1
|
Pomey M, Schaad B, Lasserre‐Moutet A, Böhme P, Jackson M. Towards a New Integrated Model for Taking Into Account the Experiential Knowledge of People With Chronic Diseases, Integrating Mediation, Therapeutic Education and Partnership: The Expanded Chronic Care Patient-Professional Partnership Model. Health Expect 2024; 27:e70054. [PMID: 39373129 PMCID: PMC11456963 DOI: 10.1111/hex.70054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 09/10/2024] [Accepted: 09/21/2024] [Indexed: 10/08/2024] Open
Abstract
INTRODUCTION The Chronic Care Model (CCM), the Expanded Chronic Care Model (ECCM) and the eHealth Enhanced Chronic Care Model (eCCM) focus on how healthcare teams and eHealth support can offer effective care and relevant solutions for patients facing chronic care conditions. However, they do not consider how patients can help these teams in their work, nor do they promote ways in which patients can help themselves. However, in the last decade, three different models have emerged that can complete our capacity to design and deliver integrated care for people with chronic diseases. In this article, we propose a revised version of the model that integrates the patient perspective and patients' experience-based knowledge. It integrates three different ways of engaging patients that complement the other patient engagement point of view: the experience of care and mediation in healthcare, therapeutic patient education and patient learning pathways, as well as patient-professional partnership. METHODOLOGY For each of the three models, we conducted a review of the literature using CINAHL, Medline, OVID, EMBASE PsychINFO, Science Direct and government reports on patient engagement and partnership with their healthcare providers, to integrate the different components of these models into the ECCM and eCCM. The goal is to create a model that better takes into account the experiential knowledge of patients and citizens throughout its different dimensions. RESULTS We identified 129 papers based on their framework, design, sample, measures and fit with patient engagement and chronic illness and added our own research when relevant. Integrating the three models provides an opportunity to amplify the role played by the patient perspective in the management of chronic disease. The Expanded Chronic Care Patient-Professional Partnership Model (E2C3PM) is intended to rebalance power relations between healthcare professionals and patients (and their caregivers). This new model is based on recognizing patients' experiential knowledge and their roles as caregivers and as full members of the care team. Integrating patient empowerment into the E2C3PM underscores the importance of coproduction care with patients at the clinical, organizational and system levels within a supportive environment. CONCLUSION Applying this new model should make it possible to better take into account the complexity of chronic diseases, improving the integration not only of care, services and eHealth support but also the various determinants of health and reaching a mutually beneficial settlement among all actors involved. PATIENT OR PUBLIC CONTRIBUTION A patient-researcher contributed to the development of the protocol, the data collection and the preparation and writing of this manuscript.
Collapse
Affiliation(s)
- Marie‐Pascale Pomey
- Research Centre of the University of Montreal Hospital CentreMontréalQuébecCanada
- Centre d'excellence sur le partenariat avec les patients et le publicMontréalQuébecCanada
- Department of Health Policy, Management and Evaluation, School of Public HealthUniversity of MontréalQuébecCanada
- Department of Family Medicine and Emergency MedicineUniversity of MontréalMontréalQuébecCanada
| | - Béatrice Schaad
- Institut des Humanités en Médecine du Centre Hospitalier Universitaire Vaudois (CHUV)LausanneSwitzerland
- Centre sur le vécu des patient.es et des professionnel.lesDirection générale du Centre Hospitalier Universitaire Vaudois (CHUV)/Faculté de Biologie et de Médecine de l'Université de Lausanne (UNIL)LausanneSwitzerland
| | - Aline Lasserre‐Moutet
- Centre d'éducation thérapeutique du patientHôpitaux Universitaires de GenèveGenèveSwitzerland
| | - Philip Böhme
- Department of Endocrinology, Diabetology and NutritionCHRU NancyNancyFrance
- University of Lorraine, Inserm, NGERENancyFrance
| | - Mathieu Jackson
- Centre d'excellence sur le partenariat avec les patients et le publicMontréalQuébecCanada
| |
Collapse
|
2
|
Liu PL, Zhao X, Ye JF. The Effects of the Use of Patient-Accessible Electronic Health Record Portals on Cancer Survivors’ Health Outcomes: Cross-sectional Survey Study. J Med Internet Res 2022; 24:e39614. [DOI: 10.2196/39614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/04/2022] [Accepted: 09/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background
In the past decade, patient-accessible electronic health record (PAEHR) systems have emerged as an important tool for health management both at the hospital level and individual level. However, little is known about the effects of PAEHR portals on the survivorship of patients with chronic health conditions (eg, cancer).
