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Mooney K, Beck SL, Wilson C, Coombs L, Whisenant M, Moraitis AM, Sloss EA, Alekhina N, Lloyd J, Steinbach M, Nicholson B, Iacob E, Donaldson G. Assessing Patient Perspectives and the Health Equity of a Digital Cancer Symptom Remote Monitoring and Management System. JCO Clin Cancer Inform 2024; 8:e2300243. [PMID: 39042843 DOI: 10.1200/cci.23.00243] [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: 11/17/2023] [Revised: 03/05/2024] [Accepted: 05/31/2024] [Indexed: 07/25/2024] Open
Abstract
PURPOSE People with cancer experience poorly controlled symptoms that persist between treatment visits. Automated digital technology can remotely monitor and facilitate symptom management at home. Essential to digital interventions is patient engagement, user satisfaction, and intervention benefits that are distributed across patient populations so as not to perpetuate inequities. We evaluated Symptom Care at Home (SCH), an automated digital platform, to determine patient engagement, satisfaction, and whether intervention subgroups gained similar symptom reduction benefits. METHODS 358 patients with cancer receiving a course of chemotherapy were randomly assigned to SCH or usual care (UC). Both groups reported daily on 11 symptoms and completed the SF36 (Short Form Health Survey) monthly. SCH participants received immediate automated self-care coaching on reported symptoms. As needed, nurse practitioners followed up for poorly controlled symptoms. RESULTS The average participant was White (83%), female (75%), and urban-dwelling (78.6%). Daily call adherence was 90% of expected days. Participants reported high user satisfaction. SCH participants had lower symptom burden than UC in all subgroups: age, sex, race, income, residence type, diagnosis, and stage (all P < .001 effect size 0.33-0.65), except for stages I and II cancers. Non-White and lower-income SCH participants gained a higher magnitude of symptom reduction than White participants and higher-income participants. Additionally, SCH men gained higher SF36 mental health (MH) benefit. There were no differences on other SF36 indices. CONCLUSION Participants were highly satisfied and consistently engaged the SCH platform. SCH men gained large MH improvements, perhaps from increased comfort in sharing concerns through automated interactions. Although all intervention subgroups benefited, non-White participants and those with lower income gained higher symptom reduction benefit, suggesting that systematic care through digital tools can overcome existing disparities in symptom care outcomes.
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Affiliation(s)
- Kathi Mooney
- College of Nursing, University of Utah, Salt Lake City, UT
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Susan L Beck
- College of Nursing, University of Utah, Salt Lake City, UT
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Christina Wilson
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL
| | - Lorinda Coombs
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Meagan Whisenant
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ann Marie Moraitis
- Department of Pediatric Oncology, Dana Farber Cancer Institute, Boston, MA
| | | | | | - Jennifer Lloyd
- College of Nursing, University of Utah, Salt Lake City, UT
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Mary Steinbach
- College of Nursing, University of Utah, Salt Lake City, UT
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | - Eli Iacob
- College of Nursing, University of Utah, Salt Lake City, UT
| | - Gary Donaldson
- College of Nursing, University of Utah, Salt Lake City, UT
- School of Medicine, University of Utah, Salt Lake City, UT
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Wang S, Shi Y, Sui M, Shen J, Chen C, Zhang L, Zhang X, Ren D, Wang Y, Yang Q, Gao J, Cheng M. Telephone follow-up based on artificial intelligence technology among hypertension patients: Reliability study. J Clin Hypertens (Greenwich) 2024; 26:656-664. [PMID: 38778548 PMCID: PMC11180679 DOI: 10.1111/jch.14823] [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: 01/22/2024] [Revised: 03/16/2024] [Accepted: 03/28/2024] [Indexed: 05/25/2024]
Abstract
Artificial intelligence (AI) telephone is reliable for the follow-up and management of hypertensives. It takes less time and is equivalent to manual follow-up to a high degree. We conducted a reliability study to evaluate the efficiency of AI telephone follow-up in the management of hypertension. During May 18 and June 30, 2020, 350 hypertensives managed by the Pengpu Community Health Service Center in Shanghai were recruited for follow-up, once by AI and once by a human. The second follow-up was conducted within 3-7 days (mean 5.5 days). The mean length time of two calls were compared by paired t-test, and Cohen's Kappa coefficient was used to evaluate the reliability of the results between the two follow-up visits. The mean length time of AI calls was shorter (4.15 min) than that of manual calls (5.24 min, P < .001). The answers related to the symptoms showed moderate to substantial consistency (κ:.465-.624, P < .001), and those related to the complications showed fair consistency (κ:.349, P < .001). In terms of lifestyle, the answer related to smoking showed a very high consistency (κ:.915, P < .001), while those addressing salt consumption, alcohol consumption, and exercise showed moderate to substantial consistency (κ:.402-.645, P < .001). There was moderate consistency in regular usage of medication (κ:.484, P < .001).
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Affiliation(s)
- Siyuan Wang
- Division of Chronic Non‐communicable Disease and InjuryShanghai Municipal Center for Disease Control and PreventionShanghaiChina
| | - Yan Shi
- Division of Chronic Non‐communicable Disease and InjuryShanghai Municipal Center for Disease Control and PreventionShanghaiChina
| | - Mengyun Sui
- Division of Chronic Non‐communicable Disease and InjuryShanghai Municipal Center for Disease Control and PreventionShanghaiChina
| | - Jing Shen
- Product DepartmentYicheng Information Technology Limited CorporationShanghaiChina
| | - Chen Chen
- Health Management DepartmentPengpu Community Health Service CenterShanghaiChina
| | - Lin Zhang
- Health Management DepartmentPengpu Community Health Service CenterShanghaiChina
| | - Xin Zhang
- Department of Chronic Non‐communicable Diseases Surveillance and ManagementJingan District Center for Disease Control and PreventionShanghaiChina
| | - Dongsheng Ren
- Department of Chronic Non‐communicable Diseases Surveillance and ManagementJingan District Center for Disease Control and PreventionShanghaiChina
| | - Yuheng Wang
- Division of Chronic Non‐communicable Disease and InjuryShanghai Municipal Center for Disease Control and PreventionShanghaiChina
| | - Qinping Yang
- Division of Chronic Non‐communicable Disease and InjuryShanghai Municipal Center for Disease Control and PreventionShanghaiChina
| | - Junling Gao
- Department of Prevention Medicine and Health Education, School of Public HealthFudan UniversityShanghaiChina
| | - Minna Cheng
- Division of Chronic Non‐communicable Disease and InjuryShanghai Municipal Center for Disease Control and PreventionShanghaiChina
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MacLean RR, Ankawi B, Driscoll MA, Gordon MA, Frankforter TL, Nich C, Szollosy SK, Loya JM, Brito L, Ribeiro MIP, Edmond SN, Becker WC, Martino S, Sofuoglu M, Heapy AA. Efficacy of Integrating the Management of Pain and Addiction via Collaborative Treatment (IMPACT) in Individuals With Chronic Pain and Opioid Use Disorder: Protocol for a Randomized Clinical Trial of a Digital Cognitive Behavioral Treatment. JMIR Res Protoc 2024; 13:e54342. [PMID: 38506917 PMCID: PMC10993119 DOI: 10.2196/54342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/25/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Chronic pain is common among individuals with opioid use disorder (OUD) who are maintained on medications for OUD (MOUD; eg, buprenorphine or methadone). Chronic pain is associated with worse retention and higher levels of substance use. Treatment of individuals with chronic pain receiving MOUD can be challenging due to their increased clinical complexity. Given the acute and growing nature of the opioid crisis, MOUD is increasingly offered in a wide range of settings, where high-quality, clinician-delivered, empirically validated behavioral treatment for chronic pain may not be available. Therefore, digital treatments that support patient self-management of chronic pain and OUD have the potential for wider implementation to fill this gap. OBJECTIVE This study aims to evaluate the efficacy of Integrating the Management of Pain and Addiction via Collaborative Treatment (IMPACT), an interactive digital treatment program with asynchronous coach feedback, compared to treatment as usual (TAU) in individuals with chronic pain and OUD receiving MOUD. METHODS Adult participants (n=160) receiving MOUD and reporting bothersome or high-impact chronic pain will be recruited from outpatient opioid treatment programs in Connecticut (United States) and randomized 1:1 to either IMPACT+TAU or TAU only. Participants randomized to IMPACT+TAU will complete an interactive digital treatment that includes 9 modules promoting training in pain and addiction coping skills and a progressive walking program. The program is augmented with a weekly personalized voice message from a trained coach based on daily participant-reported pain intensity and interference, craving to use opioids, sleep quality, daily steps, pain self-efficacy, MOUD adherence, and engagement with IMPACT collected through digital surveys. Outcomes will be assessed at 3, 6, and 9 months post randomization. The primary outcome is MOUD retention at 3 months post randomization (ie, post treatment). Secondary outcomes include pain interference, physical functioning, MOUD adherence, substance use, craving, pain intensity, sleep disturbance, pain catastrophizing, and pain self-efficacy. Semistructured qualitative interviews with study participants (n=34) randomized to IMPACT (completers and noncompleters) will be conducted to evaluate the usability and quality of the program and its outcomes. RESULTS The study has received institutional review board approval and began recruitment at 1 site in July 2022. Recruitment at a second site started in January 2023, with a third and final site anticipated to begin recruitment in January 2024. Data collection is expected to continue through June 2025. CONCLUSIONS Establishing efficacy for a digital treatment for addiction and chronic pain that can be integrated into MOUD clinics will provide options for individuals with OUD, which reduce barriers to behavioral treatment. Participant feedback on the intervention will inform updates or modifications to improve engagement and efficacy. TRIAL REGISTRATION ClinicalTrials.gov NCT05204576; https://clinicaltrials.gov/ct2/show/NCT05204576. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/54342.
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Affiliation(s)
- R Ross MacLean
- VA Connecticut Healthcare System, West Haven, CT, United States
- School of Medicine, Yale University, New Haven, CT, United States
| | - Brett Ankawi
- School of Medicine, Yale University, New Haven, CT, United States
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, VA Connecticut Healthcare System, West Haven, CT, United States
| | - Mary A Driscoll
- School of Medicine, Yale University, New Haven, CT, United States
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, VA Connecticut Healthcare System, West Haven, CT, United States
| | - Melissa A Gordon
- School of Medicine, Yale University, New Haven, CT, United States
| | | | - Charla Nich
- School of Medicine, Yale University, New Haven, CT, United States
| | - Sara K Szollosy
- VA Connecticut Healthcare System, West Haven, CT, United States
| | - Jennifer M Loya
- School of Medicine, Yale University, New Haven, CT, United States
| | - Larissa Brito
- School of Medicine, Yale University, New Haven, CT, United States
| | | | - Sara N Edmond
- School of Medicine, Yale University, New Haven, CT, United States
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, VA Connecticut Healthcare System, West Haven, CT, United States
| | - William C Becker
- School of Medicine, Yale University, New Haven, CT, United States
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, VA Connecticut Healthcare System, West Haven, CT, United States
| | - Steve Martino
- VA Connecticut Healthcare System, West Haven, CT, United States
- School of Medicine, Yale University, New Haven, CT, United States
| | - Mehmet Sofuoglu
- VA Connecticut Healthcare System, West Haven, CT, United States
- School of Medicine, Yale University, New Haven, CT, United States
| | - Alicia A Heapy
- School of Medicine, Yale University, New Haven, CT, United States
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, VA Connecticut Healthcare System, West Haven, CT, United States
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Lin YK, Aikens JE, de Zoysa N, Hall D, Funnell M, Nwankwo R, Kloss K, DeJonckheere MJ, Pop-Busui R, Piatt GA, Amiel SA, Piette JD. An mHealth Text Messaging Program Providing Symptom Detection Training and Psychoeducation to Improve Hypoglycemia Self-Management: Intervention Development Study. JMIR Form Res 2023; 7:e50374. [PMID: 37788058 PMCID: PMC10582820 DOI: 10.2196/50374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/11/2023] [Accepted: 08/18/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Hypoglycemia remains a challenge for roughly 25% of people with type 1 diabetes (T1D) despite using advanced technologies such as continuous glucose monitors (CGMs) or automated insulin delivery systems. Factors impacting hypoglycemia self-management behaviors (including reduced ability to detect hypoglycemia symptoms and unhelpful hypoglycemia beliefs) can lead to hypoglycemia development in people with T1D who use advanced diabetes technology. OBJECTIVE This study aims to develop a scalable, personalized mobile health (mHealth) behavioral intervention program to improve hypoglycemia self-management and ultimately reduce hypoglycemia in people with T1D who use advanced diabetes technology. METHODS We (a multidisciplinary team, including clinical and health psychologists, diabetes care and education specialists, endocrinologists, mHealth interventionists and computer engineers, qualitative researchers, and patient partners) jointly developed an mHealth text messaging hypoglycemia behavioral intervention program based on user-centered design principles. The following five iterative steps were taken: (1) conceptualization of hypoglycemia self-management processes and relevant interventions; (2) identification of text message themes and message content development; (3) message revision; (4) patient partner assessments for message readability, language acceptability, and trustworthiness; and (5) message finalization and integration with a CGM data-connected mHealth SMS text message delivery platform. An mHealth web-based SMS text message delivery platform that communicates with a CGM glucose information-sharing platform was also developed. RESULTS The mHealth SMS text messaging hypoglycemia behavioral intervention program HypoPals, directed by patients' own CGM data, delivers personalized intervention messages to (1) improve hypoglycemia symptom detection and (2) elicit self-reflection, provide fact-based education, and suggest practical health behaviors to address unhelpful hypoglycemia beliefs and promote hypoglycemia self-management. The program is designed to message patients up to 4 times per day over a 10-week period. CONCLUSIONS A rigorous conceptual framework, a multidisciplinary team (including patient partners), and behavior change techniques were incorporated to create a scalable, personalized mHealth SMS text messaging behavioral intervention. This program was systematically developed to improve hypoglycemia self-management in advanced diabetes technology users with T1D. A clinical trial is needed to evaluate the program's efficacy for future clinical implementation.
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Affiliation(s)
- Yu Kuei Lin
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - James E Aikens
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Nicole de Zoysa
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Diana Hall
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Martha Funnell
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, United States
| | - Robin Nwankwo
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, United States
| | - Kate Kloss
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, United States
| | | | - Rodica Pop-Busui
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Gretchen A Piatt
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, United States
| | - Stephanie A Amiel
- Department of Diabetes, King's College London, London, United Kingdom
| | - John D Piette
- Healthcare System Center for Clinical Management Research, VA Ann Arbor, Ann Arbor, MI, United States
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, United States
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5
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Seng JJB, Gwee MFR, Yong MHA, Kwan YH, Thumboo J, Low LL. Role of Caregivers in Remote Management of Patients With Type 2 Diabetes Mellitus: Systematic Review of Literature. J Med Internet Res 2023; 25:e46988. [PMID: 37695663 PMCID: PMC10520771 DOI: 10.2196/46988] [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: 03/04/2023] [Revised: 04/24/2023] [Accepted: 07/31/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND With the growing use of remote monitoring technologies in the management of patients with type 2 diabetes mellitus (T2DM), caregivers are becoming important resources that can be tapped into to improve patient care. OBJECTIVE This review aims to summarize the role of caregivers in the remote monitoring of patients with T2DM. METHODS We performed a systematic review in MEDLINE, Embase, Scopus, PsycINFO, and Web of Science up to 2022. Studies that evaluated the role of caregivers in remote management of adult patients with T2DM were included. Outcomes such as diabetes control, adherence to medication, quality of life, frequency of home glucose monitoring, and health care use were evaluated. RESULTS Of the 1198 identified citations, 11 articles were included. The majority of studies were conducted in North America (7/11, 64%) and South America (2/11, 18%). The main types of caregivers studied were family or friends (10/11, 91%), while the most common remote monitoring modalities evaluated were interactive voice response (5/11, 45%) and phone consultations (4/11, 36%). With regard to diabetes control, 3 of 6 studies showed improvement in diabetes-related laboratory parameters. A total of 2 studies showed improvements in patients' medication adherence rates and frequency of home glucose monitoring. Studies that evaluated patients' quality of life showed mixed evidence. In 1 study, increased hospitalization rates were noted in the intervention group. CONCLUSIONS Caregivers may play a role in improving clinical outcomes among patients with T2DM under remote monitoring. Studies on mobile health technologies are lacking to understand their impact on Asian populations and long-term patient outcomes.
