1
|
Redfern J, Tu Q, Hyun K, Hollings MA, Hafiz N, Zwack C, Free C, Perel P, Chow CK. Mobile phone text messaging for medication adherence in secondary prevention of cardiovascular disease. Cochrane Database Syst Rev 2024; 3:CD011851. [PMID: 38533994 PMCID: PMC10966941 DOI: 10.1002/14651858.cd011851.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND Cardiovascular diseases (CVDs) are the leading cause of death globally, accounting for almost 18 million deaths annually. People with CVDs have a five times greater chance of suffering a recurrent cardiovascular event than people without known CVDs. Although drug interventions have been shown to be cost-effective in reducing the risk of recurrent cardiovascular events, adherence to medication remains suboptimal. As a scalable and cost-effective approach, mobile phone text messaging presents an opportunity to convey health information, deliver electronic reminders, and encourage behaviour change. However, it is uncertain whether text messaging can improve medication adherence and clinical outcomes. This is an update of a Cochrane review published in 2017. OBJECTIVES To evaluate the benefits and harms of mobile phone text messaging for improving medication adherence in people with CVDs compared to usual care. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, four other databases, and two trial registers. We also checked the reference lists of all primary included studies and relevant systematic reviews and meta-analyses. The date of the latest search was 30 August 2023. SELECTION CRITERIA We included randomised controlled trials (RCTs) with participants with established arterial occlusive events. We included trials investigating interventions using short message service (SMS) or multimedia messaging service (MMS) with the aim of improving adherence to medication for the secondary prevention of cardiovascular events. The comparator was usual care. We excluded cluster-RCTs and quasi-RCTs. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were medication adherence, fatal cardiovascular events, non-fatal cardiovascular events, and combined CVD event. Secondary outcomes were low-density lipoprotein cholesterol for the effect of statins, blood pressure for antihypertensive drugs, heart rate for the effect of beta-blockers, urinary 11-dehydrothromboxane B2 for the antiplatelet effects of aspirin, adverse effects, and patient-reported experience. We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS We included 18 RCTs involving a total of 8136 participants with CVDs. We identified 11 new studies in the review update and seven studies in the previous version of the review. Participants had various CVDs including acute coronary syndrome, coronary heart disease, stroke, myocardial infarction, and angina. All studies were conducted in middle- and high-income countries, with no studies conducted in low-income countries. The mean age of participants was 53 to 64 years. Participants were recruited from hospitals or cardiac rehabilitation facilities. Follow-up ranged from one to 12 months. There was variation in the characteristics of text messages amongst studies (e.g. delivery method, frequency, theoretical grounding, content used, personalisation, and directionality). The content of text messages varied across studies, but generally included medication reminders and healthy lifestyle information such as diet, physical activity, and weight loss. Text messages offered advice, motivation, social support, and health education to promote behaviour changes and regular medication-taking. We assessed risk of bias for all studies as high, as all studies had at least one domain at unclear or high risk of bias. Medication adherence Due to different evaluation score systems and inconsistent definitions applied for the measurement of medication adherence, we did not conduct meta-analysis for medication adherence. Ten out of 18 studies showed a beneficial effect of mobile phone text messaging for medication adherence compared to usual care, whereas the other eight studies showed either a reduction or no difference in medication adherence with text messaging compared to usual care. Overall, the evidence is very uncertain about the effects of mobile phone text messaging for medication adherence when compared to usual care. Fatal cardiovascular events Text messaging may have little to no effect on fatal cardiovascular events compared to usual care (odds ratio 0.83, 95% confidence interval (CI) 0.47 to 1.45; 4 studies, 1654 participants; low-certainty evidence). Non-fatal cardiovascular events We found very low-certainty evidence that text messaging may have little to no effect on non-fatal cardiovascular events. Two studies reported non-fatal cardiovascular events, neither of which found evidence of a difference between groups. Combined CVD events We found very low-certainty evidence that text messaging may have little to no effect on combined CVD events. Only one study reported combined CVD events, and did not find evidence of a difference between groups. Low-density lipoprotein cholesterol Text messaging may have little to no effect on low-density lipoprotein cholesterol compared to usual care (mean difference (MD) -1.79 mg/dL, 95% CI -4.71 to 1.12; 8 studies, 4983 participants; very low-certainty evidence). Blood pressure Text messaging may have little to no effect on systolic blood pressure (MD -0.93 mmHg, 95% CI -3.55 to 1.69; 8 studies, 5173 participants; very low-certainty evidence) and diastolic blood pressure (MD -1.00 mmHg, 95% CI -2.49 to 0.50; 5 studies, 3137 participants; very low-certainty evidence) when compared to usual care. Heart rate Text messaging may have little to no effect on heart rate compared to usual care (MD -0.46 beats per minute, 95% CI -1.74 to 0.82; 4 studies, 2946 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS Due to limited evidence, we are uncertain if text messaging reduces medication adherence, fatal and non-fatal cardiovascular events, and combined cardiovascular events in people with cardiovascular diseases when compared to usual care. Furthermore, text messaging may result in little or no effect on low-density lipoprotein cholesterol, blood pressure, and heart rate compared to usual care. The included studies were of low methodological quality, and no studies assessed the effects of text messaging in low-income countries or beyond the 12-month follow-up. Long-term and high-quality randomised trials are needed, particularly in low-income countries.
Collapse
Affiliation(s)
- Julie Redfern
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- The George Institute for Global Health, University of New South Wales, Sydney , Australia
| | - Qiang Tu
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Karice Hyun
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Cardiology, Concord Hospital, Sydney , Australia
| | - Matthew A Hollings
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Nashid Hafiz
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Clara Zwack
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Caroline Free
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Pablo Perel
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Cardiology, Westmead Hospital, Sydney, Australia
| |
Collapse
|
2
|
Morgan JK, Rawlins CR, Walther SK, Harvey A, O'Donnell A, Greene M, Schmidt TG. A Mobile App for Postoperative Pain Management Among Older Veterans Undergoing Total Knee Arthroplasty: Mixed Methods Feasibility and Acceptability Pilot Study. JMIR Perioper Med 2023; 6:e50116. [PMID: 37851497 PMCID: PMC10620635 DOI: 10.2196/50116] [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: 06/19/2023] [Revised: 08/11/2023] [Accepted: 09/21/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Prescription opioid misuse risk is disproportionate among veterans; military veterans wounded in combat misuse prescription opioids at an even higher rate (46.2%). Opioid misuse is costly in terms of morbidity, mortality, and humanitarian and economic burden and costs the Civilian Health and Medical Program of the Department of Veterans Affairs more than US $1.13 billion annually. Preventing opioid misuse at the time of prescription is a critical component in the response to the opioid crisis. The CPMRx mobile app has been shown to decrease the odds of opioid misuse during the postoperative period. OBJECTIVE The overarching purpose of this feasibility pilot study was to explore whether deploying a mobile app (CPMRx) to track postoperative pain and medication use is feasible in a Department of Veterans Affairs medical center. In support of this goal, we had four complementary specific aims: (1) determine the technological and logistical feasibility of the mobile app, (2) assess the acceptability of the mobile app to participants, (3) measure demand for and engagement with the mobile app, and (4) explore the potential use of the mobile app to patients and providers. METHODS Participants (N=10) were veterans undergoing total knee arthroplasty within the Veterans Health Administration provided with the CPMRx app to self-manage their pain during their 7-day at-home recovery following surgery. CPMRx uses scientifically validated tools to help clinicians understand how a patient can use the least amount of medication while getting the most benefit. The suite of software includes a mobile app for patients that includes a behavioral health intervention and a clinical decision support tool for health care providers that provides feedback about pain and medication use trends. Patients filled out paper questionnaires regarding acceptability at their postoperative follow-up appointment. RESULTS Overall, quantitative measures of acceptability were high. The average rating for the amount of time required to use the app was 4.9 of 5 (5="very little"), and the average rating for ease of use was 4.4 of 5 (5="very easy"). Open-ended questions also revealed that most participants found ease of use to be high. Demand and engagement were high as well with a mean number of mobile app entries of 34.1 (SD 20.1) during the postoperative period. There were no reported technological or logistical issues with the mobile app. Participants took an average of 25.13 (SD 14.37) opioid tablets to manage their postoperative pain. CONCLUSIONS Results of this study revealed that the use of a mobile app for pain and medication management during postoperative recovery was both feasible and acceptable in older veterans undergoing total knee arthroplasty within the Veterans Health Administration. The wide variation in opioid consumption across participants revealed the potential use of the mobile app to provide actionable insights to clinicians if adopted more widely.