Objective
This study aims to investigate the effects of the use of PAEHR portals on cancer survivors’ health outcomes and to examine the mediation pathways through patient-centered communication (PCC) and health self-efficacy.
Methods
Data for this study were derived from the Health Information National Trends Survey (HINTS 5, Cycle 4) collected from February 2020 to June 2020. This study only involved respondents who reported having been diagnosed with cancer (N=626). Descriptive analyses were performed, and the mediation models were tested using Model 6 from the SPSS macro PROCESS. Statistically significant relationships among PAEHR portal use, PCC, health self-efficacy, and physical and psychological health were examined using bootstrapping procedures. In this study, we referred to the regression coefficients generated by min-max normalization as percentage coefficients (bp). The 95% bootstrapped CIs were used with 10,000 resamplings.
Results
No positive direct associations between PAEHR portal use and cancer survivors’ health outcomes were found. The results supported the indirect relationship between PAEHR portal use and cancer survivors’ psychological health via (1) PCC (bp=0.029; β=.023, 95% CI .009-.054), and (2) PCC and health self-efficacy in sequence (bp=0.006; β=.005, 95% CI .002-.014). Besides, the indirect association between PAEHR portal use and cancer survivors’ physical health (bp=0.006; β=.004, 95% CI .002-.018) via sequential mediators of PCC and health self-efficacy was also statistically acknowledged.
Conclusions
This study offers empirical evidence about the significant role of PAEHR portals in delivering PCC, improving health self-efficacy, and ultimately contributing to cancer survivors’ physical and psychological health.
Collapse
|
3
|
Tahsin F, Armas A, Kirakalaprathapan A, Cunningham H, Kadu M, Sritharan J, Steele Gray C. Information and Communication Technologies (ICTs) enabling integrated primary care for complex patients: a protocol for a scoping review. Syst Rev 2022; 11:193. [PMID: 36071450 PMCID: PMC9450266 DOI: 10.1186/s13643-022-02057-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/23/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION An increasing number of individuals are living with multiple chronic conditions, often combined with psychosocial complexities. For these patients with complex conditions, an integrated primary care model that provides care coordination and a team-based approach can help manage their multiple needs. Information and communication technologies (ICTs) are recognized as a critical enabler of integrated primary care. A better understanding of the use of ICTs in an integrated care setting and how ICTs are being leveraged would be beneficial to identify knowledge gaps and could lead to successful implementation for ICT-based interventions. OBJECTIVE This study will systematically scope the literature on the topic of ICT-enabled integrated healthcare delivery models for patients with complex care needs to identify which technologies have been used in integrated primary care settings. METHOD This study protocol outlines a scoping review of the peer-reviewed literature, using Arksey and O'Malley's (enhanced by Levac et al.) scoping review methodology. Peer-reviewed literature will be identified using a multi-database search strategy. The results of the search will be screened, abstracted, and charted in duplicate by six research team members. DISCUSSION The key findings of the study will be thematically analyzed to describe the implemented ICTs aimed for complex patients within the integrated primary care model. The finding will highlight what types of ICTs are being put in place to support these models, and how these ICTs are enabling care integration. This review will be the first step to formally identify how ICT is used to support integrated primary health care models. The results will be disseminated through peer-reviewed publications, conference presentations, and special interest groups.