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Affiliation(s)
- Jun Jie Benjamin Seng
- MOH Holding Private Limited, Singapore, Singapore
- SingHealth Regional Health System PULSES Centre, Singapore Health Services, Singapore, Singapore
| | | | | | - Yu Heng Kwan
- MOH Holding Private Limited, Singapore, Singapore
- SingHealth Regional Health System PULSES Centre, Singapore Health Services, Singapore, Singapore
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
- Program in Health Services and Systems Research, Singapore, Singapore
| | - Julian Thumboo
- SingHealth Regional Health System PULSES Centre, Singapore Health Services, Singapore, Singapore
- Program in Health Services and Systems Research, Singapore, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
| | - Lian Leng Low
- SingHealth Regional Health System PULSES Centre, Singapore Health Services, Singapore, Singapore
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore
- Outram Community Hospital, SingHealth Community Hospitals, Singapore, Singapore
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Piette JD, Thomas L, Newman S, Marinec N, Krauss J, Chen J, Wu Z, Bohnert ASB. An Automatically Adaptive Digital Health Intervention to Decrease Opioid-Related Risk While Conserving Counselor Time: Quantitative Analysis of Treatment Decisions Based on Artificial Intelligence and Patient-Reported Risk Measures. J Med Internet Res 2023; 25:e44165. [PMID: 37432726 PMCID: PMC10369305 DOI: 10.2196/44165] [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: 11/10/2022] [Revised: 04/04/2023] [Accepted: 05/17/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Some patients prescribed opioid analgesic (OA) medications for pain experience serious side effects, including dependence, sedation, and overdose. As most patients are at low risk for OA-related harms, risk reduction interventions requiring multiple counseling sessions are impractical on a large scale. OBJECTIVE This study evaluates whether an intervention based on reinforcement learning (RL), a field of artificial intelligence, learned through experience to personalize interactions with patients with pain discharged from the emergency department (ED) and decreased self-reported OA misuse behaviors while conserving counselors' time. METHODS We used data representing 2439 weekly interactions between a digital health intervention ("Prescription Opioid Wellness and Engagement Research in the ED" [PowerED]) and 228 patients with pain discharged from 2 EDs who reported recent opioid misuse. During each patient's 12 weeks of intervention, PowerED used RL to select from 3 treatment options: a brief motivational message delivered via an interactive voice response (IVR) call, a longer motivational IVR call, or a live call from a counselor. The algorithm selected session types for each patient each week, with the goal of minimizing OA risk, defined in terms of a dynamic score reflecting patient reports during IVR monitoring calls. When a live counseling call was predicted to have a similar impact on future risk as an IVR message, the algorithm favored IVR to conserve counselor time. We used logit models to estimate changes in the relative frequency of each session type as PowerED gained experience. Poisson regression was used to examine the changes in self-reported OA risk scores over calendar time, controlling for the ordinal session number (1st to 12th). RESULTS Participants on average were 40 (SD 12.7) years of age; 66.7% (152/228) were women and 51.3% (117/228) were unemployed. Most participants (175/228, 76.8%) reported chronic pain, and 46.2% (104/225) had moderate to severe depressive symptoms. As PowerED gained experience through interactions over a period of 142 weeks, it delivered fewer live counseling sessions than brief IVR sessions (P=.006) and extended IVR sessions (P<.001). Live counseling sessions were selected 33.5% of the time in the first 5 weeks of interactions (95% CI 27.4%-39.7%) but only for 16.4% of sessions (95% CI 12.7%-20%) after 125 weeks. Controlling for each patient's changes during the course of treatment, this adaptation of treatment-type allocation led to progressively greater improvements in self-reported OA risk scores (P<.001) over calendar time, as measured by the number of weeks since enrollment began. Improvement in risk behaviors over time was especially pronounced among patients with the highest risk at baseline (P=.02). CONCLUSIONS The RL-supported program learned which treatment modalities worked best to improve self-reported OA risk behaviors while conserving counselors' time. RL-supported interventions represent a scalable solution for patients with pain receiving OA prescriptions. TRIAL REGISTRATION Clinicaltrials.gov NCT02990377; https://classic.clinicaltrials.gov/ct2/show/NCT02990377.
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Affiliation(s)
- John D Piette
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, United States
- Department of Health Behavior Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Laura Thomas
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, United States
- Department of Anesthesiology, School of Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Sean Newman
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, United States
- Department of Health Behavior Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Nicolle Marinec
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, United States
- Department of Health Behavior Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Joel Krauss
- Department of Emergency Medicine, Trinity Health St. Joseph Mercy, Ann Arbor, MI, United States
| | - Jenny Chen
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, United States
- Department of Health Behavior Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Zhenke Wu
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Amy S B Bohnert
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, United States
- Department of Anesthesiology, School of Medicine, University of Michigan, Ann Arbor, MI, United States
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Uchmanowicz I, Wleklik M, Foster M, Olchowska-Kotala A, Vellone E, Kaluzna-Oleksy M, Szczepanowski R, Uchmanowicz B, Reczuch K, Jankowska EA. Digital health and modern technologies applied in patients with heart failure: Can we support patients’ psychosocial well-being? Front Psychol 2022; 13:940088. [PMID: 36275212 PMCID: PMC9580561 DOI: 10.3389/fpsyg.2022.940088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/09/2022] [Indexed: 11/26/2022] Open
Abstract
Despite advances in the treatment of heart failure (HF), the physical symptoms and stress of the disease continue to negatively impact patients’ health outcomes. Technology now offers promising ways to integrate personalized support from health care professionals via a variety of platforms. Digital health technology solutions using mobile devices or those that allow remote patient monitoring are potentially more cost effective and may replace in-person interaction. Notably, digital health methods may not only improve clinical outcomes but may also improve the psycho-social status of HF patients. Using digital health to address biopsychosocial variables, including elements of the person and their context is valuable when considering chronic illness and HF in particular, given the multiple, cross-level factors affecting chronic illness clinical management needed for HF self-care.
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Affiliation(s)
- Izabella Uchmanowicz
- Department of Nursing and Obstetrics, Wroclaw Medical University, Wrocław, Poland
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
| | - Marta Wleklik
- Department of Nursing and Obstetrics, Wroclaw Medical University, Wrocław, Poland
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
| | - Marva Foster
- Center for Healthcare Organization and Implementation Research (CHOIR), Boston VA Healthcare System, Boston, MA, United States
- Department of General Internal Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Agnieszka Olchowska-Kotala
- Department of Medical Humanities and Social Science, Faculty of Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Ercole Vellone
- Department of Nursing and Obstetrics, Wroclaw Medical University, Wrocław, Poland
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Marta Kaluzna-Oleksy
- Department of Cardiology, University of Medical Sciences in Poznan, Poznan, Poland
| | - Remigiusz Szczepanowski
- Department of Computer Science and Systems Engineering, Wrocław University of Science and Technology, Wrocław, Poland
| | - Bartosz Uchmanowicz
- Department of Family and Pediatric Nursing, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
- *Correspondence: Bartosz Uchmanowicz,
| | - Krzysztof Reczuch
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
- Institute of Heart Diseases, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Ewa Anita Jankowska
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
- Institute of Heart Diseases, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
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8
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Piette JD, Newman S, Krein SL, Marinec N, Chen J, Williams DA, Edmond SN, Driscoll M, LaChappelle KM, Kerns RD, Maly M, Kim HM, Farris KB, Higgins DM, Buta E, Heapy AA. Patient-Centered Pain Care Using Artificial Intelligence and Mobile Health Tools: A Randomized Comparative Effectiveness Trial. JAMA Intern Med 2022; 182:975-983. [PMID: 35939288 PMCID: PMC9361183 DOI: 10.1001/jamainternmed.2022.3178] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 06/09/2022] [Indexed: 11/14/2022]
Abstract
Importance Cognitive behavioral therapy for chronic pain (CBT-CP) is a safe and effective alternative to opioid analgesics. Because CBT-CP requires multiple sessions and therapists are scarce, many patients have limited access or fail to complete treatment. Objectives To determine if a CBT-CP program that personalizes patient treatment using reinforcement learning, a field of artificial intelligence (AI), and interactive voice response (IVR) calls is noninferior to standard telephone CBT-CP and saves therapist time. Design, Setting, and Participants This was a randomized noninferiority, comparative effectiveness trial including 278 patients with chronic back pain from the Department of Veterans Affairs health system (recruitment and data collection from July 11, 2017-April 9, 2020). More patients were randomized to the AI-CBT-CP group than to the control (1.4:1) to maximize the system's ability to learn from patient interactions. Interventions All patients received 10 weeks of CBT-CP. For the AI-CBT-CP group, patient feedback via daily IVR calls was used by the AI engine to make weekly recommendations for either a 45-minute or 15-minute therapist-delivered telephone session or an individualized IVR-delivered therapist message. Patients in the comparison group were offered 10 therapist-delivered telephone CBT-CP sessions (45 minutes/session). Main Outcomes and Measures The primary outcome was the Roland Morris Disability Questionnaire (RMDQ; range 0-24), measured at 3 months (primary end point) and 6 months. Secondary outcomes included pain intensity and pain interference. Consensus guidelines were used to identify clinically meaningful improvements for responder analyses (eg, a 30% improvement in RMDQ scores and pain intensity). Data analyses were performed from April 2021 to May 2022. Results The study population included 278 patients (mean [SD] age, 63.9 [12.2] years; 248 [89.2%] men; 225 [81.8%] White individuals). The 3-month mean RMDQ score difference between AI-CBT-CP and standard CBT-CP was -0.72 points (95% CI, -2.06 to 0.62) and the 6-month difference was -1.24 (95% CI, -2.48 to 0); noninferiority criterion were met at both the 3- and 6-month end points (P < .001 for both). A greater proportion of patients receiving AI-CBT-CP had clinically meaningful improvements at 6 months as indicated by RMDQ (37% vs 19%; P = .01) and pain intensity scores (29% vs 17%; P = .03). There were no significant differences in secondary outcomes. Pain therapy using AI-CBT-CP required less than half of the therapist time as standard CBT-CP. Conclusions and Relevance The findings of this randomized comparative effectiveness trial indicated that AI-CBT-CP was noninferior to therapist-delivered telephone CBT-CP and required substantially less therapist time. Interventions like AI-CBT-CP could allow many more patients to be served effectively by CBT-CP programs using the same number of therapists. Trial Registration ClinicalTrials.gov Identifier: NCT02464449.
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Affiliation(s)
- John D. Piette
- Ann Arbor Department of Veterans Affairs (VA) Center for Clinical Management Research, Ann Arbor, Michigan
- School of Public Health, University of Michigan, Ann Arbor
- Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor
| | - Sean Newman
- Ann Arbor Department of Veterans Affairs (VA) Center for Clinical Management Research, Ann Arbor, Michigan
- School of Public Health, University of Michigan, Ann Arbor
| | - Sarah L. Krein
- Ann Arbor Department of Veterans Affairs (VA) Center for Clinical Management Research, Ann Arbor, Michigan
- Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor
| | - Nicolle Marinec
- Ann Arbor Department of Veterans Affairs (VA) Center for Clinical Management Research, Ann Arbor, Michigan
- School of Public Health, University of Michigan, Ann Arbor
| | - Jenny Chen
- Ann Arbor Department of Veterans Affairs (VA) Center for Clinical Management Research, Ann Arbor, Michigan
- School of Public Health, University of Michigan, Ann Arbor
| | - David A. Williams
- Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor
| | - Sara N. Edmond
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Mary Driscoll
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Kathryn M. LaChappelle
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Robert D. Kerns
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
- Department of Psychology, Yale University, New Haven, Connecticut
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| | - Marianna Maly
- Ann Arbor Department of Veterans Affairs (VA) Center for Clinical Management Research, Ann Arbor, Michigan
- School of Public Health, University of Michigan, Ann Arbor
| | - H. Myra Kim
- Ann Arbor Department of Veterans Affairs (VA) Center for Clinical Management Research, Ann Arbor, Michigan
- School of Public Health, University of Michigan, Ann Arbor
| | - Karen B. Farris
- Department of Clinical, Social, and Administrative Sciences, College of Pharmacy, University of Michigan, Ann Arbor
| | - Diana M. Higgins
- VA Boston Healthcare System, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Eugenia Buta
- Yale Center for Analytical Sciences, Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Alicia A. Heapy
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
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9
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Pop-Busui R, Januzzi JL, Bruemmer D, Butalia S, Green JB, Horton WB, Knight C, Levi M, Rasouli N, Richardson CR. Heart Failure: An Underappreciated Complication of Diabetes. A Consensus Report of the American Diabetes Association. Diabetes Care 2022; 45:1670-1690. [PMID: 35796765 PMCID: PMC9726978 DOI: 10.2337/dci22-0014] [Citation(s) in RCA: 121] [Impact Index Per Article: 60.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 02/03/2023]
Abstract
Heart failure (HF) has been recognized as a common complication of diabetes, with a prevalence of up to 22% in individuals with diabetes and increasing incidence rates. Data also suggest that HF may develop in individuals with diabetes even in the absence of hypertension, coronary heart disease, or valvular heart disease and, as such, represents a major cardiovascular complication in this vulnerable population; HF may also be the first presentation of cardiovascular disease in many individuals with diabetes. Given that during the past decade, the prevalence of diabetes (particularly type 2 diabetes) has risen by 30% globally (with prevalence expected to increase further), the burden of HF on the health care system will continue to rise. The scope of this American Diabetes Association consensus report with designated representation from the American College of Cardiology is to provide clear guidance to practitioners on the best approaches for screening and diagnosing HF in individuals with diabetes or prediabetes, with the goal to ensure access to optimal, evidence-based management for all and to mitigate the risks of serious complications, leveraging prior policy statements by the American College of Cardiology and American Heart Association.
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Affiliation(s)
- Rodica Pop-Busui
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - James L. Januzzi
- Cardiology Division, Massachusetts General Hospital, and Cardiometabolic Trials, Baim Institute for Clinical Research, Boston, MA
| | - Dennis Bruemmer
- Center for Cardiometabolic Health, Section of Preventive Cardiology and Rehabilitation, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | - Sonia Butalia
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Jennifer B. Green
- Division of Endocrinology and Duke Clinical Research Institute, Department of Medicine, Duke University Medical Center, Durham, NC
| | - William B. Horton
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia, Charlottesville, VA
| | - Colette Knight
- Inserra Family Diabetes Institute, Hackensack University Medical Center, Hackensack Meridian School of Medicine, Hackensack, NJ
| | - Moshe Levi
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University, Washington, DC
| | - Neda Rasouli
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
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10
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Aikens JE, Valenstein M, Plegue MA, Sen A, Marinec N, Achtyes E, Piette JD. Technology-Facilitated Depression Self-Management Linked with Lay Supporters and Primary Care Clinics: Randomized Controlled Trial in a Low-Income Sample. Telemed J E Health 2022; 28:399-406. [PMID: 34086485 PMCID: PMC8968843 DOI: 10.1089/tmj.2021.0042] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To test whether technology-facilitated self-management support improves depression in primary care settings. Methods: We randomized 204 low-income primary care patients who had at least moderate depressive symptoms to intervention or control. Intervention participants received 12 months of weekly automated interactive voice response telephone calls that assessed their symptom severity and provided self-management strategies. Their patient-nominated supporter (CarePartner) received corresponding guidance on self-management support, and their primary care team received urgent notifications. Those randomized to enhanced usual care received printed generic self-management instructions. Results: One-year attrition rate was 14%. By month 6, symptom severity on the Patient Health Questionnaire-9 (PHQ-9) decreased 2.5 points more in the intervention arm than in the control arm (95% CI -4.2 to -0.8, p = 0.003). This benefit was similar at month 12 (p = 0.004). Intervention was also over twice as likely to lead to ≥50% reduction in symptom severity by month 6 (OR = 2.2 (1.1, 4.7)) and a decrease of ≥5 PHQ-9 points by month 12 (OR = 2.3 (1.2, 4.4)). Conclusions: Technology-facilitated self-management guidance with lay support and clinician notifications improves depression for primary care patients. Subsequent research should examine implementation and generalization to other chronic conditions. clinicaltrials.gov, identifier NCT01834534.
