NAFLD randomised to a home muscle strengthening program (3 d/week) with increased protein intake (target ∼1·2-1·5 g/kg/d) from predominately plant-based sources and behavioural change support (3-4 text messages/week) (Pro-Ex n 14) or usual care (UC, n 14). Feasibility was assessed via retention (≤ 10 % attrition), adherence (exercise ≥ 66 %; recommended daily protein serves ≥ 80 %) and safety (adverse events). Secondary outcomes included macronutrient intake (3 × 24-h records), weight, moderate-to-vigorous physical activity (MVPA) and 30 s sit-to-stand (STS) performance. Study retention was 89 %. Mean exercise adherence (Pro-Ex) was 52 % with one adverse event from 241 sessions. In Pro-Ex, mean daily plant protein serves increased (0·9 to 1·4/d) and animal protein decreased (1·5 to 1·2/d) after 12-weeks, but overall adherence (serves/day) was 32[RD1] % (plant) and 42 % (animal). Relative to UC, Pro-Ex experienced a mean 2·7 (95 % CI: 0·9, 4·4) increase in 30 s STS number, 46-minute (95 % CI: -153, 245) increase in MVPA, 1·7 kg (95 % CI: -3·5, 0·2) decrease in weight, 35·2 g (95 % CI: 11·0, 59·3) increase in protein. In adults with NAFLD a telehealth home exercise and dietary intervention was safe and improved habitual plant and animal protein intake, but overall adherence was modest suggesting more intensive healthcare support may be required.
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Affiliation(s)
- Christine L. Freer
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Elena S. George
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Sze-Yen Tan
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Robin M. Daly
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
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Kohn MJ, Chadwick KA, Steinman LE. Adapting Evidence-Based Falls Prevention Programs for Remote Delivery - Implementation Insights through the RE-AIM Evaluation Framework to Promote Health Equity. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:163-173. [PMID: 37036550 PMCID: PMC10088656 DOI: 10.1007/s11121-023-01519-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 04/11/2023]
Abstract
COVID-19 disproportionally impacted the health and well-being of older adults-many of whom live with chronic conditions-due to their higher risk of dying and being hospitalized. It also created several secondary pandemics, including increased falls risk, sedentary behavior, social isolation, and physical inactivity due to limitations in mobility from lock-down policies. With falls as the leading cause of preventable death and hospitalizations, it became vital for in-person evidence-based falls prevention programs (EBFPPs) to pivot to remote delivery. In Spring 2020, many EBFPP administrators began re-designing programs for remote delivery to accommodate physical distancing guidelines necessitated by the pandemic. Transition to remote delivery was essential for older adults and persons with disabilities to access EBFPPs for staying healthy, falls and injury free, out of hospitals, and also keeping them socially engaged. We collaborated with the Administration on Community Living (ACL), the National Council on Aging (NCOA), and the National Falls Prevention Resource Center (NFPRC), for an in-depth implementation evaluation of remotely delivered EBFPPs. We examined the process of adapting and implementing four EBFPPs for remote delivery, best practices for implementing the programs remotely within the RE-AIM evaluation framework. This enhances NFPRC's ongoing work supporting dissemination, implementation, and sustainability of EBFPPs. We purposively sampled organizations for maximum variation in organization and provider type, geographic location, and reach of underserved older populations (Black, Indigenous, or other People of Color (BIPOC), rural, disabilities). This qualitative evaluation includes provider-level data from semi-structured interviews (N = 22) with program administrators, staff, and leaders. The interview guide included what, why, and how adaptations were made to EBFPP interventions and implementation strategies using Wiltsey-Stirman (2019) adaptations framework (FRAME), reach, and implementation outcomes (acceptability, feasibility, fidelity, and costs; Proctor et al., 2011), focusing on equity to learn for whom these programs were working and opportunities to address inequities. Findings demonstrate remote EBFPPs made planned and fidelity-consistent adaptations to remote delivery in partnership with researchers and community organizations, focusing on participant safety both in program content and delivery. Supports using and accessing technology were needed for delivery sites and leaders to facilitate engagement, and improved over time. While remote EBFPP delivery has increased access to EBFPPs for some populations from the perspective of program administrator, leaders, and staff (e.g., caregivers, rural-dwellers, persons with physical disabilities), the digital divide remains a barrier in access to and comfort using technology. Remote-delivered EBFPPs were acceptable and feasible to delivery organizations and leaders, were able to be delivered with fidelity using adaptations from program developers, but were more resource intensive and costly to implement compared to in-person. This work has important implications beyond the pandemic. Remote delivery has expanded access to groups traditionally underserved by in-person programming, particularly disability communities. This work will help answer important questions about reach, accessibility, feasibility, and cost of program delivery for older adults and people with disabilities at risk for falls, those living with chronic conditions, and communities most vulnerable to disparities in access to health care, health promotion programming, and health outcomes. It will also provide critical information to funders about elements required to adapt EBFPPs proven effective in in-person settings for remote delivery with fidelity to achieve comparable outcomes.
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Affiliation(s)
- Marlana J Kohn
- Health Promotion Research Center, University of Washington, Seattle, USA.
| | - Kelly A Chadwick
- Health Promotion Research Center, University of Washington, Seattle, USA
| | - Lesley E Steinman
- Health Promotion Research Center, University of Washington, Seattle, USA
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De Guzman KR, Snoswell CL, Caffery LJ, Smith AC. Economic evaluations of videoconference and telephone consultations in primary care: A systematic review. J Telemed Telecare 2024; 30:3-17. [PMID: 34617819 DOI: 10.1177/1357633x211043380] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Telehealth services using videoconference and telephone modalities have been increasing exponentially in primary care since the coronavirus pandemic. The challenge now is ensuring that these services remain sustainable. This review investigates the cost-effectiveness of videoconference and telephone consultations in primary care settings, by summarizing the available published evidence. METHODS A systematic search of PubMed, Embase, Scopus, and CINAHL databases was used to identify articles published from January 2000 to July 2020, using keyword synonyms for telehealth, primary care, and economic evaluation. Databases were searched, and title, abstract, and full-text reviews were conducted. Article reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist. RESULTS Twenty articles were selected for inclusion, with 12 describing telephone triage services, seven describing telehealth substitution services, and one describing another telehealth service in primary care. These services were delivered by nurses, doctors, and allied health clinicians. Of the 20 included studies, 11 used cost analyses, five used cost-minimization analyses, and four used one or more methods, including either a cost-consequence analysis, a cost-utility analysis, or a cost-effectiveness analysis. CONCLUSIONS Telephone and videoconference consultations in primary care were cost-effective to the health system when deemed clinically appropriate, clinician when time was used efficiently, and when overall demand on health services was reduced. The societal benefits of telehealth consultations should be considered an important part of telehealth planning and should influence funding reform decisions for telehealth services in primary care.
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Affiliation(s)
- Keshia R De Guzman
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Centaine L Snoswell
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Liam J Caffery
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Centre for Innovative Medical Technology, The University of Southern Denmark, Odense, Denmark
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Nichol L, Pitt R, Wallace SJ, Rodriguez AD, Hill AJ. "There are endless areas that they can use it for": speech-language pathologist perspectives of technology support for aphasia self-management. Disabil Rehabil Assist Technol 2023; 18:1473-1488. [PMID: 35166636 DOI: 10.1080/17483107.2022.2037758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 01/28/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Aphasia is a debilitating acquired language disorder that often persists as a chronic condition. However, long-term support options are scarce, necessitating the consideration of alternative approaches. Chronic condition self-management approaches, which aim to build self-efficacy and empower people to take responsibility for the day-to-day management of their health condition, may benefit people with aphasia (PwA). Technology is widely used in chronic condition self-management and investigation is required to determine whether it could play a role in aphasia self-management. OBJECTIVE This study aimed to explore speech-language pathologist (SLP) perspectives on the potential use of technology to support aphasia self-management. METHODS A qualitative study was conducted with 15 SLPs using semi-structured interviews. Qualitative content analysis was applied to verbatim transcripts to identify codes, categories, and sub-themes which were developed into themes. RESULTS Three themes were identified: (1) technology supports holistic aphasia self-management by providing additional avenues for service delivery, overall communication, and learning opportunities thus enhancing independence and life participation; (2) SLP and communication partner (CP) assistance can support PwA to use technology for aphasia self-management; (3) considerations and potential barriers to PwA use of technology for aphasia self-management. CONCLUSIONS Technology can support aphasia self-management by expanding service delivery options, allowing for increased frequency and intensity of therapy practise, and facilitating communication and participation. Personal, professional, and organizational barriers should be addressed in the development of technology-enabled aphasia self-management approaches. SLPs and CPs can offer PwA assistance with technology but may themselves need additional support. Solutions for identified barriers should be considered, such as providing training in the use of technology and implementing aphasia-friendly modifications.IMPLICATIONS FOR REHABILITATIONSelf-management approaches are being explored in the area of aphasia management as a means of offering a holistic, sustainable intervention option that meets the long-term needs of people with aphasia.A range of technology-based resources are currently used in chronic condition self-management and in aphasia therapy, and there are many possibilities for the use of technology in aphasia self-management approaches.Speech-language pathologists identified that technology could facilitate aphasia self-management by expanding service delivery options (e.g., real-time and asynchronous telepractice), enabling increased frequency and intensity of therapy through providing a means of independent practise, offering options for augmentative alternative communication, and enhancing life participation by supporting social communication and daily tasks.,Speech-language pathologists are interested in using technology for aphasia self-management; however, barriers related to organizational policies, individual experience and confidence using technology, and technology itself must be addressed.
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Affiliation(s)
- Leana Nichol
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Rachelle Pitt
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia
- West Moreton Health, Ipswich, Australia
| | - Sarah J Wallace
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia
| | - Amy D Rodriguez
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, Decatur, GA, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Annie J Hill
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia
- Surgical, Treatment and Rehabilitation Service (STARS), Metro North Hospital and Health Service, Brisbane, Australia
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Nguyen P, Schiaffino MK, Zhang Z, Choi HW, Huh-Yoo J. Toward alert triage: scalable qualitative coding framework for analyzing alert notes from the Telehealth Intervention Program for Seniors (TIPS). JAMIA Open 2023; 6:ooad061. [PMID: 37560155 PMCID: PMC10406700 DOI: 10.1093/jamiaopen/ooad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 07/14/2023] [Accepted: 07/30/2023] [Indexed: 08/11/2023] Open
Abstract
Objective Combined with mobile monitoring devices, telehealth generates overwhelming data, which could cause clinician burnout and overlooking critical patient status. Developing novel and efficient ways to correctly triage such data will be critical to a successful telehealth adoption. We aim to develop an automated classification framework of existing nurses' notes for each alert that will serve as a training dataset for a future alert triage system for telehealth programs. Materials and Methods We analyzed and developed a coding framework and a regular expression-based keyword match approach based on the information of 24 931 alert notes from a community-based telehealth program. We evaluated our automated alert triaging model for its scalability on a stratified sampling of 800 alert notes for precision and recall analysis. Results We found 22 717 out of 24 579 alert notes (92%) belonging to at least one of the 17 codes. The evaluation of the automated alert note analysis using the regular expression-based information extraction approach resulted in an average precision of 0.86 (SD = 0.13) and recall 0.90 (SD = 0.13). Discussion The high-performance results show the feasibility and the scalability potential of this approach in community-based, low-income older adult telehealth settings. The resulting coded alert notes can be combined with participants' health monitoring results to generate predictive models and to triage false alerts. The findings build steps toward developing an automated alert triaging model to improve the identification of alert types in remote health monitoring and telehealth systems.
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Affiliation(s)
- Phuong Nguyen
- Department of Computer Science, University of Iowa, Iowa City, Iowa, USA
| | - Melody K Schiaffino
- School of Public Health, San Diego State University, San Diego, California, USA
| | - Zhan Zhang
- Seidenberg School of Computer Science and Information Systems, Pace University, New York, New York, USA
| | - Hyung Wook Choi
- Department of Information Science, Drexel University, Philadelphia, Pennsylvania, USA
| | - Jina Huh-Yoo
- Department of Information Science, Drexel University, Philadelphia, Pennsylvania, USA
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10
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Herbert J, Schumacher T, Brown LJ, Clarke ED, Collins CE. Delivery of telehealth nutrition and physical activity interventions to adults living in rural areas: a scoping review. Int J Behav Nutr Phys Act 2023; 20:110. [PMID: 37715234 PMCID: PMC10504780 DOI: 10.1186/s12966-023-01505-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/20/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Lifestyle behaviours related to smoking, alcohol, nutrition, and physical activity are leading risk factors for the development of chronic disease. For people in rural areas, access to individualised lifestyle services targeting behaviour change may be improved by using telehealth. However, the scope of literature investigating telehealth lifestyle behaviour change interventions for rural populations is unknown, making it difficult to ascertain whether telehealth interventions require adaptation for rural context via a systematic review. This scoping review aimed to address this gap, by mapping existing literature describing telehealth lifestyle interventions delivered to rural populations to determine if there is scope for systematic review of intervention effectiveness in this research topic. METHODS The PRISMA extension for scoping review checklist guided the processes of this scoping review. A search of eight electronic databases reported in English language until June 2023 was conducted. Eligible studies included adults (18 years and over), who lived in rural areas of high-income countries and undertook at least one synchronous (video or phone consultation) telehealth intervention that addressed either addictive (smoking or alcohol), or non-addictive lifestyle behaviours (nutrition or physical activity). Studies targeting addictive and non-addictive behaviours were separated after full text screening to account for the involvement of addictive substances in smoking and alcohol studies that may impact behaviour change interventions described. Studies targeting nutrition and/or physical activity interventions are presented here. RESULTS The search strategy identified 17179 citations across eight databases, with 7440 unique citations once duplicates were removed. Full texts for 492 citations were retrieved and screened for inclusion with 85 publications reporting on 73 studies eligible for data extraction and analysis. Of this, addictive behaviours were comprised of 15 publications from 13 studies. Non-addictive behaviours included 70 publications from 58 studies and are reported here. Most interventions were delivered within the United States of America (n = 43, 74.1%). The most common study design reported was Randomised Control Trial (n = 27, 46.6%). Included studies involved synchronous telehealth interventions targeting nutrition (11, 18.9%), physical activity (5, 8.6%) or nutrition and physical activity (41, 70.7%) and were delivered predominately via videoconference (n = 17, 29.3%). CONCLUSIONS Despite differences in intervention characteristics, the number of randomised control trials published suggests sufficient scope for future systematic reviews to determine intervention effectiveness related to nutrition and physical activity telehealth interventions for rural populations. TRIAL REGISTRATION The scoping review protocol was not pre-registered.
