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Alonso-Carril N, Rodriguez-Rodríguez S, Quirós C, Berrocal B, Amor AJ, Barahona MJ, Martínez D, Ferré C, Perea V. Could Online Education Replace Face-to-Face Education in Diabetes? A Systematic Review. Diabetes Ther 2024; 15:1513-1524. [PMID: 38743305 PMCID: PMC11211299 DOI: 10.1007/s13300-024-01595-6] [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: 03/21/2024] [Accepted: 04/18/2024] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVE Diabetes Self-Management Education and Support (DSMES) is a critical component of diabetes care. This study aims to examine the effect of online-based educational interventions on diabetes management compared to face-to-face interventions. METHODS A systematic review was conducted by searching three databases for studies in English or Spanish between December 2023 and March 2024. The inclusion criteria were studies that compared face-to-face DSMES with online interventions. RESULTS The follow-up duration of the trials ranged from 1 to 12 months. Multidisciplinary teams delivered online DSMES through various means, including Short Message Service (SMS), telephone calls, video calls, websites, and applications. Online DSMES was found to be comparable to face-to-face interventions in terms of glycated hemoglobin (HbA1c) levels in people with type 1 diabetes (T1D). In contrast, online interventions that focus on weight management in people with type 2 diabetes (T2D) have shown a significant reduction in HbA1c compared to face-to-face interventions. Online DSMES was found to be superior in terms of quality of life and cost-effectiveness in both T1D and T2D. None of the analyzed studies explored the differences between individual and group methodologies. CONCLUSIONS The current evidence indicates that online DSMES services provide at least comparable biomedical benefits to face-to-face interventions, suggesting that online interventions could be incorporated into clinical practice as a complement or reinforcement. However, further research is needed to explore the potential benefits and effectiveness of online group sessions in DSMES.
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Affiliation(s)
- Núria Alonso-Carril
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Dr Robert 5, 08221, Terrassa, Spain
- Department of Nursing, Rovira i Virgili University, Tarragona, Spain
| | - Silvia Rodriguez-Rodríguez
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Dr Robert 5, 08221, Terrassa, Spain
| | - Carmen Quirós
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Dr Robert 5, 08221, Terrassa, Spain
| | - Belén Berrocal
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Dr Robert 5, 08221, Terrassa, Spain
| | - Antonio J Amor
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Maria-José Barahona
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Dr Robert 5, 08221, Terrassa, Spain
| | - Davinia Martínez
- Nursing Department, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - Carme Ferré
- Department of Nursing, Rovira i Virgili University, Tarragona, Spain
| | - Verónica Perea
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, Dr Robert 5, 08221, Terrassa, Spain.
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Yoshida Y, Patil SJ, Brownson RC, Boren SA, Kim M, Dobson R, Waki K, Greenwood DA, Torbjørnsen A, Ramachandran A, Masi C, Fonseca VA, Simoes EJ. Using the RE-AIM framework to evaluate internal and external validity of mobile phone-based interventions in diabetes self-management education and support. J Am Med Inform Assoc 2021; 27:946-956. [PMID: 32377676 DOI: 10.1093/jamia/ocaa041] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/13/2020] [Accepted: 04/01/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE We evaluated the extent to which studies that tested short message service (SMS)- and application (app)-based interventions for diabetes self-management education and support (DSMES) report on factors that inform both internal and external validity as measured by the RE-AIM (Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance) framework. MATERIALS AND METHODS We systematically searched PubMed, Embase, Web of Science, CINAHL (Cumulative Index of Nursing and Allied Health Literature), and IEEE Xplore Digital Library for articles from January 1, 2009, to February 28, 2019. We carried out a multistage screening process followed by email communications with study authors for missing or discrepant information. Two independent coders coded eligible articles using a 23-item validated data extraction tool based on the RE-AIM framework. RESULTS Twenty studies (21 articles) were included in the analysis. The comprehensiveness of reporting on the RE-AIM criteria across the SMS- and app-based DSMES studies was low. With respect to internal validity, most interventions were well described and primary clinical or behavioral outcomes were measured and reported. However, gaps exist in areas of attrition, measures of potential negative outcomes, the extent to which the protocol was delivered as intended, and description on delivery agents. Likewise, we found limited information on external validity indicators across adoption, implementation, and maintenance domains. CONCLUSIONS Reporting gaps were found in internal validity but more so in external validity in the current SMS- and app-based DSMES literature. Because most studies in this review were efficacy studies, the generalizability of these interventions cannot be determined. Future research should adopt the RE-AIM dimensions to improve the quality of reporting and enhance the likelihood of translating research to practice.