Collapse
Affiliation(s)
| | - Caitlin R Rawlins
- Western North Carolina Veterans Affairs Health Care System, Asheville, NC, United States
| | - Steven K Walther
- Continuous Precision Medicine, Research Triangle Park, NC, United States
| | - Andrew Harvey
- Continuous Precision Medicine, Research Triangle Park, NC, United States
| | - Annmarie O'Donnell
- Continuous Precision Medicine, Research Triangle Park, NC, United States
| | - Marla Greene
- Western North Carolina Veterans Affairs Health Care System, Asheville, NC, United States
| | - Troy G Schmidt
- Western North Carolina Veterans Affairs Health Care System, Asheville, NC, United States
| |
Collapse
|
3
|
Stremmel C, Breitschwerdt R. Digital Transformation in the Diagnostics and Therapy of Cardiovascular Diseases: Comprehensive Literature Review. JMIR Cardio 2023; 7:e44983. [PMID: 37647103 PMCID: PMC10500361 DOI: 10.2196/44983] [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: 12/11/2022] [Revised: 06/12/2023] [Accepted: 08/07/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND The digital transformation of our health care system has experienced a clear shift in the last few years due to political, medical, and technical innovations and reorganization. In particular, the cardiovascular field has undergone a significant change, with new broad perspectives in terms of optimized treatment strategies for patients nowadays. OBJECTIVE After a short historical introduction, this comprehensive literature review aimed to provide a detailed overview of the scientific evidence regarding digitalization in the diagnostics and therapy of cardiovascular diseases (CVDs). METHODS We performed an extensive literature search of the PubMed database and included all related articles that were published as of March 2022. Of the 3021 studies identified, 1639 (54.25%) studies were selected for a structured analysis and presentation (original articles: n=1273, 77.67%; reviews or comments: n=366, 22.33%). In addition to studies on CVDs in general, 829 studies could be assigned to a specific CVD with a diagnostic and therapeutic approach. For data presentation, all 829 publications were grouped into 6 categories of CVDs. RESULTS Evidence-based innovations in the cardiovascular field cover a wide medical spectrum, starting from the diagnosis of congenital heart diseases or arrhythmias and overoptimized workflows in the emergency care setting of acute myocardial infarction to telemedical care for patients having chronic diseases such as heart failure, coronary artery disease, or hypertension. The use of smartphones and wearables as well as the integration of artificial intelligence provides important tools for location-independent medical care and the prevention of adverse events. CONCLUSIONS Digital transformation has opened up multiple new perspectives in the cardiovascular field, with rapidly expanding scientific evidence. Beyond important improvements in terms of patient care, these innovations are also capable of reducing costs for our health care system. In the next few years, digital transformation will continue to revolutionize the field of cardiovascular medicine and broaden our medical and scientific horizons.
Collapse
|
4
|
Ellis T, Cheng S, Zecchin R, Zwack C, Hyun K, Zhang L, Gallagher R, Clark R, Redfern J. Effect of an avatar-based discharge education application on knowledge and behaviour in people after acute coronary syndrome: protocol for a pragmatic prospective randomised controlled trial. BMJ Open 2023; 13:e073621. [PMID: 37604633 PMCID: PMC10445362 DOI: 10.1136/bmjopen-2023-073621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/08/2023] [Indexed: 08/23/2023] Open
Abstract
INTRODUCTION Many hospital presentations for acute coronary syndrome (ACS) occur in people previously hospitalised with coronary heart disease (CHD), leading to increased costs and health burden. Secondary prevention education including a prehospital discharge plan is recommended for all individuals to reduce the risk of recurrence. However, many clinicians lack the time or support to provide education, and patients' uptake of secondary prevention programmes is limited. An avatar-based education app is a novel and engaging way to provide self-delivered, evidence-based secondary prevention information during the hospital admission and remains accessible after discharge. This protocol aims to evaluate the effect of an avatar-based education app on individuals with ACS. METHODS AND ANALYSIS This protocol describes a prospective, randomised controlled trial with 3-month follow-up and blinded assessment of 72 participants. Intervention group participants will download the app onto their own device during the hospital admission and independently complete six interactive education modules based on the National Heart Foundation's six steps to cardiac recovery. All participants will receive a text message reminder of the study after 3 weeks. Both groups will receive usual care consisting of bedside education and a pamphlet about cardiac rehabilitation. The primary outcome is knowledge of CHD, assessed using the Coronary Artery Disease Education Questionnaire II. Secondary outcomes include quality of life, response to heart attack symptoms, cardiac-related readmissions and mortality and modifiable cardiac risk factors. Engagement with the app will be evaluated objectively. Intention-to-treat analysis will be conducted, with between-group comparisons and 95% CIs of the primary outcome analysed using analysis of covariance, adjusting for baseline values. ETHICS AND DISSEMINATION This study protocol has been approved by the Western Sydney Local Health District Human Research Ethics Committee. The results of this study will be disseminated via a peer-reviewed journal and research thesis. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12622001436763).
Collapse
Affiliation(s)
- Tiffany Ellis
- Department of Physiotherapy, Westmead Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sonia Cheng
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Robert Zecchin
- Cardiac Rehabilitation Services, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Clara Zwack
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Karice Hyun
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ling Zhang
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Robyn Gallagher
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Robyn Clark
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Julie Redfern
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
5
|
Blasco JM, Díaz-Díaz B, Igual-Camacho C, Pérez-Maletzki J, Hernández-Guilén D, Roig-Casasús S. Effectiveness of using a chatbot to promote adherence to home physiotherapy after total knee replacement, rationale and design of a randomized clinical trial. BMC Musculoskelet Disord 2023; 24:491. [PMID: 37322506 DOI: 10.1186/s12891-023-06607-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 06/06/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Rehabilitation is essential to optimize outcomes after surgical procedures in musculoskeletal disorders. However, adherence to rehabilitation continues to be an important barrier, since compliance with the programs is not always as desired, which may have a negative impact on clinical results. METHODS Randomized controlled trial aimed at to determining the effectiveness of using a virtual assistant (i.e., chatbot) to promote adherence to home rehabilitation. Overall, seventy patients under 75, undergoing total knee replacement, who have a personal smartphone and are familiar with its use, will be assigned into the control (standard care) or the experimental (standard care plus virtual assistant) group. Adherence (primary outcome) will be assessed three months after surgery. The WOMAC questionnaire, knee pain and system usability scale will be also outcomes of interest at three months and one year. Overall, an analysis of variance will look for possible time, group and time*group interactions. DISCUSSION The expected result is to determine whether the use of a chatbot that interacts with the patient can increase adherence to post-surgical home physiotherapy, and result in better clinical results (functional and pain) than standard care. TRIAL REGISTRATION clinicaltrials.gov id. NCT05363137.
