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Eaton C, Vallejo N, McDonald X, Wu J, Rodríguez R, Muthusamy N, Mathioudakis N, Riekert KA. User Engagement With mHealth Interventions to Promote Treatment Adherence and Self-Management in People With Chronic Health Conditions: Systematic Review. J Med Internet Res 2024; 26:e50508. [PMID: 39316431 DOI: 10.2196/50508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 02/27/2024] [Accepted: 07/29/2024] [Indexed: 09/25/2024] Open
Abstract
BACKGROUND There are numerous mobile health (mHealth) interventions for treatment adherence and self-management; yet, little is known about user engagement or interaction with these technologies. OBJECTIVE This systematic review aimed to answer the following questions: (1) How is user engagement defined and measured in studies of mHealth interventions to promote adherence to prescribed medical or health regimens or self-management among people living with a health condition? (2) To what degree are patients engaging with these mHealth interventions? (3) What is the association between user engagement with mHealth interventions and adherence or self-management outcomes? (4) How often is user engagement a research end point? METHODS Scientific database (Ovid MEDLINE, Embase, Web of Science, PsycINFO, and CINAHL) search results (2016-2021) were screened for inclusion and exclusion criteria. Data were extracted in a standardized electronic form. No risk-of-bias assessment was conducted because this review aimed to characterize user engagement measurement rather than certainty in primary study results. The results were synthesized descriptively and thematically. RESULTS A total of 292 studies were included for data extraction. The median number of participants per study was 77 (IQR 34-164). Most of the mHealth interventions were evaluated in nonrandomized studies (157/292, 53.8%), involved people with diabetes (51/292, 17.5%), targeted medication adherence (98/292, 33.6%), and comprised apps (220/292, 75.3%). The principal findings were as follows: (1) >60 unique terms were used to define user engagement; "use" (102/292, 34.9%) and "engagement" (94/292, 32.2%) were the most common; (2) a total of 11 distinct user engagement measurement approaches were identified; the use of objective user log-in data from an app or web portal (160/292, 54.8%) was the most common; (3) although engagement was inconsistently evaluated, most of the studies (99/195, 50.8%) reported >1 level of engagement due to the use of multiple measurement methods or analyses, decreased engagement across time (76/99, 77%), and results and conclusions suggesting that higher engagement was associated with positive adherence or self-management (60/103, 58.3%); and (4) user engagement was a research end point in only 19.2% (56/292) of the studies. CONCLUSIONS The results revealed major limitations in the literature reviewed, including significant variability in how user engagement is defined, a tendency to rely on user log-in data over other measurements, and critical gaps in how user engagement is evaluated (infrequently evaluated over time or in relation to adherence or self-management outcomes and rarely considered a research end point). Recommendations are outlined in response to our findings with the goal of improving research rigor in this area. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42022289693; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022289693.
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Affiliation(s)
- Cyd Eaton
- Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Natalie Vallejo
- Johns Hopkins School of Medicine, Baltimore, MD, United States
| | | | - Jasmine Wu
- Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Rosa Rodríguez
- Johns Hopkins School of Medicine, Baltimore, MD, United States
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Klooster IT, Kip H, van Gemert-Pijnen L, Crutzen R, Kelders S. A systematic review on eHealth technology personalization approaches. iScience 2024; 27:110771. [PMID: 39290843 PMCID: PMC11406103 DOI: 10.1016/j.isci.2024.110771] [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: 11/02/2023] [Revised: 03/05/2024] [Accepted: 08/15/2024] [Indexed: 09/19/2024] Open
Abstract
Despite the widespread use of personalization of eHealth technologies, there is a lack of comprehensive understanding regarding its application. This systematic review aims to bridge this gap by identifying and clustering different personalization approaches based on the type of variables used for user segmentation and the adaptations to the eHealth technology and examining the role of computational methods in the literature. From the 412 included reports, we identified 13 clusters of personalization approaches, such as behavior + channeling and environment + recommendations. Within these clusters, 10 computational methods were utilized to match segments with technology adaptations, such as classification-based methods and reinforcement learning. Several gaps were identified in the literature, such as the limited exploration of technology-related variables, the limited focus on user interaction reminders, and a frequent reliance on a single type of variable for personalization. Future research should explore leveraging technology-specific features to attain individualistic segmentation approaches.
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Affiliation(s)
- Iris Ten Klooster
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health, and Technology, University of Twente, Enschede, The Netherlands
| | - Hanneke Kip
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health, and Technology, University of Twente, Enschede, The Netherlands
- Department of Research, Stichting Transfore, Deventer, the Netherlands
| | - Lisette van Gemert-Pijnen
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health, and Technology, University of Twente, Enschede, The Netherlands
| | - Rik Crutzen
- Department of Health Promotion, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Saskia Kelders
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health, and Technology, University of Twente, Enschede, The Netherlands
- Optentia Research Focus Area, North-West University, Vaal Triangle Campus, Vanderbijlpark, South Africa
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Rebafka A, Bennett C, Dunn C, Roche D, Hawker C, Edwards D. Lung transplant recipients' experiences of and attitudes towards self-management: a qualitative systematic review. JBI Evid Synth 2024; 22:1656-1714. [PMID: 38757171 DOI: 10.11124/jbies-23-00070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
OBJECTIVE The objective of this review was to identify lung transplant recipients' experiences of and attitudes towards self-management. INTRODUCTION Lung transplantation is an established treatment to improve the survival of patients with end-stage lung diseases and has been performed on more than 40,000 patients worldwide. The current focus of care for lung transplant recipients is long-term management. Patients need to adapt and adhere to complex self-management tasks to prevent complications and to enable them to keep the transplanted graft as long as possible. However, to date, there are no qualitative systematic reviews that identify lung transplant recipients' experiences of and attitudes towards self-management. INCLUSION CRITERIA This review included studies of adults over 18 years of age who had received a lung transplant and were able to perform their self-management tasks independently. All studies that investigated lung transplant recipients' experiences of and attitudes towards self-management in any setting were eligible for inclusion. All types of studies that focused on qualitative data, including, but not limited to, phenomenology, grounded theory, ethnography, action research, and feminist research, were considered for inclusion. Mixed methods studies were included only when qualitative data could be extracted separately, and if they reported results relating to the phenomenon of interest. Studies published in English or German were considered for inclusion in this review. METHODS The search strategy aimed to find published studies using the databases Web of Science Core Collection, PsycINFO (Ovid), MEDLINE (Ovid), Embase (Ovid), Emcare (Ovid), and CINAHL (EBSCOhost). The search for unpublished studies included ProQuest Dissertations and Theses Database, EThOS, and OpenGrey. Databases were searched from inception to March 2022. Methodological quality of studies was independently assessed by 2 independent reviewers using the JBI checklist for qualitative research. A standardized data extraction tool from JBI was used by 2 reviewers for data collection. Meta-aggregation was undertaken to synthesize the data, and the final synthesis of the findings was reached through discussion. Results were graded according to ConQual. RESULTS Ten studies with a sample size from 8 to 73 participants from North America and Central/Northern Europe were included in the review. The critical appraisal scores of the included studies ranged from 3 to 9 out of 10. A total of 137 findings were extracted and aggregated to form 19 categories and the following 4 aggregated syntheses: i) Changes in routines, beliefs, and sense of responsibility are essential for better adaptation and self-management after lung transplantation; ii) Life after transplantation is characterized by both positive and negative feelings and experiences; iii) Better adjustment and self-management after a lung transplant require dealing with one's own feelings and beliefs; iv) After transplantation, engaging with relatives, friends, medical team, and donors is essential to improve experiences and adapt to being a transplant recipient. Based on the ConQual scores, 2 synthesized findings were graded as moderate and 2 were graded as low. CONCLUSIONS Nuanced emotional, social, relational, and psychological adjustment is required of lung transplant recipients to be able to successfully self-manage. Loved ones and health professionals contribute significantly to this process, but psychosocial or peer support may further facilitate this transition. SUPPLEMENTAL DIGITAL CONTENT A German-language version of the abstract of this review is available as Supplemental Digital Content [ http://links.lww.com/SRX/A46 ].
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Affiliation(s)
- Anne Rebafka
- The Wales Centre for Evidence Based Care: A JBI Centre of Excellence, Cardiff University, Cardiff, UK
- Center for Medicine, Medical Center, University Freiburg, Freiburg, Germany
- Institute of Nursing Science, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Clare Bennett
- The Wales Centre for Evidence Based Care: A JBI Centre of Excellence, Cardiff University, Cardiff, UK
| | - Catherine Dunn
- The Wales Centre for Evidence Based Care: A JBI Centre of Excellence, Cardiff University, Cardiff, UK
| | - Dominic Roche
- The Wales Centre for Evidence Based Care: A JBI Centre of Excellence, Cardiff University, Cardiff, UK
| | - Clare Hawker
- The Wales Centre for Evidence Based Care: A JBI Centre of Excellence, Cardiff University, Cardiff, UK
| | - Deborah Edwards
- The Wales Centre for Evidence Based Care: A JBI Centre of Excellence, Cardiff University, Cardiff, UK
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Rebafka A, Bennett C, Edwards D. "Doing it, that's something else": a glimpse into self-management after lung transplantation. JBI Evid Synth 2024; 22:1654-1655. [PMID: 39252539 DOI: 10.11124/jbies-24-00284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Affiliation(s)
- Anne Rebafka
- The Wales Centre for Evidence Based Care: A JBI Centre of Excellence, Cardiff University, Cardiff, UK
- Center for Medicine, Medical Center, University Freiburg, Freiburg, Germany
- Institute of Nursing Science, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Clare Bennett
- The Wales Centre for Evidence Based Care: A JBI Centre of Excellence, Cardiff University, Cardiff, UK
| | - Deborah Edwards
- The Wales Centre for Evidence Based Care: A JBI Centre of Excellence, Cardiff University, Cardiff, UK
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Wang R, Peng F, Guo S, Sun J, Zhang S, Li X, Wei C, Liu H. Elements of Post-Transplant Recovery in Lung Transplant Recipients: A Scoping Review. Clin Nurs Res 2024; 33:481-492. [PMID: 38770918 DOI: 10.1177/10547738241253644] [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] [Indexed: 05/22/2024]
Abstract
To clarify and refine the specific elements of post-transplant recovery in lung transplant recipients, we explored the four dimensions of recovery: physiological, psychological, social, and habitual. This study is a scoping review. Two authors conducted a comprehensive electronic literature search to identify studies published from the establishment of the database to August 2022. Deductive coding was utilized to identify and categorize elements using a predefined list of the four components (physiological, psychological, social, and habitual recovery) based on the framework of post-transplant recovery proposed by Lundmark et al. Inductive coding was applied for concepts requiring further classification. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guideline. Systematic searching identified 8,616 potential records, of which 51 studies met the inclusion criteria. Ten subdimensions and their corresponding elements were identified and categorized into four dimensions of recovery following lung transplantation. The subdimensions included physiological recovery (including symptom experience, complications, physical function, and energy reserve), psychological recovery (encompassing affective distress, psychological adaptation, and transition from illness to health), social recovery (involving family adaptation and social adaptation), and habit recovery (focusing on health behavior).