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Affiliation(s)
- Yilin Yoshida
- Section of Endocrinology, Department of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Sonal J Patil
- Department of Family Medicine, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
- Division of Public Health Sciences, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Suzanne A Boren
- Department of Health Management and Informatics, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Min Kim
- Department of Health Management and Informatics, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Rosie Dobson
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Kayo Waki
- Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | | | - Astrid Torbjørnsen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | | | | | - Vivian A Fonseca
- Section of Endocrinology, Department of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Eduardo J Simoes
- Department of Health Management and Informatics, School of Medicine, University of Missouri, Columbia, Missouri, USA
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3
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Chan CB, Popeski N, Hassanabad MF, Sigal RJ, O'Connell P, Sargious P. Use of Virtual Care for Glycemic Management in People With Types 1 and 2 Diabetes and Diabetes in Pregnancy: A Rapid Review. Can J Diabetes 2021; 45:677-688.e2. [PMID: 34045146 DOI: 10.1016/j.jcjd.2021.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/18/2021] [Accepted: 02/28/2021] [Indexed: 11/26/2022]
Abstract
Our objective in this study was to answer the main research question: In patients with diabetes, does virtual care vs face-to-face care provide different clinical, patient and practitioner experience or quality outcomes? Articles (2012 to 2020) describing interventions using virtual care with the capability for 2-way, individualized interactions compared with usual care were included. Studies involving any patients with diabetes and outcomes of glycated hemoglobin (A1C), quality of care and/or patient or health-care practitioner experience were included. Systematic reviews, randomized controlled studies, quasi-experimental trials, implementation trials, observational studies and qualitative analyses were reviewed. MEDLINE and McMaster Health Evidence databases searched in June 2020 identified 59 articles. Virtual care, in particular telemonitoring, combined with a means of 2-way communications provided improvement in A1C similar or superior to usual care, with the strongest evidence for type 2 diabetes. Virtual care was generally acceptable to patients, who expressed satisfaction with their care. Health-care providers recognized benefits but raised issues of technical support, workflow and compensation.
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Affiliation(s)
- Catherine B Chan
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada; Department of Agricultural, Food and Nutritional Sciences, Li Ka Shing Centre for Health Innovation Research, University of Alberta, Edmonton, Alberta, Canada; Department of Physiology, University of Alberta, Edmonton, Alberta, Canada.
| | - Naomi Popeski
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Mortaza Fatehi Hassanabad
- Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada; Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ronald J Sigal
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Petra O'Connell
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Peter Sargious
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada; Department of Medicine, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
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4
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Heisey-Grove DM, McClelland LE, Rathert C, Tartaglia A, Jackson K, DeShazo JP. Associations Between Patient Health Outcomes and Secure Message Content Exchanged Between Patients and Clinicians: Retrospective Cohort Study. J Med Internet Res 2020; 22:e19477. [PMID: 33118938 PMCID: PMC7661231 DOI: 10.2196/19477] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 09/05/2020] [Accepted: 09/07/2020] [Indexed: 02/06/2023] Open
Abstract
Background The number of electronic messages securely exchanged between clinic staff and patients has risen dramatically over the last decade. A variety of studies explored whether the volume of messages sent by patients was associated with outcomes. None of these studies, however, examined whether message content itself was associated with outcomes. Because secure messaging is a significant form of communication between patients and clinic staff, it is critical to evaluate the context of the communication to best understand its impact on patient health outcomes. Objective To examine associations between patients’ and clinicians’ message content and changes in patients’ health outcomes. Methods We applied a taxonomy developed specifically for secure messages to 14,394 patient- and clinic staff–generated messages derived from patient-initiated message threads. Our study population included 1602 patients, 50.94% (n=816) of whom initiated message threads. We conducted linear regression analyses to determine whether message codes were associated with changes in glycemic (A1C) levels in patients with diabetes and changes in systolic (SBP) and diastolic (DBP) blood pressure in patients with hypertension. Results Patients who initiated threads had larger declines in A1Cs (P=.01) compared to patients who did not initiate threads. Clinic nonresponse was associated with decreased SBP (β=–.30; 95% CI –0.56 to –0.04), as were staffs’ action responses (β=–30; 95% CI –0.58 to –0.02). Increased DBP, SBP, and A1C levels were associated with patient-generated appreciation and praise messages and staff encouragement with effect sizes ranging from 0.51 (A1C) to 5.80 (SBP). We found improvements in SBP associated with patients’ complaints (β=–4.03; 95% CI –7.94 to –0.12). Deferred information sharing by clinic staff was associated with increased SBP (β=1.29; 95% CI 0.4 to 2.19). Conclusions This is the first research to find associations between message content and patients’ health outcomes. Our findings indicate mixed associations between patient message content and patient outcomes. Further research is needed to understand the implications of this work; in the meantime, health care providers should be aware that their message content may influence patient health outcomes.