Collapse
Affiliation(s)
- Farah Tahsin
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.
| | - Alana Armas
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.,Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada
| | | | - Heather Cunningham
- Gerstein Science Information Centre, University of Toronto, Toronto, Canada
| | - Mudathira Kadu
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Jasvinei Sritharan
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Carolyn Steele Gray
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.,Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Canada
| |
Collapse
|
4
|
Ware P, Shah A, Ross HJ, Logan AG, Segal P, Cafazzo JA, Szacun-Shimizu K, Resnick M, Vattaparambil T, Seto E. Challenges of Telemonitoring Programs for Complex Chronic Conditions: Randomized Controlled Trial With an Embedded Qualitative Study. J Med Internet Res 2022; 24:e31754. [PMID: 35080502 PMCID: PMC8829695 DOI: 10.2196/31754] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/22/2021] [Accepted: 12/03/2021] [Indexed: 01/22/2023] Open
Abstract
Background Despite the growing prevalence of people with complex conditions and evidence of the positive impact of telemonitoring for single conditions, little research exists on telemonitoring for this population. Objective This randomized controlled trial and embedded qualitative study aims to evaluate the impact on and experiences of patients and health care providers (HCPs) using a telemonitoring system with decision support to manage patients with complex conditions, including those with multiple chronic conditions, compared with the standard of care. Methods A pragmatic, unblinded, 6-month randomized controlled trial sought to recruit 146 patients with ≥1 diagnosis of heart failure (HF), uncontrolled hypertension (HT), and insulin-requiring diabetes mellitus (DM) from outpatient specialty settings in Toronto, Ontario, Canada. Participants were randomized into the control and telemonitoring groups, with the latter being instructed to take readings relevant to their conditions. The telemonitoring system contained an algorithm that generated decision support in the form of actionable self-care directives to patients and alerts to HCPs. The primary outcome was health status (36-Item Short Form Health Survey questionnaire). Secondary outcomes included anxiety and depression, self-efficacy in chronic disease management, and self-reported health service use. HF-related quality of life and self-care measures were also collected from patients followed for HF. Within- and between-group change scores were analyzed for statistical significance (P<.05). A convenience sample of HCPs and patients in the intervention group was interviewed about their experiences. Results A total of 96 patients were recruited and randomized. Recruitment was terminated early because of implementation challenges and the onset of the COVID-19 pandemic. No significant within- and between-group differences were found for the main primary and secondary outcomes. However, a within-group analysis of patients with HF found improvements in self-care maintenance (P=.04) and physical quality of life (P=.046). Opinions expressed by the 5 HCPs and 13 patients who were interviewed differed based on the monitored conditions. Although patients with HF reported benefitting from actionable self-care guidance and meaningful interactions with their HCPs, patient and HCP users of the DM and HT modules did not think telemonitoring improved the clinical management of those conditions to the same degree. These differing experiences were largely attributed to the siloed nature of specialty care and the design of the decision support, whereby fluctuations in the status of HT and DM typically required less urgent interventions compared with patients with HF. Conclusions We recommend that future research conceive telemonitoring as a program and that self-management and clinical decision support are necessary but not sufficient components of such programs for patients with complex conditions and lower acuity. We conclude that telemonitoring for patients with complex conditions or within multidisciplinary care settings may be best operationalized through nurse-led models of care. Trial Registration ClinicalTrials.gov NCT03127852; https://clinicaltrials.gov/ct2/show/NCT03127852 International Registered Report Identifier (IRRID) RR2-10.2196/resprot.8367
Collapse
Affiliation(s)
- Patrick Ware
- Centre for Global eHealth Innovation, University Health Network, Toronto, ON, Canada
| | - Amika Shah
- Centre for Global eHealth Innovation, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Heather Joan Ross
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.,Ted Rogers Centre for Heart Research, University Health Network, Toronto, ON, Canada
| | - Alexander Gordon Logan
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.,Division of Nephrology, Mount Sinai Hospital, Toronto, ON, Canada.,Division of Nephrology, University Health Network, Toronto, ON, Canada
| | - Phillip Segal
- Division of Endocrinology, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Joseph Antony Cafazzo
- Centre for Global eHealth Innovation, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | | | - Myles Resnick
- Centre for Global eHealth Innovation, University Health Network, Toronto, ON, Canada
| | - Tessy Vattaparambil
- Centre for Global eHealth Innovation, University Health Network, Toronto, ON, Canada
| | - Emily Seto
- Centre for Global eHealth Innovation, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
5
|
Yanardağ MZ, Özer Ö, Özmen S. Investigating Self-Care Agency and Well-Being of Elderly People. SOCIAL WORK IN PUBLIC HEALTH 2021; 36:496-508. [PMID: 33882780 DOI: 10.1080/19371918.2021.1915908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The purpose of this study is to investigate the relationships between self-care agency and well-being perceptions of elderly people and to reveal whether or not self-care agency and well-being differ based on some socio-demographic characteristics. In the study, the data were collected by using Self-Care Agency Scale and WHO-5 Well-Being Scale from 394 elderly individuals residing in the city center of Burdur province between November and December 2019. In data analysis, descriptive statistical methods, one-way analysis of variance, two independent groups t-test, reliability analysis, correlation analysis and regression analysis were used. The correlation analysis results of the study indicated that there was a positive and moderate correlation between self-care agency and well-being of the participants (r = 0.41). According to the regression analysis, participants' perception on self-care agency accounted for 17.3% of total variance on well-being. According to this, increasing perceptions on self-care agency statistically increased well-being perceptions (t = 9.069; p < .001). In addition to, it was determined in the study, while participants' well-being scores showed significant differences in terms of age groups, and their' self-care agency and well-being scores showed statistically significant differences according to the educational level.