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Affiliation(s)
- James E. Aikens
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Address correspondence to: James Aikens, PhD, Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI 48104-1213, USA
| | - Marcia Valenstein
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA.,VA Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan, USA
| | - Melissa A. Plegue
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Ananda Sen
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicolle Marinec
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan, USA.,Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Eric Achtyes
- Cherry Health, Heart of the City Health Center, Grand Rapids, Michigan, USA.,Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Lansing, Michigan, USA
| | - John D. Piette
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan, USA.,Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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11
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Saad A, Bruno D, Camara B, D'Agostino J, Bolea-Alamanac B. Self-directed Technology-Based Therapeutic Methods for Adult Patients Receiving Mental Health Services: Systematic Review. JMIR Ment Health 2021; 8:e27404. [PMID: 34842556 PMCID: PMC8665378 DOI: 10.2196/27404] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 07/26/2021] [Accepted: 08/12/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Technological interventions used to treat illnesses and promote health are grouped under the umbrella term of digital therapeutics. The use of digital therapeutics is becoming increasingly common in mental health. Although many technologies are currently being implemented, research supporting their usability, efficacy, and risk requires further examination, especially for those interventions that can be used without support. OBJECTIVE This review aims to identify the evidence-based, self-directed, technology-based methods of care that can be used in adult patients after they are discharged from mental health services. The interventions reviewed are automated with no human input required (either at the patient's or at the technology's end), so the patients can implement them without any support. METHODS A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and PROSPERO (International Prospective Register of Systematic Reviews) guidelines in 3 databases: PubMed, Web of Science, and OVID. The inclusion criteria were self-directed, automated, and technology-based interventions related to mental health, primarily for adults, having a solid evaluation process. The interventions had to be self-directed, in that the participants could use the technology without any external guidance. RESULTS We identified 36 papers that met the inclusion criteria: 26 randomized controlled trials, 9 nonrandomized controlled trial quantitative studies, and 1 qualitative study. The technologies used included websites, automated text messaging, phone apps, videos, computer software, and integrated voice response. There were 22 studies focused on internet-based cognitive behavioral therapies as a therapeutic paradigm compared with the waitlist, web-based human-delivered therapy, and other interventions. Among these studies, 14 used paradigms other than the internet-based cognitive behavioral therapy. Of the 8 studies comparing guided and unguided digital care, 3 showed no differences, 3 favored guided interventions, and 2 favored unguided interventions. The research also showed that dropout rates were as high as 80%, citing potential problems with the acceptability of the suggested technologies. CONCLUSIONS There is limited research on the efficacy and suitability of self-directed technology-based care options for mental health. Digital technologies have the potential to bridge the gap between ambulatory care and independent living. However, these interventions may need to be developed collaboratively with the users to encourage their acceptability and to avoid high dropout rates.
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Affiliation(s)
- Anthony Saad
- Department of Psychiatry, Women's College Hospital, Toronto, ON, Canada
| | - Deanna Bruno
- Department of Psychiatry, Women's College Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Bettina Camara
- Department of Immunology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Blanca Bolea-Alamanac
- Department of Psychiatry, Women's College Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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12
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Machen L, Handley MA, Powe N, Tuot D. Engagement With a Health Information Technology-Augmented Self-Management Support Program in a Population With Limited English Proficiency: Observational Study. JMIR Mhealth Uhealth 2021; 9:e24520. [PMID: 33973868 PMCID: PMC8205419 DOI: 10.2196/24520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/15/2021] [Accepted: 04/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background Limited English proficiency (LEP) is an important driver of health disparities. Many successful patient-level interventions to prevent chronic disease progression and complications have used automated telephone self-management support, which relies on patient activation and communication to achieve improved health outcomes. It is not clear whether these interventions are similarly applicable to patients with LEP compared to patients with English proficiency. Objective The objectives of this study were as follows: (1) To examine the impact of LEP on patient engagement (primary outcome) with a 12-month language-concordant self-management program that included automated telephone self-management support, designed for patients with chronic kidney disease (CKD). (2) To assess the impact of LEP on change in systolic blood pressure (SBP) and albuminuria (secondary outcomes) resulting from the self-management program. Methods This was a secondary analysis of the Kidney Awareness Registry and Education (KARE) pilot trial (NCT01530958) which was funded by the National Institutes of Health in August 2011, approved by the University of California Institutional Review Board in October 2011 (No. 11-07399), and executed between 2013 and 2015. Multivariable logistic and linear models were used to examine various facets of patient engagement with the CKD self-management support program by LEP status. Patient engagement was defined by patient’s use of educational materials, completion of a health coaching action plan, and degree of participation with automated telephone self-management support. Changes in SBP and albuminuria at 12 months by LEP status were determined using multivariable linear mixed models. Results Of 137 study participants, 53 (38.7%) reported LEP, of which 45 (85%) were Spanish speaking and 8 (15%) Cantonese speaking. While patients with LEP and English proficiency similarly used the program’s educational materials (85% [17/20] vs 88% [30/34], P=.69) and completed an action plan (81% [22/27] vs 74% [35/47], P=.49), those with LEP engaged more with the automated telephone self-management support component. Average call completion was 66% among patients with LEP compared with 57% among those with English proficiency; patients with LEP requested more health coach telephone calls (P=.08) and had a significantly longer average automated call duration (3.3 [SD 1.4] min vs 2.2 [1.1 min], P<.001), indicating higher patient engagement. Patients with LEP randomized to self-management support had a larger, though nonstatistically significant (P=.74), change in SBP (–4.5 mmHg; 95% CI –9.4 to 0.3) and albuminuria (–72.4 mg/dL; 95% CI –208.9 to 64.1) compared with patients with English proficiency randomized to self-management support (–2.1 mmHg; 95% CI –8.6 to 4.3 and –11.1 mg/dL; 95% CI –166.9 to 144.7). Conclusions Patients with LEP with CKD were equally or more engaged with a language-concordant, culturally appropriate telehealth intervention compared with their English-speaking counterparts. Augmented telehealth may be useful in mitigating communication barriers among patients with LEP. Trial Registration ClinicalTrials.gov NCT01530958; https://clinicaltrials.gov/ct2/show/NCT01530958
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Affiliation(s)
- Leah Machen
- University of California, San Francisco, San Francisco, CA, United States
| | - Margaret A Handley
- University of California, San Francisco, San Francisco, CA, United States
| | - Neil Powe
- University of California, San Francisco, San Francisco, CA, United States
| | - Delphine Tuot
- University of California, San Francisco, San Francisco, CA, United States
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13
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Piette JD, Striplin D, Aikens JE, Lee A, Marinec N, Mansabdar M, Chen J, Gregory LA, Kim CS. Impacts of Post-Hospitalization Accessible Health Technology and Caregiver Support on 90-Day Acute Care Use and Self-Care Assistance: A Randomized Clinical Trial. Am J Med Qual 2021; 36:145-155. [PMID: 32723072 DOI: 10.1177/1062860620943673] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hospitalized patients often are readmitted soon after discharge, with many hospitalizations being potentially preventable. The authors evaluated a mobile health intervention designed to improve post-hospitalization support for older adults with common chronic conditions. All participants enrolled with an informal caregiver or "CarePartner" (CP). Intervention patients received automated assessment and behavior change calls. CPs received automated, structured feedback following each assessment. Clinicians received alerts about serious problems identified during patient calls. Controls had a 65% greater risk of hospitalization within 90 days post discharge than intervention patients (P = .041). For every 6.8 enrollees, the intervention prevented 1 rehospitalization or emergency department encounter. The intervention improved physical functioning at 90 days (P = .012). The intervention also improved medication adherence and indicators of the quality of communication with CPs (all P < .01). Automated telephone patient monitoring and self-care advice with feedback to primary care teams and CPs reduces readmission rates over 90 days.
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Affiliation(s)
- John D Piette
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI University of Michigan, Ann Arbor, MI University of Mississippi, Oxford, MS MidMichigan Health Network, Midland, MI University of Washington, Seattle, WA
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14
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Apergi LA, Bjarnadottir MV, Baras JS, Golden BL, Anderson KM, Chou J, Shara N. Voice Interface Technology Adoption by Patients With Heart Failure: Pilot Comparison Study. JMIR Mhealth Uhealth 2021; 9:e24646. [PMID: 33792556 PMCID: PMC8050751 DOI: 10.2196/24646] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/27/2020] [Accepted: 02/19/2021] [Indexed: 12/21/2022] Open
Abstract
Background Heart failure (HF) is associated with high mortality rates and high costs, and self-care is crucial in the management of the condition. Telehealth can promote patients’ self-care while providing frequent feedback to their health care providers about the patient’s compliance and symptoms. A number of technologies have been considered in the literature to facilitate telehealth in patients with HF. An important factor in the adoption of these technologies is their ease of use. Conversational agent technologies using a voice interface can be a good option because they use speech recognition to communicate with patients. Objective The aim of this paper is to study the engagement of patients with HF with voice interface technology. In particular, we investigate which patient characteristics are linked to increased technology use. Methods We used data from two separate HF patient groups that used different telehealth technologies over a 90-day period. Each group used a different type of voice interface; however, the scripts followed by the two technologies were identical. One technology was based on Amazon’s Alexa (Alexa+), and in the other technology, patients used a tablet to interact with a visually animated and voice-enabled avatar (Avatar). Patient engagement was measured as the number of days on which the patients used the technology during the study period. We used multiple linear regression to model engagement with the technology based on patients’ demographic and clinical characteristics and past technology use. Results In both populations, the patients were predominantly male and Black, had an average age of 55 years, and had HF for an average of 7 years. The only patient characteristic that was statistically different (P=.008) between the two populations was the number of medications they took to manage HF, with a mean of 8.7 (SD 4.0) for Alexa+ and 5.8 (SD 3.4) for Avatar patients. The regression model on the combined population shows that older patients used the technology more frequently (an additional 1.19 days of use for each additional year of age; P=.004). The number of medications to manage HF was negatively associated with use (−5.49; P=.005), and Black patients used the technology less frequently than other patients with similar characteristics (−15.96; P=.08). Conclusions Older patients’ higher engagement with telehealth is consistent with findings from previous studies, confirming the acceptability of technology in this subset of patients with HF. However, we also found that a higher number of HF medications, which may be correlated with a higher disease burden, is negatively associated with telehealth use. Finally, the lower engagement of Black patients highlights the need for further study to identify the reasons behind this lower engagement, including the possible role of social determinants of health, and potentially create technologies that are better tailored for this population.
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Affiliation(s)
- Lida Anna Apergi
- Robert H. Smith School of Business, University of Maryland, College Park, MD, United States
| | - Margret V Bjarnadottir
- Robert H. Smith School of Business, University of Maryland, College Park, MD, United States
| | - John S Baras
- Institute for Systems Research, University of Maryland, College Park, MD, United States
| | - Bruce L Golden
- Robert H. Smith School of Business, University of Maryland, College Park, MD, United States
| | - Kelley M Anderson
- Georgetown University, Washington, DC, United States.,Medstar Health Research Institute, Hyattsville, MD, United States
| | - Jiling Chou
- Medstar Health Research Institute, Hyattsville, MD, United States
| | - Nawar Shara
- Georgetown University, Washington, DC, United States.,Medstar Health Research Institute, Hyattsville, MD, United States
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15
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Janevic MR, Shute V, Murphy SL, Piette JD. Acceptability and Effects of Commercially Available Activity Trackers for Chronic Pain Management Among Older African American Adults. PAIN MEDICINE 2021; 21:e68-e78. [PMID: 31509196 DOI: 10.1093/pm/pnz215] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Wearable activity trackers may facilitate walking for chronic pain management. OBJECTIVE We assessed the acceptability of a commercially available tracker and three alternative modes of reporting daily steps among older adults in a low-income, urban community. We examined whether using the tracker (Fitbit ZipTM) was associated with improvements in functioning and activity. DESIGN Randomized controlled pilot and feasibility trial. SUBJECTS Fifty-one African American adults in Detroit, Michigan, aged 60 to 85 years, with chronic musculoskeletal pain (28 in the intervention group, 23 controls). METHODS Participants completed telephone surveys at baseline and eight weeks. Intervention participants wore trackers for six weeks, alternately reporting daily step counts via text messages, automated telephone calls, and syncing (two weeks each). We used multimethods to assess satisfaction with trackers and reporting modalities. Adherence was indicated by the proportion of expected days on which valid step counts were reported. We assessed changes in pain interference, physical function, social participation, walking frequency, and walking duration. RESULTS More than 90% of participants rated trackers as easy to use, but some had technical or dexterity-related difficulties. Text reporting yielded 79% reporting adherence vs 69% each for automated calls and syncing. Intervention participants did not show greater improvement in functioning or walking than controls. CONCLUSIONS With appropriate support, wearable activity trackers and mHealth reporting for chronic pain self-care are feasible for use by vulnerable older adults. Future research should test whether the effects of trackers on pain-related outcomes can be enhanced by incorporating behavior change strategies and training in evidence-based cognitive-behavioral techniques.
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Affiliation(s)
- Mary R Janevic
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Varick Shute
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Susan L Murphy
- Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan
| | - John D Piette
- Ann Arbor VA Center for Clinical Management Research and Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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16
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Tuvesson H, Eriksén S, Fagerström C. mHealth and Engagement Concerning Persons With Chronic Somatic Health Conditions: Integrative Literature Review. JMIR Mhealth Uhealth 2020; 8:e14315. [PMID: 32706686 PMCID: PMC7414402 DOI: 10.2196/14315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 04/30/2020] [Accepted: 05/14/2020] [Indexed: 01/13/2023] Open
Abstract
Background Chronic somatic health conditions are a global public health challenge. Being engaged in one’s own health management for such conditions is important, and mobile health (mHealth) solutions are often suggested as key to promoting engagement. Objective The aim of this study was to review, critically appraise, and synthesize the available research regarding engagement through mHealth for persons with chronic somatic health conditions. Methods An integrative literature review was conducted. The PubMed, CINAHL, and Inspec databases were used for literature searches. Quality assessment was done with the guidance of Critical Appraisal Skills Programme (CASP) checklists. We used a self-designed study protocol comprising 4 engagement aspects—cognitive, behavioral and emotional, interactional, and the usage of mHealth—as part of the synthesis and analysis. Results A total of 44 articles met the inclusion criteria and were included in the analysis. mHealth usage was the most commonly occurring engagement aspect, behavioral and emotional aspects the second, cognitive aspects the third, and interactional aspects of engagement the least common aspect in the included articles. The results showed that there is a mix of enablers and barriers to engagement in relation to the 4 engagement aspects. The perceived meaningfulness and need for the solution and its content were important to create and maintain engagement. When perceived as meaningful, suitable, and usable, mHealth can support knowledge gain and learning, facilitate emotional and behavioral aspects such as a sense of confidence, and improve interactions and communications with health care professionals. Conclusions mHealth solutions have the potential to support health care engagement for persons with chronic somatic conditions. More research is needed to further understand how, by which means, when, and among whom mHealth could further improve engagement for this population.
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Affiliation(s)
- Hanna Tuvesson
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Sara Eriksén
- Blekinge Institute of Technology, Karlskrona, Sweden
| | - Cecilia Fagerström
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.,Blekinge Centre of Competence, Blekinge County Council, Karlskrona, Sweden
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Teo AR, Marsh HE, Ono SS, Nicolaidis C, Saha S, Dobscha SK. The Importance of "Being There": a Qualitative Study of What Veterans with Depression Want in Social Support. J Gen Intern Med 2020; 35:1954-1962. [PMID: 32076990 PMCID: PMC7352022 DOI: 10.1007/s11606-020-05692-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 01/29/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Social connectedness exerts strong influences on health, including major depression and suicide. A major component of social connectedness is having individual relationships with close supports, romantic partners, and other trusted members of one's social network. OBJECTIVE The objective of this study was to understand how individuals' relationships with close supports might be leveraged to improve outcomes for primary care patients with depression and at risk for suicide. DESIGN In this qualitative study, we used a semi-structured interview guide to probe patient experiences, views, and preferences related to social support. PARTICIPANTS We conducted interviews with 30 primary care patients at a Veterans Health Administration (VA) medical center who had symptoms of major depression and a close support. APPROACH Thematic analysis of qualitative interview data examined close supports' impact on patients. We iteratively developed a codebook, used output from codes to sort data into themes, and selected quotations that exemplified themes for inclusion in this manuscript. KEY RESULTS "Being there" as an important quality of close supports emerged as a key concept. "Being there" was defined in three ways: physical proximity, frequent or responsive contact, or perceived availability. Close supports who were effective at "being there" possessed skills in intuitively sensing the patient's emotional state and communicating indirectly about depression. Three major barriers to involving close supports in depression care were concerns of overburdening the close support, a perception that awareness of the patient's depression would make the close support unnecessarily worried, and a desire and preference among patients to handle depression on their own. CONCLUSIONS "Being there" represents a novel, patient-generated way to conceptualize and talk about social support. Suicide prevention initiatives such as population-level communication campaigns might be improved by incorporating language used by patients and addressing attitudinal barriers to allowing help and involvement of close supports.
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Affiliation(s)
- Alan R Teo
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), Portland, OR, USA.
- Department of Psychiatry, Oregon Health & Science University,, Portland, OR, USA.