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Affiliation(s)
- Dawn M Heisey-Grove
- MITRE Corporation, McLean, VA, United States.,College of Health Professions, Virginia Commonwealth University, Richmond, VA, United States
| | - Laura E McClelland
- College of Health Professions, Virginia Commonwealth University, Richmond, VA, United States
| | - Cheryl Rathert
- Department of Health Management and Policy, Saint Louis University, St Louis, MO, United States
| | - Alexander Tartaglia
- College of Health Professions, Virginia Commonwealth University, Richmond, VA, United States
| | - Kevin Jackson
- Department of Nursing and Allied Health, College of Science, Engineering, and Technology, Norfolk State University, Norfolk, VA, United States
| | - Jonathan P DeShazo
- College of Health Professions, Virginia Commonwealth University, Richmond, VA, United States
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5
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Alamer A, Palm C, Almulhim AS, Te C, Pendergrass ML, Fazel MT. Impact of Non-Tailored One-Way Automated Short Messaging Service (OASMS) on Glycemic Control in Type 2 Diabetes: A Retrospective Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207590. [PMID: 33086524 PMCID: PMC7593936 DOI: 10.3390/ijerph17207590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/03/2020] [Accepted: 10/16/2020] [Indexed: 11/16/2022]
Abstract
Short message service (SMS) is easily accessible and potentially an ideal platform for delivering patient-targeted messages. However, an effective SMS dosing strategy is not well established. Our purpose was to evaluate the impact of diabetes self-care promoting messages via non-tailored one-way automated SMS (OASMS) on glycemic control in type 2 diabetes (T2DM). The change in hemoglobin A1c (HbA1c) was compared between patients who received the service and those who did not. This retrospective quasi-experimental pre-post feasibility study was conducted at an academic medical center endocrinology clinic. English-speaking adults (≥18 years) with uncontrolled T2DM (HbA1c ≥ 8%) were included. A total of 69 patients (intervention n = 34; control n = 35) met the inclusion criteria. The mean (±SD) baseline HbA1c values were 10.2% (±1.9%) and 9.9% (±1.7%) in the intervention and control arms, respectively. Median follow-up was 3.3 months (IQR = 3-4.2). An ANCOVA model adjusted for baseline HbA1c and age showed an estimated HbA1c reduction difference of -0.97% (95% CI, -1.73 to -0.20%, p = 0.014), favoring the intervention arm. Inverse propensity score weighting confirmed the ANCOVA results. Our study suggests that adding diabetes self-care promoting messages via non-tailored OASMS to usual care improves glycemic control in poorly controlled T2DM. Larger and longer studies are needed to evaluate different features of the non-tailored OASMS strategy.
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Affiliation(s)
- Ahmad Alamer
- Center for Health Outcomes and Pharmaco-Economic Research, University of Arizona College of Pharmacy, Tucson, AZ 85721, USA
- Department of Pharmacy Practice, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj 16278, Saudi Arabia
- Correspondence:
| | - Charles Palm
- Banner—University Medicine Endocrinology and Diabetes Clinic, Tucson, AZ 85714, USA; (C.P.); (C.T.); (M.L.P.); (M.T.F.)
| | - Abdulaziz S. Almulhim
- Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia;
| | - Charisse Te
- Banner—University Medicine Endocrinology and Diabetes Clinic, Tucson, AZ 85714, USA; (C.P.); (C.T.); (M.L.P.); (M.T.F.)