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Affiliation(s)
- Jaimee Herbert
- School of Health Sciences (Nutrition and Dietetics), Department of Rural Health, University of Newcastle, 114/148 Johnston St, North Tamworth, NSW, 2340, Australia
| | - Tracy Schumacher
- School of Health Sciences (Nutrition and Dietetics), Department of Rural Health, University of Newcastle, 114/148 Johnston St, North Tamworth, NSW, 2340, Australia
| | - Leanne J Brown
- School of Health Sciences (Nutrition and Dietetics), Department of Rural Health, University of Newcastle, 114/148 Johnston St, North Tamworth, NSW, 2340, Australia
| | - Erin D Clarke
- School of Health Sciences (Nutrition and Dietetics), University of Newcastle, ATC 205, ATC Building, University Drive Callaghan, Newcastle, NSW, 2308, Australia
| | - Clare E Collins
- School of Health Sciences (Nutrition and Dietetics), University of Newcastle, ATC 310, ATC Building, University Drive Callaghan, Newcastle, NSW, 2308, Australia.
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11
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Xiao Z, Han X. Evaluation of the Effectiveness of Telehealth Chronic Disease Management System: A Systematic Review and Meta-Analysis (Preprint). J Med Internet Res 2022; 25:e44256. [PMID: 37103993 PMCID: PMC10176143 DOI: 10.2196/44256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/15/2022] [Accepted: 03/10/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Long-term daily health monitoring and management play a more significant role in telehealth management systems nowadays, which require evaluation indicators to present patients' general health conditions and become applicable to multiple chronic diseases. OBJECTIVE This study aims to evaluate the effectiveness of subjective indicators of telehealth chronic disease management system (TCDMS). METHODS We selected Web of Science, ScienceDirect, Scopus, Cochrane library, IEEE, and Chinese National Knowledge Infrastructure and Wanfang, a Chinese medical database, and searched papers published from January 1, 2015, to July 1, 2022, regarding randomized controlled trials on the effectiveness of the telehealth system on patients with chronic diseases. The narrative review summarized the questionnaire indicators presented in the selected studies. In the meta-analysis, Mean Difference (MD) and Standardized Mean Difference (SMD) with a 95% CI were pooled depending on whether the measurements were the same. Subgroup analysis was conducted if the heterogeneity was significant, and the number of studies was sufficient. RESULTS Twenty RCTs with 4153 patients were included in the qualitative review. Seventeen different questionnaire-based outcomes were found, within which quality of life, psychological well-being (including depression, anxiety, and fatigue), self-management, self-efficacy, and medical adherence were most frequently used. Ten RCTs with 2095 patients remained in meta-analysis. Compared to usual care, telehealth system can significantly improve the quality of life (SMD 0.44; 95% CI 0.16-0.73; P=.002), whereas no significant effects were found on depression (SMD -0.25; 95% CI -0.72 to 0.23; P=.30), anxiety (SMD -0.10; 95% CI -0.27 to 0.07; P=.71), fatigue (SMD -0.36; 95% CI -1.06 to 0.34; P<.001), and self-care (SMD 0.77; 95% CI -0.28-1.81; P<.001). In the subdomains of quality of life, telehealth statistically significantly improved physical functioning (SMD 0.15; 95% CI 0.02 to 0.29; P=.03), mental functioning (SMD 0.37; 95% CI 0.13-0.60; P=.002), and social functioning (SMD 0.64; 95% CI 0.00-1.29; P=.05), while there was no difference on cognitive functioning (MD 8.31; 95% CI -7.33 to 23.95; P=.30) and role functioning (MD 5.30; 95% CI -7.80 to 18.39; P=.43). CONCLUSIONS TCDMS positively affected patients' physical, mental, and social quality of life across multiple chronic diseases. However, no significant difference was found in depression, anxiety, fatigue, and self-care. Subjective questionnaires had the potential ability to evaluate the effectiveness of long-term telehealth monitoring and management. However, further well-designed experiments are warranted to validate TCDMS's effects on subjective outcomes, especially when tested among different chronically ill groups.
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Affiliation(s)
- Ziyan Xiao
- Research Center Intelligent Equipment and Technology, Yangtze Delta Region Institute of Tsinghua University, Jiaxing, Zhejiang, China
- Department of Statistics and Actuarial Science, Faculty of Science, The University of Hong Kong, Hong Kong, Hong Kong
| | - Xiuping Han
- Research Center Intelligent Equipment and Technology, Yangtze Delta Region Institute of Tsinghua University, Jiaxing, Zhejiang, China
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12
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Anderson JA, Kimmel B, Sansgiry S, Venkatasubba Rao CP, Ovalle AP, Cerra-Stewart CA, Kent TA. Using Mobile Video-Teleconferencing to Deliver Secondary Stroke Prevention Interventions: A Pilot Study. TELEMEDICINE REPORTS 2022; 3:175-183. [PMID: 36204701 PMCID: PMC9531882 DOI: 10.1089/tmr.2022.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/05/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Patient self-management support (SMS) interventions help stroke survivors control stroke risk factors and assist with secondary prevention. We examined utility and preliminary effectiveness of mobile video-teleconferencing (VT) to deliver SMS to stroke survivors in rural and low-income urban Texas communities. METHODS We applied a within-subjects design to assess improvement in self-management behaviors and stroke risk factors among stroke survivors receiving SMS intervention through mobile VT. Adults with stroke and two or more uncontrolled stroke risk factors were eligible. The SMS program, Video-teleconference-Self-management TO Prevent stroke (V-STOP) was delivered over 6 weeks by trained health coaches through VT. We applied Generalized Estimating Equations with site and time in intervention as covariates to evaluate psychological, social, physiological outcomes, self-management behaviors, and quality of life. RESULTS Mean age of 106 participants was 59.3 (±10.9); most were White, Hispanic men, living with someone, with low income. Approximately 69% completed all measures at 6 weeks. Median number of sessions attended was 5 (interquartile range 3) potentially avoiding 210 km of travel per person. Satisfaction with V-STOP and VT delivery was high, at (4.8 [±0.5]) and (4.7 [±0.5]), respectively. Stroke knowledge was improved from 8.8 (±1.0) at baseline to 9.6 (±0.7) at 12 weeks, (p < 0.0001). Improvements were observed in self-efficacy, exercise behaviors, depression and anxiety, disability, and quality of life. CONCLUSION Implementation of SMS is feasible and shows good utility and preliminary effectiveness of using mobile VT to provide stroke follow-up care to stroke survivors. Participants improved self-management behaviors and stroke risk factors.
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Affiliation(s)
- Jane A. Anderson
- Department of Medicine, Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
- Department of Neurology, and Baylor College of Medicine, Houston, Texas, USA
| | - Barbara Kimmel
- Department of Medicine, Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
- Department of Neurology, and Baylor College of Medicine, Houston, Texas, USA
| | - Shubhada Sansgiry
- Department of Medicine, Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Department of Medicine, South Central Mental Illness Research, Education and Clinical Center, Houston, Texas, USA
| | - Chethan P. Venkatasubba Rao
- Department of Neurology, and Baylor College of Medicine, Houston, Texas, USA
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
- Center for Space Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Anette P. Ovalle
- Department of Neurology, and Baylor College of Medicine, Houston, Texas, USA
| | | | - Thomas A. Kent
- Center for Genomic and Precision Medicine, Institute of Bioscience and Technology Texas A&M Health Science Center, Texas, USA
- Houston Methodist Hospital, Neurological Institute, Houston, Texas, USA
- Department of Chemistry, Rice University, Houston, Texas, USA
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13
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Der-Martirosian C, Shin M, Upham ML, Douglas JH, Zeliadt SB, Taylor SL. Telehealth Complementary and Integrative Health Therapies During COVID-19 at the U.S. Department of Veterans Affairs. Telemed J E Health 2022; 29:576-583. [PMID: 35867052 DOI: 10.1089/tmj.2022.0209] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Complementary and integrative health (CIH) therapies, such as in-person acupuncture, chiropractic care, and meditation, are evidence-based nonpharmaceutical treatment options for pain. During COVID-19, the Veterans Health Administration (VA) delivered several CIH therapies virtually. This study explores veterans' utilization, advantages/disadvantages, and delivery issues of yoga, Tai Chi, meditation/mindfulness (self-care), and massage, chiropractic, and acupuncture (practitioner-delivered care), using telephone/video at 18 VA sites during COVID-19. Methods: Use of virtual care was examined quantitatively with VA administrative data for six CIH therapies before and after COVID-19 onset (2019-2021). Advantages/disadvantages and health care delivery issues of these CIH therapies through virtual care were examined qualitatively using interview data (2020-2021). Results: Overall, televisits represented a substantial portion of all CIH self-care therapies delivered by VA in 2020 (53.7%) and 2021 (82.1%), as sites developed virtual group classes using VA secure online video platforms in response to COVID-19. In contrast, a small proportion of all encounters with acupuncturists, chiropractors, and massage therapists was telephone/video encounters in 2020 (17.3%) and in 2021 (5.4%). These were predominantly one-on-one care in the form of education, follow-ups, home exercises, assessments/evaluations, or acupressure. Delivery issues included technical difficulties, lack of access to needed technology, difficulty tracking virtual visits, and capacity restrictions. Advantages included increased access to self-care, increased patient receptivity to engaging in self-care, and flexibility in staffing online group classes. Disadvantages included patient preference, patient safety, and strain on staffing. Conclusion: Despite delivery issues or disadvantages of tele-CIH self-care, veterans' use of teleself-care CIH therapies grew substantially during the COVID-19 pandemic.
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Affiliation(s)
- Claudia Der-Martirosian
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.,Veterans Emergency Management Evaluation Center, Office of Patient Care Services, North Hills, California, USA
| | - Marlena Shin
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Michelle L Upham
- VA Center of Innovation (COIN) for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington, USA
| | - Jamie H Douglas
- VA Center of Innovation (COIN) for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington, USA
| | - Steven B Zeliadt
- VA Center of Innovation (COIN) for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington, USA.,Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Stephanie L Taylor
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.,Department of Medicine and Department of Health Policy and Management, University of California Los Angeles, Los Angeles, California, USA
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14
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Wilkinson A, Higgs C, Stokes T, Dummer J, Hale L. How to Best Develop and Deliver Generic Long-Term Condition Rehabilitation Programmes in Rural Settings: An Integrative Review. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:904007. [PMID: 36188934 PMCID: PMC9397970 DOI: 10.3389/fresc.2022.904007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022]
Abstract
People living rurally frequently experience health disparities especially if living with a long-term condition (LTC) or multi-morbidity. Self-management support is a key component of LTC management and commonly included in rehabilitation programmes to enhance ability to self-manage health and encourage physical activity. Such programmes are however often condition focussed and despite evidence for their effectiveness, are not always feasible to deliver in rural settings. Generic programmes are arguably more optimal in the rural context and delivery can be face to face or remotely (via telehealth). The aim of this explorative integrative review was to collate and present international evidence for development, delivery, integration, and support of community-based, generic LTC group rehabilitation programmes delivered rurally in person, or remotely using telehealth. Electronic databases were systematically searched using MeSH terms and keywords. For inclusion, articles were screened for relevance to the aim, and practical information pertaining to the aim were extracted, charted, and organized deductively into themes of Development, Delivery, Integration, and Support. Within each theme, data were synthesized inductively into categories (Theory, Context, Interpersonal aspects, and Technology and Programme aspects). Fifty-five studies were included. Five studies contributed information about community based programmes delivered via the internet. Development was the only theme populated by information from all categories. The theme of Support was only populated with information from one category. Our review has drawn together a large body of diverse work. It has focused on finding practical information pertaining to the best ways to develop, deliver, integrate, and support a community-based generic rehabilitation programme for people living with long-term health conditions, delivered rurally and/or potentially via the internet. Practical suggestions were thematically organized into categories of theory, context, interpersonal aspects, and technology and programme aspects. While the findings of this review might appear simple and self-evident, they are perhaps difficult to enact in practice.