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Affiliation(s)
- Ruiting Wang
- Beijing University of Chinese Medicine, Beijing, China
| | - Fucong Peng
- Beijing University of Chinese Medicine, Beijing, China
| | - Shaobo Guo
- Beijing University of Chinese Medicine, Beijing, China
| | - Jing Sun
- China-Japan Friendship Hospital, Beijing, China
| | - Shuping Zhang
- Beijing University of Chinese Medicine, Beijing, China
| | - Xiangru Li
- Beijing University of Chinese Medicine, Beijing, China
| | - Changyun Wei
- Beijing University of Chinese Medicine, Beijing, China
| | - Hongxia Liu
- Beijing University of Chinese Medicine, Beijing, China
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Wingfield LR, Salaun A, Khan A, Webb H, Zhu T, Knight S. Clinical Decision Support Systems Used in Transplantation: Are They Tools for Success or an Unnecessary Gadget? A Systematic Review. Transplantation 2024; 108:72-99. [PMID: 37143191 DOI: 10.1097/tp.0000000000004627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Although clinical decision support systems (CDSSs) have been used since the 1970s for a wide variety of clinical tasks including optimization of medication orders, improved documentation, and improved patient adherence, to date, no systematic reviews have been carried out to assess their utilization and efficacy in transplant medicine. The aim of this study is to systematically review studies that utilized a CDSS and assess impact on patient outcomes. A total of 48 articles were identified as meeting the author-derived inclusion criteria, including tools for posttransplant monitoring, pretransplant risk assessment, waiting list management, immunosuppressant management, and interpretation of histopathology. Studies included 15 984 transplant recipients. Tools aimed at helping with transplant patient immunosuppressant management were the most common (19 studies). Thirty-four studies (85%) found an overall clinical benefit following the implementation of a CDSS in clinical practice. Although there are limitations to the existing literature, current evidence suggests that implementing CDSS in transplant clinical settings may improve outcomes for patients. Limited evidence was found using more advanced technologies such as artificial intelligence in transplantation, and future studies should investigate the role of these emerging technologies.
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Affiliation(s)
- Laura R Wingfield
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Achille Salaun
- Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Aparajita Khan
- Department of Neurosurgery, Stanford University, Stanford, CA
| | - Helena Webb
- School of Computer Science, University of Nottingham, Nottingham, United Kingdom
| | - Tingting Zhu
- Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Simon Knight
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
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Corinna Morlacchi L, Privitera E, Rossetti V, Santambrogio M, Bellofiore A, Rosso L, Palleschi A, Nosotti M, Blasi F. Telemonitoring: An opportunity in cystic fibrosis lung transplant recipients. Heliyon 2023; 9:e19931. [PMID: 37818011 PMCID: PMC10560782 DOI: 10.1016/j.heliyon.2023.e19931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/26/2023] [Accepted: 09/06/2023] [Indexed: 10/12/2023] Open
Abstract
Introduction Telemedicine has been successfully employed in a wide range of conditions, such as such as chronic lung disease and COVID-19. This study evaluate the role of telemonitoring for the early diagnosis of acute lung allograft dysfunction in cystic fibrosis adults who underwent lung transplant (LuTx). Quality of life and functional level achieved during a 12 months follow up were assessed. Methods Patients were randomized into two groups; control group received traditional hospital-based follow-up, whereas patients in the intervention group received, on top of standard care, a telemonitoring device, with a pulse oximeter and a spirometer integrated. Telemonitoring data were digitally transmitted to our centre. Results Sixteen patients were enrolled in each group. No statistically significant difference was found between the two groups in terms of incidence of allograft dysfunction, time from onset of symptoms to diagnosis and time of occurrence from LuTx. Moreover, both groups achieved similar quality of life and functional level. With reference to the telemonitoring group: 1) hospital reported data were consistent with those being remotely registered; 2) adherence to telemonitoring decreased during the follow up; 3) the majority of patients reported a high degree of satisfaction. Conclusion The COVID19 pandemic highlighted the necessity to investigate alternative practices to treat chronically ill individuals. Telemonitoring is a valuable tool to improve quality care to LuTx recipients.
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Affiliation(s)
- Letizia Corinna Morlacchi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis, Milan, Italy
| | - Emilia Privitera
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Healthcare Professions Department, Milan, Italy
| | - Valeria Rossetti
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis, Milan, Italy
| | - Martina Santambrogio
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis, Milan, Italy
| | - Angela Bellofiore
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis, Milan, Italy
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Healthcare Professions Department, Milan, Italy
| | - Lorenzo Rosso
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Thoracic Surgery and Lung Transplant Unit, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Italy
| | - Alessandro Palleschi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Thoracic Surgery and Lung Transplant Unit, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Italy
| | - Mario Nosotti
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Thoracic Surgery and Lung Transplant Unit, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Italy
| | - Francesco Blasi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Italy
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McLean KA, Knight SR, Diehl TM, Varghese C, Ng N, Potter MA, Zafar SN, Bouamrane MM, Harrison EM. Readiness for implementation of novel digital health interventions for postoperative monitoring: a systematic review and clinical innovation network analysis. Lancet Digit Health 2023; 5:e295-e315. [PMID: 37100544 DOI: 10.1016/s2589-7500(23)00026-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 04/28/2023]
Abstract
An increasing number of digital health interventions (DHIs) for remote postoperative monitoring have been developed and evaluated. This systematic review identifies DHIs for postoperative monitoring and evaluates their readiness for implementation into routine health care. Studies were defined according to idea, development, exploration, assessment, and long-term follow-up (IDEAL) stages of innovation. A novel clinical innovation network analysis used coauthorship and citations to examine collaboration and progression within the field. 126 DHIs were identified, with 101 (80%) being early stage innovations (IDEAL stage 1 and 2a). None of the DHIs identified had large-scale routine implementation. There is little evidence of collaboration, and there are clear omissions in the evaluation of feasibility, accessibility, and the health-care impact. Use of DHIs for postoperative monitoring remains at an early stage of innovation, with promising but generally low-quality supporting evidence. Comprehensive evaluation within high-quality, large-scale trials and real-world data are required to definitively establish readiness for routine implementation.
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Affiliation(s)
- Kenneth A McLean
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Stephen R Knight
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Thomas M Diehl
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Chris Varghese
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Nathan Ng
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Mark A Potter
- Colorectal Unit, Western General Hospital, Edinburgh, UK
| | - Syed Nabeel Zafar
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Matt-Mouley Bouamrane
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ewen M Harrison
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
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Schuurmans MM, Muszynski M, Li X, Marcinkevičs R, Zimmerli L, Monserrat Lopez D, Michel B, Weiss J, Hage R, Roeder M, Vogt JE, Brunschwiler T. Multimodal Remote Home Monitoring of Lung Transplant Recipients during COVID-19 Vaccinations: Usability Pilot Study of the COVIDA Desk Incorporating Wearable Devices. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59030617. [PMID: 36984618 PMCID: PMC10051543 DOI: 10.3390/medicina59030617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023]
Abstract
Background and Objectives: Remote patient monitoring (RPM) of vital signs and symptoms for lung transplant recipients (LTRs) has become increasingly relevant in many situations. Nevertheless, RPM research integrating multisensory home monitoring in LTRs is scarce. We developed a novel multisensory home monitoring device and tested it in the context of COVID-19 vaccinations. We hypothesize that multisensory RPM and smartphone-based questionnaire feedback on signs and symptoms will be well accepted among LTRs. To assess the usability and acceptability of a remote monitoring system consisting of wearable devices, including home spirometry and a smartphone-based questionnaire application for symptom and vital sign monitoring using wearable devices, during the first and second SARS-CoV-2 vaccination. Materials and Methods: Observational usability pilot study for six weeks of home monitoring with the COVIDA Desk for LTRs. During the first week after the vaccination, intensive monitoring was performed by recording data on physical activity, spirometry, temperature, pulse oximetry and self-reported symptoms, signs and additional measurements. During the subsequent days, the number of monitoring assessments was reduced. LTRs reported on their perceptions of the usability of the monitoring device through a purpose-designed questionnaire. Results: Ten LTRs planning to receive the first COVID-19 vaccinations were recruited. For the intensive monitoring study phase, LTRs recorded symptoms, signs and additional measurements. The most frequent adverse events reported were local pain, fatigue, sleep disturbance and headache. The duration of these symptoms was 5-8 days post-vaccination. Adherence to the main monitoring devices was high. LTRs rated usability as high. The majority were willing to continue monitoring. Conclusions: The COVIDA Desk showed favorable technical performance and was well accepted by the LTRs during the vaccination phase of the pandemic. The feasibility of the RPM system deployment was proven by the rapid recruitment uptake, technical performance (i.e., low number of errors), favorable user experience questionnaires and detailed individual user feedback.