Collapse
Affiliation(s)
- José-María Blasco
- Group in Physiotherapy in the Ageing Processess: Social and Healthcare Strategies, Departament de Fisioteràpia, Universitat de València, Calle Gascó Oliag 5, Valencia, 46010, Spain.
- IRIMED, Joint Research Unit La Fe-UV, Valencia, Spain.
| | - Beatriz Díaz-Díaz
- Group in Physiotherapy in the Ageing Processess: Social and Healthcare Strategies, Departament de Fisioteràpia, Universitat de València, Calle Gascó Oliag 5, Valencia, 46010, Spain
- Hospital Clínic i Universitari de València, Valencia, Spain
| | - Celedonia Igual-Camacho
- Group in Physiotherapy in the Ageing Processess: Social and Healthcare Strategies, Departament de Fisioteràpia, Universitat de València, Calle Gascó Oliag 5, Valencia, 46010, Spain
- Hospital Clínic i Universitari de València, Valencia, Spain
| | - José Pérez-Maletzki
- Group in Physiotherapy in the Ageing Processess: Social and Healthcare Strategies, Departament de Fisioteràpia, Universitat de València, Calle Gascó Oliag 5, Valencia, 46010, Spain
| | - David Hernández-Guilén
- Group in Physiotherapy in the Ageing Processess: Social and Healthcare Strategies, Departament de Fisioteràpia, Universitat de València, Calle Gascó Oliag 5, Valencia, 46010, Spain
| | - Sergio Roig-Casasús
- Group in Physiotherapy in the Ageing Processess: Social and Healthcare Strategies, Departament de Fisioteràpia, Universitat de València, Calle Gascó Oliag 5, Valencia, 46010, Spain
- Hospital Universitari i Politècnic la Fe de València, Valencia, Spain
| |
Collapse
|
6
|
Zwack CC, Smith C, Poulsen V, Raffoul N, Redfern J. Information Needs and Communication Strategies for People with Coronary Heart Disease: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1723. [PMID: 36767091 PMCID: PMC9914653 DOI: 10.3390/ijerph20031723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/13/2023] [Accepted: 01/13/2023] [Indexed: 06/18/2023]
Abstract
A critical aspect of coronary heart disease (CHD) care and secondary prevention is ensuring patients have access to evidence-based information. The purpose of this review is to summarise the guiding principles, content, context and timing of information and education that is beneficial for supporting people with CHD and potential communication strategies, including digital interventions. We conducted a scoping review involving a search of four databases (Web of Science, PubMed, CINAHL, Medline) for articles published from January 2000 to August 2022. Literature was identified through title and abstract screening by expert reviewers. Evidence was synthesised according to the review aims. Results demonstrated that information-sharing, decision-making, goal-setting, positivity and practicality are important aspects of secondary prevention and should be patient-centred and evidenced based with consideration of patient need and preference. Initiation and duration of education is highly variable between and within people, hence communication and support should be regular and ongoing. In conclusion, text messaging programs, smartphone applications and wearable devices are examples of digital health strategies that facilitate education and support for patients with heart disease. There is no one size fits all approach that suits all patients at all stages, hence flexibility and a suite of resources and strategies is optimal.
Collapse
Affiliation(s)
- Clara C. Zwack
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Carlie Smith
- National Heart Foundation of Australia, Brisbane, QLD 4006, Australia
| | - Vanessa Poulsen
- National Heart Foundation of Australia, Adelaide, SA 5000, Australia
| | - Natalie Raffoul
- National Heart Foundation Australia, Sydney, NSW 2011, Australia
| | - Julie Redfern
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| |
Collapse
|
7
|
Backes C, Moyano C, Rimaud C, Bienvenu C, Schneider MP. Digital Medication Adherence Support: Could Healthcare Providers Recommend Mobile Health Apps? FRONTIERS IN MEDICAL TECHNOLOGY 2022; 2:616242. [PMID: 35047896 PMCID: PMC8757821 DOI: 10.3389/fmedt.2020.616242] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 12/29/2020] [Indexed: 11/13/2022] Open
Abstract
Adherence to prescribed medication is suboptimal in 50% of the chronic population, resulting in negative medical and economic outcomes. With the widespread use of mobile phones worldwide, medication adherence apps for mobile phones become promising medication adherence aids thanks to simplicity, user-friendliness, and accessibility for the public. Yet, until today, there is insufficient evidence in favor of using mobile health (mHealth) apps to increase medication adherence. This study aims to develop a methodology for scientific and end-user (patient) mHealth evaluation (a) to identify medication adherence apps search terms, (b) to evaluate identified apps based on scientific criteria, and (c) to report best smartphone apps evaluated by patients. Search terms were identified via literature review and expertise. Firstly, an online questionnaire was developed to identify frequently used search terms by recruited patients. Related medication adherence apps were identified and selected using predefined inclusion criteria. Secondly, identified apps were evaluated thanks to a scientific evaluation method and a created online questionnaire for patient feedback. Recruited patients were invited to test and evaluate the selected apps. Out of 1,833 free-of-charge and 307 paid apps identified, only four free-of-charge and three paid apps remained included in the study after eligibility criteria. None of the selected app reached a high score. Looking at the overall scores, Medisafe (59%), MyTherapy (56%), and Meds on time (44%) received the highest scores in the scientific app evaluation. In the patient evaluation, Dosecast (3.83 out of five points), Medisafe (3.62), and SwissMeds (3.50) received the highest scores. None of the apps in this research has undergone a process for certification, for example, CE marking, through a notified body. Security and data protection aspects of existing apps highly contribute to these low evaluation scores through little information on patient's data processing and storage. This might be corrected through the introduction of General Data Protection Regulation (GDPR) in the European Economic Area (EEA) and more scrutiny through regulatory bodies in the EU/EEA and the USA. None of the applications should be recommended by healthcare providers. In addition, clinical studies with chronic patients are necessary to measure long-term app impacts.