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Affiliation(s)
- Amanda Wilkinson
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Chris Higgs
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Tim Stokes
- Department of General Practice and Rural Health, University of Otago, Dunedin, New Zealand
| | - Jack Dummer
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Leigh Hale
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
- *Correspondence: Leigh Hale
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15
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Combining patient-specific, digital 3D models with tele-education for adolescents with CHD. Cardiol Young 2022; 32:912-917. [PMID: 34392874 DOI: 10.1017/s1047951121003243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Adolescents with CHD require transition to specialised adult-centred care. Previous studies have shown that adolescents' knowledge of their medical condition is correlated with transition readiness. Three-dimensional printed models of CHD have been used to educate medical trainees and patients, although no studies have focused on adolescents with CHD. This study investigates the feasibility of combining patient-specific, digital 3D heart models with tele-education interventions to improve the medical knowledge of adolescents with CHD. METHODS Adolescent patients with CHD, aged between 13 and 18 years old, were enrolled and scheduled for a tele-education session. Patient-specific digital 3D heart models were created using images from clinically indicated cardiac magnetic resonance studies. The tele-education session was performed using commercially available, web-conferencing software (Zoom, Zoom Video Communications Inc.) and a customised software (Cardiac Review 3D, Indicated Inc.) incorporating an interactive display of the digital 3D heart model. Medical knowledge was assessed using pre- and post-session questionnaires that were scored by independent reviewers. RESULTS Twenty-two adolescents completed the study. The average age of patients was 16 years old (standard deviation 1.5 years) and 56% of patients identified as female. Patients had a variety of cardiac defects, including tetralogy of Fallot, transposition of great arteries, and coarctation of aorta. Post-intervention, adolescents' medical knowledge of their cardiac defects and cardiac surgeries improved compared to pre-intervention (p < 0.01). CONCLUSIONS Combining patient-specific, digital 3D heart models with tele-education sessions can improve adolescents' medical knowledge and may assist with transition to adult-centred care.
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16
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Kirakalaprathapan A, Oremus M. Efficacy of telehealth in integrated chronic disease management for older, multimorbid adults with heart failure: A systematic review. Int J Med Inform 2022; 162:104756. [PMID: 35381436 DOI: 10.1016/j.ijmedinf.2022.104756] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 02/02/2022] [Accepted: 03/27/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND We conducted a systematic review to assess the comparative efficacy of integrated telehealth versus other strategies of chronic disease management in older, multimorbid adults with heart failure (HF) in primary care and community settings. Specific efficacy outcomes included CVD-related hospitalizations, rehospitalizations, and mortality. MATERIALS AND METHODS We searched for randomized controlled trials (RCTs) in MEDLINE, Scopus, EMBASE, CINAHL, and CENTRAL from the date of each database's inception to January 2020. The literature search retrieved 9,181 articles, which were screened by two independent raters. Twenty-two of these articles were included in the systematic review. Data extraction, risk of bias assessment, and narrative synthesis followed article screening. RESULTS This systematic review found that integrated telehealth is efficacious in reducing CVD-related hospitalizations, rehospitalizations, and mortality in older, multimorbid adults within primary care and community settings. However, numerous discrepancies existed between the studies, due largely to differences in telehealth modalities and risk of bias. Overall, the combinations of modalities were so diverse that the reviewed literature did not suggest an optimal integrated telehealth strategy. At most, no more than three studies featured the same combination of telehealth modalities and outcomes. Furthermore, only 3 of the 22 included RCTs scored low on the Cochrane risk of bias tool. CONCLUSIONS Researchers should focus on the quality of future RCTs to better assess the efficacy of different telehealth modalities in multimorbid older adults with HF. Also, since all the included RCTs focused on HF, a knowledge gap exists with regard to the efficacy of using integrated telehealth to manage other cardiovascular diseases (CVD).
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Affiliation(s)
| | - Mark Oremus
- School of Public Health Sciences, University of Waterloo, Canada.
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17
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Pullyblank K, Brunner W, Scribani M, Krupa N, Ory MG, Smith ML. Recruitment and engagement in disease self-management programs: Special concerns for rural residents reporting depression and/or anxiety. Prev Med Rep 2022; 26:101761. [PMID: 35299592 PMCID: PMC8921301 DOI: 10.1016/j.pmedr.2022.101761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 02/07/2022] [Accepted: 03/06/2022] [Indexed: 11/30/2022] Open
Abstract
Poorer health outcomes are correlated with depression/anxiety in a rural population. Electronic modes of recruitment engage those reporting depression/anxiety into CDSME. CDSME increases patient activation regardless of history of depression/anxiety.
Chronic disease self-management education (CDSME) programs benefit individuals with chronic diseases, including mental health conditions, by improving health-related outcomes and increasing engagement with the health care system. Recruiting individuals with a history of mental health conditions to participate in CDSME is challenging, particularly in rural, underserved areas. Hence, it is important to understand factors associated with the presence of mental health conditions, and impacts of CDSME on patient engagement. This project identifies individual and program-level characteristics, as well as recruitment characteristics, associated with reporting a history of depression and/or anxiety. It also assesses factors related to program engagement and the relationship between completing CDSME and patient activation. Data were collected during CDSME workshops offered in 2019 in a rural region of New York. Of the 421 enrollees who completed survey instruments, 162 reported a history of depression and/or anxiety. Univariate analyses indicated that those reporting a history of depression and/or anxiety were younger, female, in poorer health, had more comorbidities, were Medicaid beneficiaries, and had lower patient activation scores. They also heard about and signed up for the workshop through the internet at higher rates than those not reporting a history of depression and/or anxiety. Multivariable logistic regression modeling indicated age, self-rated health, and number of comorbidities were independent predictors of reporting a history of depression and/or anxiety. Among CDSME completers, patient activation significantly improved regardless of history of depression and/or anxiety. Engaging individuals with mental health conditions in CDSME requires a multimodal recruitment strategy incorporating electronic marketing and registration.
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Affiliation(s)
- Kristin Pullyblank
- Center for Rural Community Health, Bassett Research Institute, Bassett Medical Center, One Atwell Road, Cooperstown, NY 13326, USA.,Decker College of Nursing and Health Sciences, Binghamton University, PO Box 6000, Binghamton, NY 13902, USA
| | - Wendy Brunner
- Center for Rural Community Health, Bassett Research Institute, Bassett Medical Center, One Atwell Road, Cooperstown, NY 13326, USA
| | - Melissa Scribani
- Center for Biostatistics, Bassett Research Institute, Bassett Medical Center, One Atwell Road, Cooperstown, NY 13326, USA
| | - Nicole Krupa
- Center for Biostatistics, Bassett Research Institute, Bassett Medical Center, One Atwell Road, Cooperstown, NY 13326, USA
| | - Marcia G Ory
- Center for Population Health and Aging, Texas A&M University, 212 Adriance Lab Rd, College Station, TX 77843-1266, USA.,Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, 212 Adriance Lab Rd, College Station, TX 77843-1266, USA
| | - Matthew Lee Smith
- Center for Population Health and Aging, Texas A&M University, 212 Adriance Lab Rd, College Station, TX 77843-1266, USA.,Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, 212 Adriance Lab Rd, College Station, TX 77843-1266, USA
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18
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Buyting R, Melville S, Chatur H, White CW, Légaré JF, Lutchmedial S, Brunt KR. Virtual Care With Digital Technologies for Rural Canadians Living With Cardiovascular Disease. CJC Open 2022; 4:133-147. [PMID: 35198931 PMCID: PMC8843960 DOI: 10.1016/j.cjco.2021.09.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/26/2021] [Indexed: 01/14/2023] Open
Abstract
Canada is a wealthy nation with a geographically diverse population, seeking health innovations to better serve patients in accordance with the Canada Health Act. In this country, population and geography converge with social determinants, policy, procurement regulations, and technological advances with the goal to achieve equity in the management and distribution of health care. Rural and remote patients are a vulnerable population; when managing chronic conditions like cardiovascular disease, there is currently inequity to accessing specialist physicians at the recommended frequency-increasing the likelihood of poor health outcomes. Ensuring equitable care for this population is an unrealized priority of several provincial and federal government mandates. Virtual care technology might provide practical, economical, and innovative solutions to remedy this discrepancy. We conducted a scoping review of the literature pertaining to the use of virtual care technologies to monitor patients living in rural areas of Canada with cardiovascular disease. A search strategy was developed to identify the literature specific to this context across 3 bibliographic databases. Two hundred thirty-two unique citations were ultimately assessed for eligibility, of which 37 met the inclusion criteria. In our assessment of these articles, we provide a summary of the interventions studied, their reported effectiveness in reducing adverse events and mortality, the challenges to implementation, and the receptivity of these technologies among patients, providers, and policy-makers. Furthermore, we glean insight into the barriers and opportunities to ensure equitable care for rural patients and conclude that there is an ongoing need for clinical trials on virtual care technologies in this context.
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Affiliation(s)
- Ryan Buyting
- Department of Pharmacology, Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada
- Division of Cardiac Surgery, Saint John Regional Hospital, Saint John, New Brunswick, Canada
- Division of Cardiology, Saint John Regional Hospital, Saint John, New Brunswick, Canada
- Horizon Health Network, CardioVascular Research New Brunswick (CVR-NB), Saint John, New Brunswick, Canada
- Faculty of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
- IMPART Investigator Team Canada, Saint John, New Brunswick, Canada
| | - Sarah Melville
- Division of Cardiology, Saint John Regional Hospital, Saint John, New Brunswick, Canada
- Horizon Health Network, CardioVascular Research New Brunswick (CVR-NB), Saint John, New Brunswick, Canada
- Faculty of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
- IMPART Investigator Team Canada, Saint John, New Brunswick, Canada
| | - Hanif Chatur
- Faculty of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
- IMPART Investigator Team Canada, Saint John, New Brunswick, Canada
| | - Christopher W. White
- Division of Cardiac Surgery, Saint John Regional Hospital, Saint John, New Brunswick, Canada
- Horizon Health Network, CardioVascular Research New Brunswick (CVR-NB), Saint John, New Brunswick, Canada
- Faculty of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
| | - Jean-François Légaré
- Division of Cardiac Surgery, Saint John Regional Hospital, Saint John, New Brunswick, Canada
- Horizon Health Network, CardioVascular Research New Brunswick (CVR-NB), Saint John, New Brunswick, Canada
- Faculty of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
- IMPART Investigator Team Canada, Saint John, New Brunswick, Canada
| | - Sohrab Lutchmedial
- Division of Cardiology, Saint John Regional Hospital, Saint John, New Brunswick, Canada
- Horizon Health Network, CardioVascular Research New Brunswick (CVR-NB), Saint John, New Brunswick, Canada
- Faculty of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
- IMPART Investigator Team Canada, Saint John, New Brunswick, Canada
| | - Keith R. Brunt
- Department of Pharmacology, Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada
- Faculty of Medicine, Dalhousie University, Saint John, New Brunswick, Canada
- IMPART Investigator Team Canada, Saint John, New Brunswick, Canada
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Veldman MHJ, van der Aa HPA, Bode C, Knoop H, Hulshof CTJ, Koopmanschap M, Stavleu E, van Rens GHMB, van Nispen RMA. E-nergEYEze, a vision-specific eHealth intervention based on cognitive behavioral therapy and self-management to reduce fatigue in adults with visual impairment: study protocol for a randomized controlled trial. Trials 2021; 22:966. [PMID: 34963472 PMCID: PMC8715593 DOI: 10.1186/s13063-021-05935-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 12/10/2021] [Indexed: 11/16/2022] Open
Abstract
Background More than half of the adults with visual impairment experience severe symptoms of fatigue, with a negative impact on daily life. Since there is no evidence-based treatment to reduce fatigue in adults with visual impairment, we developed E-nergEYEze, an eHealth intervention based on cognitive behavioral therapy and self-management tailored to the needs of visually impaired adults. The aim is to describe the study protocol of a randomized controlled trial testing E-nergEYEze. Methods A randomized controlled trial will be conducted to investigate the cost-effectiveness and cost-utility of E-nergEYEze to reduce fatigue severity compared to care as usual from a healthcare and societal perspective. A total of 172 severely fatigued adults with visual impairment will be recruited and randomized to either the E-nergEYEze intervention plus care as usual or to care as usual only (ratio 1:1). Inclusion criteria are having a visual impairment, experiencing severe fatigue (Checklist Individual Strength – subscale Fatigue Severity: CIS-FS > 35), being 18 years or older, understanding the Dutch language, and having access to the internet. The intervention consists of one face-to-face session and a computer training followed by internet-based modules with information and assignments on coping with fatigue. During this 5-month intervention, participants will be digitally supported by a social worker. All measurements will be administered at baseline, after 6 and 12 months, and additionally, those related to cost-effectiveness at 3 and 9 months. The primary outcome is fatigue severity (CIS-FS). Discussion Severe fatigue on top of visual impairment compromises quality of life and is associated with incremental societal costs that largely determine the economic burden of low vision or blindness. E-nergEYEze contributes to the evidence base of potentially feasible interventions to reduce the important health-related consequences of vision loss and could fulfill the gap in knowledge, skills and treatment options for low vision services. Trial registration Dutch Trial Register NTR7764. Registered on 28 May 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05935-w.