Collapse
Affiliation(s)
- Melek Zubaroğlu Yanardağ
- Faculty of Economics and Administrative Sciences, Department of Social Work, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
| | - Özlem Özer
- Faculty of Gulhane Health Sciences, Department of Healthcare Management, University of Health Sciences Turkey, Ankara, Turkey
| | - Sümeyye Özmen
- Faculty of Economics and Administrative Sciences, Department of Healthcare Management, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
| |
Collapse
|
6
|
Aleandri M, Scalorbi S, Pirazzini MC. Electronic nursing care plans through the use of NANDA, NOC, and NIC taxonomies in community setting: A descriptive study in northern Italy. Int J Nurs Knowl 2021; 33:72-80. [PMID: 33960713 PMCID: PMC9290471 DOI: 10.1111/2047-3095.12326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/02/2021] [Accepted: 04/10/2021] [Indexed: 11/29/2022]
Abstract
Purpose To carry on a descriptive analysis of nursing standardized language through the use of a software within outpatient facilities in northern Italy, organized according to the Chronic Care Model (CCM) and called Community Health Centers (CHC). Methods A descriptive design was adopted for the study. NANDA‐I, NOC, and NIC taxonomies have been used to analyze care plans pulled from the software. Both qualitative and quantitative data were analyzed. Findings The average of nursing diagnosis correctly identified with respect to the nursing assessment is 83.7% (SD 29.9%). Class 4 diagnoses from Domains 4 have been identified as the most prevalent (22.4%), followed by risk for unstable blood glucose level 00179 (16.4%) and risk for overweight 00234 (13%). The main nursing outcomes were vital signs 0802 (22.5%), blood glucose level 2300 (16%), and weight loss behavior 1627 (11%). The most prevalent nursing interventions are wound care 3660 (27%), medication administration: intramuscular 2313 (19%), and health education 5510 (14%). The analysis shows ability in identifying nursing diagnoses, but a larger variability with outcomes and interventions. The study highlights the nursing role within CHC and identifies the main areas of expertise in chronic disease management: prevention and health education. Conclusions Nurses’ role is fundamental for chronic disease management within CHC; NANDA‐I taxonomy helps to analyze care plans. Implications for nursing practice ‐ A taxonomy such as NANDA‐I represents a valid opportunity to make more visible how much nursing skills affect the achievement of a higher level of health in chronic patients. ‐ This study is useful in the further training of outpatient nurses who works in CHC. ‐ The study represents the starting point for future research to deepen the development of a standardized nursing language in outpatient facilities.
Collapse
|
7
|
Christofides EA, Desai N. Optimal Early Diagnosis and Monitoring of Diabetic Kidney Disease in Type 2 Diabetes Mellitus: Addressing the Barriers to Albuminuria Testing. J Prim Care Community Health 2021; 12:21501327211003683. [PMID: 33749371 PMCID: PMC7983418 DOI: 10.1177/21501327211003683] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 12/14/2022] Open
Abstract
Chronic kidney disease (CKD) in patients with type 2 diabetes (T2D) is associated with increased risk of end-stage renal disease (ESRD) and cardiovascular disease (CVD). Urine albumin-to-creatinine ratio (UACR) is a sensitive and early indicator of kidney damage, which should be used routinely to accurately assess CKD stage and monitor kidney health. However, this test currently is performed in only a minority of patients with T2D. Here, we review the importance of albuminuria testing and current barriers that hinder patient access to UACR testing and describe solutions to such testing in a community clinical setting.