Collapse
Affiliation(s)
- Claudine Backes
- Lab of Medication Adherence and Interprofessionality, School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Carla Moyano
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Camille Rimaud
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Christine Bienvenu
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Marie P Schneider
- Lab of Medication Adherence and Interprofessionality, School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland.,Pharma24, An Academic Community Pharmacy and Living Lab Located at the Exit of the Geneva University Hospitals, Geneva, Switzerland
| |
Collapse
|
8
|
Development features and study characteristics of mobile health apps in the management of chronic conditions: a systematic review of randomised trials. NPJ Digit Med 2021; 4:144. [PMID: 34611287 PMCID: PMC8492762 DOI: 10.1038/s41746-021-00517-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/13/2021] [Indexed: 11/21/2022] Open
Abstract
COVID-19 pandemic challenges have accelerated the reliance on digital health fuelling the expanded incorporation of mobile apps into healthcare services, particularly for the management of long-term conditions such as chronic diseases (CDs). However, the impact of health apps on outcomes for CD remains unclear, potentially owing to both the poor adoption of formal development standards in the design process and the methodological quality of studies. A systematic search of randomised trials was performed on Medline, ScienceDirect, the Cochrane Library and Scopus to provide a comprehensive outlook and review the impact of health apps on CD. We identified 69 studies on diabetes (n = 29), cardiovascular diseases (n = 13), chronic respiratory diseases (n = 13), cancer (n = 10) or their combinations (n = 4). The apps rarely adopted developmental factors in the design stage, with only around one-third of studies reporting user or healthcare professional engagement. Apps differed significantly in content, with a median of eight behaviour change techniques adopted, most frequently pertaining to the ‘Feedback and monitoring’ (91%) and ‘Shaping knowledge’ (72%) categories. As for the study methodologies, all studies adopted a traditional randomised control trial (RCT) design, with relatively short follow-ups and limited sample sizes. Findings were not significant for the majority of studies across all CD, with most RCTs revealing a high risk of bias. To support the adoption of apps for CD management, this review reinforces the need for more robust development and appropriate study characteristics to sustain evidence generation and elucidate whether study results reflect the true benefits of apps or a biased estimate due to unsuitable designs.
Collapse
|
9
|
Padilha JC, Santos VB, Lopes CT, Lopes JDL. Prevalence of pharmacological adherence in patients with coronary artery disease and associated factors. Rev Lat Am Enfermagem 2021; 29:e3464. [PMID: 34495187 PMCID: PMC8432583 DOI: 10.1590/1518-8345.4554.3464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/26/2020] [Indexed: 11/29/2022] Open
Abstract
Objective: to assess the prevalence of pharmacological adherence in patients with
coronary artery disease and to identify factors associated with
adherence. Method: a crosssectional, correlational study, including 198 patients with a previous
diagnosis of coronary artery disease. Pharmacological adherence was assessed
by the four-item Morisky Green test, and the factors that potentially
interfere with adherence were considered independent variables. The
association between the variables was determined by the Cox model, with a 5%
significance level. Results: 43% of the patients adhered to the treatment. Fatigue and palpitation, never
having consumed alcohol and being served by medical insurance were
associated with adherence. Lack of adherence was associated with considering
the treatment complex, consumption of alcohol and being served by the public
health care system. In the multiple analysis, the patients with fatigue and
palpitations had a prevalence of adherence around three times higher and
alcohol consumption was associated with a 2.88 times greater chance of
non-adherence. Conclusion: more than half of the patients were classified as non-adherent. Interventions
can be directed to some factors associated with lack of adherence.
Collapse
Affiliation(s)
- Jaqueline Correia Padilha
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem, São Paulo, SP, Brazil.,Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | - Vinicius Batista Santos
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem, Departamento de Enfermagem Clínica e Cirúrgica, São Paulo, SP, Brazil
| | - Camila Takao Lopes
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem, Departamento de Enfermagem Clínica e Cirúrgica, São Paulo, SP, Brazil
| | - Juliana de Lima Lopes
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem, Departamento de Enfermagem Clínica e Cirúrgica, São Paulo, SP, Brazil.,Scholarship holder at the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil
| |
Collapse
|
10
|
Intentional and unintentional nonadherence to hydroxyurea among people with sickle cell disease: a qualitative study. Blood Adv 2021; 4:4463-4473. [PMID: 32941646 DOI: 10.1182/bloodadvances.2020001701] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 07/28/2020] [Indexed: 11/20/2022] Open
Abstract
Hydroxyurea is an efficacious treatment for sickle cell disease (SCD), but adoption is low among individuals with SCD. The objective of this study was to examine barriers to patients' adherence to hydroxyurea use regimens by using the intentional and unintentional medication nonadherence framework. We interviewed individuals with SCD age 15 to 49.9 years who were participants in the Sickle Cell Disease Implementation Consortium (SCDIC) Needs Assessment. The intentional and unintentional medication nonadherence framework explains barriers to using hydroxyurea and adds granularity to the understanding of medication adherence barriers unique to the SCD population. In total, 90 semi-structured interviews were completed across 5 of the 8 SCDIC sites. Among interviewed participants, 57.8% (n = 52) were currently taking hydroxyurea, 28.9% (n = 26) were former hydroxyurea users at the time of the interview, and 13.3% (n = 12) had never used hydroxyurea but were familiar with the medication. Using a constructivist grounded theory approach, we discovered important themes that contributed to nonadherence to hydroxyurea, which were categorized under unintentional (eg, Forgetfulness, External Influencers) and intentional (Negative Perceptions of Hydroxyurea, Aversion to Taking Any Medications) nonadherence types. Participants more frequently endorsed adherence barriers that fell into the unintentional nonadherence type (70%) vs intentional nonadherence type (30%). Results from this study will help SCD health care providers understand patient choices and decisions as being either unintentional or intentional, guide tailored clinical discussions regarding hydroxyurea therapy, and develop specific, more nuanced interventions to address nonadherence factors.
Collapse
|
11
|
Abstract
PURPOSE OF REVIEW To review the current evidence supporting the use of digital health technologies in cardiovascular disease (CVD) care. RECENT FINDINGS Studies have evaluated the impact of the use of digital health technologies to improve CVD outcomes through several modalities: text-messaging programmes, smartphone applications (apps) and wearable devices. Text-messaging programmes are to date the most studied type of digital health interventions, and studies have demonstrated reduced CVD risk and improved medication adherence. Literature supporting the use of smartphone apps is also growing but remains limited, with some studies favouring the use of health apps but others showing negative results. Wearable devices are the latest type of technology investigated, and studies have shown positive outcomes in terms of physical activity and detection of arrhythmias. Digital health is a growing and evolving area of investigation. To date, the scientific evidence overall supports the use of such technologies in CVD care and management. Future research using new models are needed to continue to evaluate these new technologies.
Collapse
Affiliation(s)
- Karla Santo
- Academic Research Organization, Hospital Israelita Albert Einstein, Av. Albert Einstein 627, Bloco A, 2o subsolo, São Paulo, SP CEP 05652-900 Brazil
- Westmead Applied Research Centre, Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Cardiovascular Division, The George Institute for Global Health, Sydney, Australia
| | - Julie Redfern
- Westmead Applied Research Centre, Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Cardiovascular Division, The George Institute for Global Health, Sydney, Australia
| |
Collapse
|
12
|
Chen YW, Wei J, Chen HL, Cheng CH, Hou IC. Developing a Heart Transplantation Self-Management Support Mobile Health App in Taiwan: Qualitative Study. JMIR Mhealth Uhealth 2020; 8:e18999. [PMID: 32812883 PMCID: PMC7468636 DOI: 10.2196/18999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/17/2020] [Accepted: 07/07/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Heart transplantation (HTx) is the most effective treatment for end-stage heart failure patients. After transplantation, patients face physiological, psychological, social, and other health care problems. Mobile health (mHealth) apps can change the delivery of conventional health care to ubiquitous care and improve health care quality. However, a dearth of mHealth apps exists for patients with HTx worldwide, including in Taiwan. OBJECTIVE The aim of this study was to investigate the information needed and to develop a preliminary framework for an mHealth app for post-HTx patients. METHODS A qualitative approach with individual in-depth interviews was conducted at a heart center in the regional hospital of northern Taiwan from June to November 2017. Patients that had undergone HTx and their health professionals were recruited for purposeful sampling. A semistructured interview guideline was used for individual interviews and transcribed. Thematic analysis was used for data analysis. RESULTS A total of 21 subjects, including 17 patients and 4 health professionals, were recruited for the study. The following five major themes were identified: reminding, querying, experience sharing, diet, and expert consulting. Minor themes included a desire to use the app with artificial intelligence and integration with professional management. CONCLUSIONS An intelligent mHealth app that addresses the five main themes and integrates the processes of using a mobile app could facilitate HTx self-management for Taiwanese patients.