- Oregon Health & Science University and Portland State University, School of Public Health, Portland, OR, USA.
| | - Heather E Marsh
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), Portland, OR, USA
| | - Sarah S Ono
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), Portland, OR, USA
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Christina Nicolaidis
- Oregon Health & Science University and Portland State University, School of Public Health, Portland, OR, USA
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
- School of Social Work, Portland State University, Portland, OR, USA
| | - Somnath Saha
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), Portland, OR, USA
- Oregon Health & Science University and Portland State University, School of Public Health, Portland, OR, USA
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Steven K Dobscha
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), Portland, OR, USA
- Department of Psychiatry, Oregon Health & Science University,, Portland, OR, USA
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Personalized eHealth Program for Life-style Change: Results From the "Do Cardiac Health Advanced New Generated Ecosystem (Do CHANGE 2)" Randomized Controlled Trial. Psychosom Med 2020; 82:409-419. [PMID: 32176191 DOI: 10.1097/psy.0000000000000802] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Unhealthy life-style factors have adverse outcomes in cardiac patients. However, only a minority of patients succeed to change unhealthy habits. Personalization of interventions may result in critical improvements. The current randomized controlled trial provides a proof of concept of the personalized Do Cardiac Health Advanced New Generation Ecosystem (Do CHANGE) 2 intervention and evaluates effects on a) life-style and b) quality of life over time. METHODS Cardiac patients (n = 150; mean age = 61.97 ± 11.61 years; 28.7% women; heart failure, n = 33; coronary artery disease, n = 50; hypertension, n = 67) recruited from Spain and the Netherlands were randomized to either the "Do CHANGE 2" or "care as usual" group. The Do CHANGE 2 group received ambulatory health-behavior assessment technologies for 6 months combined with a 3-month behavioral intervention program. Linear mixed-model analysis was used to evaluate the intervention effects, and latent class analysis was used for secondary subgroup analysis. RESULTS Linear mixed-model analysis showed significant intervention effects for life-style behavior (Finteraction(2,138.5) = 5.97, p = .003), with improvement of life-style behavior in the intervention group. For quality of life, no significant main effect (F(1,138.18) = .58, p = .447) or interaction effect (F(2,133.1) = 0.41, p = .67) was found. Secondary latent class analysis revealed different subgroups of patients per outcome measure. The intervention was experienced as useful and feasible. CONCLUSIONS The personalized eHealth intervention resulted in significant improvements in life-style. Cardiac patients and health care providers were also willing to engage in this personalized digital behavioral intervention program. Incorporating eHealth life-style programs as part of secondary prevention would be particularly useful when taking into account which patients are most likely to benefit. TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT03178305.
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GLASGOW RUSSELLE, HUEBSCHMANN AMYG, KRIST ALEXH, DEGRUY FRANKV. An Adaptive, Contextual, Technology-Aided Support (ACTS) System for Chronic Illness Self-Management. Milbank Q 2019; 97:669-691. [PMID: 31424137 PMCID: PMC6739607 DOI: 10.1111/1468-0009.12412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Policy Points Fundamental changes are needed in how complex chronic illness conditions are conceptualized and managed. Health management plans for chronic illness need to be integrated, adaptive, contextual, technology aided, patient driven, and designed to address the multilevel social environment of patients' lives. Such primary care-based health management plans are feasible today but will be even more effective and sustainable if supported by systems thinking, technological advances, and policies that create and reinforce home, work, and health care collaborations. CONTEXT The current health care system is failing patients with chronic illness, especially those with complex comorbid conditions and social determinants of health challenges. The current system combined with unsustainable health care costs, lack of support for primary care in the United States, and aging demographics create a frightening probable future. METHODS Recent developments, including integrated behavioral health, community resources to address social determinants, population health infrastructure, patient-centered digital-health self-management support, and complexity science have the potential to help address these alarming trends. This article describes, first, the opportunity to integrate these trends and, second, a proposal for an integrated, patient-directed, adaptive, contextual, and technology-aided support (ACTS) system, based on a patient's life context and home/primary care/work-setting "support triangle." FINDINGS None of these encouraging trends is a panacea, and although most have been described previously, they have not been integrated. Here we discuss an example of integration using these components and how our proposed model (termed My Own Health Report) can be applied, along with its strengths, limitations, implications, and opportunities for practice, policy, and research. CONCLUSIONS This ACTS system builds on and extends the current chronic illness management approaches. It is feasible today and can produce even more dramatic improvements in the future.
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Affiliation(s)
- RUSSELL E. GLASGOW
- University of Colorado School of Medicine
- Adult and Child Consortium for Outcomes Research and Delivery Science
| | - AMY G. HUEBSCHMANN
- University of Colorado School of Medicine
- Adult and Child Consortium for Outcomes Research and Delivery Science
- Center for Women's Health Research
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20
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Rodgers M, Meisel Z, Wiebe D, Crits-Christoph P, Rhodes KV. Wireless Participant Incentives Using Reloadable Bank Cards to Increase Clinical Trial Retention With Abused Women Drinkers: A Natural Experiment. JOURNAL OF INTERPERSONAL VIOLENCE 2019; 34:2774-2796. [PMID: 27503325 PMCID: PMC5589513 DOI: 10.1177/0886260516662849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Retaining participants in longitudinal studies is a unique methodological challenge in many areas of investigation, and specifically for researchers aiming to identify effective interventions for women experiencing intimate partner violence (IPV). Individuals in abusive relationships are often transient and have logistical, confidentiality, and safety concerns that limit future contact. A natural experiment occurred during a large randomized clinical trial enrolling women in abusive relationships who were also heavy drinkers, which allowed for the comparison of two incentive methods to promote longitudinal retention: cash payment versus reloadable wireless bank cards. In all, 600 patients were enrolled in the overall trial, which aimed to incentivize participants using a reloadable bank card system to promote the completion of 11 weekly interactive voice response system (IVRS) phone surveys and 3-, 6-, and 12-month follow-up phone or in person interviews. The first 145 participants were paid with cash as a result of logistical delays in setting up the bank card system. At 12 weeks, participants receiving the bank card incentive completed significantly more IVRS phone surveys, odds ratio (OR) = 2.4, 95% confidence interval (CI) = [0.01, 1.69]. There were no significant differences between the two groups related to satisfaction or safety and/or privacy. The bank card system delivered lower administrative burden for tracking payments for study staff. Based on these and other results, our large medical research university is implementing reloadable bank card as the preferred method of participant incentive payments.
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Affiliation(s)
- Melissa Rodgers
- Perelman School of Medicine, University of Pennsylvania
- College of Education, The University of Texas at Austin
| | | | - Douglas Wiebe
- Perelman School of Medicine, University of Pennsylvania
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Skolarus TA, Metreger T, Wittmann D, Hwang S, Kim HM, Grubb RL, Gingrich JR, Zhu H, Piette JD, Hawley ST. Self-Management in Long-Term Prostate Cancer Survivors: A Randomized, Controlled Trial. J Clin Oncol 2019; 37:1326-1335. [PMID: 30925126 DOI: 10.1200/jco.18.01770] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This randomized clinical trial compared a personally tailored, automated telephone symptom management intervention to improve self-management among long-term survivors of prostate cancer with usual care enhanced with a nontailored newsletter about symptom management. We hypothesized that intervention-group participants would have more confident symptom self-management and reduced symptom burden. METHODS A total of 556 prostate cancer survivors who, more than 1 year after treatment, were experiencing symptom burden were recruited from April 2015 to February 2017 across four Veterans Affairs sites. Participants were randomly assigned to intervention (n = 278) or usual care (n = 278) groups. We compared differences in the primary (symptom burden according to Expanded Prostate Cancer Index Composite-26 [EPIC], confidence in self-management) and secondary outcomes between groups using intent-to-treat analyses. We compared domain-specific changes in symptom burden from baseline to 5 and 12 months among the intervention group according to the primary symptom focus area (urinary, bowel, sexual, general) of participants. RESULTS Most of the prostate cancer survivors in this study were married (54.3%), were white (69.2%), were retired (62.4%), and underwent radiation therapy (56.7% v 46.2% who underwent surgery), and the mean age was 67 years. There were no baseline differences in urinary, bowel, sexual, or hormonal domain EPIC scores across groups. We observed higher EPIC scores in the intervention arm in all domain areas at 5 months, though differences were not statistically significant. No differences were found in secondary outcomes; however, coping appraisal was higher (2.8 v 2.6; P = .02) in intervention-arm patients at 5 months. In subgroup analyses, intervention participants reported improvement from baseline at 5 and 12 months in their symptom focus area domains. CONCLUSION This intervention was well received among veterans who were long-term survivors of prostate cancer. Although overall outcome differences were not observed across groups, the intervention tailored to symptom area of choice may hold promise to improve associated burden.
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Affiliation(s)
- Ted A Skolarus
- 1 Veterans Affairs Health Services Research and Development Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI.,2 University of Michigan, Ann Arbor, MI
| | - Tabitha Metreger
- 1 Veterans Affairs Health Services Research and Development Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
| | | | - Soohyun Hwang
- 3 University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
| | - Hyungjin Myra Kim
- 1 Veterans Affairs Health Services Research and Development Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI.,2 University of Michigan, Ann Arbor, MI
| | - Robert L Grubb
- 4 Medical University of South Carolina, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC
| | - Jeffrey R Gingrich
- 5 Duke University, Durham Veterans Affairs Healthcare System, Durham, NC
| | - Hui Zhu
- 6 Case Western Reserve University, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH
| | - John D Piette
- 1 Veterans Affairs Health Services Research and Development Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI.,7 University of Michigan School of Public Health, Ann Arbor, MI
| | - Sarah T Hawley
- 1 Veterans Affairs Health Services Research and Development Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI.,2 University of Michigan, Ann Arbor, MI
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Ware P, Dorai M, Ross HJ, Cafazzo JA, Laporte A, Boodoo C, Seto E. Patient Adherence to a Mobile Phone-Based Heart Failure Telemonitoring Program: A Longitudinal Mixed-Methods Study. JMIR Mhealth Uhealth 2019; 7:e13259. [PMID: 30806625 PMCID: PMC6412156 DOI: 10.2196/13259] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 01/25/2019] [Accepted: 02/11/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Telemonitoring (TM) can improve heart failure (HF) outcomes by facilitating patient self-care and clinical decision support. However, these outcomes are only possible if patients consistently adhere to taking prescribed home readings. OBJECTIVE The objectives of this study were to (1) quantify the degree to which patients adhered to taking prescribed home readings in the context of a mobile phone-based TM program and (2) explain longitudinal adherence rates based on the duration of program enrollment, patient characteristics, and patient perceptions of the TM program. METHODS A mixed-methods explanatory sequential design was used to meet the 2 research objectives, and all explanatory methods were guided by the unified theory of acceptance and use of technology 2 (UTAUT2). Overall adherence rates were calculated as the proportion of days patients took weight, blood pressure, heart rate, and symptom readings over the total number of days they were enrolled in the program up to 1 year. Monthly adherence rates were also calculated as the proportion of days patients took the same 4 readings over each 30-day period following program enrollment. Next, simple and multivariate regressions were performed to determine the influence of time, age, sex, and disease severity on adherence rates. Additional explanatory methods included questionnaires at 6 and 12 months probing patients on the perceived benefits and ease of use of the TM program, an analysis of reasons for patients leaving the program, and semistructured interviews conducted with a purposeful sampling of patients (n=24) with a range of adherence rates and demographics. RESULTS Overall average adherence was 73.6% (SD 25.0) with average adherence rates declining over time at a rate of 1.4% per month (P<.001). The multivariate regressions found no significant effect of sex and disease severity on adherence rates. When grouping patients' ages by decade, age was a significant predictor (P=.04) whereby older patients had higher adherence rates over time. Adherence rates were further explained by patients' perceptions with regard to the themes of (1) performance expectancy (improvements in HF management and peace of mind), (2) effort expectancy (ease of use and technical issues), (3) facilitating conditions (availability of technical support and automated adherence calls), (4) social influence (support from family, friends, and trusted clinicians), and (5) habit (degree to which taking readings became automatic). CONCLUSIONS The decline in adherence rates over time is consistent with findings from other studies. However, this study also found adherence to be the highest and most consistent over time in older age groups and progressively lower over time for younger age groups. These findings can inform the design and implementation of TM interventions that maximize patient adherence, which will enable a more accurate evaluation of impact and optimization of resources. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/resprot.9911.
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Affiliation(s)
- Patrick Ware
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Toronto, Toronto, ON, Canada
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Mala Dorai
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Heather J Ross
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - Joseph A Cafazzo
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Toronto, Toronto, ON, Canada
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Audrey Laporte
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Toronto, Toronto, ON, Canada
- Canadian Centre for Health Economics, Toronto, ON, Canada
| | - Chris Boodoo
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Toronto, Toronto, ON, Canada
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Toronto, Toronto, ON, Canada
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
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23
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Adams AS, Schmittdiel JA, Altschuler A, Bayliss EA, Neugebauer R, Ma L, Dyer W, Clark J, Cook B, Willyoung D, Jaffe M, Young JD, Kim E, Boggs JM, Prosser L, Wittenberg E, Callaghan B, Shainline M, Hippler RM, Grant RW. Automated symptom and treatment side effect monitoring for improved quality of life among adults with diabetic peripheral neuropathy in primary care: a pragmatic, cluster, randomized, controlled trial. Diabet Med 2019; 36:52-61. [PMID: 30343489 PMCID: PMC7236318 DOI: 10.1111/dme.13840] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2018] [Indexed: 01/19/2023]
Abstract
AIMS To evaluate the effectiveness of automated symptom and side effect monitoring on quality of life among individuals with symptomatic diabetic peripheral neuropathy. METHODS We conducted a pragmatic, cluster randomized controlled trial (July 2014 to July 2016) within a large healthcare system. We randomized 1834 primary care physicians and prospectively recruited from their lists 1270 individuals with neuropathy who were newly prescribed medications for their symptoms. Intervention participants received automated telephone-based symptom and side effect monitoring with physician feedback over 6 months. The control group received usual care plus three non-interactive diabetes educational calls. Our primary outcomes were quality of life (EQ-5D) and select symptoms (e.g. pain) measured 4-8 weeks after starting medication and again 8 months after baseline. Process outcomes included receiving a clinically effective dose and communication between individuals with neuropathy and their primary care provider over 12 months. Interviewers collecting outcome data were blinded to intervention assignment. RESULTS Some 1252 participants completed the baseline measures [mean age (sd): 67 (11.7), 53% female, 57% white, 8% Asian, 13% black, 20% Hispanic]. In total, 1179 participants (93%) completed follow-up (619 control, 560 intervention). Quality of life scores (intervention: 0.658 ± 0.094; control: 0.653 ± 0.092) and symptom severity were similar at baseline. The intervention had no effect on primary [EQ-5D: -0.002 (95% CI -0.01, 0.01), P = 0.623; pain: 0.295 (-0.75, 1.34), P = 0.579; sleep disruption: 0.342 (-0.18, 0.86), P = 0.196; lower extremity functioning: -0.079 (-1.27, 1.11), P = 0.896; depression: -0.462 (-1.24, 0.32); P = 0.247] or process outcomes. CONCLUSIONS Automated telephone monitoring and feedback alone were not effective at improving quality of life or symptoms for people with symptomatic diabetic peripheral neuropathy. TRIAL REGISTRATION ClinicalTrials.gov (NCT02056431).
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Affiliation(s)
- Alyce S. Adams
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | | | | | - Elizabeth A. Bayliss
- Kaiser Permanente Colorado Institute for Health Research, Denver, CO, USA
- University of Colorado School of Medicine, Denver, CO, USA
| | | | - Lin Ma
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Wendy Dyer
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Joel Clark
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Bonieta Cook
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | | | - Marc Jaffe
- Kaiser Permanente South San Francisco Medical Center, South San Francisco, CA, USA
| | | | - Eileen Kim
- Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | - Jennifer M. Boggs
- Kaiser Permanente Colorado Institute for Health Research, Denver, CO, USA
| | - Lisa Prosser
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | - Brian Callaghan
- University of Michigan, Michigan Medicine, Neurology Clinic, Ann Arbor, MI, USA
| | - Michael Shainline
- Kaiser Permanente Colorado Institute for Health Research, Denver, CO, USA
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Christy KR, Jensen JD. Examining the relationship between the Big Five, Grit and avoidance of automated communication scales in adults 40-65. BEHAVIOUR & INFORMATION TECHNOLOGY 2018; 38:336-344. [PMID: 31133769 PMCID: PMC6533608 DOI: 10.1080/0144929x.2018.1533996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/02/2018] [Indexed: 06/09/2023]
Abstract
Automated communication technologies (ACTs) have largely become commonplace in day to day life. Although these technologies are widely used, there is a not insubstantial proportion of the population that prefers to avoid contact with ACTs. Recently, a scale was developed to assess dispositional avoidance of automated communication technologies. The current study provides validation of the scale in an older adult population and demonstrates that the avoidance of automated communication scale can be discriminated from personality measures, including the Big Five and Grit, and is predictive of avoidance of ACTs.