Collapse
Affiliation(s)
| | - Niraj Desai
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| |
Collapse
|
8
|
Sheth HS, Grimes VD, Rudge D, Ayers B, Moreland LW, Fischer GS, Aggarwal R. Improving Pneumococcal Vaccination Rates in Rheumatology Patients by Using Best Practice Alerts in the Electronic Health Records. J Rheumatol 2020; 48:1472-1479. [DOI: 10.3899/jrheum.200806] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2020] [Indexed: 11/22/2022]
Abstract
ObjectiveTo improve pneumococcal vaccination (PV) rates among rheumatology clinic patients on immunosuppressive therapy in the outpatient settings.MethodsThis quality improvement project was based on the pre–post intervention design. Phase I of the project targeted patients with rheumatoid arthritis from 13 rheumatology clinics (January 2013–July 2015) on immunosuppressive therapy to receive the pneumococcal polysaccharide vaccine (PPSV23). In the Phase II study (January 2016–October 2017), all patients on immunosuppressive medications regardless of diagnosis were targeted to receive PPSV23 and the pneumococcal conjugate vaccine (PCV13). The best practice alerts (BPAs) for both PVs were developed based on the Centers for Disease Control and Prevention guidelines, which appeared on electronic medical records for eligible patients at the time of assessment by the medical assistant. The BPA was designed to inform the vaccination status and enable the physician to order the PV, or to document refusal or deferral reasons. Education regarding vaccine guidelines, BPAs, vaccination process, and regular feedback of results were important project interventions. The vaccination rates during pre–post intervention for each study phase were compared using chi-square test.ResultsDuring phase I, PPSV23 vaccination rates improved from a 28% preintervention rate to 61.5% (P < 0.0001). During phase II, 77.4% of patients had received either PPSV23, PCV13, or both, compared to 49.6% of patients in the preintervention period (P < 0.0001). The documentation rates (vaccine received, ordered, patient refusal and deferral reasons) increased significantly in both phases.ConclusionElectronic identification of vaccine eligibility and implementation of BPAs with capabilities to order and document resulted in significantly improved PV rates. The process has potential for self-sustainability and generalizability.
Collapse
|
9
|
Sun R, Burke LE, Korytkowski MT, Saul MI, Li D, Sereika SM. A longitudinal examination of patient portal use on glycemic control among patients with uncontrolled type 2 diabetes. Diabetes Res Clin Pract 2020; 170:108483. [PMID: 33038473 DOI: 10.1016/j.diabres.2020.108483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 08/23/2020] [Accepted: 09/25/2020] [Indexed: 01/22/2023]
Abstract
AIM This study examined glycemia level over a 2-year period between portal users and non-users. METHODS This retrospective cohort study used data from electronic health records (EHRs) of a large academic medical center and its ancillary patient portal. A total of 15,528 patients with uncontrolled type 2 diabetes mellitus (T2DM) were included. Using propensity score matching (PSM), portal users and non-users were balanced on demographic and clinical characteristics. Mixed-effects polynomial regression modeling was employed to evaluate the HbA1c change over time between groups. RESULTS The patient sample was 85.9% (13,333) white and 52.5% (7375) male. On average, patients were 62.8 (SD, 11.7) years old and with obesity (mean BMI: 34.2 ± 7.2 kg/m2) with uncontrolled T2DM (initial HbA1c: 8.5 ± 1.5%). After PSM, portal users (n = 4924) and non-users (n = 4924) were matched on all variables except for the insurance. The mixed-effects modeling showed a nonlinear decrease of HbA1c in both groups over time. A significant interaction was observed with a greater decline, followed by a smaller rise of HbA1c in portal users than non-users. CONCLUSIONS The use of the patient portal was significantly associated with a lower HbA1c. This finding supports patient portals as a promising tool for improving clinical outcomes in patients with uncontrolled T2DM.