Collapse
Affiliation(s)
- Yi-Wen Chen
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Jeng Wei
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Hwei-Ling Chen
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | | | - I-Ching Hou
- School of Nursing, National Yang-Ming University, Taipei, Taiwan
| |
Collapse
|
13
|
Domańska B, Vansant S, Mountian I. A Companion App to Support Rheumatology Patients Treated with Certolizumab Pegol: Results From a Usability Study. JMIR Form Res 2020; 4:e17373. [PMID: 32716310 PMCID: PMC7418011 DOI: 10.2196/17373] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 05/05/2020] [Accepted: 06/03/2020] [Indexed: 12/19/2022] Open
Abstract
Background Certolizumab pegol (CZP) is an anti-tumor necrosis factor drug approved for the treatment of multiple moderate to severe chronic inflammatory diseases. In the European Union, CZP is approved for administration by subcutaneous self-injection using a prefilled syringe, prefilled pen, or reusable electromechanical auto-injector (electronic device). CimplyMe is a companion app for use alongside CZP self-injection devices, designed to support CZP-treated patients self-managing their treatment and disease. Objective This study aimed to validate the usability of the companion app by demonstrating that tasks required for use can be performed successfully by intended end users. Methods We recruited 15 patients with moderate to severe rheumatoid arthritis, currently prescribed biologic treatment, and using apps on a smart phone. Patients were assessed on their ability to use the companion app in a setting designed to simulate a location where patients regularly administer biologic treatment. To assess the usability of the key features of the app, 8 critical and 3 noncritical tasks were designed. Patients’ success on each task was recorded through observations or knowledge-based questions. Successes with difficulty and use errors were also recorded. If a patient made a use error at the first attempt, a second attempt was allowed. Second-attempt use errors were recorded as a task failure. Results A total of 207 first attempts at the 14 components of the 8 critical tasks were evaluated (3 patients failed to complete one component); 178 (86.0%) critical tasks were successfully completed at the first attempt. The remaining first attempts comprised 16 (7.7%) successes with difficulty and 13 (6.3%) use errors, which had to be repeated. One critical task was not re-attempted by one patient due to time constraints; however, there were no use errors in the 12 completed second attempts. A total of 107 first attempts at the 3 noncritical tasks were made, all of which (107/107, 100.0%) were completed without use errors. Conclusions In simulated testing, patients were able to successfully use the companion app without formal training. This study suggests the companion app is easy to use and could help patients prescribed CZP better manage their treatment and disease.
Collapse
|
14
|
Nadal C, Sas C, Doherty G. Technology Acceptance in Mobile Health: Scoping Review of Definitions, Models, and Measurement. J Med Internet Res 2020; 22:e17256. [PMID: 32628122 PMCID: PMC7381045 DOI: 10.2196/17256] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 04/14/2020] [Accepted: 04/30/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Designing technologies that users will be interested in, start using, and keep using has long been a challenge. In the health domain, the question of technology acceptance is even more important, as the possible intrusiveness of technologies could lead to patients refusing to even try them. Developers and researchers must address this question not only in the design and evaluation of new health care technologies but also across the different stages of the user's journey. Although a range of definitions for these stages exists, many researchers conflate related terms, and the field would benefit from a coherent set of definitions and associated measurement approaches. OBJECTIVE This review aims to explore how technology acceptance is interpreted and measured in mobile health (mHealth) literature. We seek to compare the treatment of acceptance in mHealth research with existing definitions and models, identify potential gaps, and contribute to the clarification of the process of technology acceptance. METHODS We searched the PubMed database for publications indexed under the Medical Subject Headings terms "Patient Acceptance of Health Care" and "Mobile Applications." We included publications that (1) contained at least one of the terms "acceptability," "acceptance," "adoption," "accept," or "adopt"; and (2) defined the term. The final corpus included 68 relevant studies. RESULTS Several interpretations are associated with technology acceptance, few consistent with existing definitions. Although the literature has influenced the interpretation of the concept, usage is not homogeneous, and models are not adapted to populations with particular needs. The prevalence of measurement by custom surveys suggests a lack of standardized measurement tools. CONCLUSIONS Definitions from the literature were published separately, which may contribute to inconsistent usage. A definition framework would bring coherence to the reporting of results, facilitating the replication and comparison of studies. We propose the Technology Acceptance Lifecycle, consolidating existing definitions, articulating the different stages of technology acceptance, and providing an explicit terminology. Our findings illustrate the need for a common definition and measurement framework and the importance of viewing technology acceptance as a staged process, with adapted measurement methods for each stage.
Collapse
Affiliation(s)
- Camille Nadal
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Corina Sas
- School of Computing and Communications, Lancaster University, Lancaster, United Kingdom
| | - Gavin Doherty
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
15
|
Nicholls SJ, Nelson M, Astley C, Briffa T, Brown A, Clark R, Colquhoun D, Gallagher R, Hare DL, Inglis S, Jelinek M, O'Neil A, Tirimacco R, Vale M, Redfern J. Optimising Secondary Prevention and Cardiac Rehabilitation for Atherosclerotic Cardiovascular Disease During the COVID-19 Pandemic: A Position Statement From the Cardiac Society of Australia and New Zealand (CSANZ). Heart Lung Circ 2020; 29:e99-e104. [PMID: 32473781 PMCID: PMC7192068 DOI: 10.1016/j.hlc.2020.04.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has introduced a major disruption to the delivery of routine health care across the world. This provides challenges for the use of secondary prevention measures in patients with established atherosclerotic cardiovascular disease (CVD). The aim of this Position Statement is to review the implications for effective delivery of secondary prevention strategies during the COVID-19 pandemic. CHALLENGES The COVID-19 pandemic has introduced limitations for many patients to access standard health services such as visits to health care professionals, medications, imaging and blood tests as well as attendance at cardiac rehabilitation. In addition, the pandemic is having an impact on lifestyle habits and mental health. Taken together, this has the potential to adversely impact the ability of practitioners and patients to adhere to treatment guidelines for the prevention of recurrent cardiovascular events. RECOMMENDATIONS Every effort should be made to deliver safe, ongoing access to health care professionals and the use of evidenced based therapies in individuals with CVD. An increase in use of a range of electronic health platforms has the potential to transform secondary prevention. Integrating research programs that evaluate the utility of these approaches may provide important insights into how to develop more optimal approaches to secondary prevention beyond the pandemic.