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Affiliation(s)
- Manon H J Veldman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Ophthalmology, Amsterdam Public Health Research Institute, De Boelelaan, 1117, Amsterdam, The Netherlands.
| | - Hilde P A van der Aa
- Amsterdam UMC, Vrije Universiteit Amsterdam, Ophthalmology, Amsterdam Public Health Research Institute, De Boelelaan, 1117, Amsterdam, The Netherlands
| | - Christina Bode
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Hans Knoop
- Amsterdam UMC, University of Amsterdam, Medical Psychology, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Carel T J Hulshof
- Amsterdam UMC, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, The Netherlands
| | - Marc Koopmanschap
- Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - Edwin Stavleu
- Royal Dutch Visio, Centre of Expertise for Visually Impaired and Blind People, Huizen, The Netherlands
| | - Ger H M B van Rens
- Amsterdam UMC, Vrije Universiteit Amsterdam, Ophthalmology, Amsterdam Public Health Research Institute, De Boelelaan, 1117, Amsterdam, The Netherlands.,Elkerliek Hospital, Ophthalmology, Helmond, The Netherlands
| | - Ruth M A van Nispen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Ophthalmology, Amsterdam Public Health Research Institute, De Boelelaan, 1117, Amsterdam, The Netherlands
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Sussman K, Burns MK, Lembke ES. Effects of ECHO MTSS Teleconsultation Model on Self-Efficacy of Data-Based Individualization of Academic Interventions. JOURNAL OF EDUCATIONAL AND PSYCHOLOGICAL CONSULTATION 2021. [DOI: 10.1080/10474412.2021.1996243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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21
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Pal T, Hull PC, Koyama T, Lammers P, Martinez D, McArthy J, Schremp E, Tezak A, Washburn A, Whisenant JG, Friedman DL. Enhancing Cancer care of rural dwellers through telehealth and engagement (ENCORE): protocol to evaluate effectiveness of a multi-level telehealth-based intervention to improve rural cancer care delivery. BMC Cancer 2021; 21:1262. [PMID: 34814868 PMCID: PMC8609269 DOI: 10.1186/s12885-021-08949-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/01/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Despite lower cancer incidence rates, cancer mortality is higher among rural compared to urban dwellers. Patient, provider, and institutional level factors contribute to these disparities. The overarching objective of this study is to leverage the multidisciplinary, multispecialty oncology team from an academic cancer center in order to provide comprehensive cancer care at both the patient and provider levels in rural healthcare centers. Our specific aims are to: 1) evaluate the clinical effectiveness of a multi-level telehealth-based intervention consisting of provider access to molecular tumor board expertise along with patient access to a supportive care intervention to improve cancer care delivery; and 2) identify the facilitators and barriers to future larger scale dissemination and implementation of the multi-level intervention. METHODS Coordinated by a National Cancer Institute-designated comprehensive cancer center, this study will include providers and patients across several clinics in two large healthcare systems serving rural communities. Using a telehealth-based molecular tumor board, sequencing results are reviewed, predictive and prognostic markers are discussed, and treatment plans are formulated between expert oncologists and rural providers. Simultaneously, the rural patients will be randomized to receive an evidence-based 6-week self-management supportive care program, Cancer Thriving and Surviving, versus an education attention control. Primary outcomes will be provider uptake of the molecular tumor board recommendation and patient treatment adherence. A mixed methods approach guided by the Consolidated Framework for Implementation Research that combines qualitative key informant interviews and quantitative surveys will be collected from both the patient and provider in order to identify facilitators and barriers to implementing the multi-level intervention. DISCUSSION The proposed study will leverage information technology-enabled, team-based care delivery models in order to deliver comprehensive, coordinated, and high-quality cancer care to rural and/or underserved populations. Simultaneous attention to institutional, provider, and patient level barriers to quality care will afford the opportunity for us to broadly share oncology expertise and develop dissemination and implementation strategies that will enhance the cancer care delivered to patients residing within underserved rural communities. TRIAL REGISTRATION Clinicaltrials.gov , NCT04758338 . Registered 17 February 2021 - Retrospectively registered, http://www.clinicaltrials.gov/.
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Affiliation(s)
- Tuya Pal
- Vanderbilt-Ingram Cancer Center, 2220 Pierce Avenue, Nashville, TN, 37232, USA
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, 2220 Pierce Avenue, 536 Robinson Research Building, Nashville, TN, 37232, USA
| | - Pamela C Hull
- University of Kentucky Markey Cancer Center, 800 Rose Street, Lexington, KY, 40536, USA
- Department of Behavioral Science, University of Kentucky College of Medicine, Rural and Underserved Health Research Center, Healthy Kentucky Research Building, 760 Press Avenue, Lexington, KY, 40536, USA
| | - Tatsuki Koyama
- Vanderbilt-Ingram Cancer Center, 2220 Pierce Avenue, Nashville, TN, 37232, USA
- Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End, Suite 1100, Nashville, TN, 37203, USA
| | - Phillip Lammers
- Baptist Cancer Center, 80 Humphreys Center Suite 330, Memphis, TN, 38120, USA
| | - Denise Martinez
- Division of Pediatric Hematology & Oncology, Department of Pediatrics, Vanderbilt University Medical Center, 395 Preston Research Building, 2220 Pierce Avenue, Nashville, TN, 37232, USA
| | - Jacob McArthy
- Division of Pediatric Hematology & Oncology, Department of Pediatrics, Vanderbilt University Medical Center, 395 Preston Research Building, 2220 Pierce Avenue, Nashville, TN, 37232, USA
| | - Emma Schremp
- Division of Pediatric Hematology & Oncology, Department of Pediatrics, Vanderbilt University Medical Center, 395 Preston Research Building, 2220 Pierce Avenue, Nashville, TN, 37232, USA
| | - Ann Tezak
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, 2220 Pierce Avenue, 536 Robinson Research Building, Nashville, TN, 37232, USA
| | - Anne Washburn
- Vanderbilt-Ingram Cancer Center, 2220 Pierce Avenue, Nashville, TN, 37232, USA
| | - Jennifer G Whisenant
- Division of Hematology & Oncology, Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN, 37232, USA
| | - Debra L Friedman
- Vanderbilt-Ingram Cancer Center, 2220 Pierce Avenue, Nashville, TN, 37232, USA.
- Division of Pediatric Hematology & Oncology, Department of Pediatrics, Vanderbilt University Medical Center, 395 Preston Research Building, 2220 Pierce Avenue, Nashville, TN, 37232, USA.
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A model of integrated remote monitoring and behaviour change for osteoarthritis. BMC Musculoskelet Disord 2021; 22:669. [PMID: 34372822 PMCID: PMC8350550 DOI: 10.1186/s12891-021-04555-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 07/12/2021] [Indexed: 11/23/2022] Open
Abstract
Background The National Institute for Health and Care Excellence recommends the use of digital and mobile health technologies to facilitate behaviour change interventions. Due to its high prevalence and dependence upon patient self-management strategies, osteoarthritis is one musculoskeletal condition which may benefit from such approaches. This is particularly pertinent due to the increasing use of remote monitoring technologies to collect patient data and facilitate self-management in individuals outside of hospital clinics. In practice however, application of digital behaviour change interventions is difficult due to insufficient reporting of behaviour change theories in the current literature. When digital technologies are employed to alter behaviour change in osteoarthritis, they often focus on physical activity. Currently, such interventions focus of self-efficacy but do not often explicitly report the behaviour change techniques they use to facilitate these changes. Methods This paper proposes a new model of integrating specific behaviour change principles (persuasive design) in an integrated model of remote monitoring and digital behaviour change interventions for osteoarthritis. Results There is potential to combine remote monitoring systems of patient data through digital and mobile technologies with behaviour change principles to improve physical activity behaviours in individuals with osteoarthritis. The use of persuasive design principles (e.g. prompts or nudges) through mobile notifications and strategic system design can be directed to enhance behaviour change. A validated measure of behaviour change, such as the patient activation measure, will allow effective evaluation of such systems. Conclusions Digital behaviour change interventions should be directed towards the underlying principles of behaviour change they employ, although this is not commonly reported in practice. Such interventions can be integrated within remote monitoring pathways using persuasive design techniques to enhance patient activation. This approach can enhance self-management in individuals with musculoskeletal conditions, such as osteoarthritis.
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Melton T, Jasmin H, Johnson HF, Coley A, Duffey S, Renfro CP. Describing the delivery of clinical pharmacy services via telehealth: A systematic review. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Tyler Melton
- University of Tennessee Health Science Center College of Pharmacy Knoxville Tennessee USA
| | - Hilary Jasmin
- University of Tennessee Health Science Center Health Sciences Library Memphis Tennessee USA
| | - Haden F. Johnson
- University of Tennessee Health Science Center College of Pharmacy Memphis Tennessee USA
| | - Annika Coley
- University of Tennessee Health Science Center College of Pharmacy Memphis Tennessee USA
| | - Sawyer Duffey
- University of Tennessee Health Science Center College of Pharmacy Memphis Tennessee USA
| | - Chelsea P. Renfro
- University of Tennessee Health Science Center College of Pharmacy Memphis Tennessee USA
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Chu C, Cram P, Pang A, Stamenova V, Tadrous M, Bhatia RS. Rural Telemedicine Use Before and During the COVID-19 Pandemic: Repeated Cross-sectional Study. J Med Internet Res 2021; 23:e26960. [PMID: 33769942 PMCID: PMC8023379 DOI: 10.2196/26960] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/03/2021] [Accepted: 03/24/2021] [Indexed: 12/15/2022] Open
Abstract
Background The COVID-19 pandemic has led to a notable increase in telemedicine adoption. However, the impact of the pandemic on telemedicine use at a population level in rural and remote settings remains unclear. Objective This study aimed to evaluate changes in the rate of telemedicine use among rural populations and identify patient characteristics associated with telemedicine use prior to and during the pandemic. Methods We conducted a repeated cross-sectional study on all monthly and quarterly rural telemedicine visits from January 2012 to June 2020, using administrative data from Ontario, Canada. We compared the changes in telemedicine use among residents of rural and urban regions of Ontario prior to and during the pandemic. Results Before the pandemic, telemedicine use was steadily low in 2012-2019 for both rural and urban populations but slightly higher overall for rural patients (11 visits per 1000 patients vs 7 visits per 1000 patients in December 2019, P<.001). The rate of telemedicine visits among rural patients significantly increased to 147 visits per 1000 patients in June 2020. A similar but steeper increase (P=.15) was observed among urban patients (220 visits per 1000 urban patients). Telemedicine use increased across all age groups, with the highest rates reported among older adults aged ≥65 years (77 visits per 100 patients in 2020). The proportions of patients with at least 1 telemedicine visit were similar across the adult age groups (n=82,246/290,401, 28.3% for patients aged 18-49 years, n=79,339/290,401, 27.3% for patients aged 50-64 years, and n=80,833/290,401, 27.8% for patients aged 65-79 years), but lower among younger patients <18 years (n=23,699/290,401, 8.2%) and older patients ≥80 years (n=24,284/290,401, 8.4%) in 2020 (P<.001). There were more female users than male users of telemedicine (n=158,643/290,401, 54.6% vs n=131,758/290,401, 45.4%, respectively, in 2020; P<.001). There was a significantly higher proportion of telemedicine users residing in relatively less rural than in more rural regions (n=261,814/290,401, 90.2% vs n=28,587/290,401, 9.8%, respectively, in 2020; P<.001). Conclusions Telemedicine adoption increased in rural and remote areas during the COVID-19 pandemic, but its use increased in urban and less rural populations. Future studies should investigate the potential barriers to telemedicine use among rural patients and the impact of rural telemedicine on patient health care utilization and outcomes.
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Affiliation(s)
- Cherry Chu
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Peter Cram
- Division of General Internal Medicine and Geriatrics, Sinai Health System and University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Andrea Pang
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Vess Stamenova
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Mina Tadrous
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - R Sacha Bhatia
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
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Rasmussen B, Wynter K, Rawson HA, Skouteris H, Ivory N, Brumby SA. Self-management of diabetes and associated comorbidities in rural and remote communities: a scoping review. Aust J Prim Health 2021; 27:243-254. [PMID: 34229829 DOI: 10.1071/py20110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 04/06/2021] [Indexed: 11/23/2022]
Abstract
Chronic health conditions are more prevalent in rural and remote areas than in metropolitan areas; living in rural and remote areas may present particular barriers to the self-management of chronic conditions like diabetes and comorbidities. The aims of this review were to: (1) synthesise evidence examining the self-management of diabetes and comorbidities among adults living in rural and remote communities; and (2) describe barriers and enablers underpinning self-management reported in studies that met our inclusion criteria. A systematic search of English language papers was undertaken in PsycINFO, Medline Complete, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, EMBASE and the Cochrane Database of Systematic Reviews, searching for literature indexed from the beginning of the database until 6 March 2020. Essential key concepts were diabetes, comorbidities, self-management and rural or remote. Twelve studies met the inclusion criteria. Six of these reported interventions to promote self-management for adults with diabetes in rural and remote communities and described comorbidities. These interventions had mixed results; only three demonstrated improvements in clinical outcomes or health behaviours. All three of these interventions specifically targeted adults living with diabetes and comorbidities in rural and remote areas; two used the same telehealth approach. Barriers to self-management included costs, transport problems and limited health service access. Interventions should take account of the specific challenges of managing both diabetes and comorbidities; telehealth may address some of the barriers associated with living in rural and remote areas.