Collapse
Affiliation(s)
- Ran Sun
- Department of Health & Community Systems, University of Pittsburgh School of Nursing, 3500 Victoria St, Pittsburgh, PA 15213, USA.
| | - Lora E Burke
- Department of Health & Community Systems, University of Pittsburgh School of Nursing, 3500 Victoria St, Pittsburgh, PA 15213, USA
| | - Mary T Korytkowski
- Department of Medicine, University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA 15213, USA
| | - Melissa I Saul
- University of Pittsburgh School of Health and Rehabilitation Sciences, 3600 Atwood St, Pittsburgh, PA 15260, USA
| | - Dan Li
- Department of Health & Community Systems, University of Pittsburgh School of Nursing, 3500 Victoria St, Pittsburgh, PA 15213, USA
| | - Susan M Sereika
- Department of Health & Community Systems, University of Pittsburgh School of Nursing, 3500 Victoria St, Pittsburgh, PA 15213, USA
| |
Collapse
|
10
|
Jiang Y, Liu F, Guo J, Sun P, Chen Z, Li J, Cai L, Zhao H, Gao P, Ding Z, Wu X. Evaluating an Intervention Program Using WeChat for Patients With Chronic Obstructive Pulmonary Disease: Randomized Controlled Trial. J Med Internet Res 2020; 22:e17089. [PMID: 32314971 PMCID: PMC7201319 DOI: 10.2196/17089] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 02/08/2020] [Accepted: 03/12/2020] [Indexed: 12/18/2022] Open
Abstract
Background The application of telemedicine in home pulmonary rehabilitation interventions for the management of patients with chronic obstructive pulmonary disease (COPD) has achieved promising results. Objective This study aimed to develop a WeChat official account (Pulmonary Internet Explorer Rehabilitation [PeR]) based on social media. It further evaluated the effect of PeR on the quality of life, symptoms, and exercise self-efficacy of patients with COPD. Methods The functional modules of PeR were developed by a multidisciplinary team according to the electronic health–enhanced chronic care model (eCCM) components. A total of 106 patients were randomly selected (53 in the PeR group and 53 in the outpatient face-to-face group [FtF]). Pulmonary rehabilitation intervention was conducted for 3 months, and the outcome was observed for 3 months. The primary outcome was patient quality of life measured with the COPD assessment test (CAT). The secondary outcomes were evaluated using the modified Medical Research Council scale (mMRC), exercise self-regulatory efficacy scale (Ex-SRES), and St George’s Respiratory Questionnaire (SGRQ). Results The intention-to-treat analysis was used in the study. A total of 94 participants completed the 6-month pulmonary rehabilitation program. No statistically significant differences were observed in CAT (F1,3=7.78, P=.001), Ex-SRES (F1,3=21.91, P<.001), and mMRC scores (F1,3=29.64, P<.001) between the two groups with the variation in time tendency. The Ex-SRES score had a significant effect on the CAT score (P=.03). The partial regression coefficient of Ex-SRES to CAT was 0.81, and Exp (B) was 2.24. Conclusions The telemedicine technology was effective using the eCCM combined with a behavioral intervention strategy centering on self-efficacy. Pulmonary rehabilitation at home through PeR and FtF could improve the sense of self-efficacy and quality of life and alleviate symptoms in patients with COPD. Trial Registration Chinese Clinical Trial Registry ChiCTR1900022770; https://tinyurl.com/tmmvpq3
Collapse
Affiliation(s)
- Yuyu Jiang
- Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Fenglan Liu
- Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Jianlan Guo
- Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Pingping Sun
- Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Zhongyi Chen
- Research Office of Chronic Disease Management and Rehabilitation, Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Jinping Li
- Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Liming Cai
- Affiliated Hospital of Jiangnan University, Wuxi, China
| | | | - Ping Gao
- Wuxi Second Hospital of Traditional Chinese Medicine, Wuxi, China
| | | | - Xiaoliang Wu
- Huishan District Rehabilitation Hospital, Wuxi, China
| |
Collapse
|
11
|
Pradeepa R, Rajalakshmi R, Mohan V. Use of Telemedicine Technologies in Diabetes Prevention and Control in Resource-Constrained Settings: Lessons Learned from Emerging Economies. Diabetes Technol Ther 2019; 21:S29-S216. [PMID: 31169429 DOI: 10.1089/dia.2019.0038] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Telemedicine is a promising strategy that utilizes telecommunication to provide health care in remote areas, facilitating beneficial interaction between the health care provider and people in rural areas and making affordable and accessible medical care available to remote, inaccessible areas of the world. This article provides an overview of some of the ways telemedicine is improving diabetes care outcomes at the community level. Telemedicine can play a number of roles in moving quality diabetes care forward. It is currently being used to create awareness among urban and rural population about the risk factors and prevention of diabetes; to facilitate patient monitoring; for remote diabetic retinopathy screening; and in diabetes prevention at the primary, secondary, and tertiary level. We also highlight the use of automated artificial intelligence software combined with telemedicine to conduct efficient real-time screening of complications such as diabetic retinopathy in remote areas where such facilities are currently unavailable.