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, College of Medicine, Tucson, AZ 85724, USA
| | - Merri L. Pendergrass
- Banner—University Medicine Endocrinology and Diabetes Clinic, Tucson, AZ 85714, USA; (C.P.); (C.T.); (M.L.P.); (M.T.F.)
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, College of Medicine, Tucson, AZ 85724, USA
- Department of Pharmacy Practice & Science, College of Pharmacy, The University of Arizona, Tucson, AZ 85721, USA
| | - Maryam T. Fazel
- Banner—University Medicine Endocrinology and Diabetes Clinic, Tucson, AZ 85714, USA; (C.P.); (C.T.); (M.L.P.); (M.T.F.)
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, College of Medicine, Tucson, AZ 85724, USA
- Department of Pharmacy Practice & Science, College of Pharmacy, The University of Arizona, Tucson, AZ 85721, USA
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Han HR, Gleason KT, Sun CA, Miller HN, Kang SJ, Chow S, Anderson R, Nagy P, Bauer T. Using Patient Portals to Improve Patient Outcomes: Systematic Review. JMIR Hum Factors 2019; 6:e15038. [PMID: 31855187 PMCID: PMC6940868 DOI: 10.2196/15038] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/23/2019] [Accepted: 08/31/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND With the advent of electronic health record (EHR) systems, there is increasing attention on the EHR system with regard to its use in facilitating patients to play active roles in their care via secure patient portals. However, there is no systematic review to comprehensively address patient portal interventions and patient outcomes. OBJECTIVE This study aimed to synthesize evidence with regard to the characteristics and psychobehavioral and clinical outcomes of patient portal interventions. METHODS In November 2018, we conducted searches in 3 electronic databases, including PubMed, EMBASE, and Cumulative Index to Nursing and Allied Health Literature, and a total of 24 articles met the eligibility criteria. RESULTS All but 3 studies were conducted in the United States. The types of study designs varied, and samples predominantly involved non-Hispanic white and highly educated patients with sizes ranging from 50 to 22,703. Most of the portal interventions used tailored alerts or educational resources tailored to the patient's condition. Patient portal interventions lead to improvements in a wide range of psychobehavioral outcomes, such as health knowledge, self-efficacy, decision making, medication adherence, and preventive service use. Effects of patient portal interventions on clinical outcomes including blood pressure, glucose, cholesterol, and weight loss were mixed. CONCLUSIONS Patient portal interventions were overall effective in improving a few psychological outcomes, medication adherence, and preventive service use. There was insufficient evidence to support the use of patient portals to improve clinical outcomes. Understanding the role of patient portals as an effective intervention strategy is an essential step to encourage patients to be actively engaged in their health care.
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Affiliation(s)
- Hae-Ra Han
- The Johns Hopkins University, School of Nursing, Baltimore, MD, United States
- The Johns Hopkins University, Center for Cardiovascular and Chronic Care, Baltimore, MD, United States
- The Johns Hopkins University, Center for Community Innovation and Scholarship, Baltimore, MD, United States
| | - Kelly T Gleason
- The Johns Hopkins University, School of Nursing, Baltimore, MD, United States
| | - Chun-An Sun
- The Johns Hopkins University, School of Nursing, Baltimore, MD, United States
| | - Hailey N Miller
- The Johns Hopkins University, School of Nursing, Baltimore, MD, United States
| | - Soo Jin Kang
- Daegu University, Department of Nursing, Daegu, Republic of Korea
| | - Sotera Chow
- The Johns Hopkins University, School of Nursing, Baltimore, MD, United States
| | - Rachel Anderson
- The Johns Hopkins University, School of Nursing, Baltimore, MD, United States
| | - Paul Nagy
- The Johns Hopkins University, School of Medicine, Baltimore, MD, United States
| | - Tom Bauer
- The Johns Hopkins Hospitals and Health System, Baltimore, MD, United States
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7
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Alvarado MM, Kum HC, Gonzalez Coronado K, Foster MJ, Ortega P, Lawley MA. Barriers to Remote Health Interventions for Type 2 Diabetes: A Systematic Review and Proposed Classification Scheme. J Med Internet Res 2017; 19:e28. [PMID: 28193598 PMCID: PMC5329647 DOI: 10.2196/jmir.6382] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 11/05/2016] [Accepted: 11/23/2016] [Indexed: 01/17/2023] Open
Abstract
Background Diabetes self-management involves adherence to healthy daily habits typically involving blood glucose monitoring, medication, exercise, and diet. To support self-management, some providers have begun testing remote interventions for monitoring and assisting patients between clinic visits. Although some studies have shown success, there are barriers to widespread adoption. Objective The objective of our study was to identify and classify barriers to adoption of remote health for management of type 2 diabetes. Methods The following 6 electronic databases were searched for articles published from 2010 to 2015: MEDLINE (Ovid), Embase (Ovid), CINAHL, Cochrane Central, Northern Light Life Sciences Conference Abstracts, and Scopus (Elsevier). The search identified studies involving remote technologies for type 2 diabetes self-management. Reviewers worked in teams of 2 to review and extract data from identified papers. Information collected included study characteristics, outcomes, dropout rates, technologies used, and barriers identified. Results A total of 53 publications on 41 studies met the specified criteria. Lack of data accuracy due to input bias (32%, 13/41), limitations