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Affiliation(s)
- Macé M Schuurmans
- Division of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland
- Faculty of Medicine, University of Zurich, 8032 Zurich, Switzerland
| | | | - Xiang Li
- Department of Mathematics, ETH Zurich, 8092 Zurich, Switzerland
- Department of Computer Science, ETH Zurich, 8092 Zurich, Switzerland
| | | | | | - Diego Monserrat Lopez
- IBM Research Europe, 8803 Rüschlikon, Switzerland
- Department of Biosystems Science and Engineering, ETH Zurich, 4058 Basel, Switzerland
| | - Bruno Michel
- IBM Research Europe, 8803 Rüschlikon, Switzerland
| | - Jonas Weiss
- IBM Research Europe, 8803 Rüschlikon, Switzerland
| | - René Hage
- Division of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland
- Faculty of Medicine, University of Zurich, 8032 Zurich, Switzerland
| | - Maurice Roeder
- Division of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland
- Faculty of Medicine, University of Zurich, 8032 Zurich, Switzerland
| | - Julia E Vogt
- Department of Computer Science, ETH Zurich, 8092 Zurich, Switzerland
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Mellon L, Doyle F, Hickey A, Ward KD, de Freitas DG, McCormick PA, O'Connell O, Conlon P. Interventions for increasing immunosuppressant medication adherence in solid organ transplant recipients. Cochrane Database Syst Rev 2022; 9:CD012854. [PMID: 36094829 PMCID: PMC9466987 DOI: 10.1002/14651858.cd012854.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Non-adherence to immunosuppressant therapy is a significant concern following a solid organ transplant, given its association with graft failure. Adherence to immunosuppressant therapy is a modifiable patient behaviour, and different approaches to increasing adherence have emerged, including multi-component interventions. There has been limited exploration of the effectiveness of interventions to increase adherence to immunosuppressant therapy. OBJECTIVES This review aimed to look at the benefits and harms of using interventions for increasing adherence to immunosuppressant therapies in solid organ transplant recipients, including adults and children with a heart, lung, kidney, liver and pancreas transplant. SEARCH METHODS We searched the Cochrane Kidney and Transplant Register of Studies up to 14 October 2021 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register were identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA All randomised controlled trials (RCTs), quasi-RCTs, and cluster RCTs examining interventions to increase immunosuppressant adherence following a solid organ transplant (heart, lung, kidney, liver, pancreas) were included. There were no restrictions on language or publication type. DATA COLLECTION AND ANALYSIS Two authors independently screened titles and abstracts of identified records, evaluated study quality and assessed the quality of the evidence using the GRADE approach. The risk of bias was assessed using the Cochrane tool. The ABC taxonomy for measuring medication adherence provided the analysis framework, and the primary outcomes were immunosuppressant medication initiation, implementation (taking adherence, dosing adherence, timing adherence, drug holidays) and persistence. Secondary outcomes were surrogate markers of adherence, including self-reported adherence, trough concentration levels of immunosuppressant medication, acute graft rejection, graft loss, death, hospital readmission and health-related quality of life (HRQoL). Meta-analysis was conducted where possible, and narrative synthesis was carried out for the remainder of the results. MAIN RESULTS Forty studies involving 3896 randomised participants (3718 adults and 178 adolescents) were included. Studies were heterogeneous in terms of the type of intervention and outcomes assessed. The majority of studies (80%) were conducted in kidney transplant recipients. Two studies examined paediatric solid organ transplant recipients. The risk of bias was generally high or unclear, leading to lower certainty in the results. Initiation of immunosuppression was not measured by the included studies. There is uncertain evidence of an association between immunosuppressant medication adherence interventions and the proportion of participants classified as adherent to taking immunosuppressant medication (4 studies, 445 participants: RR 1.09, 95% CI 0.95 to 1.20; I² = 78%). There was very marked heterogeneity in treatment effects between the four studies evaluating taking adherence, which may have been due to the different types of interventions used. There was evidence of increasing dosing adherence in the intervention group (8 studies, 713 participants: RR 1.14, 95% CI 1.03 to 1.26, I² = 61%). There was very marked heterogeneity in treatment effects between the eight studies evaluating dosing adherence, which may have been due to the different types of interventions used. It was uncertain if an intervention to increase immunosuppressant adherence had an effect on timing adherence or drug holidays. There was limited evidence that an intervention to increase immunosuppressant adherence had an effect on persistence. There was limited evidence that an intervention to increase immunosuppressant adherence had an effect on secondary outcomes. For self-reported adherence, it is uncertain whether an intervention to increase adherence to immunosuppressant medication increases the proportion of participants classified as medically adherent to immunosuppressant therapy (9 studies, 755 participants: RR 1.21, 95% CI 0.99 to 1.49; I² = 74%; very low certainty evidence). Similarly, it is uncertain whether an intervention to increase adherence to immunosuppressant medication increases the mean adherence score on self-reported adherence measures (5 studies, 471 participants: SMD 0.65, 95% CI -0.31 to 1.60; I² = 96%; very low certainty evidence). For immunosuppressant trough concentration levels, it is uncertain whether an intervention to increase adherence to immunosuppressant medication increases the proportion of participants who reach target immunosuppressant trough concentration levels (4 studies, 348 participants: RR 0.98, 95% CI 0.68 to 1.40; I² = 40%; very low certainty evidence). It is uncertain whether an intervention to increase adherence to immunosuppressant medication may reduce hospitalisations (5 studies, 460 participants: RR 0.67, 95% CI 0.44 to 1.02; I² = 64%; low certainty evidence). There were limited, low certainty effects on patient-reported health outcomes such as HRQoL. There was no clear evidence to determine the effect of interventions on secondary outcomes, including acute graft rejection, graft loss and death. No harms from intervention participation were reported. AUTHORS' CONCLUSIONS Interventions to increase taking and dosing adherence to immunosuppressant therapy may be effective; however, our findings suggest that current evidence in support of interventions to increase adherence to immunosuppressant therapy is overall of low methodological quality, attributable to small sample sizes, and heterogeneity identified for the types of interventions. Twenty-four studies are currently ongoing or awaiting assessment (3248 proposed participants); therefore, it is possible that findings may change with the inclusion of these large ongoing studies in future updates.
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Affiliation(s)
- Lisa Mellon
- Department of Health Psychology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Frank Doyle
- Department of Health Psychology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Anne Hickey
- Department of Health Psychology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Kenneth D Ward
- School of Public Health, University of Memphis, Memphis, Tennessee, USA
| | - Declan G de Freitas
- Department of Nephrology and Kidney Transplantation, Beaumont Hospital, Dublin, Ireland
| | - P Aiden McCormick
- Irish Liver Transplant Unit, St Vincent's University Hospital, Dublin, Ireland
| | - Oisin O'Connell
- Irish National Lung and Heart Transplant Program, Mater Misericordiae University, Dublin, Ireland
| | - Peter Conlon
- Department of Nephrology and Kidney Transplantation, Beaumont Hospital, Dublin, Ireland
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11
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Mobile Health Interventions and RCTs: Structured Taxonomy and Research Framework. J Med Syst 2022; 46:66. [PMID: 36068371 DOI: 10.1007/s10916-022-01856-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 08/17/2022] [Indexed: 10/14/2022]
Abstract
Mobile Health Interventions (MHIs) have addressed a range of healthcare challenges and have been evaluated using Randomized Controlled Trials (RCTs) to establish clinical effectiveness. Using PRISMA we conducted a systematic literature review of RCTs for MHIs and identified 70 studies which were analyzed and classified using Nickerson-Varshney-Muntermann (NVM) taxonomy. From the resultant iterations of the taxonomy, we extracted insights from the categorized studies. RCTs cover a wide range of health conditions including chronic diseases, general wellness, unhealthy practices, family planning, end-of-life, and post-transplant care. The MHIs that were utilized by the RCTs were varied as well, although most studies did not find significant differences between MHIs and usual care. The challenges for MHI-based RCTs include the use of technologies, delayed outcomes, patient recruitment, patient retention, and complex regulatory requirements. These variances can lead to a higher rate of Type I/Type II errors. Further considerations are the impact of infrastructure, contextual and cultural factors, and reductions in the technological relevancy of the intervention itself. Finally, due to the delayed effect of most outcomes, RCTs of insufficient duration are unable to measure significant, lasting improvements. Using the insights from seventy identified studies, we developed a classification of existing RCTs along with guidelines for MHI-based RCTs and a research framework for future RCTs. The framework offers opportunities for (a) personalization of MHIs, (b) use of richer technologies, and (c) emerging areas for RCTs.
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12
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Gholamzadeh M, Abtahi H, Safdari R. Telemedicine in lung transplant to improve patient-centered care: A systematic review. Int J Med Inform 2022; 167:104861. [PMID: 36067628 DOI: 10.1016/j.ijmedinf.2022.104861] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/23/2022] [Accepted: 08/27/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Long-term care combined with complex follow-up processes is among the essential needs of lung transplantation. Therefore, Telemedicine-based strategies can provide an effective approach for both patients and clinicians by applying remote patient monitoring. Hence, the main objective of this study was to investigate Telemedicine and telehealth usage in lung transplantation. METHOD A systematic review was conducted in four databases using keywords. Eligible studies were all English papers that developed Telemedicine-based programs to enhance patient care in lung organ transplantation. The interventions were analyzed analysis to determine the main descriptive areas. The quality of the included articles was evaluated using Mixed Methods Appraisal Tool (MMAT) tool by two authors. RESULTS Of the 261 retrieved articles, 27 met our inclusion criteria. Of these, 22 studies were devoted to the post-transplantation phase. All articles were published from 2002 to 2021 and the trend of publications has increased in recent years. Most of the studies were conducted in the United States and Canada. All eligible studies can be categorized into five types of Telemedicine interventions, 15 (55.56%) articles devoted to Telemonitoring, four (14.81%) for Teleconsultation, four (14.81%) articles for Telerehabilitation, three (11.11%) articles for Telespirometery, and one (3.70%) article were done regarding Tele-education. CONCLUSION This integrated review provides researchers with a new understanding of Telemedicine-based care solutions. Findings show that remote patient care in lung transplantation includes various aspects, especially self-care improvement.
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Affiliation(s)
- Marsa Gholamzadeh
- Ph.D. Candidate in Medical Informatics, Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Abtahi
- Pulmonary and Critical Care Department, Thoracic Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Safdari
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran.
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13
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Abtahi H, Safdari R, Gholamzadeh M. Pragmatic solutions to enhance self-management skills in solid organ transplant patients: systematic review and thematic analysis. BMC PRIMARY CARE 2022; 23:166. [PMID: 35773642 PMCID: PMC9247970 DOI: 10.1186/s12875-022-01766-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 06/06/2022] [Indexed: 02/07/2023]
Abstract
Background In organ transplantation, all patients must follow a complex treatment regimen for the rest of their lives. Hence, patients play an active role in the continuity of the care process in the form of self-management tasks. Thus, the main objective of our study was to investigate the pragmatic solutions applied by different studies to enhance adherence to self-management behaviors. Method A systematic review was conducted in five databases from 2010 to August 2021 using keywords. Eligible studies were all English papers that developed self-management programs to enhance patient care in solid organ transplantation. The interventions were analyzed using thematic analysis to determine the main descriptive areas. The quality of the included articles was evaluated using the research critical appraisal program (CASP) tool. Results Of the 691 retrieved articles, 40 met our inclusion criteria. Of these, 32 studies were devoted to the post-transplantation phase. Five main areas were determined (e-health programs for telemonitoring, non-electronic educational programs, non-electronic home-based symptom-monitoring programs, electronic educational plans for self-monitoring, and Telerehabilitation) according to thematic analysis. Most studies (72.5%) declared that developed programs and applied solutions had a statistically significant positive impact on self-management behavior enhancement in transplant patients. Conclusion The results showed that an effective solution for improving organ transplantation needs patient collaboration to address psychological, social, and clinical aspects of patient care. Such programs can be applied during candidate selection, waiting list, and after transplantation by putting the patient at the center of care. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01766-z.
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Affiliation(s)
- Hamidreza Abtahi
- Pulmonary and Critical care Medicine Department, Thoracic Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Safdari
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Marsa Gholamzadeh
- Ph.D. Candidate in Medical Informatics, Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Fardanesh Alley, 5th FloorQods Ave, Tehran, Iran.
