Disease Management in Telemedicine and e-Health

Pathways of Media Contact to Health Literacy in Middle-Aged and Older People: The Chain Mediation Effect of Perceived Social Support and Self-Efficacy

Objective

To understand the status of media exposure, social support, self-efficacy, and health literacy among middle-aged and older adults in China, and explore the impact path of media exposure on the health literacy of this population, providing a reference for promoting their physical and mental health.

Methods

From July to November 2022, a multi-stage random sampling method was employed to survey 16,938 Chinese middle-aged and older adults aged 46 and above. Structural equation modeling and statistical analysis were conducted using LISREL 8.8 and Mplus 8.3 software.

Results

The average score for media exposure among Chinese middle-aged and older adults was (18.55±5.36), perceived social support was (60.68±12.51), self-efficacy was (28.76±5.40), and health literacy was (35.49±6.05). Statistical results revealed that media exposure has a positive impact on the health literacy of middle-aged and older adults, with a direct effect of 0.091 (p < 0.001). Mediation analysis showed that media exposure can affect the health literacy of this population through the independent mediating effects of perceived social support (β = 0.013, p < 0.001) and self-efficacy (β = 0.029, p < 0.001), as well as through a chain mediation effect involving perceived social support and self-efficacy (β = 0.015, p < 0.001).

Conclusion

As a pathway for health information dissemination, media exposure plays a crucial role in the intervention of health literacy among middle-aged and older adults. Perceived social support and self-efficacy not only have independent mediating effects but also significant chain mediating effects in the relationship between media exposure and health literacy among this population. Therefore, improving the health literacy of middle-aged and older people can be popularized through media and improved in a multi-path, all-round, and precise way with the help of related technologies and social forces from which media literacy can be improved.

Improving Blood Pressure Control Using Smart Technology

BACKGROUND

The authors sought to determine if wireless oscillometric home blood pressure monitoring (HBPM) that integrates with smartphone technology improves blood pressure (BP) control among patients with new or existing uncontrolled hypertension (HTN).

METHODS

A prospective observational cohort study monitored BP control before and after an educational intervention and introduction to HBPM. Patients in the intervention group were instructed to track their BP using a smartphone device three to seven times per week. Cases were matched to controls at a 1:3 allocation ratio on several clinical characteristics over the same period and received usual care. The proportion of patients with controlled BP was compared between groups at pre- and postintervention, ∼9 months later. Results and Materials: The total study population included 484 patients with mean age 60 years (range 23-102 years), 47.7% female, and 84.6% Caucasian. Mean preintervention BP was 137.8 mm Hg systolic and 81.4 mm Hg diastolic. Mean BP control rates improved for patients who received HBPM from 42% to 67% compared with matched control patients who improved from 59% to 67% (p < 0.01).

CONCLUSION

HBPM with smartphone technology has the potential to improve HTN management among patients with uncontrolled or newly diagnosed HTN. Technology needs to be easy to use and operate and would work best when integrated into local electronic health record systems. In systems without this capability, medical assistants or other personnel may be trained to facilitate the process. Nurse navigator involvement was instrumental in bridging communication between the patients and provider.

Attitudes of Primary Care Physicians Toward Sickle Cell Disease Care, Guidelines, and Comanaging Hydroxyurea With a Specialist

BACKGROUND

Sickle cell disease (SCD) is a complex chronic disease requiring multidisciplinary care that involves primary care physicians (PCPs) working with a hematologist or SCD specialists. However, PCPs often lack access to SCD specialists and are unaware of SCD guidelines or efficacious treatment.

METHODS

We partnered with Community Care of North Carolina (CCNC) to identify assigned PCPs for SCD patients with Medicaid across North Carolina. CCNC network administrators distributed a web-based questionnaire for completion. The questionnaire involved 12 self-reported items on a yes-no or a 1 to 5 Likert-type scale that assessed PCP attitudes toward SCD care, awareness of recent guidelines, and comanaging hydroxyurea.

RESULTS

Of the 53 PCPs who completed the electronic survey, 73% felt they were comfortable with the number of SCD patients in their practice. Most PCPs reported having infrequent communications with an SCD specialist (67%) and most were also not aware of the 2014 SCD guidelines (66%). Many reported that they would frequently use the new SCD guidelines if provided to them (76%). Furthermore, 51% of PCPs expressed comfort with using mobile apps to access SCD guidelines and provided email contact to receive further information. The majority also reported being comfortable comanaging hydroxyurea with an SCD specialist (65%).

CONCLUSION

Few PCPs in North Carolina were aware of the new SCD guidelines or had regular communication with an SCD specialist. The majority of PCPs, however, demonstrated a favorable attitude toward receiving the SCD guidelines and comanaging hydroxyurea with a specialist. In response to this gap in care, we have developed a mobile-based SCD toolbox specifically for PCPs to provide guidelines, algorithms, and a method to communicate with local SCD specialists. With the interest in receiving these guidelines, we are confident the toolbox will provide an easy to use platform to assist PCPs to utilize the SCD guidelines.