on scalability (24%, 10/41), and technology illiteracy (24%, 10/41) were the most commonly cited barriers. Technology illiteracy was most prominent in low-income populations, whereas limitations on scalability were more prominent in mid-income populations. Barriers identified were applied to a conceptual model of successful remote health, which includes patient engagement, patient technology accessibility, quality of care, system technology cost, and provider productivity. In total, 40.5% (60/148) of identified barrier instances impeded patient engagement, which is manifest in the large dropout rates cited (up to 57%). Conclusions The barriers identified represent major challenges in the design of remote health interventions for diabetes. Breakthrough technologies and systems are needed to alleviate the barriers identified so far, particularly those associated with patient engagement. Monitoring devices that provide objective and reliable data streams on medication, exercise, diet, and glucose monitoring will be essential for widespread effectiveness. Additional work is needed to understand root causes of high dropout rates, and new interventions are needed to identify and assist those at the greatest risk of dropout. Finally, future studies must quantify costs and benefits to determine financial sustainability.
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Affiliation(s)
- Michelle M Alvarado
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
| | - Hye-Chung Kum
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States.,Department of Health Policy and Management, School of Public Health, Texas A&M Health Science Center, College Station, TX, United States
| | - Karla Gonzalez Coronado
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
| | - Margaret J Foster
- Medical Sciences Library, Texas A&M University, College Station, TX, United States
| | - Pearl Ortega
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
| | - Mark A Lawley
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States
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8
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Isaacs T, Hunt D, Ward D, Rooshenas L, Edwards L. The Inclusion of Ethnic Minority Patients and the Role of Language in Telehealth Trials for Type 2 Diabetes: A Systematic Review. J Med Internet Res 2016; 18:e256. [PMID: 27670360 PMCID: PMC5057063 DOI: 10.2196/jmir.6374] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 08/17/2016] [Accepted: 08/21/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Type 2 diabetes is a serious, pervasive metabolic condition that disproportionately affects ethnic minority patients. Telehealth interventions can facilitate type 2 diabetes monitoring and prevent secondary complications. However, trials designed to test the effectiveness of telehealth interventions may underrecruit or exclude ethnic minority patients, with language a potential barrier to recruitment. The underrepresentation of minorities in trials limits the external validity of the findings for this key patient demographic. OBJECTIVE This systematic review examines (1) the research reporting practices and prevalence of ethnic minority patients included in telehealth randomized controlled trials (RCTs) targeting type 2 diabetes and the trial characteristics associated with recruiting a high proportion of minority patients, and (2) the proportion of included RCTs that report using English language proficiency as a patient screening criterion and how and why they do so. METHODS Telehealth RCTs published in refereed journals targeting type 2 diabetes as a primary condition for adults in Western majority English-speaking countries were included. Ethnically targeted RCTs were excluded from the main review, but were included in a post hoc subgroup analysis. Abstract and full-text screening, risk of bias assessment, and data extraction were independently conducted by two reviewers. RESULTS Of 3358 records identified in the search, 79 articles comprising 58 RCTs were included. Nearly two-thirds of the RCTs (38/58) reported on the ethnic composition of participants, with a median proportion of 23.5% patients (range 0%-97.7%). Fourteen studies (24%) that included at least 30% minority patients were all US-based, predominantly recruited from urban areas, and described the target population as underserved, financially deprived, or uninsured. Eight of these 14 studies (57%) offered intervention materials in a language other than English or employed bilingual staff. Half of all identified RCTs (29/58) included language proficiency as a participant-screening criterion. Language proficiency was operationalized using nonstandardized measures (eg, having sufficient "verbal fluency"), with only three studies providing reasons for excluding patients on language grounds. CONCLUSIONS There was considerable variability across studies in the inclusion of ethnic minority patients in RCTs, with higher participation rates in countries with legislation to mandate their inclusion (eg, United States) than in those without such legislation (eg, United Kingdom). Less than 25% of the RCTs recruited a sizeable proportion of ethnic minorities, which raises concerns about external validity. The lack of objective measures or common procedures for assessing language proficiency across trials implies that language-related eligibility decisions are often based on trial recruiters' impressionistic judgments, which could be subject to bias. The variability and inconsistent reporting on ethnicity and other socioeconomic factors in descriptions of research participants could be more specifically emphasized in trial reporting guidelines to promote best practice. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews: CRD42015024899; http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015024899 (Archived by WebCite at http://www.webcitation.org/6kQmI2bdF).