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14
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Kiani S, Abasi S, Yazdani A. Evaluation of m‐Health‐rehabilitation for respiratory disorders: A systematic review. Health Sci Rep 2022; 5:e575. [PMID: 35387314 PMCID: PMC8973261 DOI: 10.1002/hsr2.575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 02/26/2022] [Accepted: 02/28/2022] [Indexed: 11/23/2022] Open
Abstract
Background and Aims Chronic respiratory diseases are prominent causes of morbidity worldwide that impose significant social and economic burdens on individuals and communities. Pulmonary rehabilitation is one of the main aspects of medical rehabilitation. Nowadays, mobile health apps deliver pulmonary rehabilitation support via smartphones. This article presents a systematic review of the literature on m‐Health apps used in respiration disorders rehabilitation. Methods A systematic search was performed on MEDLINE (through PubMed), Web of Science, and Scopus in May 2021 without any date limitation. This study was using a combination of keywords and MeSH terms associated with pulmonary rehabilitation. Relevant studies were selected by two independents and were categorized studies results. The inclusion criterion was m‐Health apps for pulmonary rehabilitation and exclusion criteria mobile‐based interventions, by voice call or short message service and cardiopulmonary articles. Results Searching scientific databases yielded 161 relevant articles. Then, 27 articles were included in the study with a complete evaluation of the articles. Sixty percent of them were related to patients with chronic obstructive pulmonary disease (COPD). Rehabilitation aiming to improve the quality of life, promote self‐management, encourage physical activity, and reduce the symptoms as the most common goals of pulmonary rehabilitation using m‐Health apps; 89% of these studies showed that m‐Health apps can be effective in improving pulmonary rehabilitation. In addition, 37% of studies reported high usability and acceptance. However, the results of some studies show that adherence to apps decreases in the long run. Conclusion Our study shows that m‐Health pulmonary rehabilitation apps are effective in improving the quality of life, self‐management, and physical activity. According to the results, it seems that using the m‐Health apps for pulmonary rehabilitation can be useful in the COVID‐19 pandemic and help reduce respiratory disorders in patients with COVID‐19 disease.
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Affiliation(s)
- Shamim Kiani
- Student Research Committee, Department of Health Information Management, School of Health Management and Information Sciences Shiraz University of Medical Sciences Shiraz Iran
| | - Sanaz Abasi
- Student Research Committee, Department of Health Information Management, School of Health Management and Information Sciences Shiraz University of Medical Sciences Shiraz Iran
| | - Azita Yazdani
- Department of Health Information Management, Clinical Education Research Center, Health Human Resources Research Center, School of Health Management and Information Sciences Shiraz University of Medical Sciences Shiraz Iran
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15
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Review and Evaluation of mHealth Apps in Solid Organ Transplantation: Past, Present, and Future. Transplant Direct 2022; 8:e1298. [PMID: 35368987 PMCID: PMC8966961 DOI: 10.1097/txd.0000000000001298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/14/2021] [Accepted: 01/04/2022] [Indexed: 11/26/2022] Open
Abstract
With the rapid and widespread expansion of smartphone availability and usage, mobile health (mHealth) has become a viable multipurpose treatment medium for the US healthcare system.
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16
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Campagna BR, Tutino R, Stevanovic K, Flood J, Halevi G, Shemesh E, Annunziato RA. Acceleration of mobile health for monitoring post-transplant in the COVID-19 era: Applications for pediatric settings. Pediatr Transplant 2022; 26:e14152. [PMID: 34661316 PMCID: PMC8646582 DOI: 10.1111/petr.14152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Since the start of the COVID-19 pandemic and consequent lockdowns, the use of telehealth interventions has rapidly increased both in the general population and among transplant recipients. Among pediatric transplant recipients, this most frequently takes the form of interventions on mobile devices, or mHealth, such as remote visits via video chat or phone, phone-based monitoring, and mobile apps. Telehealth interventions may offer the opportunity to provide care that minimizes many of the barriers of in-person care. METHODS The present review followed the PRISMA guidelines. Sources up until October 2020 were initially identified through searches of PsycInfo® and PubMed® . RESULTS We identified ten papers that reported findings from adult interventions and five studies based in pediatrics. Eight of the adult publications stemmed from the same two trials; within the pediatric subset, this was the case for two papers. Studies that have looked at mHealth interventions have found high acceptability rates over the short run, but there is a general lack of data on long-term use. CONCLUSIONS The literature surrounding pediatric trials specifically is sparse with all findings referencing interventions that are in early stages of development, ranging from field tests to small feasibility trials. The lack of research highlights the need for a multi-center RCT that utilizes robust measures of medication adherence and other outcome variables, with longer-term follow-up before telehealth interventions should be fully embraced.
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Affiliation(s)
- Bianca R. Campagna
- Department of PsychologyFordham UniversityBronxNew YorkUSA,Department of PediatricsKravis Children’s HospitalIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Rebecca Tutino
- Department of PsychologyFordham UniversityBronxNew YorkUSA,Department of PediatricsKravis Children’s HospitalIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | | | - Julia Flood
- Department of PsychologyFordham UniversityBronxNew YorkUSA
| | - Gali Halevi
- Department of MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA,Department of Medical EducationIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Eyal Shemesh
- Department of PediatricsKravis Children’s HospitalIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Rachel A. Annunziato
- Department of PsychologyFordham UniversityBronxNew YorkUSA,Department of PediatricsKravis Children’s HospitalIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
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17
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Abasi S, Yazdani A, Kiani S, Mahmoudzadeh‐Sagheb Z. Effectiveness of mobile health-based self-management application for posttransplant cares: A systematic review. Health Sci Rep 2021; 4:e434. [PMID: 34869915 PMCID: PMC8596943 DOI: 10.1002/hsr2.434] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 09/15/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND AIMS Patients after transplantation need medical management for the rest of their lives, and self-management seems to lead to greater adherence to medical standards, improve early physical changes, and increase patient empowerment. The main objective of this article is to systematic review of the consideration to mobile health applications (m-Health apps) used in transplantation. METHODS A systematic search was conducted MEDLINE (through PubMed), Web of Science, Scopus, and Science Direct from inception to November 2020. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was used in this study. Comprehensive research was carried out using a combination of keywords and MeSH terms associated with m-Health, empowerment, self-management, and transplantation. Two independent reviewers screened titles and abstracts, assessed full-text articles, and extracted data from articles that met inclusion criteria. Eligible studies were original research articles that included posttransplant care and mobile phone-based applications to support self-management and self-care. Also, thesis, book chapters, letters to editors, short briefs, reports, technical reports, book reviews, systematic reviews, or meta-analysis were excluded. RESULTS We divided all the reviewed articles into four categories, self-management (medication adherence, adherence to medical regimen, and remote monitoring), evaluation, interaction, and interface; 37.5% of the studies were focused on lung transplantation. In 56.25% of the studies, medication adherence was considered because one of the main reasons for the rejection and graft loss is stated medication nonadherence. Also, 62.5% of the studies demonstrated that the use of m-health improved medication adherence and self-management in transplantation. CONCLUSIONS The use of m-Health apps interventions to self-management after transplantation has shown promising feasibility and acceptability, and there is modest evidence to support the efficacy of these interventions. We found that m-Health solutions can help the patient in self-management in many ways after transplantation.
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Affiliation(s)
- Sanaz Abasi
- Department of Health Information ManagementSchool of Health Management and Information Sciences, Shiraz University of Medical SciencesShirazIran
| | - Azita Yazdani
- Clinical Education Research Center, Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical SciencesShirazIran
| | - Shamim Kiani
- Department of Health Information ManagementSchool of Health Management and Information Sciences, Shiraz University of Medical SciencesShirazIran
| | - Zahra Mahmoudzadeh‐Sagheb
- Department of Health Information ManagementHealth Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical SciencesShirazIran
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18
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Dawes AJ, Lin AY, Varghese C, Russell MM, Lin AY. Mobile health technology for remote home monitoring after surgery: a meta-analysis. Br J Surg 2021; 108:1304-1314. [PMID: 34661649 DOI: 10.1093/bjs/znab323] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 08/16/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Mobile health (mHealth) technology has been proposed as a method of improving post-discharge surveillance. Little is known about how mHealth has been used to track patients after surgery and whether its use is associated with differences in postoperative recovery. METHODS Three databases (PubMed, MEDLINE and the Cochrane Central Registry of Controlled Trials) were searched to identify studies published between January 1999 and February 2021. Mobile health was defined as any smartphone or tablet computer capable of electronically capturing health-related patient information and transmitting these data to the clinical team. Comparable outcomes were pooled via meta-analysis with additional studies compiled via narrative review. The quality of each study was assessed based on Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. RESULTS Forty-five articles met inclusion criteria. While the majority of devices were designed to capture general health information, others were specifically adapted to the expected outcomes or potential complications of the index procedure. Exposure to mHealth was associated with fewer emergency department visits (odds ratio 0.42, 95 per cent c.i. 0.23 to 0.79) and readmissions (odds ratio 0.47, 95 per cent c.i. 0.29 to 0.77) as well as accelerated improvements in quality of life after surgery. There were limited data on other postoperative outcomes. CONCLUSION Remote home monitoring via mHealth is feasible, adaptable, and may even promote more effective postoperative care. Given the rapid expansion of mHealth, physicians and policymakers need to understand these technologies better so that they can be integrated into high-quality clinical care.
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Affiliation(s)
- A J Dawes
- Section of Colon and Rectal Surgery, Division of General Surgery, Stanford University School of Medicine, Stanford, California, USA.,Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, Stanford, California, USA
| | - A Y Lin
- Department of Surgery, Wellington Regional Hospital, Wellington, New Zealand.,Department of Surgery and Anaesthesia (Wellington), University of Otago, New Zealand
| | - C Varghese
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - M M Russell
- Section of Colon and Rectal Surgery, Division of General Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - A Y Lin
- Section of Colon and Rectal Surgery, Division of General Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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19
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Kostalova B, Ribaut J, Dobbels F, Gerull S, Mala-Ladova K, Zullig LL, De Geest S. Medication adherence interventions in transplantation lack information on how to implement findings from randomized controlled trials in real-world settings: A systematic review. Transplant Rev (Orlando) 2021; 36:100671. [PMID: 34773910 DOI: 10.1016/j.trre.2021.100671] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/19/2021] [Accepted: 09/19/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Growing numbers of randomized controlled trials (RCTs) are showing the effectiveness of interventions to improve medication adherence in transplantation recipients. However, real-world implementation is still a major challenge. This systematic review assesses the range of information available in RCTs supporting these interventions' clinical adoption in adult transplant populations. METHODS We included RCTs of interventions that a) targeted any phase of medication adherence in solid organ or allogeneic stem cell transplantation recipients and b) were published between January 2015 and November 2020. We excluded study protocols, conference abstracts and studies focusing only on pediatric populations. We identified relevant database and trial registries as well as traced references backward and citations forward. Implementation-relevant information was evaluated using adapted versions of Peters' ten criteria: 1. healthcare/organizational context; 2. social/economic/policy context; 3. patient involvement; 4. other stakeholder involvement; 5. sample representativeness; 6. trial conducted in a real-world-setting; 7. presence of feasibility study; 8. implementation strategy; 9. process evaluation; 10. implementation outcomes, using a stoplight color-rating system. RESULTS Screening 17'004 titles/abstracts resulted in 23 eligible RCTs, including 2'339 patients (n = 19-209/study). All included studies focused on the implementation phase of medication adherence. The best-reported criteria were feasibility study (43%), representative sample (17%) and conducted in a real-world-setting (17%). Least reported were context (9%), implementation strategies (4%), process evaluation (4%). CONCLUSIONS RCTs testing medication adherence interventions tend to report limited implementation-relevant information. This hinders their translation to real-world transplant settings. Integrating implementation science principles early in the conceptualization of RCTs would fuel real-world-translation, reducing research waste.