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Affiliation(s)
- Bodil Rasmussen
- Deakin University School of Nursing and Midwifery, 1 Gheringhap Street, Geelong, Vic. 3220, Australia; and Centre for Quality and Patient Safety Research - Western Health Partnership, Sunshine Hospital, 176 Furlong Road, St Albans, Vic. 3021, Australia; and Department of Public Health, University of Copenhagen, Denmark; and Faculty of Health Sciences, University of Southern Denmark, Denmark; and Corresponding author.
| | - Karen Wynter
- Deakin University School of Nursing and Midwifery, 1 Gheringhap Street, Geelong, Vic. 3220, Australia; and Centre for Quality and Patient Safety Research - Western Health Partnership, Sunshine Hospital, 176 Furlong Road, St Albans, Vic. 3021, Australia
| | - Helen A Rawson
- Deakin University School of Nursing and Midwifery, 1 Gheringhap Street, Geelong, Vic. 3220, Australia; and Nursing and Midwifery, Monash University, 35 Rainforest Walk, Clayton, Vic. 3800, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Vic. 3004, Australia
| | - Nicola Ivory
- Deakin University School of Psychology, 1 Gheringhap Street, Geelong, Vic. 3220, Australia
| | - Susan A Brumby
- School of Medicine, Deakin University, 75 Pigdons Road, Waurn Ponds, Vic. 3216, Australia; and National Centre for Farmer Health, Western District Health Service, 20 Foster Street, Hamilton, Vic. 3300, Australia
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Ferguson SL, Pitt C, Pitt L. Using artificial intelligence to examine online patient reviews. J Health Psychol 2020; 26:2424-2434. [PMID: 32301353 DOI: 10.1177/1359105320913954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Healthcare consumers are increasingly turning to online sources such as educational websites, forums and social media platforms to share their experiences with medical services and to demystify the uncertainties associated with undergoing various procedures. This study demonstrates a non-invasive way of understanding the feelings and emotions that consumers share via electronic word of mouth. By using IBM Watson, a content analysis tool that harnesses artificial intelligence, we show how a large amount of unstructured qualitative data can be transformed into quantitative data that can be subsequently analysed to generate novel insights into what patients are sharing about their healthcare experiences online.
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Boucher LM, O'Brien KK, Baxter LN, Fitzgerald ML, Liddy CE, Kendall CE. Healthy aging with HIV: The role of self-management support. PATIENT EDUCATION AND COUNSELING 2019; 102:1565-1569. [PMID: 30827568 DOI: 10.1016/j.pec.2019.02.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 01/19/2019] [Accepted: 02/19/2019] [Indexed: 06/09/2023]
Abstract
People living with HIV on antiretroviral treatment have significantly improved longevity, but as a result may also face increasing multimorbidity due to aging and long-term medication use. Thus, care needs for this population have evolved to require a chronic disease management approach in which self-management plays a central role. Here we highlight the importance of expanding self-management support options for people living with HIV, and discuss strategies for implementing and evaluating self-management interventions, outlining potential opportunities, challenges and solutions. We contend that standardized programs such as those offered through the Self-Management Resource Centre provide a rich opportunity to build the evidence base regarding the potential effectiveness of self-management support among people living with HIV. Thus we recommend enhancing self-management support through meaningful community-level collaboration with people with lived experience, careful assessment of process and outcome factors including who does not participate and why, attention to stigma and the specific needs of HIV priority groups, and consideration of how to extend engagement with services to address social and material needs beyond self-management program participation. We hope this reflection will serve as an aide for researchers and program managers to improve the array of evidence-based self-management support options available to people living with HIV.
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Affiliation(s)
- Lisa M Boucher
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyère St, Ottawa, ON, K1N 5C8, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Kelly K O'Brien
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada; Rehabilitation Sciences Institute, School of Graduate Studies, University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada
| | | | - Michael L Fitzgerald
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyère St, Ottawa, ON, K1N 5C8, Canada
| | - Clare E Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyère St, Ottawa, ON, K1N 5C8, Canada; Department of Family Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Claire E Kendall
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyère St, Ottawa, ON, K1N 5C8, Canada; Department of Family Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada; Institute of Clinical and Evaluative Sciences, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
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Patil SJ, Lewis M, Tallon EM, Wareg NK, Murray KS, Elliott SG, Stevermer JJ, Kruse RL, Mehr DR. Lay Advisor Interventions in Rural Populations: A Systematic Review and Meta-analysis. Am J Prev Med 2019; 57:117-126. [PMID: 31130461 DOI: 10.1016/j.amepre.2019.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 02/03/2019] [Accepted: 02/04/2019] [Indexed: 01/22/2023]
Abstract
CONTEXT Age-adjusted death rates for heart disease are higher in rural areas than in urban areas. Lay advisors could potentially facilitate improvement in cardiovascular health outcomes. The aim of this systematic review and meta-analysis is to estimate lay advisor intervention effects on cardiovascular health metrics in rural populations. EVIDENCE ACQUISITION Searches of databases including MEDLINE, CINAHL, and Scopus from 1975 through October 2017 retrieved 323 citations, of which 272 abstracts were reviewed. Two authors independently abstracted data from eligible studies. Analysis was conducted in March 2018. EVIDENCE SYNTHESIS Of 21 articles included in the systematic review, eight were RCTs and 13 were pre- and post-intervention studies. Of the RCTs, three took place in the U.S. Only two studies had low risk of bias. Using a random effects model, meta-analysis of six RCTs (1,641 participants) showed that lay advisor interventions in rural residents were associated with improvement in HbA1c of 0.4% (95% CI=0.13, 0.66, p=0.004, I2=60.65%). From four RCTs (873 participants), lay advisor interventions significantly improved BMI with pooled effect of 2.18 (95% CI=1.13, 3.24, p<0.001, I2=0.00%). Most studies had normal baseline blood pressure and cholesterol levels before intervention, and no significant effects were noted for these outcomes. Diverse types of measures used for diet, physical activity, and smoking precluded statistical synthesis. CONCLUSIONS Lay advisor interventions had significant positive effects on glycemic control and BMI for rural residents; however, further rigorous studies are needed in U.S. rural populations, and elements of effective lay advisor interventions require further investigation.
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Affiliation(s)
- Sonal J Patil
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri.
| | - Melissa Lewis
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri
| | - Erin M Tallon
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri
| | - Nuha K Wareg
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri
| | - Katie S Murray
- Department of Surgery, University of Missouri, Columbia, Missouri
| | - Susan G Elliott
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri
| | - James J Stevermer
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri
| | - Robin L Kruse
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri
| | - David R Mehr
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri
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Buote R, Asghari S, Aubrey-Bassler K, Knight JC, Lukewich J. Primary health care services for patients with chronic disease in Newfoundland and Labrador: a descriptive analysis. CMAJ Open 2019; 7:E8-E14. [PMID: 30647075 PMCID: PMC6336483 DOI: 10.9778/cmajo.20180091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Newfoundland and Labrador has a rapidly aging population, much of which is rural, with poor health behaviours and high rates of chronic disease. These factors contribute to a unique challenge in health care delivery. Our aim was to describe the availability of publicly funded primary health care programs and services delivered by regional health authorities across the province. METHODS We performed a descriptive analysis using data from a cross-sectional provincial primary health care survey deployed across Newfoundland and Labrador. Survey data included location, disease-specific chronic disease prevention programming, types of routine primary care, allied health prevention and promotion, chronic disease prevention and management services, and team-based care. The mode of service delivery was identified for most programs and services. RESULTS Surveys were returned by 153 sites (99.4% response rate). Family physician services were available at 66% of sites (95/145) and nurse practitioner services were available at 51% (74/144) of sites. Many sites offered screening for cervical (60%, 86/144), colon (42%, 59/142) and prostate cancers (43%, 60/141), in addition to various self-management and education services. Allied health services, such as clinical nutrition counselling (47%, 68/46) and occupational therapy (46%, 68/147), were available at many sites. Available health care services were most often offered by on-site staff, and few sites provided primary health care services through telehealth. Overall, rural sites offered a greater variety of services than urban sites. INTERPRETATION Considerable variability exists in the range of primary health care services available across Newfoundland and Labrador, with limited delivery of some programs and services. Future research should examine how availability of programs and services affects health outcomes and costs.
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Affiliation(s)
- Richard Buote
- Divisions of Community Health and Humanities (Buote, Knight, Lukewich), and Discipline of Family Medicine (Asghari, Aubrey-Bassler), Memorial University of Newfoundland Center for Rural Health Studies (Asghari); Primary Healthcare Research Unit (Aubrey-Bassler, Knight), Faculty of Medicine, Memorial University of Newfoundland; Health Analytics and Information Services (Knight), Newfoundland and Labrador Centre for Health Information; School of Nursing (Lukewich), Memorial University of Newfoundland, St. John's, NL
| | - Shabnam Asghari
- Divisions of Community Health and Humanities (Buote, Knight, Lukewich), and Discipline of Family Medicine (Asghari, Aubrey-Bassler), Memorial University of Newfoundland Center for Rural Health Studies (Asghari); Primary Healthcare Research Unit (Aubrey-Bassler, Knight), Faculty of Medicine, Memorial University of Newfoundland; Health Analytics and Information Services (Knight), Newfoundland and Labrador Centre for Health Information; School of Nursing (Lukewich), Memorial University of Newfoundland, St. John's, NL
| | - Kris Aubrey-Bassler
- Divisions of Community Health and Humanities (Buote, Knight, Lukewich), and Discipline of Family Medicine (Asghari, Aubrey-Bassler), Memorial University of Newfoundland Center for Rural Health Studies (Asghari); Primary Healthcare Research Unit (Aubrey-Bassler, Knight), Faculty of Medicine, Memorial University of Newfoundland; Health Analytics and Information Services (Knight), Newfoundland and Labrador Centre for Health Information; School of Nursing (Lukewich), Memorial University of Newfoundland, St. John's, NL
| | - John C Knight
- Divisions of Community Health and Humanities (Buote, Knight, Lukewich), and Discipline of Family Medicine (Asghari, Aubrey-Bassler), Memorial University of Newfoundland Center for Rural Health Studies (Asghari); Primary Healthcare Research Unit (Aubrey-Bassler, Knight), Faculty of Medicine, Memorial University of Newfoundland; Health Analytics and Information Services (Knight), Newfoundland and Labrador Centre for Health Information; School of Nursing (Lukewich), Memorial University of Newfoundland, St. John's, NL
| | - Julia Lukewich
- Divisions of Community Health and Humanities (Buote, Knight, Lukewich), and Discipline of Family Medicine (Asghari, Aubrey-Bassler), Memorial University of Newfoundland Center for Rural Health Studies (Asghari); Primary Healthcare Research Unit (Aubrey-Bassler, Knight), Faculty of Medicine, Memorial University of Newfoundland; Health Analytics and Information Services (Knight), Newfoundland and Labrador Centre for Health Information; School of Nursing (Lukewich), Memorial University of Newfoundland, St. John's, NL
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He C, Zhou Q, Chen W, Tian J, Zhou L, Peng H, Luan S, Wang S. Using an Internet-Based Hospital to Address Maldistribution of Health Care Resources in Rural Areas of Guangdong Province, China: Retrospective and Descriptive Study. JMIR Med Inform 2018; 6:e51. [PMID: 30578195 PMCID: PMC6320436 DOI: 10.2196/medinform.9495] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 04/30/2018] [Accepted: 07/20/2018] [Indexed: 11/15/2022] Open
Abstract
Background Health care maldistribution is a long-term problem in China. Telemedicine is an efficient way to deliver medical resources to remote areas; however, there are few studies on the effectiveness and challenges in providing health care from rural to urban areas in China. Objective The objective was to describe the effectiveness and challenges of telemedicine for providing health care from Guangzhou to rural areas in Guangdong Province. Methods We designed surveys and conducted them immediately after the consultation and 2-4 weeks later. Data were collected from June 2015 to May 2016 including patients’ demographic features, patient satisfaction, medicine effect, patient compliance, acceptability of prescription expenses, patients’ desire to revisit the department, the top 10 diseases, and self-reported difficulties in telemedicine experience. The monthly average prescription expense was described using a line chart. The monthly consultation and prescription, as well as monthly prescriptions of Western medicines and herbs, were described using a bar chart. Results Women comprised majority (45,386/67,740, 67.00%) of participants and men comprised the minority (22,354/67,740, 33.00%). The top 3 diseases were upper respiratory diseases (12,371/36,311, 34.07%), laryngopharyngitis (4938/36,311, 13.60%), and menstrual disorders (4669/36,311, 12.86%). The monthly prescription for Western medicine was much more than that for Chinese herbs. The annual average medicine expense per prescription was 62.9 ¥. The participants’ perception of expense was acceptable (8775/12,450, 70.48%), mostly acceptable (2497/12,450, 20.01%), accepted but somewhat expensive (980/12,450, 7.9%), and unacceptable because of high cost (198/12,450, 1.6%). The surveys on patient satisfaction demonstrated very satisfied (55,687/67,740, 82.21%), satisfied (5891/67,740, 8.70%), basic satisfaction (3561/67,740, 5.26%), dissatisfaction (1454/67,740, 2.15%), and no comment (1147/67,740, 1.69%). Participants reported their treatment outcome as follows: full recovery (5008/12,450, 40.22%), recovering (4873/12,450, 39.14%), no effect (2153/12,450, 17.29%), or worsening (416/12,450, 3.3%). Approximately 89.01% (20,240/22,740) of participants will revisit the department, whereas 10.99% (2500/22,740) will not. Most patients complied with the doctors’ advice completely (5430/10,290, 52.77%), whereas the rest reported partial compliance (3684/10,290, 35.80%) or no compliance at all (1176/10,290, 11.43%). The participants reported poor computer skills (4980/22,740, 21.90%), transportation inconvenience (4670/22,740, 20.50%), unstable internet connection (3820/22,740, 16.80%), language barriers (3708/22,740, 16.30%), medication and medical hardware shortage (2459/22,740, 10.82%), tiring commute (2068/22,740, 9.08%), family care burdens (679/22,740, 3.0%), and other unclassified difficulties (356/22,740, 1.6%) as difficulties in using telemedicine. Conclusions Telemedicine has a wide disease spectrum, similar to ordinary medicine in China. It saves costs, has high patient satisfaction and price acceptability, and can relieve disease and syndromes. However, certain problems need to be resolved. Telemedicine could be a feasible approach to address the health care maldistribution in rural China. This study may provide useful information for policy making and guidance for further telemedicine practice in China and other developing countries.