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Bauer R, Glenn T, Strejilevich S, Conell J, Alda M, Ardau R, Baune BT, Berk M, Bersudsky Y, Bilderbeck A, Bocchetta A, Castro AMP, Cheung EYW, Chillotti C, Choppin S, Cuomo A, Del Zompo M, Dias R, Dodd S, Duffy A, Etain B, Fagiolini A, Fernández Hernandez M, Garnham J, Geddes J, Gildebro J, Gitlin MJ, Gonzalez-Pinto A, Goodwin GM, Grof P, Harima H, Hassel S, Henry C, Hidalgo-Mazzei D, Lund AH, Kapur V, Kunigiri G, Lafer B, Larsen ER, Lewitzka U, Licht RW, Misiak B, Piotrowski P, Miranda-Scippa Â, Monteith S, Munoz R, Nakanotani T, Nielsen RE, O'Donovan C, Okamura Y, Osher Y, Reif A, Ritter P, Rybakowski JK, Sagduyu K, Sawchuk B, Schwartz E, Slaney C, Sulaiman AH, Suominen K, Suwalska A, Tam P, Tatebayashi Y, Tondo L, Veeh J, Vieta E, Vinberg M, Viswanath B, Zetin M, Whybrow PC, Bauer M. Internet use by older adults with bipolar disorder: international survey results. Int J Bipolar Disord 2018; 6:20. [PMID: 30178112 PMCID: PMC6161969 DOI: 10.1186/s40345-018-0127-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 08/01/2018] [Indexed: 12/12/2022] Open
Abstract
Background The world population is aging and the number of older adults with bipolar disorder is increasing. Digital technologies are viewed as a framework to improve care of older adults with bipolar disorder. This analysis quantifies Internet use by older adults with bipolar disorder as part of a larger survey project about information seeking. Methods A paper-based survey about information seeking by patients with bipolar disorder was developed and translated into 12 languages. The survey was anonymous and completed between March 2014 and January 2016 by 1222 patients in 17 countries. All patients were diagnosed by a psychiatrist. General estimating equations were used to account for correlated data. Results Overall, 47% of older adults (age 60 years or older) used the Internet versus 87% of younger adults (less than 60 years). More education and having symptoms that interfered with regular activities increased the odds of using the Internet, while being age 60 years or older decreased the odds. Data from 187 older adults and 1021 younger adults were included in the analysis excluding missing values. Conclusions Older adults with bipolar disorder use the Internet much less frequently than younger adults. Many older adults do not use the Internet, and technology tools are suitable for some but not all older adults. As more health services are only available online, and more digital tools are developed, there is concern about growing health disparities based on age. Mental health experts should participate in determining the appropriate role for digital tools for older adults with bipolar disorder.
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Affiliation(s)
- Rita Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Tasha Glenn
- ChronoRecord Association, Fullerton, CA, USA
| | - Sergio Strejilevich
- Bipolar Disorder Program, Neuroscience Institute, Favaloro University, Buenos Aires, Argentina
| | - Jörn Conell
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,AMEOS Klinika Holstein, Neustadt, Germany
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Raffaella Ardau
- Unit of Clinical Pharmacology, University Hospital of Cagliari, Cagliari, Italy
| | - Bernhard T Baune
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Michael Berk
- School of Medicine, IMPACT Strategic Research Centre, Deakin University, Geelong, VIC, Australia.,University Hospital Geelong, Barwon Health, Geelong, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia.,Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia.,Orygen Youth Health Research Centre and the National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - Yuly Bersudsky
- Department of Psychiatry, Faculty of Health Sciences, Ben Gurion University of the Negev; Beer Sheva Mental Health Center, Beer Sheva, Israel
| | - Amy Bilderbeck
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Alberto Bocchetta
- Section of Neurosciences and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Sardinia, Italy
| | - Angela M Paredes Castro
- School of Medicine, IMPACT Strategic Research Centre, Deakin University, Geelong, VIC, Australia.,University Hospital Geelong, Barwon Health, Geelong, VIC, Australia
| | - Eric Y W Cheung
- Department of General Adult Psychiatry, Castle Peak Hospital, Hong Kong, China
| | - Caterina Chillotti
- Unit of Clinical Pharmacology, University Hospital of Cagliari, Cagliari, Italy
| | - Sabine Choppin
- AP-HP, Hôpitaux Universitaires Henri-Mondor, Créteil, France
| | - Alessandro Cuomo
- Department of Molecular Medicine and Department of Mental Health (DAI), University of Siena and University of Siena Medical Center (AOUS), Siena, Italy
| | - Maria Del Zompo
- Section of Neurosciences and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Sardinia, Italy
| | - Rodrigo Dias
- Bipolar Disorder Research Program, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Seetal Dodd
- School of Medicine, IMPACT Strategic Research Centre, Deakin University, Geelong, VIC, Australia.,University Hospital Geelong, Barwon Health, Geelong, VIC, Australia.,Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Anne Duffy
- Department of Psychiatry, University of Calgary, Calgary, Canada
| | - Bruno Etain
- AP-HP, Hôpitaux Universitaires Henri-Mondor, INSERM U955 (IMRB), Université Paris Est, Créteil, France
| | - Andrea Fagiolini
- Department of Molecular Medicine and Department of Mental Health (DAI), University of Siena and University of Siena Medical Center (AOUS), Siena, Italy
| | - Miryam Fernández Hernandez
- Department of Psychiatry, University Hospital of Alava, University of the Basque Country, CIBERSAM, Vitoria, Spain
| | - Julie Garnham
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - John Geddes
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Jonas Gildebro
- Department of Affective Disorders, Q, Mood Disorders Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Michael J Gitlin
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Ana Gonzalez-Pinto
- Department of Psychiatry, University Hospital of Alava, University of the Basque Country, CIBERSAM, Vitoria, Spain
| | - Guy M Goodwin
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Paul Grof
- Mood Disorders Center of Ottawa, Ottawa, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Hirohiko Harima
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Setagaya, Tokyo, Japan
| | - Stefanie Hassel
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Chantal Henry
- AP-HP, Hôpitaux Universitaires Henri-Mondor, INSERM U955 (IMRB), Université Paris Est, Créteil, France.,Unité Perception et Mémoire, Institut Pasteur, F-75015, Paris, France
| | - Diego Hidalgo-Mazzei
- Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Anne Hvenegaard Lund
- Department of Affective Disorders, Q, Mood Disorders Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Vaisnvy Kapur
- Department of Clinical Psychology, NIMHANS, Bangalore, 560029, India
| | | | - Beny Lafer
- Bipolar Disorder Research Program, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Erik R Larsen
- Institute of Clinical Research, Research Unit of Psychiatry, University of Southern Denmark, Odense, Denmark.,Department of Psychiatry, Psychiatry in the Region of Southern Denmark, Odense, Denmark
| | - Ute Lewitzka
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Rasmus W Licht
- Aalborg University Hospital, Psychiatry, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Blazej Misiak
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Patryk Piotrowski
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Ângela Miranda-Scippa
- Department of Neuroscience and Mental Health, Federal University of Bahia, Salvador, Brazil
| | - Scott Monteith
- Michigan State University College of Human Medicine, Traverse City Campus, Traverse City, MI, USA
| | - Rodrigo Munoz
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Takako Nakanotani
- Affective Disorders Research Project, Tokyo Metropolitan Institute of Medical Science, Setagaya, Tokyo, Japan
| | - René E Nielsen
- Aalborg University Hospital, Psychiatry, Aalborg, Denmark
| | - Claire O'Donovan
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Yasushi Okamura
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Setagaya, Tokyo, Japan
| | - Yamima Osher
- Department of Psychiatry, Faculty of Health Sciences, Ben Gurion University of the Negev; Beer Sheva Mental Health Center, Beer Sheva, Israel
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Goethe-University Frankfurt am Main, Frankfurt, Germany
| | - Philipp Ritter
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Kemal Sagduyu
- Department of Psychiatry, University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Brett Sawchuk
- Department of Psychiatry, University of Calgary, Calgary, Canada
| | | | - Claire Slaney
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Ahmad H Sulaiman
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kirsi Suominen
- City of Helsinki, Department of Social Services and Health Care, Psychiatry, Helsinki, Finland
| | - Aleksandra Suwalska
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Peter Tam
- Department of Psychiatry, Department of Medicine, University of Hong Kong, Hong Kong, China
| | - Yoshitaka Tatebayashi
- Affective Disorders Research Project, Tokyo Metropolitan Institute of Medical Science, Setagaya, Tokyo, Japan
| | - Leonardo Tondo
- McLean Hospital and Harvard Medical School, Boston, MA, USA.,Lucio Bini Center, Cagliari, Rome, Italy
| | - Julia Veeh
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Goethe-University Frankfurt am Main, Frankfurt, Germany
| | - Eduard Vieta
- Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Maj Vinberg
- Psychiatric Center Copenhagen, Copenhagen, Denmark
| | - Biju Viswanath
- Department of Psychiatry, NIMHANS, Bangalore, 560029, India
| | - Mark Zetin
- Department of Psychology, Chapman University, Orange, CA, USA
| | - Peter C Whybrow
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
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Rosland AM, Piette JD, Trivedi R, Kerr EA, Stoll S, Tremblay A, Heisler M. Engaging family supporters of adult patients with diabetes to improve clinical and patient-centered outcomes: study protocol for a randomized controlled trial. Trials 2018; 19:394. [PMID: 30041685 PMCID: PMC6057090 DOI: 10.1186/s13063-018-2785-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 07/04/2018] [Indexed: 01/02/2023] Open
Abstract
Background Most adults with diabetes who are at high risk for complications have family or friends who are involved in their medical and self-care (“family supporters”). These family supporters are an important resource who could be leveraged to improve patients’ engagement in their care and patient health outcomes. However, healthcare teams lack structured and feasible approaches to effectively engage family supporters in patient self-management support. This trial tests a strategy to strengthen the capacity of family supporters to help adults with high-risk diabetes engage in healthcare, successfully enact care plans, and lower risk of diabetes complications. Methods/design We will conduct a randomized trial evaluating the CO-IMPACT (Caring Others Increasing EnageMent in Patient Aligned Care Teams) intervention. Two hunded forty adults with diabetes who are at high risk for diabetes complications due to poor glycemic control or high blood pressure will be randomized, along with a family supporter (living either with the patient or remotely), to CO-IMPACT or enhanced usual primary care for 12 months. CO-IMPACT provides patient-supporter dyads: it provides one coaching session addressing supporter techniques for helping patients with behavior change motivation, action planning, and proactive communication with healthcare providers; biweekly automated phone calls to prompt dyad action on new patient health concerns; phone calls to prompt preparation for patients’ primary care visits; and primary care visit summaries sent to both patient and supporter. Primary outcomes are changes in patient activation, as measured by the Patient Activation Measure-13, and change in 5-year cardiac event risk, as measured by the United Kingdom Prospective Diabetes Study cardiac risk score for people with diabetes. Secondary outcomes include patients’ diabetes self-management behaviors, diabetes distress, and glycemic and blood pressure control. Measures among supporters will include use of effective support techniques, burden, and distress about patient’s diabetes care. Discussion If effective in improving patient activation and diabetes management, CO-IMPACT will provide healthcare teams with evidence-based tools and techniques to engage patients’ available family or friends in supporting patient self-management, even if they live remotely. The core skills addressed by CO-IMPACT can be used by patients and their supporters over time to respond to changing patient health needs and priorities. Trial registration ClinicalTrials.gov, NCT02328326. Registered on 31 December 2014. Electronic supplementary material The online version of this article (10.1186/s13063-018-2785-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ann-Marie Rosland
- VA Pittsburgh Center for Health Equity Research and Promotion, University Drive (151C), Building 30, 2nd Suite 2A128, Pittsburgh, PA, 15240-1001, USA. .,Department of Internal Medicine, University of Pittsburgh, 230 McKee Place, Pittsburgh, PA, 15213, USA.
| | - John D Piette
- Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Center for Clinical Management Research, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.,Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, 1700 SPH I, Ann Arbor, MI, 48109, USA
| | - Ranak Trivedi
- Center for Innovation to Implementation, VA Palo Alto Center for Innovation to Implementation, 795 Willow Road, 152MPD Building 324, Palo Alto, CA, USA.,Department of Psychiatry and Behavioral Sciences, Standford University Medical School, 401 Quarry Road, Stanford, CA, 94305-5717, USA
| | - Eve A Kerr
- Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Center for Clinical Management Research, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.,Department of Internal Medicine, University of Michigan Medical School, 1600 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Shelley Stoll
- Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Center for Clinical Management Research, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.,Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, 1700 SPH I, Ann Arbor, MI, 48109, USA
| | - Adam Tremblay
- Department of Internal Medicine, University of Michigan Medical School, 1600 Plymouth Road, Ann Arbor, MI, 48109, USA.,Department of Ambulatory Care, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA
| | - Michele Heisler
- Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Center for Clinical Management Research, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.,Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, 1700 SPH I, Ann Arbor, MI, 48109, USA.,Department of Internal Medicine, University of Michigan Medical School, 1600 Plymouth Road, Ann Arbor, MI, 48109, USA
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Ratanawongsa N, Quan J, Handley MA, Sarkar U, Schillinger D. Language-concordant automated telephone queries to assess medication adherence in a diverse population: a cross-sectional analysis of convergent validity with pharmacy claims. BMC Health Serv Res 2018; 18:254. [PMID: 29625571 PMCID: PMC5889590 DOI: 10.1186/s12913-018-3071-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 03/28/2018] [Indexed: 12/15/2022] Open
Abstract
Background Clinicians have difficulty accurately assessing medication non-adherence within chronic disease care settings. Health information technology (HIT) could offer novel tools to assess medication adherence in diverse populations outside of usual health care settings. In a multilingual urban safety net population, we examined the validity of assessing adherence using automated telephone self-management (ATSM) queries, when compared with non-adherence using continuous medication gap (CMG) on pharmacy claims. We hypothesized that patients reporting greater days of missed pills to ATSM queries would have higher rates of non-adherence as measured by CMG, and that ATSM adherence assessments would perform as well as structured interview assessments. Methods As part of an ATSM-facilitated diabetes self-management program, low-income health plan members typed numeric responses to rotating weekly ATSM queries: “In the last 7 days, how many days did you MISS taking your …” diabetes, blood pressure, or cholesterol pill. Research assistants asked similar questions in computer-assisted structured telephone interviews. We measured continuous medication gap (CMG) by claims over 12 preceding months. To evaluate convergent validity, we compared rates of optimal adherence (CMG ≤ 20%) across respondents reporting 0, 1, and ≥ 2 missed pill days on ATSM and on structured interview. Results Among 210 participants, 46% had limited health literacy, 57% spoke Cantonese, and 19% Spanish. ATSM respondents reported ≥1 missed day for diabetes (33%), blood pressure (19%), and cholesterol (36%) pills. Interview respondents reported ≥1 missed day for diabetes (28%), blood pressure (21%), and cholesterol (26%) pills. Optimal adherence rates by CMG were lower among ATSM respondents reporting more missed days for blood pressure (p = 0.02) and cholesterol (p < 0.01); by interview, differences were significant for cholesterol (p = 0.01). Conclusions Language-concordant ATSM demonstrated modest potential for assessing adherence. Studies should evaluate HIT assessments of medication beliefs and concerns in diverse populations. Trial registration NCT00683020, registered May 21, 2008. Electronic supplementary material The online version of this article (10.1186/s12913-018-3071-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Neda Ratanawongsa
- General Internal Medicine and UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California, 1001 Potrero Avenue, Box 1364, San Francisco, CA, 94143, USA.
| | - Judy Quan
- General Internal Medicine and UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California, 1001 Potrero Avenue, Box 1364, San Francisco, CA, 94143, USA
| | - Margaret A Handley
- General Internal Medicine and UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California, 1001 Potrero Avenue, Box 1364, San Francisco, CA, 94143, USA.,Department of Epidemiology and Biostatistics, Division of Preventive Medicine and Public Health, University of California, 1001 Potrero Avenue, Box 1364, San Francisco, CA, 94143, USA
| | - Urmimala Sarkar
- General Internal Medicine and UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California, 1001 Potrero Avenue, Box 1364, San Francisco, CA, 94143, USA
| | - Dean Schillinger
- General Internal Medicine and UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California, 1001 Potrero Avenue, Box 1364, San Francisco, CA, 94143, USA
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Teo AR, Marsh HE, Forsberg CW, Nicolaidis C, Chen JI, Newsom J, Saha S, Dobscha SK. Loneliness is closely associated with depression outcomes and suicidal ideation among military veterans in primary care. J Affect Disord 2018; 230:42-49. [PMID: 29407537 DOI: 10.1016/j.jad.2018.01.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 01/05/2018] [Accepted: 01/13/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although the substantial influence of social relationships on health is well-known, studies that concurrently examine the influence of varying dimensions of social connectedness on major depression are more limited. This study's aim was to determine to what degree several facets of social connectedness (number of confidants, social support, interpersonal conflict, social norms, and loneliness) are correlated with depression-related outcomes. METHODS Participants were primary care patients (n = 301) with probable major depression at a Veterans Health Administration hospital and its satellite clinics. Social connectedness was primarily measured using multi-item instruments from the NIH Toolbox of Adult Social Relationship Scales. Primary outcomes were clinical symptoms (depression and suicidal ideation) and secondary outcomes were self-reported health-related behaviors (medication adherence, patient activation, and help-seeking intentions). RESULTS In multivariate models adjusting for potential confounders and other facets of connectedness, loneliness was associated with higher levels of depression and suicidal ideation, as well as lower patient activation and help-seeking intentions. Social support and social norms about depression treatment were each associated with higher patient activation and help-seeking intentions. Social connectedness was not associated with medication adherence. LIMITATIONS The limitations of this study are primarily related to its cross-sectional survey design and study population. CONCLUSIONS Multiple aspects of social connectedness are associated with depression outcomes among military veterans with depression. Loneliness may represent the most important component of connectedness, as it is associated with depression severity, suicidality, and health-related behaviors.