Collapse
Affiliation(s)
| | - Mark Nelson
- University of Tasmania, Hobart, Tas, Australia
| | | | - Tom Briffa
- University of Western Australia, Perth, WA, Australia
| | - Alex Brown
- South Australian Health and Medical Research Institute and University of Adelaide, Adelaide, SA, Australia
| | - Robyn Clark
- Flinders University, Adelaide, SA, Australia
| | | | | | - David L Hare
- University of Melbourne, Melbourne, Vic, Australia; Austin Health, Melbourne, Vic, Australia
| | - Sally Inglis
- University of Technology Sydney, Sydney, NSW, Australia
| | - Michael Jelinek
- University of Melbourne, Melbourne, Vic, Australia; St. Vincent's Hospital, Melbourne, Vic, Australia
| | | | - Rosy Tirimacco
- Country Health SA Local Health Network, Adelaide, SA, Australia
| | - Margarite Vale
- University of Melbourne, Melbourne, Vic, Australia; The COACH Program, Melbourne, Vic, Australia
| | | |
Collapse
|
16
|
Sardi L, Idri A, Redman LM, Alami H, Bezad R, Fernández-Alemán JL. Mobile health applications for postnatal care: Review and analysis of functionalities and technical features. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 184:105114. [PMID: 31655305 PMCID: PMC9052424 DOI: 10.1016/j.cmpb.2019.105114] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 07/04/2019] [Accepted: 10/02/2019] [Indexed: 05/05/2023]
Abstract
BACKGROUND Providing a continuum of care from antenatal, childbirth and postnatal period results in reduced maternal and neonatal morbidity and mortality. Timely, high quality postnatal care is crucial for maximizing maternal and newborn health. In this vein, the use of postnatal mobile applications constitutes a promising strategy. METHODS A Systematic Literature Review (SLR) protocol was adopted to perform the selection, data extraction and functional evaluation of the available postnatal apps on iOS and Android platforms. The analysis of the functionalities and technical features of the apps selected was performed according to a 37-items assessment questionnaire developed on the basis of the scientific literature of postnatal care and a preliminary analysis of available postnatal apps RESULTS: A total of 48 postnatal apps were retrieved from the app repositories of the iOS and Android platforms. The results of the functional content analysis show that the postnatal apps selected relatively achieved low scores owing to the complexity and the ramification of the postnatal care. CONCLUSIONS The present study helps in identifying areas related to the postnatal care that require further endeavors to be properly addressed. It also provides directions for developers to leverage the advancement and innovation on mobile technology to build complete and well-suited postnatal apps.
Collapse
Affiliation(s)
- Lamyae Sardi
- Software Project Management Research Team, ENSIAS, Mohammed V University, Rabat, Morocco.
| | - Ali Idri
- Software Project Management Research Team, ENSIAS, Mohammed V University, Rabat, Morocco; Complex Systems Engineering, University Mohamed VI Polytechnic, Ben Guerir, Morocco.
| | - Leanne M Redman
- Reproductive Endocrinology and Women's Health Lab, Pennington Biomedical Research Center, Baton Rouge, LA, USA.
| | - Hassan Alami
- Faculty of Medicine, Mohammed V University, Rabat, Morocco; Maternity Les orangers, University Hospital of Rabat, Morocco.
| | - Rachid Bezad
- Faculty of Medicine, Mohammed V University, Rabat, Morocco; Maternity Les orangers, University Hospital of Rabat, Morocco.
| | - José Luis Fernández-Alemán
- Department of Informatics and Systems, Faculty of Computer Science, University of Murcia, Murcia, Spain.
| |
Collapse
|
17
|
Armitage LC, Kassavou A, Sutton S. Do mobile device apps designed to support medication adherence demonstrate efficacy? A systematic review of randomised controlled trials, with meta-analysis. BMJ Open 2020; 10:e032045. [PMID: 32005778 PMCID: PMC7045248 DOI: 10.1136/bmjopen-2019-032045] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To estimate the efficacy of app-based interventions designed to support medication adherence and investigate which behaviour change techniques (BCTs) used by the apps are associated with efficacy. DESIGN Systematic review of randomised controlled trials (RCTs), with meta-analysis. SETTING Medline/PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Embase and Web of Science were searched from 1990 to November 2018 for RCTs conducted in any healthcare setting. PARTICIPANTS Studies of participants of any age taking prescribed medication for any health condition and for any duration. INTERVENTION An app-based intervention delivered through a smartphone, tablet computer or personal digital assistant to help, support or advise about medication adherence. COMPARATOR One of (1) usual care, (2) a control app which did not use any BCTs to improve medication adherence or (3) a non-app-based comparator. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the pooled effect size of changes in medication adherence. The secondary outcome was the association between BCTs used by the apps and the effect size. RESULTS The initial search identified 13 259 citations. After title and abstract screening, full-text articles of 83 studies were screened for eligibility. Nine RCTs with 1159 recruited participants were included. The mean age of participants was >50 years in all but one study. Health conditions of target populations included cardiovascular disease, depression, Parkinson's disease, psoriasis and multimorbidity. The meta-analysis indicated that patients who use mobile apps to support them in taking medications are more likely to self-report adherence to medications (OR 2.120, 95% CI 1.635 to 2.747, n=988) than those in the comparator groups. Meta-regression of the BCTs did not reveal any significant associations with effect size. CONCLUSIONS App-based medication adherence interventions may have a positive effect on patient adherence. Larger scale studies are required to further evaluate this effect, including long-term sustainability, and intervention and participant characteristics that are associated with efficacy and app usage. PROSPERO REGISTRATION NUMBER PROSPERO Protocol Registration Number: CRD42017080150.
Collapse
Affiliation(s)
- Laura Catherine Armitage
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Aikaterini Kassavou
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephen Sutton
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| |
Collapse
|
18
|
Jimenez G, Lum E, Huang Z, Theng YL, Boehm BO, Car J. Reminders for medication adherence in Type 2 diabetes management apps. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2020. [DOI: 10.1002/jppr.1595] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Geronimo Jimenez
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine Nanyang Technological University Singapore Singapore
| | - Elaine Lum
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine Nanyang Technological University Singapore Singapore
- Institute of Health and Biomedical Innovation, School of Clinical Sciences, Faculty of Health Queensland University of Technology Brisbane Australia
| | - Zhilian Huang
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine Nanyang Technological University Singapore Singapore
- NTU Institute for Health Technologies Nanyang Technological University Singapore Singapore
| | - Yin Leng Theng
- Ageing Research Institute for Society and Education Nanyang Technological University Singapore Singapore
- Centre of Healthy and Sustainable Cities, Wee Kim Wee School of Communication and Information Nanyang Technological University Singapore Singapore
| | - Bernard O. Boehm
- NTU Institute for Health Technologies Nanyang Technological University Singapore Singapore
- Lee Kong Chian School of Medicine Nanyang Technological University Singapore Singapore
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine Nanyang Technological University Singapore Singapore
| |
Collapse
|
19
|
Putri IRP, Nursalam N, Kurniawati ND. Information Technology-based Interventions for Health Care Support in Patients with Chronic Kidney Disease: A Systematic Review. JURNAL NERS 2020. [DOI: 10.20473/jn.v14i3.17030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Self-management and support in managing therapeutic regimens is very important for patients with CKD. Information technology-based interventions are increasingly being used to support the self-management of patients with CKD. This study aimed to conduct a systematic review to evaluate information technology-based interventions in relation to the support of the health management of patients with CKD.Method: We conducted a systematic review using electronic databases (Scopus, Science Direct, ProQuest) limited to the last 8 years from 2010 to 2018 with the relevant keywords. The studies included used RCT, pilot and case-control methods focusing on patients with CKD stage 1-5 and that reported on at least one outcome from the health management of patients with CKD.Result: Out of the 7.852 studies taken, 13 studies fulfilled the inclusion criteria. The interventions in this systematic review are multifaceted, including smartphone/PDA (6/13), telematics devices (2/13), internet/web (3/13) and a combination of several interventions (2 studies). In total, 12 (92%) out of the 13 studies showed a positive outcome from the intervention, 7 studies showed improved outcomes in the clinical points, 3 studies had improved adherence and 2 studies improved knowledge.Conclusion: This evidence indicates the potential of IT-based interventions (i.e. smartphone/PDA, computer, internet/web, telematic device) to support the health management of patients with CKD. The variety of interventions in this systematic review requires further research on which interventions are best applied.