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Affiliation(s)
- Cui He
- Department of Rehabilitation, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Qiru Zhou
- Department of Guangdong Online Hospital, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Wei Chen
- Outpatient Department, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Junzhang Tian
- Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Lihua Zhou
- Nursing Department, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Hong Peng
- Department of Otorhinolaryngology, Head and Neck Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Shuo Luan
- Department of Rehabilitation, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Shengfei Wang
- Department of Guangdong Online Hospital, Guangdong Second Provincial General Hospital, Guangzhou, China
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Clark E, MacCrosain A, Ward NS, Jones F. The key features and role of peer support within group self-management interventions for stroke? A systematic review. Disabil Rehabil 2018; 42:307-316. [PMID: 30325686 DOI: 10.1080/09638288.2018.1498544] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: To assess the key features of group self-management interventions for stroke and explore the role of peer support in this setting.Method: A segregated mixed research synthesis was conducted. A literature search was performed in OvidSP, EMBASE, AMED and EBSCO (up to January 2018). Studies were included if they delivered group interventions containing self-management principles to stroke survivors on more than two consecutive occasions. The bias of included studies was assessed using NICE guidelines. Quantitative data were analyzed using frequency counts and qualitative data were analyzed thematically.Results: Twelve studies were included in the review including a total of 3298 participants (age range 56-89) and eight different self-management interventions. Key features of group self-management interventions were identified as increasing knowledge, collaboration and/or communication, accessing resources, goal setting, and problem solving. Peer support facilitated the sharing of experiences, social comparison, vicarious learning, and increased motivation.Conclusion: Future self-management interventions should be designed to maximize peer support and incorporate techniques which facilitate, knowledge building, goal setting, access to resources, problem solving, and communication.Implications for rehabilitationGroup self-management interventions offer a way to provide peer support to stroke survivors and should be utilized in practice.Peer support is seen by stroke survivors as valuable because it can facilitate the sharing of experiences, social comparison, vicarious learning, and increase motivation.Knowledge building, goal setting, problem solving, collaborative skills, and the ability to access resources should be incorporated into interventions aiming to enhance self-management behaviors in the stroke population.
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Affiliation(s)
- Ella Clark
- National Hospital for Neurology and Neurosurgery, London, England
| | | | - Nick S Ward
- National Hospital for Neurology and Neurosurgery, London, England.,Sobell Department of Motor Neuroscience and Motor Disorders, University College London, London, England
| | - Fiona Jones
- Faculty of Health Social Care and Education, Kingston University and St Georges University of London, London, England
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Rush KL, Hatt L, Janke R, Burton L, Ferrier M, Tetrault M. The efficacy of telehealth delivered educational approaches for patients with chronic diseases: A systematic review. PATIENT EDUCATION AND COUNSELING 2018; 101:1310-1321. [PMID: 29486994 DOI: 10.1016/j.pec.2018.02.006] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 02/09/2018] [Accepted: 02/10/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The virtual delivery of patient education and other forms of telehealth have been proposed as alternatives to providing needed care for patients with chronic diseases. The purpose of this systematic review was to compare the efficacy of virtual education delivery on patient outcomes compared with usual care. METHODS The review examined citations from 3 databases, MEDLINE, CINAHL, and EMBASE using the search words telehealth, chronic disease, patient education, and related concepts. From 2447 records published between 2006 and 2017, 16 high to moderate quality studies were selected for review. Eligible papers compared virtual education to usual care using designs allowing for assessment of causality. RESULTS Telehealth modalities included the web, telephone, videoconference, and television delivered to patients with diabetes, chronic obstructive pulmonary disease, irritable bowel syndrome and heart failure. In 11 of 16 studies, virtually delivered interventions significantly improved outcomes compared to control conditions. In the remaining 5 studies, virtual education showed comparable outcomes to the control conditions. CONCLUSIONS Findings demonstrated that virtual education delivered to patients with chronic diseases was comparable, or more effective, than usual care. RESEARCH IMPLICATIONS Despite its benefits, there is potential for further research into the individual components which improve effectiveness of virtually delivered interventions.
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Affiliation(s)
- Kathy L Rush
- School of Nursing, University of British Columbia, Okanagan, Kelowna, Canada.
| | - Linda Hatt
- Irving K. Barber School of Arts and Sciences, University of British Columbia, Okanagan, Kelowna, Canada
| | - Robert Janke
- Library, University of British Columbia, Okanagan, Kelowna, Canada
| | - Lindsay Burton
- School of Nursing, University of British Columbia, Okanagan, Kelowna, Canada
| | - Matthew Ferrier
- School of Nursing, University of British Columbia, Okanagan, Kelowna, Canada
| | - Meghan Tetrault
- School of Nursing, University of British Columbia, Okanagan, Kelowna, Canada
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Berry A, McCabe CS, Muir S, Walsh N. Digital behaviour change interventions to facilitate physical activity in osteoarthritis: a systematic review. PHYSICAL THERAPY REVIEWS 2018. [DOI: 10.1080/10833196.2018.1470747] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Alice Berry
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Candy S. McCabe
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
- Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Sarah Muir
- Research Centre for Behaviour Change, Psychology Department, Bournemouth University, Bournemouth, UK
| | - Nicola Walsh
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
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35
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Smith ML, Bergeron CD, Ahn S, Towne SD, Mingo CA, Robinson KT, Mathis J, Meng L, Ory MG. Engaging the Underrepresented Sex: Male Participation in Chronic Disease Self-Management Education (CDSME) Programs. Am J Mens Health 2018; 12:935-943. [PMID: 29355070 PMCID: PMC6131430 DOI: 10.1177/1557988317750943] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 08/30/2017] [Accepted: 10/31/2017] [Indexed: 12/13/2022] Open
Abstract
Females are more likely than males to participate in evidence-based health promotion and disease prevention programs targeted for middle-aged and older adults. Despite the availability and benefits of Stanford's Chronic Disease Self-Management Education (CDSME) programs, male participation remains low. This study identifies personal characteristics of males who attended CDSME program workshops and identifies factors associated with successful intervention completion. Data were analyzed from 45,375 male CDSME program participants nationwide. Logistic regression was performed to examine factors associated with workshop attendance. Males who were aged 65-79 (OR = 1.27, p < .001), Hispanic (OR = 1.22, p < .001), African American (OR = 1.13, p < .001), Asian/Pacific Islander (OR = 1.26, p < .001), Native Hawaiian (OR = 3.14, p < .001), and residing in nonmetro areas (OR = 1.26, p < .001) were more likely to complete the intervention. Participants with 3+ chronic conditions were less likely to complete the intervention (OR = 0.87, p < .001). Compared to health-care organization participants, participants who attended workshops at senior centers (OR = 1.38, p < .001), community/multipurpose facilities (OR = 1.21, p < .001), and faith-based organizations (OR = 1.37, p < .001) were more likely to complete the intervention. Men who participated in workshops with more men were more likely to complete the intervention (OR = 2.14, p < .001). Once enrolled, a large proportion of males obtained an adequate intervention dose. Findings highlight potential strategies to retain men in CDSME programs, which include diversifying workshop locations, incorporating Session Zero before CDSME workshops, and using alternative delivery modalities (e.g., online).
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Affiliation(s)
- Matthew Lee Smith
- Center for Population Health and Aging,
Texas A&M University, College Station, TX, USA
- Department of Environmental and
Occupational Health, School of Public Health, Texas A&M University, College
Station, TX, USA
- Department of Health Promotion and
Behavior, College of Public Health, The University of Georgia, Athens, GA, USA
| | | | - SangNam Ahn
- Center for Population Health and Aging,
Texas A&M University, College Station, TX, USA
- Division of Health Systems Management
and Policy, School of Public Health, The University of Memphis, Memphis, TN,
USA
| | - Samuel D. Towne
- Center for Population Health and Aging,
Texas A&M University, College Station, TX, USA
- Department of Health Promotion and
Community Health Sciences, School of Public Health, Texas A&M University,
College Station, TX, USA
| | - Chivon A. Mingo
- Gerontology Institute, College of Arts
& Sciences, Georgia State University, Atlanta, GA, USA
| | - Kayin T. Robinson
- Department of Health Promotion and
Behavior, College of Public Health, The University of Georgia, Athens, GA, USA
| | - Jamarcus Mathis
- Department of Health Promotion and
Behavior, College of Public Health, The University of Georgia, Athens, GA, USA
| | - Lu Meng
- Department of Environmental and
Occupational Health, School of Public Health, Texas A&M University, College
Station, TX, USA
| | - Marcia G. Ory
- Center for Population Health and Aging,
Texas A&M University, College Station, TX, USA
- Department of Environmental and
Occupational Health, School of Public Health, Texas A&M University, College
Station, TX, USA
- Department of Health Promotion and
Community Health Sciences, School of Public Health, Texas A&M University,
College Station, TX, USA
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“In this together”: Social identification predicts health outcomes (via self-efficacy) in a chronic disease self-management program. Soc Sci Med 2018; 208:172-179. [DOI: 10.1016/j.socscimed.2018.03.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 02/12/2018] [Accepted: 03/03/2018] [Indexed: 11/23/2022]
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Banbury A, Nancarrow S, Dart J, Gray L, Parkinson L. Telehealth Interventions Delivering Home-based Support Group Videoconferencing: Systematic Review. J Med Internet Res 2018; 20:e25. [PMID: 29396387 PMCID: PMC5816261 DOI: 10.2196/jmir.8090] [Citation(s) in RCA: 152] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 09/10/2017] [Accepted: 11/02/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Group therapy and education and support sessions are used within health care across a range of disciplines such as chronic disease self-management and psychotherapy interventions. However, there are barriers that constrain group attendance, such as mobility, time, and distance. Using videoconferencing may overcome known barriers and improve the accessibility of group-based interventions. OBJECTIVE The aim of this study was to review the literature to determine the feasibility, acceptability, effectiveness, and implementation of health professional-led group videoconferencing to provide education or social support or both, into the home setting. METHODS Electronic databases were searched using predefined search terms for primary interventions for patient education and/or social support. The quality of studies was assessed using the Mixed Methods Appraisal Tool. We developed an analysis framework using hierarchical terms feasibility, acceptability, effectiveness, and implementation, which were informed by subheadings. RESULTS Of the 1634 records identified, 17 were included in this review. Home-based groups by videoconferencing are feasible even for those with limited digital literacy. Overall acceptability was high with access from the home highly valued and little concern of privacy issues. Some participants reported preferring face-to-face groups. Good information technology (IT) support and training is required for facilitators and participants. Communication can be adapted for the Web environment and would be enhanced by clear communication strategies and protocols. A range of improved outcomes were reported but because of the heterogeneity of studies, comparison of these across studies was not possible. There was a trend for improvement in mental health outcomes. Benefits highlighted in the qualitative data included engaging with others with similar problems; improved accessibility to groups; and development of health knowledge, insights, and skills. Videoconference groups were able to replicate group processes such as bonding and cohesiveness. Similar outcomes were reported for those comparing face-to-face groups and videoconference groups. CONCLUSIONS Groups delivered by videoconference are feasible and potentially can improve the accessibility of group interventions. This may be particularly useful for those who live in rural areas, have limited mobility, are socially isolated, or fear meeting new people. Outcomes are similar to in-person groups, but future research on facilitation process in videoconferencing-mediated groups and large-scale studies are required to develop the evidence base.