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Affiliation(s)
- Alan R Teo
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), 3710 SW US Veterans Hospital Rd (R&D 66), Portland, OR 97239-2964, United States; Oregon Health & Science University, Department of Psychiatry, 3181 SW Sam Jackson Park Rd (Multnomah Pavilion, Room 2316), Portland, OR 97239-3098, United States; Oregon Health & Science University and Portland State University, School of Public Health, 506 SW Mill St, Suite 450 (OMPH-SCH), Portland, OR 97201-5404, United States.
| | - Heather E Marsh
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), 3710 SW US Veterans Hospital Rd (R&D 66), Portland, OR 97239-2964, United States
| | - Christopher W Forsberg
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), 3710 SW US Veterans Hospital Rd (R&D 66), Portland, OR 97239-2964, United States
| | - Christina Nicolaidis
- Oregon Health & Science University and Portland State University, School of Public Health, 506 SW Mill St, Suite 450 (OMPH-SCH), Portland, OR 97201-5404, United States; Oregon Health & Science University, Department of Internal Medicine, 3181 SW Sam Jackson Park Rd L475, Portland, OR 97239-3098, United States; Portland State University, School of Social Work, 1600 SW 4th Ave, Portland, OR 97201-5522, United States
| | - Jason I Chen
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), 3710 SW US Veterans Hospital Rd (R&D 66), Portland, OR 97239-2964, United States
| | - Jason Newsom
- Portland State University, School of Community Health: Institute on Aging, P.O. Box 751 - IOA, Portland, OR 97207-0751, United States
| | - Somnath Saha
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), 3710 SW US Veterans Hospital Rd (R&D 66), Portland, OR 97239-2964, United States; Oregon Health & Science University, Department of Internal Medicine, 3181 SW Sam Jackson Park Rd L475, Portland, OR 97239-3098, United States; Oregon Health & Science University, Department of Medical Informatics and Clinical Epidemiology, 3181 SW Sam Jackson Park Rd (5th Floor, Biomedical Information Communication Center), Portland, OR 97239-3098, United States
| | - Steven K Dobscha
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), 3710 SW US Veterans Hospital Rd (R&D 66), Portland, OR 97239-2964, United States; Oregon Health & Science University, Department of Psychiatry, 3181 SW Sam Jackson Park Rd (Multnomah Pavilion, Room 2316), Portland, OR 97239-3098, United States
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Rigotti NA, Chang Y, Rosenfeld LC, Japuntich SJ, Park ER, Tindle HA, Levy DE, Reid ZZ, Streck J, Gomperts T, Kelley JHK, Singer DE. Interactive Voice Response Calls to Promote Smoking Cessation after Hospital Discharge: Pooled Analysis of Two Randomized Clinical Trials. J Gen Intern Med 2017; 32:1005-1013. [PMID: 28616847 PMCID: PMC5570745 DOI: 10.1007/s11606-017-4085-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 03/31/2017] [Accepted: 05/17/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hospitalization offers smokers an opportunity to quit smoking. Starting cessation treatment in hospital is effective, but sustaining treatment after discharge is a challenge. Automated telephone calls with interactive voice response (IVR) technology could support treatment continuance after discharge. OBJECTIVE To assess smokers' use of and satisfaction with an IVR-facilitated intervention and to test the relationship between intervention dose and smoking cessation. DESIGN Analysis of pooled quantitative and qualitative data from the intervention groups of two similar randomized controlled trials with 6-month follow-up. PARTICIPANTS A total of 878 smokers admitted to three hospitals. All received cessation counseling in hospital and planned to stop smoking after discharge. INTERVENTION After discharge, participants received free cessation medication and five automated IVR calls over 3 months. Calls delivered messages promoting smoking cessation and medication adherence, offered medication refills, and triaged smokers to additional telephone counseling. MAIN MEASURES Number of IVR calls answered, patient satisfaction, biochemically validated tobacco abstinence 6 months after discharge. KEY RESULTS Participants answered a median of three of five IVR calls; 70% rated the calls as helpful, citing the social support, access to counseling and medication, and reminders to quit as positive factors. Older smokers (OR 1.36, 95% CI 1.20-1.54 per decade) and smokers hospitalized for a smoking-related disease (OR 1.65, 95% CI 1.21-2.23) completed more calls. Smokers who completed more calls had higher quit rates at 6-month follow-up (OR 1.49, 95% CI 1.30-1.70, for each additional call) after multivariable adjustment for age, sex, education, discharge diagnosis, nicotine dependence, duration of medication use, and perceived importance of and confidence in quitting. CONCLUSIONS Automated IVR calls to support smoking cessation after hospital discharge were viewed favorably by patients. Higher IVR utilization was associated with higher odds of tobacco abstinence at 6-month follow-up. IVR technology offers health care systems a potentially scalable means of sustaining tobacco cessation interventions after hospital discharge. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifiers NCT01177176, NCT01714323.
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Affiliation(s)
- Nancy A Rigotti
- Tobacco Research and Treatment Center, Massachusetts General Hospital, 50 Staniford St., Room #914, Boston, MA, 02114, USA.
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, 50 Staniford St., Room #914, Boston, MA, 02114, USA.
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA.
- Department of Medicine, Harvard Medical School, Boston, MA, USA.
| | - Yuchiao Chang
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, 50 Staniford St., Room #914, Boston, MA, 02114, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Lisa C Rosenfeld
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- McLean Hospital, Providence, RI, USA
| | - Sandra J Japuntich
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Elyse R Park
- Tobacco Research and Treatment Center, Massachusetts General Hospital, 50 Staniford St., Room #914, Boston, MA, 02114, USA
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- McLean Hospital, Providence, RI, USA
| | - Hilary A Tindle
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Douglas E Levy
- Tobacco Research and Treatment Center, Massachusetts General Hospital, 50 Staniford St., Room #914, Boston, MA, 02114, USA
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Zachary Z Reid
- Tobacco Research and Treatment Center, Massachusetts General Hospital, 50 Staniford St., Room #914, Boston, MA, 02114, USA
| | - Joanna Streck
- Department of Psychological Science, University of Vermont, Burlington, VT, USA
| | - Timothy Gomperts
- Tobacco Research and Treatment Center, Massachusetts General Hospital, 50 Staniford St., Room #914, Boston, MA, 02114, USA
| | - Jennifer H K Kelley
- Tobacco Research and Treatment Center, Massachusetts General Hospital, 50 Staniford St., Room #914, Boston, MA, 02114, USA
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA
| | - Daniel E Singer
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, 50 Staniford St., Room #914, Boston, MA, 02114, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Heapy AA, Higgins DM, Goulet JL, LaChappelle KM, Driscoll MA, Czlapinski RA, Buta E, Piette JD, Krein SL, Kerns RD. Interactive Voice Response-Based Self-management for Chronic Back Pain: The COPES Noninferiority Randomized Trial. JAMA Intern Med 2017; 177:765-773. [PMID: 28384682 PMCID: PMC5818820 DOI: 10.1001/jamainternmed.2017.0223] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Recommendations for chronic pain treatment emphasize multimodal approaches, including nonpharmacologic interventions to enhance self-management. Cognitive behavioral therapy (CBT) is an evidence-based treatment that facilitates management of chronic pain and improves outcomes, but access barriers persist. Cognitive behavioral therapy delivery assisted by health technology can obviate the need for in-person visits, but the effectiveness of this alternative to standard therapy is unknown. The Cooperative Pain Education and Self-management (COPES) trial was a randomized, noninferiority trial comparing IVR-CBT to in-person CBT for patients with chronic back pain. OBJECTIVE To assess the efficacy of interactive voice response-based CBT (IVR-CBT) relative to in-person CBT for chronic back pain. DESIGN, SETTING, AND PARTICIPANTS We conducted a noninferiority randomized trial in 1 Department of Veterans Affairs (VA) health care system. A total of 125 patients with chronic back pain were equally allocated to IVR-CBT (n = 62) or in-person CBT (n = 63). INTERVENTIONS Patients treated with IVR-CBT received a self-help manual and weekly prerecorded therapist feedback based on their IVR-reported activity, coping skill practice, and pain outcomes. In-person CBT included weekly, individual CBT sessions with a therapist. Participants in both conditions received IVR monitoring of pain, sleep, activity levels, and pain coping skill practice during treatment. MAIN OUTCOMES AND MEASURES The primary outcome was change from baseline to 3 months in unblinded patient report of average pain intensity measured by the Numeric Rating Scale (NRS). Secondary outcomes included changes in pain-related interference, physical and emotional functioning, sleep quality, and quality of life at 3, 6, and 9 months. We also examined treatment retention. RESULTS Of the 125 patients (97 men, 28 women; mean [SD] age, 57.9 [11.6] years), the adjusted average reduction in NRS with IVR-CBT (-0.77) was similar to in-person CBT (-0.84), with the 95% CI for the difference between groups (-0.67 to 0.80) falling below the prespecified noninferiority margin of 1 indicating IVR-CBT is noninferior. Fifty-four patients randomized to IVR-CBT and 50 randomized to in-person CBT were included in the analysis of the primary outcome. Statistically significant improvements in physical functioning, sleep quality, and physical quality of life at 3 months relative to baseline occurred in both treatments, with no advantage for either treatment. Treatment dropout was lower in IVR-CBT with patients completing on average 2.3 (95% CI, 1.0-3.6) more sessions. CONCLUSIONS AND RELEVANCE IVR-CBT is a low-burden alternative that can increase access to CBT for chronic pain and shows promise as a nonpharmacologic treatment option for chronic pain, with outcomes that are not inferior to in-person CBT. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01025752.
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Affiliation(s)
- Alicia A Heapy
- VA Connecticut Healthcare System Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, West Haven2Yale School of Medicine, New Haven, Connecticut
| | - Diana M Higgins
- VA Boston Healthcare System, Boston, Massachusetts4Boston University School of Medicine, Boston, Massachusetts
| | - Joseph L Goulet
- VA Connecticut Healthcare System Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, West Haven2Yale School of Medicine, New Haven, Connecticut
| | - Kathryn M LaChappelle
- VA Connecticut Healthcare System Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, West Haven
| | - Mary A Driscoll
- VA Connecticut Healthcare System Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, West Haven2Yale School of Medicine, New Haven, Connecticut
| | - Rebecca A Czlapinski
- VA Connecticut Healthcare System Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, West Haven
| | - Eugenia Buta
- Yale School of Medicine, New Haven, Connecticut5Yale Center for Analytical Sciences, New Haven, Connecticut
| | - John D Piette
- VA Ann Arbor Center for Clinical Management Research Health Services Research and Development Center of Innovation, Ann Arbor, Michigan7University of Michigan School of Public Health, Ann Arbor8University of Michigan Medical School, Ann Arbor
| | - Sarah L Krein
- VA Ann Arbor Center for Clinical Management Research Health Services Research and Development Center of Innovation, Ann Arbor, Michigan8University of Michigan Medical School, Ann Arbor
| | - Robert D Kerns
- VA Connecticut Healthcare System Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, West Haven2Yale School of Medicine, New Haven, Connecticut
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Skolarus TA, Metreger T, Hwang S, Kim HM, Grubb RL, Gingrich JR, Hawley ST. Optimizing veteran-centered prostate cancer survivorship care: study protocol for a randomized controlled trial. Trials 2017; 18:181. [PMID: 28420419 PMCID: PMC5395886 DOI: 10.1186/s13063-017-1925-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 03/30/2017] [Indexed: 11/17/2022] Open
Abstract
Background Although prostate cancer is the most common cancer among veterans receiving care in the Veterans Health Administration (VA), more needs to be done to understand and improve survivorship care for this large population. This study, funded by VA Health Services Research & Development (HSR&D), seeks to address the need to improve patient-centered survivorship care for veterans with prostate cancer. Methods/Design This is a two-armed randomized controlled trial (RCT) with a target enrollment of up to 325 prostate cancer survivors per study arm (total anticipated n = 600). Patients will be recruited from four VA sites. Patient eligibility criteria include age range of 40–80 years, one to ten years post-treatment, and currently experiencing prostate cancer symptom burden. We will compare the “Building Your New Normal” program, a personally-tailored automated telephone symptom management intervention for improving symptom self-management to usual care enhanced with a non-tailored newsletter about symptom management. Primary outcomes include changes in symptom burden, bother, and health services utilization at five and 12 months after enrollment. Secondary outcomes include long-term psychosocial outcomes (e.g. subjective health, perceived cancer control). We will use multivariable regression analysis to evaluate the impact of the intervention on primary and secondary outcomes. We will conduct a process evaluation to understand the effective intervention components and explore possibilities for broader implementation and dissemination. Discussion Our central hypothesis is that intervention group participants will have improved and more confident symptom self-management and prostate cancer quality of life following the intervention and that these outcomes will translate to more efficient use of health services. The study results will provide much needed information about how to optimize the quality of care, and life, of veteran prostate cancer survivors. Trial registration ClinicalTrials.gov ID NCT01900561; Registered on 22 July 2013. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1925-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ted A Skolarus
- VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.,Department of Urology, Dow Division of Health Services Research, University of Michigan, Ann Arbor, MI, USA
| | - Tabitha Metreger
- VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA
| | - Soohyun Hwang
- VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA
| | - Hyungjin Myra Kim
- VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.,University of Michigan Center for Consulting for Statistics, Computing and Analytics Research, Ann Arbor, MI, USA
| | - Robert L Grubb
- Department of Surgery (Urology), St. Louis VA Medical Center, Washington University School of Medicine, 915 North Grand Blvd., St. Louis, MO, 63106, USA
| | - Jeffrey R Gingrich
- Department of Urology, VA Pittsburgh Healthcare System, University of Pittsburgh, 7180 Highland Drive, Pittsburgh, PA, 15206, USA
| | - Sarah T Hawley
- VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA. .,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
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Beratarrechea A, Moyano D, Irazola V, Rubinstein A. mHealth Interventions to Counter Noncommunicable Diseases in Developing Countries: Still an Uncertain Promise. Cardiol Clin 2017; 35:13-30. [PMID: 27886783 DOI: 10.1016/j.ccl.2016.08.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
mHealth constitutes a promise for health care delivery in low- and middle-income countries (LMICs) where health care systems are unprepared to combat the threat of noncommunicable diseases (NCDs). This article assesses the impact of mHealth on NCD outcomes in LMICs. A systematic review identified controlled studies evaluating mHealth interventions that addressed NCDs in LMICs. From the 1274 abstracts retrieved, 108 articles were selected for full text review and 20 randomized controlled trials were included from 14 LMICs. One-way SMS was the most commonly used mobile function to deliver reminders, health education, and information. mHealth interventions in LMICs have positive but modest effects on chronic disease outcomes.
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Affiliation(s)
- Andrea Beratarrechea
- South American Center of Excellence for Cardiovascular Health, Institute for Clinical Effectiveness and Health Policy, Ravignani 2024, Buenos Aires C1414CPV, Argentina.
| | - Daniela Moyano
- South American Center of Excellence for Cardiovascular Health, Institute for Clinical Effectiveness and Health Policy, Ravignani 2024, Buenos Aires C1414CPV, Argentina
| | - Vilma Irazola
- South American Center of Excellence for Cardiovascular Health, Institute for Clinical Effectiveness and Health Policy, Ravignani 2024, Buenos Aires C1414CPV, Argentina
| | - Adolfo Rubinstein
- South American Center of Excellence for Cardiovascular Health, Institute for Clinical Effectiveness and Health Policy, Ravignani 2024, Buenos Aires C1414CPV, Argentina
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Mooney KH, Beck SL, Wong B, Dunson W, Wujcik D, Whisenant M, Donaldson G. Automated home monitoring and management of patient-reported symptoms during chemotherapy: results of the symptom care at home RCT. Cancer Med 2017; 6:537-546. [PMID: 28135050 PMCID: PMC5345623 DOI: 10.1002/cam4.1002] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 12/07/2016] [Accepted: 12/08/2016] [Indexed: 11/11/2022] Open
Abstract
Technology‐aided remote interventions for poorly controlled symptoms may improve cancer symptom outcomes. In a randomized controlled trial, the efficacy of an automated symptom management system was tested to determine if it reduced chemotherapy‐related symptoms. Prospectively, 358 patients beginning chemotherapy were randomized to the Symptom Care at Home (SCH) intervention (n = 180) or enhanced usual care (UC) (n = 178). Participants called the automated monitoring system daily reporting severity of 11 symptoms. SCH participants received automated self‐management coaching and nurse practitioner (NP) telephone follow‐up for poorly controlled symptoms. NPs used a guideline‐based decision support system. Primary endpoints were symptom severity across all symptoms, and the number of severe, moderate, mild, and no symptom days. A secondary endpoint was individual symptom severity. Mixed effects linear modeling and negative binominal regressions were used to compare SCH with UC. SCH participants had significantly less symptom severity across all symptoms (P < 0.001). On average, the relative symptom burden reduction for SCH participants was 3.59 severity points (P < 0.001), roughly 43% of UC. With a very rapid treatment benefit, SCH participants had significant reductions in severe (67% less) and moderate (39% less) symptom days compared with UC (both P < 0.001). All individual symptoms, except diarrhea, were significantly lower for SCH participants (P < 0.05). Symptom Care at Home dramatically improved symptom outcomes. These results demonstrate that symptoms can be improved through automated home monitoring and follow‐up to intensify care for poorly controlled symptoms.