Collapse
|
20
|
Zhao YY, Dang FP, Zhai TT, Li HJ, Wang RJ, Ren JJ. The effect of text message reminders on medication adherence among patients with coronary heart disease: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e18353. [PMID: 31876709 PMCID: PMC6946488 DOI: 10.1097/md.0000000000018353] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To determine the effectiveness of text message reminders (TMR) on medication adherence (MA) and to investigate the effects of TMR on clinical outcomes. METHODS The PubMed, Cochrane library, EMbase, and China Biology Medicine databases were searched for randomized-controlled trials with TMR as the intervention for patients with coronary heart disease. Two reviewers independently extracted data and assessed the risk of bias. Meta-analysis was conducted using Stata 15.0 software. RESULTS In total, 1678 patients in 6 trials were included. Compared with the control group, the MA was 2.85 times greater among the intervention group (RR [relative risk] 2.85; 95% confidence interval [CI] 1.07-7.58). TMR reduced systolic blood pressure (BP) (weighted mean difference) = -6.51; 95% CI -9.79 to -3.23), cholesterol (standard mean difference = -0.26; 95% CI -0.4 to -0.12) and increased the number of patients with BP <140/90 mm Hg (RR 1.39; 95% CI 1.26-1.54). CONCLUSION TMR significantly promoted MA and reduced systolic BP, cholesterol level, and body mass index, but had no effect on mortality, diastolic BP, or lipoproteins. However, substantial heterogeneity existed in our analyses.
Collapse
Affiliation(s)
| | - Fang-Ping Dang
- School of Nursing of Lanzhou University, Gansu, Lanzhou, China
| | - Tian-Tian Zhai
- School of Nursing of Lanzhou University, Gansu, Lanzhou, China
| | - Hui-Ju Li
- School of Nursing of Lanzhou University, Gansu, Lanzhou, China
| | - Rui-Juan Wang
- School of Nursing of Lanzhou University, Gansu, Lanzhou, China
| | - Jing-Jie Ren
- School of Nursing of Lanzhou University, Gansu, Lanzhou, China
| |
Collapse
|
21
|
Roosan D, Li Y, Law A, Truong H, Karim M, Chok J, Roosan M. Improving Medication Information Presentation Through Interactive Visualization in Mobile Apps: Human Factors Design. JMIR Mhealth Uhealth 2019; 7:e15940. [PMID: 31763991 PMCID: PMC6902132 DOI: 10.2196/15940] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/09/2019] [Accepted: 10/17/2019] [Indexed: 12/18/2022] Open
Abstract
Background Despite the detailed patient package inserts (PPIs) with prescription drugs that communicate crucial information about safety, there is a critical gap between patient understanding and the knowledge presented. As a result, patients may suffer from adverse events. We propose using human factors design methodologies such as hierarchical task analysis (HTA) and interactive visualization to bridge this gap. We hypothesize that an innovative mobile app employing human factors design with an interactive visualization can deliver PPI information aligned with patients’ information processing heuristics. Such an app may help patients gain an improved overall knowledge of medications. Objective The objective of this study was to explore the feasibility of designing an interactive visualization-based mobile app using an HTA approach through a mobile prototype. Methods Two pharmacists constructed the HTA for the drug risperidone. Later, the specific requirements of the design were translated using infographics. We transferred the wireframes of the prototype into an interactive user interface. Finally, a usability evaluation of the mobile health app was conducted. Results A mobile app prototype using HTA and infographics was successfully created. We reiterated the design based on the specific recommendations from the usability evaluations. Conclusions Using HTA methodology, we successfully created a mobile prototype for delivering PPI on the drug risperidone to patients. The hierarchical goals and subgoals were translated into a mobile prototype.
Collapse
Affiliation(s)
- Don Roosan
- Western University of Health Sciences, College of Pharmacy, Pomona, CA, United States
| | - Yan Li
- Claremont Graduate University, Claremont, CA, United States
| | - Anandi Law
- Western University of Health Sciences, College of Pharmacy, Pomona, CA, United States
| | - Huy Truong
- Keck Graduate Institute, School of Pharmacy, Claremont, CA, United States
| | - Mazharul Karim
- Western University of Health Sciences, College of Pharmacy, Pomona, CA, United States
| | - Jay Chok
- Keck Graduate Institute, School of Pharmacy, Claremont, CA, United States
| | - Moom Roosan
- Chapman University, School of Pharmacy, Irvine, CA, United States
| |
Collapse
|
22
|
Pompeo-Fargnoli A, Fargnoli AS. Mental health treatment to assist in heart disease improved outcomes. J Health Psychol 2019; 26:1119-1125. [PMID: 31311333 DOI: 10.1177/1359105319864643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In this commentary, we highlight key scientific advancements in the area of depression and heart disease dual diagnosis, to explore how new approaches can be integrated from a mental health counseling perspective. The incorporation of mental health counseling is suggested as an aid in the treatment of patients with a cardiac disease diagnosis. However, there is no structured awareness or training program for mental health counselors to associate depression with heart disease since this involves both a high level of interdisciplinary research and collaboration with existing healthcare providers. Alongside rampant calls for changes in our modern healthcare system, new holistic practices may emerge, placing mental health services at the forefront to assist in improving cardiac disease patient outcomes.
Collapse
|
23
|
e-Health in Cardiovascular Medicine. Med Sci (Basel) 2019; 7:medsci7060072. [PMID: 31226826 PMCID: PMC6631138 DOI: 10.3390/medsci7060072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 06/11/2019] [Indexed: 01/13/2023] Open
|
24
|
Santo K, Singleton A, Chow CK, Redfern J. Evaluating Reach, Acceptability, Utility, and Engagement with An App-Based Intervention to Improve Medication Adherence in Patients with Coronary Heart Disease in the MedApp-CHD Study: A Mixed-Methods Evaluation. Med Sci (Basel) 2019; 7:medsci7060068. [PMID: 31167489 PMCID: PMC6631463 DOI: 10.3390/medsci7060068] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/27/2019] [Accepted: 05/31/2019] [Indexed: 12/03/2022] Open
Abstract
Objective: The aim of this study was to assess the reach, acceptability, utility, and engagement with the apps that were used in the MEDication reminder APPlications (apps) to improve medication adherence in Coronary Heart Disease (MedApp-CHD) study, a randomised clinical trial to improve medication adherence, using a mixed-methods approach. Methods: The MedApp-CHD study randomised 163 patients with coronary heart disease (CHD) to one of three groups: (i) usual care (n = 56), (ii) a basic medication reminder app (n = 54), or (iii) an advanced medication reminder app (n = 53). For this mixed-methods evaluation, the data sources included patient screening logs, feedback questionnaires collected at three-month follow-up, focus groups discussions, and analytical data from the app software. Results: Ninety-four percent (98/104) of participants who received a medication reminder app completed the three-month feedback questionnaire and 15 participated in the focus group discussions. The themes that were identified included that participants (i) found the medication reminders useful in reminding them to take the medications on the correct time every day, (ii) liked having the medication list as an easily-accessible record of medications’ names and dosages, (iii) reported being likely to continue to use the apps after the study completion, (iv) would be likely to recommend the apps to their family and friends, and (v) those who used the clinical measurements feature found it useful as a tool to track and graph the blood pressure and glucose levels over time (especially those with diabetes and/or hypertension). In addition, analytical data from the app software demonstrated that the participants used the medication-related features more than the clinical measurements feature. Furthermore, data from the patient screening logs showed that the main reason for exclusion, other than not meeting the CHD criteria, was not having a suitable smartphone, and those that were excluded for this reason were older and had a higher proportion of females than those enrolled in the study. Conclusion: This study provides important insights regarding the features that are most useful in apps that aim to improve medication adherence. This mixed-methods evaluation suggests that, currently, young male patients with CHD are more likely to use such apps, that the apps were well-accepted and useful in reminding the patients to take the medications, and that the patients were engaged in regularly using the apps.