Collapse
Affiliation(s)
- Rajendra Pradeepa
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialties Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control and IDF Centre of Excellence in Diabetes Care, Chennai, India
| | - Ramachandran Rajalakshmi
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialties Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control and IDF Centre of Excellence in Diabetes Care, Chennai, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialties Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control and IDF Centre of Excellence in Diabetes Care, Chennai, India
| |
Collapse
|
12
|
Customization of the TRU-PBMT App (Technology Recordings to better Understand Pediatric Blood and Marrow Transplant). J Pediatr Nurs 2018; 42:86-91. [PMID: 30219304 DOI: 10.1016/j.pedn.2018.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 06/10/2018] [Accepted: 07/04/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE Our investigative team is integrating mobile health technologies into pediatric blood and marrow transplant (PBMT) care. We aim to evaluate whether patient-generated health data can be used to monitor health status and enhance symptom management. While there are numerous health-related apps, none address the symptoms or care needs specific to PBMT patients. This article describes development of the Technology Recording to better Understand Pediatric Blood and Marrow Transplant (TRU-PBMT) mobile application. DESIGN AND METHODS A one-time survey was distributed to PBMT clinicians, caregivers, and outpatients to elicit feedback and suggestions for the app's design. RESULTS Feedback from clinicians (n = 23), caregivers (n = 5), and PBMT outpatients (n = 4) indicated the app would be acceptable and useable with this group of patients between eight and eighteen years of age. Suggestions from respondents included: making the app language and graphics more child-friendly; adding symptoms such as fatigue, mucositis, bleeding; and a visual stool chart. CONCLUSION Patient, caregiver, and clinician feedback was valuable in creation of the TRU-PBMT app. We designed a pediatric friendly, PBMT-symptom-specific app, which we will test in future studies. IMPLICATIONS FOR PRACTICE This app facilitates patient-generated health data collection and informs health care plans.
Collapse
|
13
|
From chronic disease management to person-centered eHealth; a review on the necessity for blended care. CLINICAL EHEALTH 2018. [DOI: 10.1016/j.ceh.2018.01.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
|
14
|
Kloek C, Bossen D, de Bakker DH, Veenhof C, Dekker J. Blended Interventions to Change Behavior in Patients With Chronic Somatic Disorders: Systematic Review. J Med Internet Res 2017; 19:e418. [PMID: 29269338 PMCID: PMC5754569 DOI: 10.2196/jmir.8108] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 09/18/2017] [Accepted: 09/23/2017] [Indexed: 01/07/2023] Open
Abstract
Background Blended behavior change interventions combine therapeutic guidance with online care. This new way of delivering health care is supposed to stimulate patients with chronic somatic disorders in taking an active role in their disease management. However, knowledge about the effectiveness of blended behavior change interventions and how they should be composed is scattered. Objective This comprehensive systematic review aimed to provide an overview of characteristics and effectiveness of blended behavior change interventions for patients with chronic somatic disorders. Methods We searched for randomized controlled trials published from 2000 to April 2017 in PubMed, Embase, CINAHL, and Cochrane Central Register of Controlled Trials. Risk of bias was assessed using the Cochrane Collaboration tool. Study characteristics, intervention characteristics, and outcome data were extracted. Studies were sorted based on their comparison group. A best-evidence synthesis was conducted to summarize the effectiveness. Results A total of 25 out of the 29 included studies were of high quality. Most studies (n=21; 72%) compared a blended intervention with no intervention. The majority of interventions focused on changing pain behavior (n=17; 59%), and the other interventions focused on lifestyle change (n=12; 41%). In addition, 26 studies (90%) focused on one type of behavior, whereas 3 studies (10%) focused on multiple behaviors. A total of 23 studies (79%) mentioned a theory as basis for the