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Affiliation(s)
- Barbora Kostalova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Akademika Heyrovskeho 1203, 500 05 Hradec Kralove, Czech Republic.
| | - Janette Ribaut
- Institute of Nursing Science, Department of Public Health, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland; Department of Theragnostic, Hematology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland.
| | - Fabienne Dobbels
- Institute of Nursing Science, Department of Public Health, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland; Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35 blok d, box 7001, 3000 Leuven, Belgium.
| | - Sabine Gerull
- Department of Theragnostic, Hematology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland; Department of Hematology, Cantonal Hospital of Aarau, Tellstrasse 25, 5001 Aarau, Switzerland.
| | - Katerina Mala-Ladova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Akademika Heyrovskeho 1203, 500 05 Hradec Kralove, Czech Republic.
| | - Leah L Zullig
- Department of Population Health Science, Duke University, 215 Morris St, Durham, NC 27701, USA; Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 508 Fulton St, Durham, NC 27705, USA.
| | - Sabina De Geest
- Institute of Nursing Science, Department of Public Health, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland; Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35 blok d, box 7001, 3000 Leuven, Belgium.
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20
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Holderried M, Hoeper A, Holderried F, Heyne N, Nadalin S, Unger O, Ernst C, Guthoff M. Attitude and potential benefits of modern information and communication technology use and telemedicine in cross-sectoral solid organ transplant care. Sci Rep 2021; 11:9037. [PMID: 33907269 PMCID: PMC8079672 DOI: 10.1038/s41598-021-88447-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 04/06/2021] [Indexed: 12/20/2022] Open
Abstract
Situations like the COVID-19 pandemic urgently require the implementation of eHealth for vulnerable patient populations. Here we quantitatively evaluate use and potential of modern information and communication technology (ICT) in solid organ transplant (SOT) recipients. We conducted a structured, questionnaire-based, cross-sectional study that was addressed to patients after kidney, liver, pancreas, or combined transplantation. We focused on: sociodemographic data, present use of digital technologies in daily life and for health reasons, patients' eHealth literacy, and their overall attitude towards eHealth. A total of 234 patients completed the questionnaire. Most of the patients (90%) have a web-enabled computer, 78.2% have a smartphone, and 71.8% regularly search the internet for health-related information. Sixty-eight percent would like to receive discharge summaries online, and 54% would like to chat online with their physicians. Even though ICT use in daily life was age-related, no significant difference could be shown for health reasons or the type of transplanted organ. Modern ICT use is predominantly accepted for health reasons by SOT recipients. Regardless of the transplanted organ, a deeper integration of eHealth has potential for improving cross-sectoral care. To successfully implement eHealth technologies in cross-sectoral care future research should include online physician-patient communication, data security, data safety, and the aspects of quality and safety of care.
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Affiliation(s)
- Martin Holderried
- eHealth Research-Group, Department of Strategic Medical Development and Quality Management, University of Tuebingen, Hoppe-Seyler-Str. 6, 72076, Tuebingen, Germany
- Institute for Healthcare and Public Management, University of Hohenheim, Hohenheim, Stuttgart, Germany
| | - Ansgar Hoeper
- eHealth Research-Group, Department of Strategic Medical Development and Quality Management, University of Tuebingen, Hoppe-Seyler-Str. 6, 72076, Tuebingen, Germany
| | - Friederike Holderried
- eHealth Research-Group, Department of Strategic Medical Development and Quality Management, University of Tuebingen, Hoppe-Seyler-Str. 6, 72076, Tuebingen, Germany.
| | - Nils Heyne
- Department of Diabetology, Endocrinology, Nephrology, Section of Nephrology and Hypertension, University of Tuebingen, Tuebingen, Germany
| | - Silvio Nadalin
- Department of General-, Visceral- and Transplant Surgery, University of Tuebingen, Tuebingen, Germany
| | - Oliver Unger
- Faculty of Business Management and Economics, Julius-Maximilians-University, Wuerzburg, Germany
| | - Christian Ernst
- Institute for Healthcare and Public Management, University of Hohenheim, Hohenheim, Stuttgart, Germany
| | - Martina Guthoff
- Department of Diabetology, Endocrinology, Nephrology, Section of Nephrology and Hypertension, University of Tuebingen, Tuebingen, Germany
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21
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Schenkel FA, Barr ML, McCloskey CC, Possemato T, O'Conner J, Sadeghi R, Bembi M, Duong M, Patel J, Hackmann AE, Ganesh S. Use of a Bluetooth tablet-based technology to improve outcomes in lung transplantation: A pilot study. Am J Transplant 2020; 20:3649-3657. [PMID: 32558226 PMCID: PMC7754459 DOI: 10.1111/ajt.16154] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 06/10/2020] [Accepted: 06/13/2020] [Indexed: 01/25/2023]
Abstract
The impact of remote patient monitoring platforms to support the postoperative care of solid organ transplant recipients is evolving. In an observational pilot study, 28 lung transplant recipients were enrolled in a novel postdischarge home monitoring program and compared to 28 matched controls during a 2-year period. Primary endpoints included hospital readmissions and total days readmitted. Secondary endpoints were survival and inflation-adjusted hospital readmission charges. In univariate analyses, monitoring was associated with reduced readmissions (incidence rate ratio [IRR]: 0.56; 95% confidence interval [CI]: 0.41-0.76; P < .001), days readmitted (IRR: 0.46; 95% CI: 0.42-0.51; P < .001), and hospital charges (IRR: 0.52; 95% CI: 0.51-0.54; P < .001). Multivariate analyses also showed that remote monitoring was associated with lower incidence of readmission (IRR: 0.38; 95% CI: 0.23-0.63; P < .001), days readmitted (IRR: 0.14; 95% CI: 0.05-0.37; P < .001), and readmission charges (IRR: 0.11; 95% CI: 0.03-0.46; P = .002). There were 2 deaths among monitored patients compared to 6 for controls; however, this difference was not significant. This pilot study in lung transplant recipients suggests that supplementing postdischarge care with remote monitoring may be useful in preventing readmissions, reducing subsequent inpatient days, and controlling hospital charges. A multicenter, randomized control trial should be conducted to validate these findings.
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Affiliation(s)
- Felicia A. Schenkel
- Keck Medical CenterUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Mark L. Barr
- Division of Cardiothoracic SurgeryDepartment of SurgeryUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | | | - Tammie Possemato
- Keck Medical CenterUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Jeremy O'Conner
- Keck Medical CenterUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Roya Sadeghi
- Keck Medical CenterUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Maria Bembi
- Keck Medical CenterUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Marian Duong
- Keck Medical CenterUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Jaynita Patel
- Keck Medical CenterUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Amy E. Hackmann
- Division of Cardiothoracic SurgeryDepartment of SurgeryUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Sivagini Ganesh
- Division of Pulmonary and Critical Care MedicineDepartment of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
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22
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Duettmann W, Naik MG, Zukunft B, Osmonodja B, Bachmann F, Choi M, Roller R, Mayrdorfer M, Halleck F, Schmidt D, Budde K. eHealth in transplantation. Transpl Int 2020; 34:16-26. [DOI: 10.1111/tri.13778] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/17/2020] [Accepted: 10/23/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Wiebke Duettmann
- Department of Nephrology and Medical Intensive Care Charité – Universitätsmedizin Berlin Berlin Germany
| | - Marcel G. Naik
- Department of Nephrology and Medical Intensive Care Charité – Universitätsmedizin Berlin Berlin Germany
| | - Bianca Zukunft
- Department of Nephrology and Medical Intensive Care Charité – Universitätsmedizin Berlin Berlin Germany
| | - Bilgin Osmonodja
- Department of Nephrology and Medical Intensive Care Charité – Universitätsmedizin Berlin Berlin Germany
| | - Friederike Bachmann
- Department of Nephrology and Medical Intensive Care Charité – Universitätsmedizin Berlin Berlin Germany
| | - Mira Choi
- Department of Nephrology and Medical Intensive Care Charité – Universitätsmedizin Berlin Berlin Germany
| | - Roland Roller
- German Research Center for Artificial Intelligence Berlin Germany
| | - Manuel Mayrdorfer
- Department of Nephrology and Medical Intensive Care Charité – Universitätsmedizin Berlin Berlin Germany
| | - Fabian Halleck
- Department of Nephrology and Medical Intensive Care Charité – Universitätsmedizin Berlin Berlin Germany
| | - Danilo Schmidt
- Business Division IT Department of Research and Teaching Charité—Universitätsmedizin Berlin Berlin Germany
| | - Klemens Budde
- Department of Nephrology and Medical Intensive Care Charité – Universitätsmedizin Berlin Berlin Germany
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23
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Gomis-Pastor M, Mirabet S, Roig E, Lopez L, Brossa V, Galvez-Tugas E, Rodriguez-Murphy E, Feliu A, Ontiveros G, Garcia-Cuyàs F, Salazar A, Mangues MA. Interdisciplinary Mobile Health Model to Improve Clinical Care After Heart Transplantation: Implementation Strategy Study. JMIR Cardio 2020; 4:e19065. [PMID: 33231557 PMCID: PMC7723747 DOI: 10.2196/19065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/05/2020] [Accepted: 09/16/2020] [Indexed: 12/12/2022] Open
Abstract
Background Solid organ transplantation could be the only life-saving treatment for end-stage heart failure. Nevertheless, multimorbidity and polypharmacy remain major problems after heart transplant. A technology-based behavioral intervention model was established to improve clinical practice in a heart transplant outpatient setting. To support the new strategy, the mHeart app, a mobile health (mHealth) tool, was developed for use by patients and providers. Objective The primary objective of this study was to describe the implementation of the mHeart model and to outline the main facilitators identified when conceiving an mHealth approach. The secondary objectives were to evaluate the barriers, benefits, and willingness to use mHealth services reported by heart transplant recipients and cardiology providers. Methods This was an implementation strategy study directed by a multidisciplinary cardiology team conducted in four stages: design of the model and the software, development of the mHeart tool, interoperability among systems, and quality and security requirements. A mixed methods study design was applied combining a literature review, several surveys, interviews, and focus groups. The approach involved merging engineering and behavioral theory science. Participants were chronic-stage heart transplant recipients, patient associations, health providers, stakeholders, and diverse experts from the legal, data protection, and interoperability fields. Results An interdisciplinary and patient-centered process was applied to obtain a comprehensive care model. The heart transplant recipients (N=135) included in the study confirmed they had access to smartphones (132/135, 97.7%) and were willing to use the mHeart system (132/135, 97.7%). Based on stakeholder agreement (>75%, N=26), the major priorities identified of the mHealth approach were to improve therapy management, patient empowerment, and patient-provider interactions. Stakeholder agreement on the barriers to implementing the system was weak (<75%). Establishing the new model posed several challenges to the multidisciplinary team in charge. The main factors that needed to be overcome were ensuring data confidentiality, reducing workload, minimizing the digital divide, and increasing interoperability. Experts from various fields, scientific societies, and patient associations were essential to meet the quality requirements and the model scalability. Conclusions The mHeart model will be applicable in distinct clinical and research contexts, and may inspire other cardiology health providers to create innovative ways to deal with therapeutic complexity and multimorbidity through health care systems. Professionals and patients are willing to use such innovative mHealth programs. The facilitators and key strategies described were needed for success in the implementation of the new holistic theory–based mHealth strategy.