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Affiliation(s)
- Annie Banbury
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Rockhampton, Australia
- School of Health and Human Sciences, Southern Cross University, Lismore, Australia
| | - Susan Nancarrow
- Office of the Deputy Vice Chancellor (Research), Southern Cross University, Lismore, Australia
| | - Jared Dart
- Faculty of Health Sciences, Bond University, Gold Coast, Australia
| | - Leonard Gray
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Lynne Parkinson
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Rockhampton, Australia
- School of Medicine and Public Health, Newcastle University, Newcastle, Australia
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38
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Zhang H, Zhang H, Wang X, Yang Z, Zhao Y. Analysis of Requirements for Developing an mHealth-Based Health Management Platform. JMIR Mhealth Uhealth 2017; 5:e117. [PMID: 28778840 PMCID: PMC5561389 DOI: 10.2196/mhealth.5890] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 01/25/2017] [Accepted: 03/25/2017] [Indexed: 12/23/2022] Open
Abstract
Background Studies have consistently shown that mobile and Web-based apps have positive impacts on people’s daily lifestyles, health management, and disease treatment. As the development of medical and health informatization in China has evolved, different kinds of mobile-based apps for individuals and hospitals have been developed by software vendors. However, doubts and challenges posed by the media have prevented these apps from having a stable and substantial user base. Analyses of user requirements have not typically been performed prior to the design of such mobile apps. The health information government authority in Liaoning Province, China, was planning to establish a mobile health (mHealth)-based health management platform, aiming to alleviate the difficulties citizens have in seeking hospital services. Objective The goal of this study was to determine the actual health and medical needs of citizens that may be addressed by medical information technologies. The results may contribute to the functional design and development of health management and appointed treatment-oriented mobile apps. Methods In this study, a semi-structured questionnaire on mHealth requirements was designed and tested, and 240 questionnaires were given to the outpatients of the First Hospital of the China Medical University in Shenyang, Liaoning Province, China; of these, 228 valid responses were collected, for a response rate of 95%. We discussed the current development of mHealth with 50 related experts and engineers from health authorities and a medical information company. SPSS 13.0 was used for statistical analyses. Results After detailed analyses of the questionnaire data, several findings were evident: first, most citizens and patients were unclear about their health conditions (64.5%, 147/228) and were interested in receiving a mobile app as a tool to manage their health and medical needs (71.1%, 162/228). Patients in different outpatient departments had different opinions regarding online registration. Conversely, the main problems for outpatients were long waiting times (66.4%, 148/223) and difficulties in making appointments (46.5%, 106/228), and they also worried about payments and Internet problems when using a mobile app for appointment reservations. Furthermore, as the main service target of mHealth is the health management of the general population, we first need to solve the associated interoperability and data security problems associated with such apps. Conclusions This study provides insight into the health and medical requirements of smartphone apps, and draws attention to some of the challenges and opportunities of mHealth. We suggest several value-added features and characteristics that app developers should take into consideration when developing health and medical-related apps. The findings also highlight some major challenges that require further consideration and research to ensure that these apps meet the core needs of patients and aid the development of the health information system in Liaoning Province, China.
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Affiliation(s)
- Hehua Zhang
- Shengjing Hospital of China Medical University, China Medical University, Shenyang, Liaoning, China
| | - Han Zhang
- Department of Medical Informatics, China Medical University, Shenyang, Liaoning, China
| | - Xiaoning Wang
- Department of Medical Informatics, China Medical University, Shenyang, Liaoning, China
| | - Zuosen Yang
- Health Information Center of Liaoning Province, Shenyang, Liaoning, China
| | - Yuhong Zhao
- Shengjing Hospital of China Medical University, China Medical University, Liaoning, Shenyang, China
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Banbury A, Parkinson L, Nancarrow S, Dart J, Gray LC, Buckley J. Delivering patient education by group videoconferencing into the home: Lessons learnt from the Telehealth Literacy Project. J Telemed Telecare 2017; 22:483-488. [PMID: 27799452 DOI: 10.1177/1357633x16674359] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 08/31/2016] [Indexed: 11/16/2022]
Abstract
We examined the procedures for implementing group videoconference (VC) education for older people delivered into the home environment to identify the most common themes affecting the optimum delivery of VC home-based groups to older people. Participants (n = 52) were involved in a six-week group VC patient education program. There were a total of 44 sessions, undertaken by nine groups, with an average of four participants (range 1-7) and the facilitator. Participants could see and hear each other in real-time whilst in their homes with customised tablets or a desktop computer. The data presented here are based on a program log maintained by the facilitator throughout the implementation phase of the project and post intervention. The VC group experience is influenced by factors including the VC device location, connection processes, meeting times, use of visual aids and test calls. Social presence can be improved by communication protocols and strategies. Robust information technology (IT) support is essential in mitigating technical problems to enhance users' experience. Group patient education can be delivered by VC into homes of older people. However, careful pre-program planning, training and support should be considered when implementing such programs.
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Affiliation(s)
- Annie Banbury
- Human Health and Social Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Lynne Parkinson
- Human Health and Social Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Susan Nancarrow
- Health and Human Sciences, Southern Cross University, Lismore, New South Wales, Australia
| | - Jared Dart
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Leonard C Gray
- Centre for Online Health, University of Queensland, Brisbane, Queensland, Australia
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40
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Inskip JA, Lauscher HN, Li LC, Dumont GA, Garde A, Ho K, Hoens AM, Road JD, Ryerson CJ, Camp PG. Patient and health care professional perspectives on using telehealth to deliver pulmonary rehabilitation. Chron Respir Dis 2017; 15:71-80. [PMID: 28569116 PMCID: PMC5802656 DOI: 10.1177/1479972317709643] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The objective of this study was to identify the necessary features of pulmonary telerehabilitation (P-TR) from the perspectives of individuals living with chronic lung disease and health care professionals (HCPs) who deliver pulmonary rehabilitation (PR). Focus groups were carried out with patients (n = 26) and HCPs (n = 26) to elicit and explore their opinions about the critical elements of in-person PR and ideas for how these elements could be supported using technology. A questionnaire was used to assess technology use, PR experience, and general health status. Four key elements of PR were identified as critical to P-TR: the social aspect of PR; communicating with HCPs for education and support; using biosensors for monitoring and promoting self-knowledge; and the evolution of support with progress over time. A range of technology-enabled devices and programs were suggested as means to recreate aspects of these integral elements. Consultations with patients and HCPs suggest that users are interested in technology and want to ensure it recreates the important aspects of PR. Patients and HCPs identified similar key elements for P-TR. The opinions and suggestions of patients and HCPs should be the driving force of innovation if P-TR is to succeed in improving health outcomes.
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Affiliation(s)
- J A Inskip
- 1 Centre for Heart Lung Innovation, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,2 Department of Physical Therapy, UBC, Vancouver, British Columbia, Canada
| | - H Novak Lauscher
- 3 Digital Emergency Medicine, UBC, Vancouver, British Columbia, Canada
| | - L C Li
- 2 Department of Physical Therapy, UBC, Vancouver, British Columbia, Canada.,4 Arthritis Research Canada, Richmond, Canada
| | - G A Dumont
- 5 Electrical and Computer Engineering, UBC, Vancouver, Canada
| | - A Garde
- 5 Electrical and Computer Engineering, UBC, Vancouver, Canada
| | - K Ho
- 3 Digital Emergency Medicine, UBC, Vancouver, British Columbia, Canada
| | - A M Hoens
- 2 Department of Physical Therapy, UBC, Vancouver, British Columbia, Canada
| | - J D Road
- 6 Division of Respiratory Medicine, Department of Medicine, UBC, Vancouver, British Columbia, Canada
| | - C J Ryerson
- 1 Centre for Heart Lung Innovation, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,7 Providence Health Care, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - P G Camp
- 1 Centre for Heart Lung Innovation, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,2 Department of Physical Therapy, UBC, Vancouver, British Columbia, Canada.,7 Providence Health Care, St. Paul's Hospital, Vancouver, British Columbia, Canada
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41
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Wray F, Clarke D, Forster A. Post-stroke self-management interventions: a systematic review of effectiveness and investigation of the inclusion of stroke survivors with aphasia. Disabil Rehabil 2017; 40:1237-1251. [DOI: 10.1080/09638288.2017.1294206] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Faye Wray
- Academic Unit of Elderly Care and Rehabilitation, Leeds Institute of Health Sciences, University of Leeds, Bradford, UK
| | - David Clarke
- Academic Unit of Elderly Care and Rehabilitation, Leeds Institute of Health Sciences, University of Leeds, Bradford, UK
| | - Anne Forster
- Academic Unit of Elderly Care and Rehabilitation, Leeds Institute of Health Sciences, University of Leeds, Bradford, UK
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Warmington K, Flewelling C, Kennedy CA, Shupak R, Papachristos A, Jones C, Linton D, Beaton DE, Lineker S. Telemedicine delivery of patient education in remote Ontario communities: feasibility of an Advanced Clinician Practitioner in Arthritis Care (ACPAC)-led inflammatory arthritis education program. Open Access Rheumatol 2017; 9:11-19. [PMID: 28280400 PMCID: PMC5338940 DOI: 10.2147/oarrr.s122015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective Telemedicine-based approaches to health care service delivery improve access to care. It was recognized that adults with inflammatory arthritis (IA) living in remote areas had limited access to patient education and could benefit from the 1-day Prescription for Education (RxEd) program. The program was delivered by extended role practitioners with advanced training in arthritis care. Normally offered at one urban center, RxEd was adapted for videoconference delivery through two educator development workshops that addressed telemedicine and adult education best practices. This study explores the feasibility of and participant satisfaction with telemedicine delivery of the RxEd program in remote communities. Materials and methods Participants included adults with IA attending the RxEd program at one of six rural sites. They completed post-course program evaluations and follow-up interviews. Educators provided post-course feedback to identify program improvements that were later implemented. Results In total, 123 people (36 in-person and 87 remote, across 6 sites) participated, attending one of three RxEd sessions. Remote participants were satisfied with the quality of the video-conference (% agree/strongly agree): could hear the presenter (92.9%) and discussion between sites (82.4%); could see who was speaking at other remote sites (85.7%); could see the slides (95.3%); and interaction between sites adequately facilitated (94.0%). Educator and participant feedback were consistent. Suggested improvements included: use of two screens (speaker and slides); frontal camera angles; equal interaction with remote sites; and slide modifications to improve the readability on screen. Interview data included similar constructive feedback but highlighted the educational and social benefits of the program, which participants noted would have been inaccessible if not offered via telemedicine. Conclusion Study findings confirm the feasibility of delivering the RxEd program to remote communities by using telemedicine. Future research with a focus on the sustainability of this and other models of technology-supported patient education for adults with IA across Ontario is warranted.
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Affiliation(s)
| | | | - Carol A Kennedy
- Musculoskeletal Health & Outcomes Research, St. Michael's Hospital; Institute for Work & Health
| | - Rachel Shupak
- Martin Family Centre for Arthritis Care & Research, St. Michael's Hospital
| | | | - Caroline Jones
- Martin Family Centre for Arthritis Care & Research, St. Michael's Hospital
| | - Denise Linton
- Musculoskeletal Health & Outcomes Research, St. Michael's Hospital
| | - Dorcas E Beaton
- Musculoskeletal Health & Outcomes Research, St. Michael's Hospital; Institute for Work & Health; Graduate Department of Health Policy, Management and Evaluation; Graduate Department of Rehabilitation Science; Department of Occupational Science and Occupational Therapy, University of Toronto
| | - Sydney Lineker
- The Arthritis Society (Ontario Division), Toronto, ON, Canada
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Clark E, Bennett K, Ward N, Jones F. One size does not fit all – Stroke survivor’s views on group self-management interventions. Disabil Rehabil 2016; 40:569-576. [DOI: 10.1080/09638288.2016.1268653] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Ella Clark
- The National Hospital for Neurology and Neurosurgery, Queen Square, London & Sobell Department of Motor Neuroscience, UCL Institute of Neurology, London, United Kingdom of Great Britain and Northern Ireland
| | - Kate Bennett
- The Institute of Psychology and Health and Society, University of Liverpool, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Nick Ward
- The National Hospital for Neurology and Neurosurgery, Queen Square, London & Sobell Department of Motor Neuroscience, UCL Institute of Neurology, London, United Kingdom of Great Britain and Northern Ireland
| | - Fiona Jones
- Faculty of Health, Social Care and Education, Kingston University and St Georges University of London, London, United Kingdom of Great Britain and Northern Ireland
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Kennedy CA, Warmington K, Flewelling C, Shupak R, Papachristos A, Jones C, Linton D, Beaton DE, Lineker S, Hogg-Johnson S. A prospective comparison of telemedicine versus in-person delivery of an interprofessional education program for adults with inflammatory arthritis. J Telemed Telecare 2016; 23:197-206. [PMID: 26957111 DOI: 10.1177/1357633x16635342] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction We evaluated two modes of delivery of an inflammatory arthritis education program ("Prescription for Education" (RxEd)) in improving arthritis self-efficacy and other secondary outcomes. Methods We used a non-randomized, pre-post design to compare videoconferencing (R, remote using telemedicine) versus local (I, in-person) delivery of the program. Data were collected at baseline (T1), immediately following RxEd (T2), and at six months (T3). Self-report questionnaires served as the data collection tool. Measures included demographics, disorder-related, Arthritis Self-Efficacy Scale (SE), previous knowledge (Arthritis Community Research and Evaluation Unit (ACREU) rheumatoid arthritis knowledge questionnaire), coping efficacy, Illness Intrusiveness, and Effective Consumer Scale. Analysis included: baseline comparisons and longitudinal trends (R vs I groups); direct between-group comparisons; and Generalized Estimating Equations (GEE) analysis. Results A total of 123 persons attended the program (I: n = 36; R: n = 87) and 111 completed the baseline questionnaire (T1), with follow-up completed by 95% ( n = 117) at T2 and 62% ( n = 76) at T3. No significant baseline differences were found across patient characteristics and outcome measures. Both groups (R and I) showed immediate effect (improved arthritis SE, mean change (95% confidence interval (CI)): R 1.07 (0.67, 1.48); I 1.48 (0.74, 2.23)) after the program that diminished over six months (mean change (95% CI): R 0.45 (-0.1, 0.1); I 0.73 (-0.25, 1.7)). For each of the secondary outcomes, both groups showed similar trends for improvement (mean change scores (95% CI)) over time. GEE analysis did not show any meaningful differences between groups (R vs I) over time. Discussion Improvements in arthritis self-efficacy and secondary outcomes displayed similar trends for I and R participant groups.