Collapse
Affiliation(s)
- Karla Santo
- Westmead Applied Research Centre, Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2145, Australia.
- The George Institute for Global Health, Sydney, NSW 2050, Australia.
| | - Anna Singleton
- Westmead Applied Research Centre, Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2145, Australia.
| | - Clara K Chow
- Westmead Applied Research Centre, Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2145, Australia.
- The George Institute for Global Health, Sydney, NSW 2050, Australia.
- Westmead Hospital, Cardiology Department, Sydney, NSW 2145, Australia.
| | - Julie Redfern
- Westmead Applied Research Centre, Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2145, Australia.
- The George Institute for Global Health, Sydney, NSW 2050, Australia.
| |
Collapse
|
25
|
Santo K, Singleton A, Rogers K, Thiagalingam A, Chalmers J, Chow CK, Redfern J. Medication reminder applications to improve adherence in coronary heart disease: a randomised clinical trial. Heart 2018; 105:323-329. [PMID: 30150326 DOI: 10.1136/heartjnl-2018-313479] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 08/01/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The aim of the MEDication reminder APPs to improve medication adherence in Coronary Heart Disease Study was to evaluate the effectiveness and feasibility of using publicly available high-quality medication reminder applications (apps) to improve medication adherence compared with usual care in patients with coronary heart disease (CHD). An additional aim was to examine whether an app with additional features improved adherence further. METHODS Patients with CHD (n=163) were randomised to one of three groups: (1) usual care, (2) a basic app or (3) an advanced app with interactive/customisable features. The primary analysis compared usual care versus app use on the primary outcome of the 8-item Morisky Medication Adherence Scale (MMAS-8) at 3 months. Secondary outcomes included blood pressure and cholesterol levels. RESULTS The mean age was 57.9 years and 87.7% were male. At 3 months, patients using an app had higher adherence (mean MMAS-8 score 7.11) compared with the usual care group (mean MMAS-8 score 6.63) with a mean difference between groups of 0.47 (95% CI 0.12 to 0.82, p=0.008). There was no significant difference in patients using the basic app versus the advanced app (mean difference -0.16, 95% CI -0.56 to 0.24, p=0.428). There were no significant differences in secondary clinical outcome measures. CONCLUSION Patients with CHD who used medication reminder apps had better medication adherence compared with usual care, and using apps with additional features did not improve this outcome further. These data suggest medication apps are likely to help patients with chronic health conditions adhere to medicines, but further examination of whether such benefits are sustained is warranted. CLINICAL TRIAL REGISTRATION NUMBER ACTRN12616000661471; Results.
Collapse
Affiliation(s)
- Karla Santo
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,The George Institute for Global Health, Sydney, New South Wales, Australia.,Westmead Applied Research Centre, Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Anna Singleton
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Westmead Applied Research Centre, Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Kris Rogers
- The George Institute for Global Health, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Aravinda Thiagalingam
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Westmead Applied Research Centre, Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Cardiology Department, Westmead Hospital, Sydney, New South Wales, Australia.,Cardio-respiratory Division, Westmead Institute for Medical Research, Sydney, New South Wales, Australia
| | - John Chalmers
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,The George Institute for Global Health, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Clara K Chow
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Cardiology Department, Westmead Hospital, Sydney, New South Wales, Australia.,The George Institute for Global Health, Sydney, New South Wales, Australia.,Westmead Applied Research Centre, Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Julie Redfern
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,The George Institute for Global Health, Sydney, New South Wales, Australia.,Westmead Applied Research Centre, Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
26
|
Soeiro ADM, Leal TDCAT, Bossa AS, Soeiro MCFDA, Serrano Jr CV, Oliveira Jr MT. CardioER® - Using smartphone medical applications as an aid to clinical decision-making – are we ready for this? Rev Assoc Med Bras (1992) 2018; 64:658-662. [DOI: 10.1590/1806-9282.64.08.658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 02/16/2018] [Indexed: 11/22/2022] Open
|
27
|
Hossain I, Lim ZZ, Ng JJL, Koh WJ, Wong PS. Public attitudes towards mobile health in Singapore: a cross-sectional study. Mhealth 2018; 4:41. [PMID: 30363776 PMCID: PMC6182026 DOI: 10.21037/mhealth.2018.09.02] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 08/29/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Smartphone-mediated mobile health (mHealth) may assist patients with medication adherence, and disease monitoring. This study aimed to describe awareness and usage of, and attitudes towards, mHealth among the public in Singapore who own a smartphone. It also aimed to identify factors that influenced the above in the study population. METHODS An online cross-sectional survey was administered via convenience sampling in November 2017. Participants were included if they were at least 18 years old and owned a smartphone. No identifiable data was collected. Responses were summarized using descriptive statistics. Multiple logistic regression analysis was used to identify factors associated with awareness and usage of, and attitudes towards, mHealth. RESULTS Participants (n=199) were mostly of Chinese ethnicity (84.4%), female (64.8%), young (mean age 33.7 years), and generally healthy (86.9% reported no chronic medical conditions). On average, participants were aware of 4.4 out of 7 mHealth functions and used 2.2 functions. Managing appointments, and fitness/diet tracking were the most well-known (93.5% and 82.4% respectively), and widely used (80.6% and 59.8% respectively) functions. A simple interface, data security, and being free to use, were rated as the most important factors influencing participants' willingness to use mHealth. Most (64.3%) participants were keen to learn to use mHealth in future, 49.7% believed mHealth could help improve their health, but only 13.1% were willing to pay for it. Being employed (OR 3.71) was associated with higher mHealth usage, adjusted for baseline smartphone usage. Participants living in non-subsidized housing were more keen to try (OR 3.18), and willing to pay (OR 3.36) for mHealth. CONCLUSIONS Participants generally held positive attitudes towards mHealth, although usage was low. Lack of willingness to pay, and socioeconomic factors, are potential barriers to the widespread adoption of mHealth. Future research specifically involving patients is needed.
Collapse
Affiliation(s)
- Ihtimam Hossain
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore
| | - Zi Zhao Lim
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore
| | - Joshua Jia Le Ng
- School of Applied Science, Temasek Polytechnic, Singapore, Singapore
| | - Wan Jia Koh
- School of Applied Science, Temasek Polytechnic, Singapore, Singapore
| | - Pei Shieen Wong
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore
| |
Collapse
|