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Affiliation(s)
- Mar Gomis-Pastor
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Sonia Mirabet
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Eulalia Roig
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Laura Lopez
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Vicens Brossa
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Elisabeth Galvez-Tugas
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Anna Feliu
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Gerardo Ontiveros
- Information System Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Albert Salazar
- Director Manager, Hospital Universitari Vall Hebron, Barcelona, Spain
| | - M Antonia Mangues
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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24
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Shi YX, Liu CX, Liu F, Zhang HM, Yu MM, Jin YH, Shang SM, Fu YX. Efficacy of Adherence-Enhancing Interventions for Immunosuppressive Therapy in Solid Organ Transplant Recipients: A Systematic Review and Meta-Analysis Based on Randomized Controlled Trials. Front Pharmacol 2020; 11:578887. [PMID: 33192520 PMCID: PMC7606769 DOI: 10.3389/fphar.2020.578887] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/07/2020] [Indexed: 01/06/2023] Open
Abstract
Background Immunosuppressant non-adherence is a widespread problem among solid organ recipients. With the newly published clinical trials, the randomized controlled trials (RCTs) based systematic review of adherence-enhancing interventions on immunosuppressant adherence in solid organ recipients has not been completed. In this systematic review and meta-analysis, we compared the efficacy of adherence-enhancing interventions versus routine intervention, as performed with RCTs, on immunosuppressant adherence in solid organ transplantation recipients. Methods PubMed, Embase, Cochrane Library, CINAHL full text, and PsycINFO were searched from database inception to December 2019. This review was conducted following the PRISMA’s reporting guidelines and according to the principles recommended by Cochrane Handbook for Systematic Review. Results The search yielded 10,479 articles. A total of 27 articles (26 studies) with 715 participants were included in our analysis. Results from the meta-analysis revealed that as compared with that of the routine intervention group, the rates of overall adherence, dosing adherence, and timing adherence were significantly increased within the adherence-enhancing intervention group, with the pooled risk ratio (RR) of overall adherence = 1.17, [95% confidence interval (CI): 1.07 to 1.28; p = 0.0006]; RR of dosing adherence = 1.21 (95% CI: 1.08 to 1.36, p = 0.001); RR of timing adherence = 1.16 (95% CI: 1.03 to 1.29, p = 0.01). There was a significantly increased adherence score in the adherence-enhancing intervention group; however, no statistical significance on the immunosuppressant blood concentration was found between the two study groups. Results obtained from a subgroup analysis shown interventions led by a multidisciplinary team, both the assessment time at 6 months and 12 months demonstrated a significantly increased adherence rate in the intervention group compared with the control group. Conclusions The findings of this report indicate that clinicians (doctors and nurses) should maintain a long-term intervention protocol to ensure immunosuppressant adherence within solid organ transplant recipients. To accomplish this goal, we recommend a multidisciplinary team-led, comprehensive intervention approach combined with mobile health monitoring for the administration of an effective immunosuppressive therapy regimen.
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Affiliation(s)
- Yue-Xian Shi
- School of Nursing, Peking University, Beijing, China
| | - Chun-Xia Liu
- Department of Urinary Surgery, Peking University Third Hospital, Beijing, China
| | - Fei Liu
- School of Public Health, Peking University, Beijing, China
| | - Hai-Ming Zhang
- Liver Transplantation Center, Clinical Center for Pediatric Liver Transplantation, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Ming-Ming Yu
- School of Nursing, Peking University, Beijing, China
| | - Yin-Hui Jin
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.,Center for Evidence-Based and Translational Medicine, Wuhan University, Wuhan, China
| | | | - Ying-Xin Fu
- Department of Kidney Transplantation, Tianjin First Center Hospital, Tianjin, China
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25
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Tang J, James L, Howell M, Tong A, Wong G. eHealth Interventions for Solid Organ Transplant Recipients: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Transplantation 2020; 104:e224-e235. [PMID: 32732828 DOI: 10.1097/tp.0000000000003294] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Lack of support for self-management may contribute to adverse health outcomes. eHealth has the potential to support self-management, but evidence in solid organ transplantation remains unclear. This review aims to evaluate the benefits and harms of eHealth interventions to support self-management in solid organ transplant recipients. METHODS We searched Cochrane Central Register of Controlled Trials, MEDLINE, and Embase databases for randomized trials of eHealth interventions in solid organ transplant recipients. We calculated the risk ratios or standardized mean difference of outcomes, and summary estimates were determined using random-effects models. The Cochrane risk of bias tool and Grading of Recommendations, Assessment, Development, and Evaluations were used to assess trial quality. RESULTS Twenty-one trials from 6 countries involving 2114 participants were included. Compared with standard care, eHealth interventions improved medication adherence (risk ratio, 1.34; CI, 1.12-2.56; I = 75%) and self-monitoring behavior (risk ratio, 2.58; CI, 1.56-4.27; I = 0%) up to 12 mo posttransplant. The treatment effects were largely consistent across different subgroups except for intervention functionality and mode of delivery. The effects on other outcomes were uncertain. Nine trials reported harms. The overall risk of bias was considered high or unclear, and the quality of evidence was low to very low for all outcomes. CONCLUSIONS eHealth interventions may improve medication adherence and self-monitoring behavior in the short term, but high-quality intervention studies are needed to determine whether eHealth will improve long-term patient-relevant outcomes.
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Affiliation(s)
- James Tang
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Laura James
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Martin Howell
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Germaine Wong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
- Centre for Transplant and Renal Research, Westmead Hospital, Westmead, NSW, Australia
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26
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Geramita EM, DeVito Dabbs AJ, DiMartini AF, Pilewski JM, Switzer GE, Posluszny DM, Myaskovsky L, Dew MA. Impact of a Mobile Health Intervention on Long-term Nonadherence After Lung Transplantation: Follow-up After a Randomized Controlled Trial. Transplantation 2020; 104:640-651. [PMID: 31335759 PMCID: PMC7170004 DOI: 10.1097/tp.0000000000002872] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND In a randomized controlled trial, lung transplant recipients (LTRs) using a mobile health intervention, Pocket Personal Assistant for Tracking Health (Pocket PATH), showed better adherence to the medical regimen than LTRs receiving usual care during the first year posttransplant. We examined whether these effects were maintained beyond the end of the trial and evaluated other potential risk factors for long-term nonadherence. METHODS Adherence in 8 areas was evaluated at follow-up in separate LTR and family caregiver (collateral) assessments. Pocket PATH and usual care groups' nonadherence rates were compared; multivariable regression analyses then examined and controlled for other patient characteristics' associations with nonadherence. RESULTS One hundred five LTRs (75% of survivors) were assessed (M = 3.9 years posttransplant, SD = 0.8). Nonadherence rates in the past month were 23%-81% for self-care and lifestyle requirements (diet, exercise, blood pressure monitoring, spirometry), 13%-23% for immunosuppressants and other medications, and 4% for tobacco use, with 31% clinic appointment nonadherence in the past year. In multivariable analysis, the Pocket PATH group showed lower risk of nonadherence to lifestyle requirements (diet/exercise) than the usual care group (P < 0.05). Younger age and factors during the first year posttransplant (acute graft rejection, chronically elevated anxiety, less time rehospitalized, nonadherence at the final randomized controlled trial assessment) were each associated with nonadherence in at least 1 area at follow-up (P < 0.05). CONCLUSIONS Pocket PATH did not have sustained impact on most areas of the regimen, although we identified other risk factors for long-term nonadherence. Future work should explore strategies to facilitate sustained effects of mobile health interventions.
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Affiliation(s)
- Emily M. Geramita
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Annette J. DeVito Dabbs
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA
| | - Andrea F. DiMartini
- Departments of Psychiatry and Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Joseph M. Pilewski
- Departments of Medicine, Pediatrics, and Cell Biology, University of Pittsburgh, Pittsburgh, PA
| | - Galen E. Switzer
- Department of Medicine, University of Pittsburgh, and Center for Health Equity Research and Promotion, Veterans Administration Pittsburgh Healthcare System, Pittsburgh, PA
| | | | - Larissa Myaskovsky
- Department of Internal Medicine, and Center for Healthcare Equity in Kidney Disease, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Mary Amanda Dew
- Departments of Psychiatry, Psychology, Epidemiology, Biostatistics, Nursing, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, PA
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27
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Blumenthal JA, Smith PJ, Sherwood A, Mabe S, Snyder L, Frankel C, McKee DC, Hamilton N, Keefe FJ, Shearer S, Schwartz J, Palmer S. Remote Therapy to Improve Outcomes in Lung Transplant Recipients: Design of the INSPIRE-III Randomized Clinical Trial. Transplant Direct 2020; 6:e535. [PMID: 32195326 PMCID: PMC7056276 DOI: 10.1097/txd.0000000000000979] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 12/21/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Impaired functional capacity and emotional distress are associated with lower quality of life (QoL) and worse clinical outcomes in post lung transplant patients. Strategies to increase physical activity and reduce distress are needed. METHODS The Investigational Study of Psychological Interventions in Recipients of Lung Transplant-III study is a single site, parallel group randomized clinical trial in which 150 lung transplant recipients will be randomly assigned to 3 months of telephone-delivered coping skills training combined with aerobic exercise (CSTEX) or to a Standard of Care plus Education control group. The primary endpoints are a global measure of distress and distance walked on the 6-Minute Walk Test. Secondary outcomes include measures of transplant-specific QoL, frailty, health behaviors, and chronic lung allograft dysfunction-free survival. RESULTS Participants will be evaluated at baseline, at the conclusion of 3 months of weekly treatment, at 1-year follow-up, and followed annually thereafter for clinical events for up to 4 years (median = 2 y). We also will determine whether functional capacity, distress, and health behaviors (eg, physical activity, medication adherence, and volume of air forcefully exhaled in 1 second (FEV1), mediate the effects of the CSTEX intervention on clinical outcomes. CONCLUSIONS Should the CSTEX intervention result in better outcomes compared with the standard of care plus post-transplant education, the remotely delivered CSTEX intervention can be made available to all lung transplant recipients as a way of enhancing their QoL and improving clinical outcomes.