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Affiliation(s)
- Carol A Kennedy
- 1 Musculoskeletal Health and Outcomes Research, St. Michael's Hospital, Canada.,2 Institute for Work and Health, Canada.,3 Department of Physical Therapy, University of Toronto, Canada
| | - Kelly Warmington
- 4 Knowledge Translation, The Hospital for Sick Children, Canada.,5 Learning Institute, The Hospital for Sick Children, Canada
| | | | - Rachel Shupak
- 7 Martin Family Centre for Arthritis Care & Research, St. Michael's Hospital, Canada
| | - Angelo Papachristos
- 7 Martin Family Centre for Arthritis Care & Research, St. Michael's Hospital, Canada
| | - Caroline Jones
- 7 Martin Family Centre for Arthritis Care & Research, St. Michael's Hospital, Canada
| | - Denise Linton
- 1 Musculoskeletal Health and Outcomes Research, St. Michael's Hospital, Canada
| | - Dorcas E Beaton
- 1 Musculoskeletal Health and Outcomes Research, St. Michael's Hospital, Canada.,2 Institute for Work and Health, Canada.,8 Graduate Department of Health Policy, Management and Evaluation, University of Toronto, Canada.,9 Graduate Department of Rehabilitation Science, University of Toronto, Canada.,10 Department of Occupational Science and Occupational Therapy, University of Toronto, Canada
| | | | - Sheilah Hogg-Johnson
- 2 Institute for Work and Health, Canada.,12 Dalla Lana School of Public Health, University of Toronto, Canada
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45
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Chang JE, Sequeira A, McCord CE, Garney WR. Videoconference Grief Group Counseling in Rural Texas: Outcomes, Challenges, and Lessons Learned. JOURNAL FOR SPECIALISTS IN GROUP WORK 2016. [DOI: 10.1080/01933922.2016.1146376] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Banbury A, Parkinson L, Nancarrow S, Dart J, Gray L, Buckley J. Multi-site videoconferencing for home-based education of older people with chronic conditions: the Telehealth Literacy Project. J Telemed Telecare 2015; 20:353-9. [PMID: 25399994 DOI: 10.1177/1357633x14552369] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We examined the acceptability of multi-site videoconferencing as a method of providing group education to older people in their homes. There were 9 groups comprising 52 participants (mean age 73 years) with an average of four chronic conditions. Tablet computers or PCs were installed in participant's homes and connected to the Internet by the National Broadband Network (high-speed broad band network) or by the 4G wireless network. A health literacy and self-management programme was delivered by videoconference for 5 weeks. Participants were able to view and interact with all group members and the facilitator on their devices. During the study, 44 group videoconferences were conducted. Evaluation included 16 semi-structured interviews, 3 focus groups and a journal detailing project implementation. The participants reported enjoying home-based group education by videoconference and found the technology easy to use. Using home-based groups via videoconference was acceptable for providing group education, and considered particularly valuable for people living alone and/or with limited mobility. Audio difficulties were the most commonly reported problem. Participants connected with 4G experienced more problems (audio and visual) than participants on the National Broadband Network and those living in multi-dwelling residences reported more problems than those living in single-dwelling residences. Older people with little computer experience can be supported to use telehealth equipment. Telehealth has the potential to improve access to education about chronic disease self-management.
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Affiliation(s)
- Annie Banbury
- Health Collaborative Research Network and Human Health and Social Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Lynne Parkinson
- Health Collaborative Research Network and Human Health and Social Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Susan Nancarrow
- Health and Human Sciences, Southern Cross University, Lismore, New South Wales, Australia
| | - Jared Dart
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Len Gray
- Centre for Online Health, University of Queensland, Brisbane, Queensland, Australia
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An internet survey of the characteristics and physical activity of community-dwelling Australian adults with acquired brain injury: Exploring interest in an internet-delivered self-management program focused on physical activity. Disabil Health J 2015; 9:54-63. [PMID: 26372088 DOI: 10.1016/j.dhjo.2015.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 04/28/2015] [Accepted: 08/06/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Individuals with acquired brain injury (ABI) are more likely to be physically inactive and experience barriers to accessing services to address inactivity. This study was designed to guide the development of an internet-delivered self-management program to increase physical activity after ABI. OBJECTIVE The aims of this study were to examine the current physical activity status of community-dwelling Australian adults with ABI, the barriers to physical activity they experience and to explore interest an internet-delivered self-management program aimed at increasing physical activity. METHODS An online survey of Australian adults with ABI was used to collect information about demographic characteristics; general health; emotional well-being; mobility and physical activity status, and satisfaction; barriers to physical activity; confidence in overcoming barriers, and; interest in an internet self-management program. Data were analyzed descriptively and correlational analyses examined relationships between variables. RESULTS Data were analyzed from 59 respondents. Over half were not satisfied with their current physical activity status. The most frequently reported barriers were pain/discomfort, fatigue and fear, and confidence to overcome these barriers was very low. Interest in an internet-delivered self-management program was high (74%) and not related to the amount of physical activity, satisfaction with physical activity and mobility status or total number of barriers. CONCLUSION Australian adults with ABI are not satisfied with their activity levels and experience barriers in maintaining their physical activity levels. Participants were interested in accessing an internet-delivered self-management program aimed at improving physical activity levels. Therefore such a program warrants development and evaluation.
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Liddy C, Johnston S, Guilcher S, Irving H, Hogel M, Jaglal S. Impact of a chronic disease self-management program on healthcare utilization in eastern Ontario, Canada. Prev Med Rep 2015; 2:586-90. [PMID: 26844122 PMCID: PMC4721386 DOI: 10.1016/j.pmedr.2015.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
This study aims to examine patients' patterns of health care utilization before and after participation in a Chronic Disease Self-Management Program (CDSMP). We conducted a pre-post study using health care administrative data from 186 individuals in the Ottawa region who participated in our CDSMP between September 2009 and January 2011. We collected the number of general practitioner/specialist visits, planned/unplanned emergency department visits, and hospitalizations, measured 6 months and 1 year before and after participation in the CDSMP. Multivariate analysis was performed to identify associations between patient characteristics and pre-post CDSMP health care utilization. CDSMP participation showed no effect on number of physician visits, hospitalizations, or emergency department visits. Individuals with > 5 chronic conditions were more likely to visit a physician and the emergency department following the CDSMP than those with 1 chronic condition. Among individuals > 61 years of age, those with the marital status widowed were more likely to visit their physician and the emergency department following the CDSMP than married individuals. To conclude, the CDSMP appeared not to decrease health care utilization. Low baseline utilization rates, short-term follow-ups, and a relatively healthy patient population may have contributed to the program's low impact. We examine patients' health care use before and after a self-management program. Patients complete six workshops teaching chronic disease self-management skills. The program does not appear to decrease health care utilization. Several factors (e.g. low baseline usage, high patient health) may reduce impact.
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Affiliation(s)
- Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyere St, Annex E, Ottawa, Ontario K1N 5C8, Canada; Department of Family Medicine, University of Ottawa, 43 Bruyere Street (Floor 3JB), Ottawa, Ontario K1N 5C8, Canada
| | - Sharon Johnston
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyere St, Annex E, Ottawa, Ontario K1N 5C8, Canada; Department of Family Medicine, University of Ottawa, 43 Bruyere Street (Floor 3JB), Ottawa, Ontario K1N 5C8, Canada
| | - Sara Guilcher
- Canadian Population Health Initiative, Canadian Institute for Health Information, 4110 Yonge Street, Suite 300, Toronto, Ontario M2P 2B7, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
| | - Hannah Irving
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyere St, Annex E, Ottawa, Ontario K1N 5C8, Canada
| | - Matthew Hogel
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, 43 Bruyere St, Annex E, Ottawa, Ontario K1N 5C8, Canada
| | - Susan Jaglal
- Toronto Rehabilitation Institute-University Health Network, 7-504, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada; Institute for Clinical Evaluative Sciences, University of Toronto, 155 College Street, Suite 424, Toronto, Ontario M5T 3M6, Canada
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49
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Jones TM, Dean CM, Hush JM, Dear BF, Titov N. A systematic review of the efficacy of self-management programs for increasing physical activity in community-dwelling adults with acquired brain injury (ABI). Syst Rev 2015; 4:51. [PMID: 25927591 PMCID: PMC4422226 DOI: 10.1186/s13643-015-0039-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/31/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Individuals living with acquired brain injury, typically caused by stroke or trauma, are far less likely to achieve recommended levels of physical activity for optimal health and well-being. With a growing number of people living with chronic disease and disability globally, self-management programs are seen as integral to the management of these conditions and the prevention of secondary health conditions. However, to date, there has been no systematic review of the literature examining the efficacy of self-management programs specifically on physical activity in individuals with acquired brain injury, whether delivered face-to-face or remotely. Therefore, the purpose of this review is to evaluate the efficacy of self-management programs in increasing physical activity levels in adults living in the community following acquired brain injury. The efficacy of remote versus face-to-face delivery was also examined. METHODS A systematic review of the literature was conducted. Electronic databases were searched. Two independent reviewers screened all studies for eligibility, assessed risk of bias, and extracted relevant data. RESULTS Five studies met the inclusion criteria for this review. Studies were widely heterogeneous with respect to program content and delivery characteristics and outcomes, although all programs utilized behavioral change principles. Four of the five studies examined interventions in which physical activity was a component of a multifaceted intervention, where the depth to which physical activity specific content was covered, and the extent to which skills were taught and practiced, could not be clearly established. Three studies showed favorable physical activity outcomes following self-management interventions for stroke; however, risk of bias was high, and overall efficacy remains unclear. Although not used in isolation from face-to-face delivery, remote delivery via telephone was the predominant form of delivery in two studies with support for its inclusion in self-management programs for individuals following stroke. CONCLUSIONS The efficacy of self-management programs in increasing physical activity levels in community-dwelling adults following acquired brain injury (ABI) is still unknown. Research into the efficacy of self-management programs specifically aimed at improving physical activity in adults living in the community following acquired brain injury is needed. The efficacy of remote delivery methods also warrants further investigation. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42013006748.
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Affiliation(s)
- Taryn M Jones
- Department of Health Professions, Macquarie University, Ground Floor, 75 Talavera Rd, Sydney, NSW, 2109, Australia. .,Centre for Physical Health, Macquarie University, Ground Floor, 75 Talavera Rd, Sydney, 2109, Australia.
| | - Catherine M Dean
- Department of Health Professions, Macquarie University, Ground Floor, 75 Talavera Rd, Sydney, NSW, 2109, Australia. .,Centre for Physical Health, Macquarie University, Ground Floor, 75 Talavera Rd, Sydney, 2109, Australia.
| | - Julia M Hush
- Department of Health Professions, Macquarie University, Ground Floor, 75 Talavera Rd, Sydney, NSW, 2109, Australia. .,Centre for Physical Health, Macquarie University, Ground Floor, 75 Talavera Rd, Sydney, 2109, Australia.
| | - Blake F Dear
- Department of Psychology, Centre for Emotional Health, Building C3A, Level 7, Macquarie University, Sydney, 2109, Australia. .,Centre for Physical Health, Macquarie University, Ground Floor, 75 Talavera Rd, Sydney, 2109, Australia.
| | - Nickolai Titov
- Department of Psychology, Centre for Emotional Health, Building C3A, Level 7, Macquarie University, Sydney, 2109, Australia. .,Centre for Physical Health, Macquarie University, Ground Floor, 75 Talavera Rd, Sydney, 2109, Australia.
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Tozzi AE, Carloni E, Gesualdo F, Russo L, Raponi M. Attitude of families of patients with genetic diseases to use m-health technologies. Telemed J E Health 2014; 21:86-9. [PMID: 25469727 DOI: 10.1089/tmj.2014.0080] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Dealing with complex chronic disease may take great advantage of mobile health (m-health) technologies. We performed an online survey on the perception of use of m-health technologies among families of patients affected with Down's syndrome, Williams' syndrome, and 22q11 deletion syndrome. MATERIALS AND METHODS The survey included questions on sociodemographic characteristics, availability of a connection to the Internet on different devices, interest in m-health technologies, and functions to be implemented in order to meet family needs. Through multivariate analysis we studied the association between characteristics of enrolled families and interest in m-health. RESULTS In total, 166 people completed the questionnaire. Forty-seven percent connected to the Internet through a mobile phone, versus 34% through a tablet. Eighty percent were interested in m-health solutions for their child's disease; the main reasons of interest were saving time (49%) and being more involved in the disease management (49%). Desired m-health services were aimed at rapid consultation with a physician (68%) and at retrieving updated information on research and on ongoing clinical studies (66%). Interest in m-health services was associated with availability of a mobile Internet connection, whereas no association was found with living in a remote area. CONCLUSIONS Families of patients with Down's syndrome, Williams' syndrome, and 22q11 deletion syndrome show a positive attitude toward m-health technologies. Such syndromes represent a good model for translating published recommendations into m-health applications, which may improve compliance. Expectations regarding m-health lead to patient empowerment, and m-health applications are perceived as useful not only for people living far away from healthcare centers.
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Affiliation(s)
- Alberto E Tozzi
- IRCCS, Telemedicine Unit, Bambino Gesù Children's Hospital , Rome, Italy
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