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Affiliation(s)
- Kathi H Mooney
- Huntsman Cancer Institute, University of Utah, College of Nursing, Salt Lake City, Utah
| | - Susan L Beck
- Huntsman Cancer Institute, University of Utah, College of Nursing, Salt Lake City, Utah
| | - Bob Wong
- Huntsman Cancer Institute, University of Utah, College of Nursing, Salt Lake City, Utah
| | - William Dunson
- Huntsman Cancer Institute, University of Utah, College of Nursing, Salt Lake City, Utah
| | - Debra Wujcik
- Huntsman Cancer Institute, University of Utah, College of Nursing, Salt Lake City, Utah
| | - Meagan Whisenant
- Huntsman Cancer Institute, University of Utah, College of Nursing, Salt Lake City, Utah
| | - Gary Donaldson
- Huntsman Cancer Institute, University of Utah, College of Nursing, Salt Lake City, Utah
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Xu RH, Wong ELY. Involvement in shared decision-making for patients in public specialist outpatient clinics in Hong Kong. Patient Prefer Adherence 2017; 11:505-512. [PMID: 28331297 PMCID: PMC5352249 DOI: 10.2147/ppa.s126316] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This study is a preliminary exploration of the association between patient involvement in decision-making and patient socioeconomic characteristics and experience in specialist outpatient clinics (SOPCs) in Hong Kong. METHODS Cross-sectional telephone interviews were conducted using the Specialist Outpatient Experience Questionnaire (SOPEQ) in 26 Hospital Authority public SOPCs in Hong Kong. The SOPEQ was designed by The School of Public Health and Primary Care at The Chinese University of Hong Kong, fully taking into account both literature review and the local context of the public specialist outpatient system in Hong Kong. A total of 22,525 eligible participants were recruited for the study. RESULTS There were 13,966 valid responses. The results indicated that the patients who had more involvement in decision-making were younger (odds ratio [OR] =2.10; 95% CI 1.75, 2.53), more highly educated (OR =1.67; 95% CI 1.45, 1.93), less likely to be receiving a government allowance (OR =0.61; 95% CI 0.57, 0.65), and less likely to be in the new case group (OR =0.84; 95% CI 0.78, 0.92). Participants living with their families (OR =3.38; 95% CI 2.03, 5.63) or who were unemployed (OR =1.10; 95% CI 1.01, 1.21) had a more decisive role in the decision- making process. Those participants who had been more involved in decision-making and wanted to continue being more involved had greater levels of satisfaction (mean =7.94; P<0.001) and a better health status (OR =0.49; 95% CI 0.41, 0.58). CONCLUSION Engaging patients in their health care management remains a challenge in improving patient-centered care. Our results suggest that patient engagement is associated with perceived health status and the experience of using a health service. Understanding patients' characteristics and roles facilitates the development of preferred styles in the decision-making model.
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Affiliation(s)
- Richard H Xu
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China
| | - Eliza LY Wong
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China
- Correspondence: Eliza LY Wong, 4/F, School of Public Health and Primary Care, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, People’s Republic of China, Email
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Iyngkaran P, Toukhsati SR, Harris M, Connors C, Kangaharan N, Ilton M, Nagel T, Moser DK, Battersby M. Self Managing Heart Failure in Remote Australia - Translating Concepts into Clinical Practice. Curr Cardiol Rev 2016; 12:270-284. [PMID: 27397492 PMCID: PMC5304248 DOI: 10.2174/1573403x12666160703183001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 12/28/2015] [Accepted: 01/11/2016] [Indexed: 11/23/2022] Open
Abstract
Congestive heart failure (CHF) is an ambulatory health care condition characterized by episodes of decompensation and is usually without cure. It is a leading cause for morbidity and mortality and the lead cause for hospital admissions in older patients in the developed world. The long-term requirement for medical care and pharmaceuticals contributes to significant health care costs. CHF management follows a hierarchy from physician prescription to allied health, predominately nurse-led, delivery of care. Health services are easier to access in urban compared to rural settings. The differentials for more specialized services could be even greater. Remote Australia is thus faced with unique challenges in delivering CHF best practice. Chronic disease self-management programs (CDSMP) were designed to increase patient participation in their health and alleviate stress on health systems. There have been CDSMP successes with some diseases, although challenges still exist for CHF. These challenges are amplified in remote Australia due to geographic and demographic factors, increased burden of disease, and higher incidence of comorbidities. In this review we explore CDSMP for CHF and the challenges for our region.
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Janevic MR, Aruquipa Yujra AC, Marinec N, Aguilar J, Aikens JE, Tarrazona R, Piette JD. Feasibility of an interactive voice response system for monitoring depressive symptoms in a lower-middle income Latin American country. Int J Ment Health Syst 2016; 10:59. [PMID: 27688798 PMCID: PMC5034527 DOI: 10.1186/s13033-016-0093-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 09/17/2016] [Indexed: 11/10/2022] Open
Abstract
Background Innovative, scalable solutions are needed to address the vast unmet need for mental health care in low- and middle-income countries (LMICs). Methods We conducted a feasibility study of a 14-week automated telephonic interactive voice response (IVR) depression self-care service among Bolivian primary care patients with at least moderately severe depressive symptoms. We analyzed IVR call completion rates, the reliability and validity of IVR-collected data, and participant satisfaction. Results Of the 32 participants, the majority were women (78 % or 25/32) and non-indigenous (75 % or 24/32). Participants had moderate depressive symptoms at baseline (PHQ-8 score mean 13.3, SD = 3.5) and reported good or fair general health status (88 % or 28/32). Fifty-four percent of weekly IVR calls (approximately 7 out of 13 active call-weeks) were completed. Neither PHQ-8 scores nor IVR call completion differed significantly by ethnicity, education, self-reported depression diagnosis, self-reported overall health, number of chronic conditions, or health literacy. The reliability for IVR-collected PHQ-8 scores was good (Cronbach’s alpha = 0.83). Virtually every participant (97 %) was “mostly” or “very” satisfied with the program. Many described the program as beneficial for their mood and self-care, albeit limited by some technological difficulties and the lack of human interaction. Conclusion Findings suggest that IVR could feasibly be used to provide monitoring and self-care education to depressed patients in Bolivia. An expanded stepped-care service offering contact with lay health workers for more depressed individuals and expanded mHealth content may foster greater patient engagement and enhance its therapeutic value while remaining cost-effective. Trial registration ISRCTN ISRCTN 18403214. Registered 14 September 2016. Retrospectively registered
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Affiliation(s)
- Mary R Janevic
- Center for Managing Chronic Disease, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109 USA
| | | | - Nicolle Marinec
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI 48105 USA
| | - Juvenal Aguilar
- Estado Plurinacional de Bolivia Ministerio de Salud, La Paz, Bolivia
| | - James E Aikens
- School of Medicine, University of Michigan, 1018 Fuller St., Ann Arbor, MI 48104 USA
| | - Rosa Tarrazona
- QUANTICA Organización Profesional para el Avance de la Salud Mental, La Paz, Bolivia
| | - John D Piette
- Center for Managing Chronic Disease, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109 USA
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Trivedi R, Slightam C, Fan VS, Rosland AM, Nelson K, Timko C, Asch SM, Zeliadt SB, Heidenreich P, Hebert PL, Piette JD. A Couples' Based Self-Management Program for Heart Failure: Results of a Feasibility Study. Front Public Health 2016; 4:171. [PMID: 27626029 PMCID: PMC5004799 DOI: 10.3389/fpubh.2016.00171] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 08/03/2016] [Indexed: 11/15/2022] Open
Abstract
Background Heart failure (HF) is associated with frequent exacerbations and shortened lifespan. Informal caregivers such as significant others often support self-management in patients with HF. However, existing programs that aim to enhance self-management seldom engage informal caregivers or provide tools that can help alleviate caregiver burden or improve collaboration between patients and their informal caregivers. Objective To develop and pilot test a program targeting the needs of self-management support among HF patients as well as their significant others. Methods We developed the Dyadic Health Behavior Change model and conducted semi-structured interviews to determine barriers to self-management from various perspectives. Participants’ feedback was used to develop a family-centered self-management program called “SUCCEED: Self-management Using Couples’ Coping EnhancEment in Diseases.” The goals of this program are to improve HF self-management, quality of life, communication within couples, relationship quality, and stress and caregiver burden. We conducted a pilot study with 17 Veterans with HF and their significant others to determine acceptability of the program. We piloted psychosocial surveys at baseline and after participants’ program completion to evaluate change in depressive symptoms, caregiver burden, self-management of HF, communication, quality of relationship, relationship mutuality, and quality of life. Results Of the 17 couples, 14 completed at least 1 SUCCEED session. Results showed high acceptability for each of SUCCEED’s sessions. At baseline, patients reported poor quality of life, clinically significant depressive symptoms, and inadequate self-management of HF. After participating in SUCCEED, patients showed improvements in self-management of HF, communication, and relationship quality, while caregivers reported improvements in depressive symptoms and caregiver burden. Quality of life of both patients and significant others declined over time. Conclusion In this small pilot study, we showed positive trends with involving significant others in self-management. SUCCEED has the potential of addressing the growing public health problem of HF among patients who receive care from their significant other.
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Affiliation(s)
- Ranak Trivedi
- Stanford University, Stanford, CA, USA; VA Palo Alto Health Care System, Menlo Park, CA, USA
| | | | - Vincent S Fan
- VA Puget Sound Health Care System, Seattle, WA, USA; University of Washington, Seattle, WA, USA
| | - Ann-Marie Rosland
- University of Michigan, Ann Arbor, MI, USA; VA Ann Arbor Health Care System, Ann Arbor, MI, USA
| | - Karin Nelson
- VA Puget Sound Health Care System, Seattle, WA, USA; University of Washington, Seattle, WA, USA
| | | | - Steven M Asch
- Stanford University, Stanford, CA, USA; VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Steven B Zeliadt
- VA Puget Sound Health Care System, Seattle, WA, USA; University of Washington, Seattle, WA, USA
| | - Paul Heidenreich
- Stanford University, Stanford, CA, USA; VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Paul L Hebert
- VA Puget Sound Health Care System, Seattle, WA, USA; University of Washington, Seattle, WA, USA
| | - John D Piette
- University of Michigan, Ann Arbor, MI, USA; VA Ann Arbor Health Care System, Ann Arbor, MI, USA
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Ausili D, Rebora P, Di Mauro S, Riegel B, Valsecchi MG, Paturzo M, Alvaro R, Vellone E. Clinical and socio-demographic determinants of self-care behaviours in patients with heart failure and diabetes mellitus: A multicentre cross-sectional study. Int J Nurs Stud 2016; 63:18-27. [PMID: 27567403 DOI: 10.1016/j.ijnurstu.2016.08.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 07/25/2016] [Accepted: 08/14/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND Self-care is vital for patients with heart failure to maintain health and quality of life, and it is even more vital for those who are also affected by diabetes mellitus, since they are at higher risk of worse outcomes. The literature is unclear on the influence of diabetes on heart failure self-care as well as on the influence of socio-demographic and clinical factors on self-care. OBJECTIVES (1) To compare self-care maintenance, self-care management and self-care confidence of patients with heart failure and diabetes versus those heart failure patients without diabetes; (2) to estimate if the presence of diabetes influences self-care maintenance, self-care management and self-care confidence of heart failure patients; (3) to identify socio-demographic and clinical determinants of self-care maintenance, self-care management and self-care confidence in patients with heart failure and diabetes. DESIGN Secondary analysis of data from a multicentre cross-sectional study. SETTING Outpatient clinics from 29 Italian provinces. PARTICIPANTS 1192 adults with confirmed diagnosis of heart failure. METHODS Socio-demographic and clinical data were abstracted from patients' medical records. Self-care maintenance, self-care management and self-care confidence were measured with the Self-Care of Heart Failure Index Version 6.2; each scale has a standardized score from 0 to 100, where a score <70 indicates inadequate self-care. Multiple linear regression analyses were performed. RESULTS Of 1192 heart failure patients, 379 (31.8%) had diabetes. In these 379, heart failure self-care behaviours were suboptimal (means range from 53.2 to 55.6). No statistically significant differences were found in any of the three self-care measures in heart failure patients with and without diabetes. The presence of diabetes did not influence self-care maintenance (p=0.12), self-care management (p=0.21) or self-care confidence (p=0.51). Age (p=0.04), number of medications (p=0.01), presence of a caregiver (p=0.04), family income (p=0.009) and self-care confidence (p<0.001) were determinants of self-care maintenance. Gender (p=0.01), number of medications (p=0.004) and self-care confidence (p<0.001) were significant determinants of self-care management. Number of medications (p=0.002) and cognitive function (p<0.001) were determinants of self-care confidence. CONCLUSIONS Self-care was poor in heart failure patients with diabetes mellitus. This population needs more intensive interventions to improve self-care. Determinants of self-care in heart failure patients with diabetes mellitus should be systematically assessed by clinicians to identify patients at risk of inadequate self-care.
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Affiliation(s)
- Davide Ausili
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.
| | - Paola Rebora
- Center of Biostatistics for Clinical Epidemiology, Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Stefania Di Mauro
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Barbara Riegel
- Biobehavioral Research Center, University of Pennsylvania, Philadelphia, PA, United States
| | - Maria Grazia Valsecchi
- Center of Biostatistics for Clinical Epidemiology, Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Marco Paturzo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Interactive Voice Response-An Innovative Approach to Post-Stroke Depression Self-Management Support. Transl Stroke Res 2016; 8:77-82. [PMID: 27394917 DOI: 10.1007/s12975-016-0481-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 06/13/2016] [Accepted: 06/27/2016] [Indexed: 10/21/2022]
Abstract
Automated interactive voice response (IVR) call systems can provide systematic monitoring and self-management support to depressed patients, but it is unknown if stroke patients are able and willing to engage in IVR interactions. We sought to assess the feasibility and acceptability of IVR as an adjunct to post-stroke depression follow-up care. The CarePartner program is a mobile health program designed to optimize depression self-management, facilitate social support from a caregiver, and strengthen connections between stroke survivors and primary care providers (PCPs). Ischemic stroke patients and an informal caregiver, if available, were recruited during the patient's acute stroke hospitalization or follow-up appointment. The CarePartner program was activated in patients with depressive symptoms during their stroke hospitalization or follow-up. The 3-month intervention consisted of weekly IVR calls monitoring both depressive symptoms and medication adherence along with tailored suggestions for depressive symptom self-management. After each completed IVR call, informal caregivers were automatically updated, and, if needed, the subject's PCP was notified. Of the 56 stroke patients who enrolled, depressive symptoms were identified in 13 (23 %) subjects. Subjects completed 74 % of the weekly IVR assessments. A total of six subjects did not complete the outcome assessment, including two non-study-related deaths. PCPs were notified five times, including two times for suicidal ideation and three times for medication non-adherence. Stroke patients with depressive symptoms were able to engage in an IVR call system. Future studies are needed to explore the efficacy of an IVR approach for post-stroke self-management and monitoring of stroke-related outcomes.
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Walsh S, Golden E, Priebe S. Systematic review of patients' participation in and experiences of technology-based monitoring of mental health symptoms in the community. BMJ Open 2016; 6:e008362. [PMID: 27329437 PMCID: PMC4916567 DOI: 10.1136/bmjopen-2015-008362] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To review systematically the literature on patients' experiences of, and participation in, technology-based monitoring of mental health symptoms. This practice was defined as patients monitoring their mental health symptoms, emotions or behaviours outside of routine clinical appointments by submitting symptom data using technology, with feedback arising from the data (for example, supportive messages or symptom summaries, being sent to the patient, clinician or carer). DESIGN Systematic review following PRISMA guidelines of studies evaluating technology-based symptom monitoring. Tools from narrative synthesis were used to analyse quantitative findings on participation rates and qualitative findings on patient views. DATA SOURCES PubMed, EMBASE, PsycINFO, BNI, CINAHL, Cochrane Registers and Web of Science electronic databases were searched using a combination of 'psychiatry', 'symptom monitoring' and 'technology' descriptors. A secondary hand search was performed in grey literature and references. RESULTS 57 papers representing 42 studies met the inclusion criteria for the review. Technology-based symptom monitoring was used for a range of mental health conditions, either independently of a specific therapeutic intervention or as an integrated component of therapeutic interventions. The majority of studies reported moderate-to-strong rates of participation, though a third reported lower rates. Qualitative feedback suggests that acceptability of monitoring is related to perceived validity, ease of practice, convenient technology, appropriate frequency and helpfulness of feedback, as well as the impact of monitoring on participants' ability to manage health and personal relationships. CONCLUSIONS Such symptom monitoring practices appear to be well accepted and may be a feasible complement to clinical practice. However, there is limited availability of data and heterogeneity of studies. Future research should examine robustly patients' role in the development and evaluation of technology-based symptom monitoring in order to maximise its clinical utility.