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Affiliation(s)
- Talia Isaacs
- University of Bristol, Graduate School of Education, Bristol, United Kingdom.
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9
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Kuo A, Dang S. Secure Messaging in Electronic Health Records and Its Impact on Diabetes Clinical Outcomes: A Systematic Review. Telemed J E Health 2016; 22:769-77. [PMID: 27027337 DOI: 10.1089/tmj.2015.0207] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
UNLABELLED In 2009, President Barack Obama signed into law the Health Information Technology for Economic and Clinical Health (HITECH) Act, which aims for the universal adoption of electronic health records (EHRs) in primary care settings and "meaningful use" of this technology. The objectives of "meaningful use" are well defined and executed in stages; one of the objectives of stage 2, beginning in 2014, was implementation of a secure messaging system between patients and providers. Secure messaging has been shown to positively affect patients who struggle with managing chronic diseases on a day to day basis. This review aims to assess the clinical evidence supporting the use of secure messaging in EHRs in self-management of diabetes. METHODS A systematic search of PubMed was conducted, and 320 results were returned. Of these, 11 were selected based on outlined criteria. CONCLUSIONS Evidence from 7 of the 11 included studies suggests significant improvement in patients' hemoglobin A1c (HbA1c) with the use of secure messaging. However, improvements in patients' secondary outcomes, such as blood pressure and cholesterol, were inconsistent. Further work must be done to determine how to best maximize the potential of available tools such as secure messaging and EHRs to improve patient outcomes.
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Affiliation(s)
- Alyce Kuo
- 1 University of Miami , Coral Gables, Florida
| | - Stuti Dang
- 2 Miami VA Healthcare System Geriatric, Research Education and Clinical Center and Extended Care and Research Services , Miami, Florida.,3 Division of Geriatrics and Palliative Care, Department of Medicine, University of Miami Miller School of Miami , Miami, Florida
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10
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Meng D, Palen TE, Tsai J, McLeod M, Garrido T, Qian H. Association between secure patient-clinician email and clinical services utilisation in a US integrated health system: a retrospective cohort study. BMJ Open 2015; 5:e009557. [PMID: 26553841 PMCID: PMC4654385 DOI: 10.1136/bmjopen-2015-009557] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To assess associations between secure patient-clinician email use and clinical services utilisation over time. DESIGN Retrospective cohort study between July 2010 and December 2013. Controlling for a utilisation surge around first secure email use, we analysed difference of differences between propensity score-matched groups of secure patient-clinician email users and non-users for utilisation 1-12 months before and 7-18 months after first email (users) or a randomly assigned index date (non-users). SETTING US integrated healthcare delivery system. PARTICIPANTS 9345 adults with first secure email use between July 2011 and July 2012 and continuous enrolment for ≥30 months and 9345 adults without secure email use between July 2010 and July 2012 matched to users on demographics, health status, and baseline utilisation. PRIMARY OUTCOME MEASURES Rates of office visits, patient-initiated phone calls, scheduled telephone visits, after-hours clinic visits, emergency department visits, and hospitalisations. RESULTS After controlling for multiple factors, no statistically significant differences in utilisation between secure email users and non-users occurred. Utilisation transiently increased by 88-237% around first email use. Annual rates of patient-initiated phone calls decreased among secure email users, 0.2 fewer calls per person (95% CI -0.3 to -0.1), from a mean of 4.1 calls per person 1-12 months before first use to a mean of 3.8 calls per person 7-18 months after first use. Rates of patient-initiated phone calls also decreased among non-users, 0.1 fewer calls per person (95% CI -0.2 to 0.0), from a mean of 4.2 calls per person 1-12 months before the index date to mean of 4.1 calls per person 7-18 months after the index date. CONCLUSIONS Compared with non-users, patient use of secure email with clinicians was not associated with statistically significant differences in clinical services utilisation 7-18 months after first use.