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Affiliation(s)
- James A. Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Patrick J. Smith
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Andrew Sherwood
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Stephanie Mabe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Laurie Snyder
- Department of Medicine, Duke University Medical Center, Durham, NC
| | - Courtney Frankel
- Department of Medicine, Duke University Medical Center, Durham, NC
| | - Daphne C. McKee
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Natalie Hamilton
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Francis J. Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Sheila Shearer
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Jeanne Schwartz
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Scott Palmer
- Department of Medicine, Duke University Medical Center, Durham, NC
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28
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Shahmoradi L, Abtahi H, Amini S, Gholamzadeh M. Systematic review of using medical informatics in lung transplantation studies. Int J Med Inform 2020; 136:104096. [PMID: 32058262 DOI: 10.1016/j.ijmedinf.2020.104096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/09/2020] [Accepted: 02/04/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Lung transplantation is one of the advanced treatment options performed even in patients suffering from end-stage lung disease. Due to the positive results of medical informatics in other fields of medicine, lung transplant researchers have also conducted remarkable studies to improve transplant outcomes. The main objective of this article was to review the current studies of health information technology used in lung transplantation. METHODS A systematic search was performed in four scientific databases (Web of Science, Scopus, Science Direct, and PubMed) from January 2000 to December 2018. The criteria for inclusion were included in any study describing the use of health information technology or medical informatics in terms of lung transplantation, English papers, and original researchers. The retrieved articles were accordingly screened based on the inclusion and exclusion criteria to select relevant studies. The survey and synthesis of included articles were conducted based on predefined classification. RESULTS Out of 263 articles, 27 studies met our inclusion criteria. All included studies involved the application of health information technology in lung transplantation. The types of health information technology methods applied in reviewed articles included mhealth (11.1 %), DSS (7.4 %), decision aid tools (7.4 %), telemedicine (22.2 %), AI methods (11.1 %), data mining (37 %), and patient education (3.7 %). The majority of studies (88.9 %) showed the positive impact of health information technology to enhance lung transplantation outcomes. Finally, the main approaches in different phases of lung transplantation processes were interpreted and summarized in the visual model. CONCLUSION This systematic review provides new insights regarding the application of medical informatics in the lung transplantation domain. The missing areas of medical informatics in the lung transplantation domain were recognized through this study.
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Affiliation(s)
- Leila Shahmoradi
- Halal Research Center of IRI, FDA, Tehran, Iran; Associate Professor of Health Information Management, Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Abtahi
- Associate Professor of Pulmonary and Critical Care Department, Thoracic Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahideh Amini
- Assistant Professor of Clinical Pharmacy Department, Faculty of pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Marsa Gholamzadeh
- Ph.D. student in Medical Informatics, Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran.
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29
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Han A, Min SI, Ahn S, Min SK, Hong HJ, Han N, Kim YS, Ahn C, Ha J. Mobile medication manager application to improve adherence with immunosuppressive therapy in renal transplant recipients: A randomized controlled trial. PLoS One 2019; 14:e0224595. [PMID: 31689320 PMCID: PMC6830819 DOI: 10.1371/journal.pone.0224595] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 10/17/2019] [Indexed: 01/01/2023] Open
Abstract
Background Nonadherence to immunosuppressive therapy after renal transplantation is associated with poor graft outcomes. We aimed to evaluate whether the use of the Adhere4U mobile medication manager application could improve adherence among renal transplant recipients ≥1 year posttransplantation. Adhere4U can provide medication reminders, monitor medication use, and provide information on immunosuppressants. Methods We conducted a prospective randomized controlled study to compare the rate of nonadherence to index immunosuppressant (tacrolimus or cyclosporine) in a group using the Adhere4U app (mobile group) and in another group receiving conventional care (control group). The primary outcome was the nonadherence rate, which was evaluated using an electronic medication event monitoring system during the 6-month intervention period. Our secondary outcome included self-reported adherence using the Basel Assessment of Adherence to Immunosuppressive Medication Scale (BAASIS) and the visual analog scale (VAS) based on a 4-week recall on days 28, 90, and 180. Longitudinal data of repeated measures of self-rated adherence were analyzed using generalized estimating equations (GEE) to compare the between-group difference in adherence change over time. Results Between November 2013 and May 2015, 138 renal transplant recipients were randomly allocated to the control (n = 67) or the mobile group (n = 71). The overall nonadherence rate over the 6-month study period by electronic monitoring was 63.6%, with no between-group difference [mobile group, 65.0% (n = 39/60); control group, 62.1% (n = 36/58); odds ratio 1.14; 95% confidence interval 0.53–2.40; p = 0.89]. Self-rated nonadherence assessed using the BAASIS and VAS at baseline was 53.7% and 51.5%, respectively. Although the self-rated nonadherence by BAASIS of the mobile group was lower than the control group throughout the study period, there was no between-group difference in the change of nonadherence over time (χ2 = 2.82, df = 3, p = 0.42 by logistic GEE). There also was no significant between-group difference in the nonadherence by VAS (χ2 = 1.71, df = 3, p = 0.63 by logistic GEE) over time. The main limitation of this study was the low rate of patient engagement with the app among the mobile group. The rate of app use was 47.6% (31/65) at 28 days, 33.9% (19/56) at 90 days, and 11.5% (6/52) at 180 days. Conclusions The Adhere4U application did not improve adherence to immunosuppressive therapy. Our evidence is limited by the high rate of attrition. Further studies on strategies to facilitate patient engagement with mobile interventions are warranted.
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Affiliation(s)
- Ahram Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-il Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sanghyun Ahn
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Kee Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hye-jin Hong
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Nayoung Han
- Research Institute of Pharmaceutical Science, College of Pharmacy, Seoul National University, Seoul, Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jongwon Ha
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Korea
- * E-mail:
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30
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Eno AK, Ruck JM, Van Pilsum Rasmussen SE, Waldram MM, Thomas AG, Purnell TS, Garonzik Wang JM, Massie AB, Al Almmary F, Cooper LM, Segev DL, Levan MA, Henderson ML. Perspectives on implementing mobile health technology for living kidney donor follow-up: In-depth interviews with transplant providers. Clin Transplant 2019; 33:e13637. [PMID: 31194892 PMCID: PMC6690770 DOI: 10.1111/ctr.13637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 05/21/2019] [Accepted: 06/07/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND United States transplant centers are required to report follow-up data for living kidney donors for 2 years post-donation. However, living kidney donor (LKD) follow-up is often incomplete. Mobile health (mHealth) technologies could ease data collection burden but have not yet been explored in this context. METHODS We conducted semi-structured in-depth interviews with a convenience sample of 21 transplant providers and thought leaders about challenges in LKD follow-up, and the potential role of mHealth in overcoming these challenges. RESULTS Participants reported challenges conveying the importance of follow-up to LKDs, limited data from international/out-of-town LKDs, and inadequate staffing. They believed the 2-year requirement was insufficient, but expressed difficulty engaging LKDs for even this short time and inadequate resources for longer-term follow-up. Participants believed an mHealth system for post-donation follow-up could benefit LKDs (by simplifying communication/tasks and improving donor engagement) and transplant centers (by streamlining communication and decreasing workforce burden). Concerns included cost, learning curves, security/privacy, patient language/socioeconomic barriers, and older donor comfort with mHealth technology. CONCLUSIONS Transplant providers felt that mHealth technology could improve LKD follow-up and help centers meet reporting thresholds. However, designing a secure, easy to use, and cost-effective system remains challenging.
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Affiliation(s)
- Ann K Eno
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jessica M Ruck
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Madeleine M Waldram
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alvin G Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Tanjala S Purnell
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
- Department of Health Behavior and Society, Johns Hopkins School of Public Health, Baltimore, Maryland
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, Maryland
| | | | - Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Fawaz Al Almmary
- Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lisa M Cooper
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
- Department of Health Behavior and Society, Johns Hopkins School of Public Health, Baltimore, Maryland
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, Maryland
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
- Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, Maryland
| | | | - Macey L Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, Maryland
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Chronic lung allograft dysfunction: Definition, diagnostic criteria, and approaches to treatment-A consensus report from the Pulmonary Council of the ISHLT. J Heart Lung Transplant 2019; 38:493-503. [PMID: 30962148 DOI: 10.1016/j.healun.2019.03.009] [Citation(s) in RCA: 513] [Impact Index Per Article: 102.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 03/18/2019] [Indexed: 02/06/2023] Open
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Shneider C, Dunphy C, Shemesh E, Annunziato RA. Assessment and Treatment of Nonadherence in Transplant Recipients. Gastroenterol Clin North Am 2018; 47:939-948. [PMID: 30337042 DOI: 10.1016/j.gtc.2018.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Stable intake of an immunosuppressant medication regimen is essential for posttransplant survival in the vast majority of cases. And yet, many patients are nonadherent (do not take their medications as prescribed), and suffer consequences ranging from rejection to morbidity and mortality. We review the evidence related to monitoring of adherence to medications, and intervention strategies. Our aim is to provide a baseline from which readers may approach behavioral aspects of posttransplant care. This review may also help readers in designing clinical programs for routine monitoring of adherence, and inform the choice of intervention when adherence falls below a certain threshold.