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Affiliation(s)
- Sophie Walsh
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
| | - Eoin Golden
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
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Piette JD, Marinec N, Janda K, Morgan E, Schantz K, Yujra ACA, Pinto B, Soto JMH, Janevic M, Aikens JE. Structured Caregiver Feedback Enhances Engagement and Impact of Mobile Health Support: A Randomized Trial in a Lower-Middle-Income Country. Telemed J E Health 2016; 22:261-8. [PMID: 26352854 PMCID: PMC4968278 DOI: 10.1089/tmj.2015.0099] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 07/01/2015] [Accepted: 07/01/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Patients' engagement in mobile health (m-health) interventions using interactive voice response (IVR) calls is less in low- and middle-income countries (LMICs) than in industrialized ones. We conducted a study to determine whether automated telephone feedback to informal caregivers ("CarePartners") increased engagement in m-health support among diabetes and hypertension patients in Bolivia. MATERIALS AND METHODS Patients with diabetes and/or hypertension were identified through ambulatory clinics affiliated with four hospitals. All patients enrolled with a CarePartner. Patients were randomized to weekly IVR calls including self-management questions and self-care education either alone ("standard m-health") or with automated feedback about health and self-care needs sent to their CarePartner after each IVR call ("m-health+CP"). RESULTS The 72 participants included 39 with diabetes and 53 with hypertension, of whom 19 had ≤6 years of education. After 1,225 patient-weeks of attempted IVR assessments, the call completion rate was higher among patients randomized to m-health+CP compared with standard m-health (62.0% versus 44.9%; p < 0.047). CarePartner feedback more than tripled call completion rates among indigenous patients and patients with low literacy (p < 0.001 for both). M-health+CP patients were more likely to report excellent health via IVR (adjusted odds ratio [AOR] = 2.60; 95% confidence interval [CI], 1.07, 6.32) and less likely to report days in bed due to illness (AOR = 0.42; 95% CI, 0.19, 0.91). CONCLUSIONS In this study we found that caregiver feedback increased engagement in m-health and may improve patients' health status relative to standard approaches. M-health+CP represents a scalable strategy for increasing the reach of self-management support in LMICs.
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Affiliation(s)
- John D. Piette
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan
- School of Public Health, University of Michigan, Ann Arbor, Michigan
- School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Nicolle Marinec
- Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan
- School of Public Health, University of Michigan, Ann Arbor, Michigan
- School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Kathryn Janda
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Emily Morgan
- School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Karolina Schantz
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | | | | | | | - Mary Janevic
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - James E. Aikens
- School of Medicine, University of Michigan, Ann Arbor, Michigan
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Heapy AA, Higgins DM, LaChappelle KM, Kirlin J, Goulet JL, Czlapinski RA, Buta E, Piette JD, Krein SL, Richardson CR, Kerns RD. Cooperative pain education and self-management (COPES): study design and protocol of a randomized non-inferiority trial of an interactive voice response-based self-management intervention for chronic low back pain. BMC Musculoskelet Disord 2016; 17:85. [PMID: 26879051 PMCID: PMC4754867 DOI: 10.1186/s12891-016-0924-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 02/03/2016] [Indexed: 01/18/2023] Open
Abstract
Background The Institute of Medicine report “Relieving Pain in America” recommends the promotion of patient self-management of pain for all people with pain. Given the high prevalence of chronic pain in the US, new strategies are needed to enhance access to cognitive behavioral therapy (CBT) and other evidence-based treatments designed to facilitate self-management of chronic pain conditions. Although CBT is efficacious, many patients have limited or no access to CBT. Technology-assisted delivery of CBT may improve access while maintaining efficacy. Methods/Design We describe a randomized non-inferiority trial of interactive voice response (IVR)-based CBT for patients with chronic low back pain. This intervention uses daily IVR monitoring and weekly pre-recorded therapist feedback, based on patient-reported information, to provide treatment for patients at home. A total of 230 patients with chronic low back pain are being identified from a single statewide health system serving US military veterans. Participants are randomized to receive either ten weeks of in-person CBT or IVR-based CBT. The primary outcome is pain intensity as measured by the Numeric Rating Scale immediately post-treatment. Secondary outcomes include pain-related interference, emotional functioning, and quality of life measured immediately post treatment, and 6 and 9 months post recruitment. Exploratory objectives of the study are to examine: (1) potential mediators of impact on clinical outcomes (treatment retention, self-reported skill practice ratings, IVR call adherence, and treatment satisfaction); and (2) moderators of treatment engagement, adherence to therapist recommendations for pain coping skill practice, and effects on clinical outcomes. Discussion This non-inferiority trial may identify an alternative to resource intensive in-person CBT that allows many more patients to receive care while also increasing retention of those enrolled in the program. Trial registration ClinicalTrials.gov: NCT01025752. Registered 3 December 2009.
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Affiliation(s)
- Alicia A Heapy
- VA Connecticut Healthcare System, Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, 11ACLGS, 950 Campbell Avenue, West Haven, CT, 06516, USA. .,Yale School of Medicine, New Haven, CT, USA.
| | - Diana M Higgins
- VA Boston Healthcare System, Boston, MA, USA.,Boston University School of Medicine, Boston, MA, USA
| | - Kathryn M LaChappelle
- VA Connecticut Healthcare System, Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, 11ACLGS, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | | | - Joseph L Goulet
- VA Connecticut Healthcare System, Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, 11ACLGS, 950 Campbell Avenue, West Haven, CT, 06516, USA.,Yale School of Medicine, New Haven, CT, USA
| | - Rebecca A Czlapinski
- VA Connecticut Healthcare System, Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, 11ACLGS, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | | | - John D Piette
- VA Ann Arbor Center for Clinical Management Research Health Services Research and Development Center of Innovation, Ann Arbor, MI, USA.,University of Michigan School of Public Health, Ann Arbor, MI, USA.,University of Michigan Medical School, Ann Arbor, MI, USA
| | - Sarah L Krein
- VA Ann Arbor Center for Clinical Management Research Health Services Research and Development Center of Innovation, Ann Arbor, MI, USA.,University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Robert D Kerns
- VA Connecticut Healthcare System, Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, 11ACLGS, 950 Campbell Avenue, West Haven, CT, 06516, USA.,Yale School of Medicine, New Haven, CT, USA
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Abstract
The presence of social support, and more recently, connection, has been linked to multiple health benefits and longevity measures and the lack of connection is associated with premature morbidity and mortality. Connected health is a growing industry, and we were interested in determining whether or not scholars in the field have established the ways in which technology could facilitate or promote connection between patients and healthcare providers. This integrative literature review sought to collect and analyze research studies addressing social support or connection in a sample of patients with diabetes to evaluate the social support or connection metrics in use, the type of technology deployed by researchers to achieve connection, and to assess the state of the science in this area. We hypothesized that being connected to someone who cares is good for your health. We believe this holds true even when connection is accomplished with mobile technologies. Thirty five studies were included in this review, 21 utilized technology to enhance patient-provider connection. The articles included in this review were from a total of more than nine countries and took place in hospital, physician office, and community settings. They represented people from childhood through to old age. Technologies evaluated include: telephone interventions, email, text messaging, interactive voice response (IVR), video blogs, apps, websites, and social media. There were multiple operational definitions of social support and self-management used as variables within the studies. Findings from this review suggest that being connected does matter to patients with diabetes, and being connected to family matters the most, even though the associations are complex and not always predictable. Furthermore, patients with diabetes will utilize a variety of technologies to connect with healthcare providers, team members, and even other people with the same disease. The use of technology with diabetes patients positively impacts a variety of health outcomes, such as HbA1c, weight, physical activity, healthy eating, cholesterol and frequency of glycemic monitoring.
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Affiliation(s)
- Karen Colorafi
- College of Nursing, Washington State University, Spokane, WA, USA
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Technology-Based Support for Older Adult Communication in Safety-Critical Domains. PSYCHOLOGY OF LEARNING AND MOTIVATION 2016. [DOI: 10.1016/bs.plm.2015.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Abstract
The interface between eHealth technologies and disease management in chronic conditions such as chronic heart failure (CHF) has advanced beyond the research domain. The substantial morbidity, mortality, health resource utilization and costs imposed by chronic disease, accompanied by increasing prevalence, complex comorbidities and changing client and health staff demographics, have pushed the boundaries of eHealth to alleviate costs whilst maintaining services. Whilst the intentions are laudable and the technology is appealing, this nonetheless requires careful scrutiny. This review aims to describe this technology and explore the current evidence and measures to enhance its implementation.
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An Automated Telephone Monitoring System to Identify Patients with Cirrhosis at Risk of Re-hospitalization. Dig Dis Sci 2015; 60:3563-9. [PMID: 26070524 DOI: 10.1007/s10620-015-3744-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 06/03/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Hospitalizations for cirrhosis are costly and associated with increased mortality. Disease management outside of clinic, such as the use of interactive voice response (IVR) calls, may identify signs to prevent hospitalization. The aim of this study was to investigate whether IVR monitoring can predict hospitalization and mortality in cirrhosis. METHODS One hundred patients with decompensated cirrhosis were enrolled in this observational study, of which 79 patients were included in the final analysis. Participants were followed until death, transplant, or last clinical follow-up (range 7-874 days). Analysis focused on potential predictors identified during the first month of IVR calls: presence of jaundice, abdominal/leg swelling, weakness, paracentesis requirement, medication changes, and weight change. The primary outcome was time to first hospital admission; secondary outcomes included hospitalization and time to death. Potential predictors with a p value <0.1 were further analyzed after adjustment for covariates (Model for End-stage Liver Disease score, serum sodium, number of medications). RESULTS Twenty (25%) patients died, and 49 (62%) were hospitalized at least once. Fifty-six (70%) patients completed >80% of their IVR calls. After adjustment for covariates, weakness was associated with an increased risk of first hospitalization (HR 2.14, CI 1.13-4.05, p = 0.02) and hospitalization rate (HR 2.1, CI 1.0-4.3, p = 0.048). Weight change of ≥ five pounds (2.3 kg) in a week increased the rate of hospitalization by 2.7 (CI 1.0-7.1, p = 0.045). No variable predicted death after covariate adjustment. CONCLUSIONS These results suggest IVR calls can be used to predict hospitalization in cirrhosis.
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Potentials of internet-based patient engagement and education programs to reduce hospital readmissions: a spotlight on need in heart failure. Nurs Clin North Am 2015; 50:283-91. [PMID: 25999071 DOI: 10.1016/j.cnur.2015.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Internet-based applications and mobile health technology has advanced at unprecedented rates over the last decade and has proved to be a highly effective platform for communication. Simultaneously, the United States health care system has reached a critical and unsustainable level of spending, arising largely from ingrained system inefficiencies and overall suboptimum communication. Internet-based and mobile health technology offers an innovative solution to both of these problems. The prevention of readmissions for heart failure provides an excellent example of how this new technology can be used in today's health care environment to improve patient care.
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Aikens JE, Trivedi R, Heapy A, Pfeiffer PN, Piette JD. Potential Impact of Incorporating a Patient-Selected Support Person into mHealth for Depression. J Gen Intern Med 2015; 30:797-803. [PMID: 25666218 PMCID: PMC4441673 DOI: 10.1007/s11606-015-3208-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although telephone care management improves depression outcomes, its implementation as a standalone strategy is often not feasible in resource-constrained settings. Moreover, little research has examined the potential role of self-management support from patients' trusted confidants. OBJECTIVE To investigate the potential benefits of integrating a patient-selected support person into automated mobile health (mHealth) for depression. DESIGN Patient preference trial. PARTICIPANTS Depressed primary care patients who were at risk for antidepressant nonadherence (i.e., Morisky Medication Adherence Scale total score > 1). INTERVENTION Patients received weekly interactive voice response (IVR) telephone calls for depression that included self-management guidance. They could opt to designate a lay support person from outside their home to receive guidance on supporting their self-management. Patients' clinicians were automatically notified of urgent patient issues. MAIN MEASURES Each week over a period of 6 months, we used IVR calls to monitor depression with the Patient Health Questionnaire-9 (PHQ-9; with total < 5 classified as remission), adherence (single item reflecting perfect adherence over the past week), and functional impairment (any bed days due to mental health). KEY RESULTS Of 221 at-risk patients, 61% participated with a support person. Analyses were adjusted for race, medical comorbidity, and baseline levels of symptom severity and adherence. Significant interaction effects indicated that during the initial phase of the program, only patients who participated with a support person improved significantly in their likelihood of either adhering to antidepressant medication (AOR = 1.31, 95% CI: 1.16-1.47, p < 0.001) or achieving remission of depression symptoms (AOR = 1.24, 95% CI: 1.14-1.34, p < 0.001). These benefits were maintained throughout the 6-month observation period. CONCLUSIONS Incorporating the "human factor" of a patient-selected support person into automated mHealth for depression self-management may yield sustained improvements in antidepressant adherence and depression symptom remission. However, this needs to be confirmed in a subsequent randomized controlled trial.
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Affiliation(s)
- James E Aikens
- Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104-1213, USA,
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Aikens JE, Rosland AM, Piette JD. Improvements in illness self-management and psychological distress associated with telemonitoring support for adults with diabetes. Prim Care Diabetes 2015; 9:127-134. [PMID: 25065270 PMCID: PMC4303563 DOI: 10.1016/j.pcd.2014.06.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 06/20/2014] [Accepted: 06/24/2014] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The objective of this observational open label trial was to characterize changes in diabetes self-management and psychological distress associated with a mobile health (mHealth) interactive voice response (IVR) self-management support program. METHODS For 3-6 months, 301 patients with diabetes received weekly IVR calls assessing health status and self-care and providing tailored pre-recorded self-management support messages. Patients could participate together with an informal caregiver who received suggestions on self-management support, and patients' clinicians were notified automatically when patients reported significant problems. RESULTS Patients completed 84% of weekly calls, providing 5682 patient-weeks of data. Thirty-nine percent participated with an informal caregiver. Outcome analyses adjusted for study design factors and sociodemographics indicated significant pre-post improvement in medication adherence, physical functioning, depressive symptoms, and diabetes-related distress (all p values <0.001). Analyses of self-management problems indicated that as the intervention proceeded, there were significant improvements in patients' IVR-reported frequency of weekly medication adherence, SMBG performance, checking feet, and frequency of abnormal self-monitored blood glucose readings (all p values <0.001). CONCLUSIONS We conclude that the combined program of automated telemonitoring, clinician notification, and informal caregiver involvement was associated with consistent improvements in medication adherence, diabetes self-management behaviors, physical functioning, and psychological distress. A randomized controlled trial is needed to verify these encouraging findings.
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Affiliation(s)
- James E Aikens
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Ann-Marie Rosland
- Division of General Internal Medicine, University of Michigan, Ann Arbor, MI, USA; VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA
| | - John D Piette
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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Aikens JE, Trivedi R, Aron DC, Piette JD. Integrating support persons into diabetes telemonitoring to improve self-management and medication adherence. J Gen Intern Med 2015; 30:319-26. [PMID: 25421436 PMCID: PMC4351288 DOI: 10.1007/s11606-014-3101-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 09/19/2014] [Accepted: 10/15/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the potential benefits for medication adherence of integrating a patient-selected support person into an automated diabetes telemonitoring and self-management program, and to determine whether these benefits vary by patients' baseline level of psychological distress. STUDY DESIGN The study was a quasi-experimental patient preference trial. METHODS The study included patients with type 2 diabetes who participated in three to six months of weekly automated telemonitoring via interactive voice response (IVR) calls, with the option of designating a supportive relative or friend to receive automated updates on the patient's health and self-management, along with guidance regarding potential patient assistance. We measured long-term medication adherence using the four-point Morisky Medication Adherence Scale (MMAS-4, possible range 0-4), weekly adherence with an IVR item, and psychological distress at baseline with the Mental Composite Summary (MCS) of the SF-12. RESULTS Of 98 initially nonadherent patients, 42% opted to involve a support person. Participants with a support person demonstrated significantly greater improvement in long-term adherence than those who participated alone (linear regression slopes: -1.17 vs. -0.57, respectively, p =0.001). Among distressed patients in particular, the odds of weekly nonadherence tended to decrease 25% per week for those with a support person (p =0.030), yet remained high for those who participated alone (p =0.820). CONCLUSIONS Despite their multiple challenges in illness self-management, patients with diabetes who are both nonadherent and psychologically distressed may benefit by the incorporation of a support person when they receive assistance via automated telemonitoring.
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Affiliation(s)
- James E Aikens
- Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104-1213, USA,
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