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Affiliation(s)
- Di Meng
- Health Information Technology Transformation and Analytics, Kaiser Permanente, Oakland, California, USA
| | - Ted E Palen
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, USA
| | - Joanne Tsai
- Health Information Technology Transformation and Analytics, Kaiser Permanente, Oakland, California, USA
| | - Melanie McLeod
- Health Information Technology Transformation and Analytics, Kaiser Permanente, Oakland, California, USA
| | - Terhilda Garrido
- Health Information Technology Transformation and Analytics, Kaiser Permanente, Oakland, California, USA
| | - Heather Qian
- Health Information Technology Transformation and Analytics, Kaiser Permanente, Oakland, California, USA
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Potentials of internet-based patient engagement and education programs to reduce hospital readmissions: a spotlight on need in heart failure. Nurs Clin North Am 2015; 50:283-91. [PMID: 25999071 DOI: 10.1016/j.cnur.2015.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Internet-based applications and mobile health technology has advanced at unprecedented rates over the last decade and has proved to be a highly effective platform for communication. Simultaneously, the United States health care system has reached a critical and unsustainable level of spending, arising largely from ingrained system inefficiencies and overall suboptimum communication. Internet-based and mobile health technology offers an innovative solution to both of these problems. The prevention of readmissions for heart failure provides an excellent example of how this new technology can be used in today's health care environment to improve patient care.
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Hosler AS, Solanki MN, Savadatti S. Assessing Needs and Feasibility of Diabetes Self-management Coaching at Faith-Based Organizations for Indo-Guyanese Immigrants. DIABETES EDUCATOR 2015; 41:320-7. [DOI: 10.1177/0145721715577637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose The purpose of this study is to explore barriers and needs related to diabetes care and the feasibility of diabetes self-management (DSM) “coaching” at faith-based organizations (FBOs) for the Indo-Guyanese community in Schenectady, New York. Methods Participants were recruited though flyers and mass mailings, and in-depth interviews were conducted at their homes by a team of culturally matched interviewers using a semi-structured questionnaire. Characteristics of participants were compared with existing population-based data to confirm their representativeness. Responses were transcribed, coded, and summarized, and findings are presented along with selective quotations. Key dimensions of feasibility were scored and charted for visualization. Results Findings revealed barriers regarding diet-related knowledge and skills, access to structured DSM education, hyperglycemia control, and environmental support for physical activity. Participants responded positively to receiving free DSM coaching at their FBOs. All participants preferred a qualified health care professional such as certified diabetes educator as their coach and wanted coaching in all aspects of DSM; however, food preparation/diet was the most frequently requested specific topic. Participants uniformly disliked contact with the coach through e-mails and text messages but liked receiving periodic telephone calls at home by the coach. Overall, DSM coaching at FBOs rated high on the key dimensions of feasibility, namely, affordability, accessibility, acceptability, cultural relevance, and safety. Conclusions This study sheds light on the feasibility of an FBO-based DSM intervention for the Indo-Guyanese. It offers insights into developing culturally appropriate DSM intervention format and strategy.
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Affiliation(s)
- Akiko S. Hosler
- Department of Epidemiology and Biostatistics, University at Albany (SUNY) School of Public Health, Rensselaer, New York (Dr Hosler, Ms Solanki, Ms Savadatti)
| | - Malini N. Solanki
- Department of Epidemiology and Biostatistics, University at Albany (SUNY) School of Public Health, Rensselaer, New York (Dr Hosler, Ms Solanki, Ms Savadatti)
| | - Sanghamitra Savadatti
- Department of Epidemiology and Biostatistics, University at Albany (SUNY) School of Public Health, Rensselaer, New York (Dr Hosler, Ms Solanki, Ms Savadatti)
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