Apple HealthKit and Health App: Patient Uptake and Barriers in Primary Care

BACKGROUND

The Apple (Cupertino, CA) HealthKit is a new telemonitoring platform that promises to make it easier for patients and healthcare institutions to collect, transmit, and store data from devices that monitor common conditions such as diabetes, hypertension, and asthma. To assess the potential use for this platform in primary care, we need to know how many Apple Healthkit users there are and if they have conditions that could benefit from telemonitoring.

MATERIALS AND METHODS

We examined patients in the Mayo Clinic primary care practice in Rochester, MN, who registered to connect to their Mayo Clinic medical record with Apple HealthKit. We used the primary care registry to identify users with chronic conditions of diabetes, hypertension, asthma, and depression. We also examined users for recent measurements of blood pressure, glucose, hemoglobin A1C, and cholesterol.

RESULTS

Of 98,151 patients there were 503 registrants of HealthKit. There were 95 (19%) who had hypertension, 37 (7.4%) who had diabetes, 125 (25%) who had depression, and 56 (11%) who had asthma. Overall, there were 245 (49%) who had readily telemonitorable conditions.

CONCLUSIONS

Almost half of primary care Apple HealthKit registrants have conditions that could benefit from telemonitoring. This pre-installed telemonitoring platform, available on every new iPhone(®) (Apple), can be used to monitor a significant number of primary care patients. However, it also has continued provider and informatics barriers that need to be addressed.

mHealth Clinic Appointment PC Tablet: Implementation, Challenges and Solutions

BACKGROUND

Patients requiring daily intravenous (IV) home parenteral nutrition (HPN) would benefit from in-home professional observation to improve self-care, to assess, detect and prevent serious complications.

AIMS

The study aims are to assess the viability and utility of conducting mobile healthcare (mHealth) videoconference assessments with patients managing lifelong daily 12-hour IV nutrition infusions in their homes. The challenges and solutions to implementing mobile personal computer (PC) tablet based clinic appointments are described.

METHODS

A wireless Apple iPad Mini™ mobile touch-screen tablet computer with 5 mega-pixel camera was loaned to patients. Each tablet had Polycom RealPresence software and a fourth generation (4G) mobile telecommunications data plan. These supported audio-visual mobile videoconferencing encrypted connections between health professionals in their offices and HPN patients and their family members in their homes. Patients' and professionals' evaluations of their mHealth clinic experiences are collected.

RESULTS

Patients (mean age = 41.9, SD = 2.8 years) had been prescribed 12-hour home parenteral nutrition (HPN) infusions daily due short bowel disorders. Patients had been on HPN from 1 to 10 years (M=4, SD=3.6). Evaluation of clinic appointments revealed that 100% of the patients (n=45) and the professionals (n=6) indicated that they can clearly hear and easily see one another. The mHealth audio-visual interactions were highly rated by patients and family members. Professionals highly rated their ability to obtain a medical history and visual inspection of patients. Several challenges were identified and recommendations for resolutions are described.

DISCUSSION

All patients and professionals highly rated the iPad mHealth clinic appointments for convenience and ease of communicating between homes and offices. An important challenge for all mHealth visits is the clinical professional's ability to make clinically accurate judgments about what they observed and heard from the patients. Following our solutions for obtaining clear visuals with the iPad can improve ability to make clinical assessments.

Telemonitoring Blood Pressure by Secure Message on a Patient Portal: Use, Content, and Outcomes

INTRODUCTION

Secure messages on a patient portal allow patients to asynchronously communicate with their healthcare teams. Patients can use this mode of communication to transmit data such as home blood pressure (BP) measurements.

MATERIALS AND METHODS

In this retrospective study, we examined 52,373 secure messages for content related to home BP monitoring. Text searches of the messages were followed by manual message review to identify BP-related messages. Two physicians independently reviewed a sample of these messages and the provider responses.

RESULTS

Of 19,545 total message users, there were 4,412 message users with a diagnosis of hypertension and 365 who sent BP-related messages. Of the 52,373 secure messages, 624 messages (1.2%) contained information about home BP. Providers responded to messages with a change in medication dose or a prescription in 17%. When new medications were recommended, providers needed more pharmacy information in 53%. Messages contained a concern about high BP in 27% and concern about low BP in 8.5%. BP data in patient messages only attained American Heart Association-endorsed measurement criteria in 7% of messages.

CONCLUSIONS

Patient-generated secure messages with BP data often result in message responses from providers for a BP medication dose change or a new prescription. Despite its increasing use, BP management by secure message has significant limitations and might be better served by BP virtual visits (e-visits) containing specific data requirements such as an average BP value from at least 12 readings and a preferred pharmacy for a prescription.