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Affiliation(s)
- Caitlin Shneider
- Center for Translational Science, Children's National Medical Center, 111 Michigan Avenue Northwest, 5th Floor Main, Suite 5500, Office 5533, Washington, DC 20010, USA
| | - Claire Dunphy
- Clinical Psychology, Department of Psychology, Fordham University, 441 East Fordham Road, Dealy Hall, Bronx, NY 10458, USA
| | - Eyal Shemesh
- Division of Behavioral and Developmental Health, The Department of Pediatrics, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, Box 1198, 1 Gustave L Levy Place, New York, NY 10029, USA.
| | - Rachel A Annunziato
- Psychology, Fordham College at Rose Hill, Fordham University, 441 East Fordham Road, Dealy Hall, Bronx, NY 10458, USA
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Eno AK, Thomas AG, Ruck JM, Van Pilsum Rasmussen SE, Halpern SE, Waldram MM, Muzaale AD, Purnell TS, Massie AB, Garonzik Wang JM, Lentine KL, Segev DL, Henderson ML. Assessing the Attitudes and Perceptions Regarding the Use of Mobile Health Technologies for Living Kidney Donor Follow-Up: Survey Study. JMIR Mhealth Uhealth 2018; 6:e11192. [PMID: 30305260 PMCID: PMC6231841 DOI: 10.2196/11192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/03/2018] [Accepted: 07/05/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND In 2013, the Organ Procurement and Transplantation Network began requiring transplant centers in the United States to collect and report postdonation living kidney donor follow-up data at 6 months, 1 year, and 2 years. Despite this requirement, <50% of transplant centers have been able to collect and report the required data. Previous work identified a number of barriers to living kidney donor follow-up, including logistical and administrative barriers for transplant centers and cost and functional barriers for donors. Novel smartphone-based mobile health (mHealth) technologies might reduce the burden of living kidney donor follow-up for centers and donors. However, the attitudes and perceptions toward the incorporation of mHealth into postdonation care among living kidney donors are unknown. Understanding donor attitudes and perceptions will be vital to the creation of a patient-oriented mHealth system to improve living donor follow-up in the United States. OBJECTIVE The goal of this study was to assess living kidney donor attitudes and perceptions associated with the use of mHealth for follow-up. METHODS We developed and administered a cross-sectional 14-question survey to 100 living kidney donors at our transplant center. All participants were part of an ongoing longitudinal study of long-term outcomes in living kidney donors. The survey included questions on smartphone use, current health maintenance behaviors, accessibility to health information, and attitudes toward using mHealth for living kidney donor follow-up. RESULTS Of the 100 participants surveyed, 94 owned a smartphone (35 Android, 58 iPhone, 1 Blackberry), 37 had accessed their electronic medical record on their smartphone, and 38 had tracked their exercise and physical activity on their smartphone. While 77% (72/93) of participants who owned a smartphone and had asked a medical question in the last year placed the most trust with their doctors, nurses, or other health care professionals regarding answering a health-related question, 52% (48/93) most often accessed health information elsewhere. Overall, 79% (74/94) of smartphone-owning participants perceived accessing living kidney donor information and resources on their smartphone as useful. Additionally, 80% (75/94) perceived completing some living kidney donor follow-up via mHealth as useful. There were no significant differences in median age (60 vs 59 years; P=.65), median years since donation (10 vs 12 years; P=.45), gender (36/75, 36%, vs 37/75, 37%, male; P=.57), or race (70/75, 93%, vs 18/19, 95%, white; P=.34) between those who perceived mHealth as useful for living kidney donor follow-up and those who did not, respectively. CONCLUSIONS Overall, smartphone ownership was high (94/100, 94.0%), and 79% (74/94) of surveyed smartphone-owning donors felt that it would be useful to complete their required follow-up with an mHealth tool, with no significant differences by age, sex, or race. These results suggest that patients would benefit from an mHealth tool to perform living donor follow-up.
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Affiliation(s)
- Ann K Eno
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Alvin G Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, United States
| | - Jessica M Ruck
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | - Samantha E Halpern
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Duke University School of Medicine, Durham, NC, United States
| | - Madeleine M Waldram
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Abimereki D Muzaale
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Tanjala S Purnell
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, United States
- Department of Health, Behavior, and Society, Johns Hopkins School of Public Health, Baltimore, MD, United States
| | - Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, United States
| | | | - Krista L Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, United States
- Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, MD, United States
| | - Macey L Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, MD, United States
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Rebafka A, Bennett C, Jones J, Carrier J, Kugler C, Edwards D. Lung transplant recipients' experiences of and attitudes towards self-management: a qualitative systematic review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2018; 16:831-837. [PMID: 29634507 DOI: 10.11124/jbisrir-2017-003524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION The question for this review is: what are lung transplant recipients' experiences of and attitudes towards self-management?
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Affiliation(s)
- Anne Rebafka
- Department of Internal Medicine, University Medical Centre Freiburg, Freiburg, Germany
- Nursing Science, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- The Wales Centre For Evidence Based Care: a Joanna Briggs Institute Centre of Excellence
| | - Clare Bennett
- The Wales Centre For Evidence Based Care: a Joanna Briggs Institute Centre of Excellence
- Institute of Health & Society, University of Worcester, Worcester, UK
| | - Jonathan Jones
- The Wales Centre For Evidence Based Care: a Joanna Briggs Institute Centre of Excellence
| | - Judith Carrier
- The Wales Centre For Evidence Based Care: a Joanna Briggs Institute Centre of Excellence
| | - Christiane Kugler
- Nursing Science, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Deborah Edwards
- The Wales Centre For Evidence Based Care: a Joanna Briggs Institute Centre of Excellence
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Duncan S, Annunziato RA, Dunphy C, LaPointe Rudow D, Shneider BL, Shemesh E. A systematic review of immunosuppressant adherence interventions in transplant recipients: Decoding the streetlight effect. Pediatr Transplant 2018; 22:10.1111/petr.13086. [PMID: 29218760 PMCID: PMC5811374 DOI: 10.1111/petr.13086] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2017] [Indexed: 12/23/2022]
Abstract
Non-adherence to immunosuppressant medications is an important risk factor for graft dysfunction. To evaluate the effectiveness of adherence-enhancing interventions, we reviewed adherence intervention studies in solid organ transplant recipients (all ages). Using the following databases: PsycINFO, PubMed, Scopus, and ScienceDirect, we identified 41 eligible studies. Only three non-randomized trials showed a possible positive effect on objective indicators of transplant outcomes (such as rejection, liver enzyme levels, kidney function). None of the 21 RCTs showed an improvement in transplant outcomes. Three studies showed a higher rate of adverse events in the intervention group as compared with controls, although this may be related to ascertainment bias. Improvement in adherence as measured indirectly (eg, with electronic monitoring devices) was not aligned with effects on transplant outcomes. We conclude that adherence interventions, to date, have largely been ineffective in improving transplant outcomes. To improve this track record, intervention efforts may wish to concentrate on non-adherent patients (rather than use convenience sampling, which excludes many of the patients who need the intervention), use direct measures of adherence to guide the interventions, and employ strategies that are intensive and yet engaging enough to ensure that non-adherent patients are able to participate.
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Affiliation(s)
- S Duncan
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, New York, NY, USA
- Department of Psychology, Fordham University, Bronx, NY, USA
| | - R A Annunziato
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, New York, NY, USA
- Department of Psychology, Fordham University, Bronx, NY, USA
| | - C Dunphy
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, New York, NY, USA
- Department of Psychology, Fordham University, Bronx, NY, USA
| | - D LaPointe Rudow
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, New York, NY, USA
| | - B L Shneider
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - E Shemesh
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, New York, NY, USA
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Senft Y, Kirsch M, Denhaerynck K, Dobbels F, Helmy R, Russell CL, Berben L, De Geest S. Practice patterns to improve pre and post-transplant medication adherence in heart transplant centres: a secondary data analysis of the international BRIGHT study. Eur J Cardiovasc Nurs 2017; 17:356-367. [PMID: 29231747 DOI: 10.1177/1474515117747577] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND As medication non-adherence is a major risk factor for poor post-transplant outcomes, we explored how adherence is assessed, enhanced and integrated across the transplant continuum. AIM The aim of this study was to study practice patterns regarding pre- and post-transplant medication adherence assessment and interventions in international heart transplant centres. METHODS We used data from the Building Research Initiative Group: chronic illness management and adherence in heart transplantation (BRIGHT) study, a cross-sectional study conducted in 36 heart transplant centres in 11 countries. On a 27-item questionnaire, 100 clinicians (range one to five per centre) reported their practice patterns regarding adherence assessment and intervention strategies pre-transplant, immediately post-transplant, less than one year, and one or more year post-transplant. Educational/cognitive, counselling/behavioural and psychosocial/affective strategies were assessed. Clinicians' responses (intervention present vs. absent; or incongruence in reporting intervention) were aggregated at the centre level. RESULTS The adherence assessment method most commonly used along the transplant continuum was questioning patients (range 75-88.9%). Pre-transplant, all three categories of intervention strategy were applied. Providing reading materials (82.9%) or instructions (68.6%), involving family or support persons in education (91.4%), and establishing partnership (91.4%) were used most frequently. Post-transplant, strategies closely resembled those employed pre-transplant. Training patients (during recovery) and cueing were more often applied during hospitalisation (74.3%). After the first year post-transplant, except for motivational interviewing (25.7-28.6%), the number of strategies decreased. CONCLUSIONS Across the transplant continuum, diverse adherence interventions are implemented; however, post-transplant, the frequency of adherence interventions decreases. Therefore, increased investment is necessary in long-term adherence interventions.
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Affiliation(s)
- Yuliya Senft
- 1 Department of Haematology, University Hospital of Basel, Switzerland
| | - Monika Kirsch
- 2 Department of Anesthesiology, University Hospital of Basel, Switzerland
| | - Kris Denhaerynck
- 3 Institute of Nursing Science, University of Basel, Switzerland
| | | | - Remon Helmy
- 3 Institute of Nursing Science, University of Basel, Switzerland
| | - Cynthia L Russell
- 5 School of Nursing and Health Studies, University of Missouri-Kansas City, USA
| | - Lut Berben
- 3 Institute of Nursing Science, University of Basel, Switzerland
| | - Sabina De Geest
- 3 Institute of Nursing Science, University of Basel, Switzerland.,4 Academic Centre for Nursing and Midwifery, KU Leuven, Belgium
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Fleming JN, Taber DJ, McElligott J, McGillicuddy JW, Treiber F. Mobile Health in Solid Organ Transplant: The Time Is Now. Am J Transplant 2017; 17:2263-2276. [PMID: 28188681 DOI: 10.1111/ajt.14225] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/24/2017] [Accepted: 02/04/2017] [Indexed: 01/25/2023]
Abstract
Despite being in existence for >40 years, the application of telemedicine has lagged significantly in comparison to its generated interest. Detractors include the immobile design of most historic telemedicine interventions and the relative lack of smartphones among the general populace. Recently, the exponential increase in smartphone ownership and familiarity have provided the potential for the development of mobile health (mHealth) interventions that can be mirrored realistically in clinical applications. Existing studies have demonstrated some potential clinical benefits of mHealth in the various phases of solid organ transplantation (SOT). Furthermore, studies in nontransplant chronic diseases may be used to guide future studies in SOT. Nevertheless, substantially more must be accomplished before mHealth becomes mainstream. Further evidence of clinical benefits and a critical need for cost-effectiveness analysis must prove its utility to patients, clinicians, hospitals, insurers, and the federal government. The SOT population is an ideal one in which to demonstrate the benefits of mHealth. In this review, the current evidence and status of mHealth in SOT is discussed, and a general path forward is presented that will allow buy-in from the health care community, insurers, and the federal government to move mHealth from research to standard care.
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Affiliation(s)
- J N Fleming
- Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC
| | - D J Taber
- Department of Surgery, Medical University of South Carolina, Charleston, SC.,Department of Pharmacy, Ralph H Johnson VAMC, Charleston, SC
| | - J McElligott
- Center for Telehealth, Medical University of South Carolina, Charleston, SC
| | - J W McGillicuddy
- Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - F Treiber
- Technology Center to Advance Healthful Lifestyles, College of Nursing, Medical University of South Carolina, Charleston, SC
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