intervention. The therapeutic guidance in most studies (n=18; 62%) was non face-to-face by using email, phone, or videoconferencing, and in the other studies (partly), it was face-to-face (n=11; 38%). In 26 studies (90%), the online care was provided via a website, and in 3 studies (10%) via an app. In 22 studies (76%), the therapeutic guidance and online care were integrated instead of two separate aspects. A total of 26 outcome measures were included in the evidence synthesis comparing blended interventions with no intervention: for the coping strategy catastrophizing, we found strong evidence for a significant effect. In addition, 1 outcome measure was included in the evidence synthesis comparing blended interventions with face-to-face interventions, but no evidence for a significant effect was found. A total of 6 outcome measures were included in the evidence synthesis comparing blended interventions with online interventions, but no evidence for a significant effect was found. Conclusions Blended behavior change interventions for patients with chronic somatic disorders show variety in the type of therapeutic guidance, the type of online care, and how these two delivery modes are integrated. The evidence of the effectiveness of blended interventions is inconsistent and nonsignificant for most outcome measures. Future research should focus on which type of blended intervention works for whom.
Collapse
Affiliation(s)
- Corelien Kloek
- Tranzo, Tilburg University, Tilburg, Netherlands.,Netherlands Institute for Health Services Research, Utrecht, Netherlands.,Research Group Innovation of Human Movement Care, HU University of Applied Sciences, Utrecht, Netherlands.,Brain Center Rudolf Magnus, Department of Rehabilitation, Physical Therapy Science & Sports, University Medical Center Utrecht, Utrecht, Netherlands
| | - Daniël Bossen
- ACHIEVE Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands.,Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Dinny H de Bakker
- Tranzo, Tilburg University, Tilburg, Netherlands.,Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Cindy Veenhof
- Research Group Innovation of Human Movement Care, HU University of Applied Sciences, Utrecht, Netherlands.,Brain Center Rudolf Magnus, Department of Rehabilitation, Physical Therapy Science & Sports, University Medical Center Utrecht, Utrecht, Netherlands
| | - Joost Dekker
- EMGO Institute, VU University Medical Center Amsterdam, Amsterdam, Netherlands.,Department of Rehabilitation Medicine, VU University Medical Center Amsterdam, Amsterdam, Netherlands.,Department of Psychiatry, VU University Medical Center Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
15
|
Talboom-Kamp EPWA, Verdijk NA, Kasteleyn MJ, Harmans LM, Talboom IJSH, Numans ME, Chavannes NH. Effect of a combined education and eHealth programme on the control of oral anticoagulation patients (PORTALS study): a parallel cohort design in Dutch primary care. BMJ Open 2017; 7:e017909. [PMID: 28963313 PMCID: PMC5623459 DOI: 10.1136/bmjopen-2017-017909] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To analyse the effect on therapeutic control and self-management skills of the implementation of self-management programmes, including eHealth by e-learning versus group training. SETTING Primary Care Thrombosis Service Center. PARTICIPANTS Of the 247 oral anticoagulation therapy (OAT) patients, 63 started self-management by e-learning, 74 self-management by group training and 110 received usual care. INTERVENTION AND METHODS Parallel cohort design with two randomised self-management groups (e-learning and group training) and a group receiving usual care. The effect of implementation of self-management on time in therapeutic range (TTR) was analysed with multilevel linear regression modelling. Usage of a supporting eHealth platform and the impact on self-efficacy (Generalised Self-Efficacy Scale (GSES)) and education level were analysed with linear regression analysis. After intervention, TTR was measured in three time periods of 6 months. MAIN OUTCOME MEASURES (1) TTR, severe complications,(2) usage of an eHealth platform,(3) GSES, education level. RESULTS Analysis showed no significant differences in TTR between the three time periods (p=0.520), the three groups (p=0.460) or the groups over time (p=0.263). Comparison of e-learning and group training showed no significant differences in TTR between the time periods (p=0.614), the groups (p=0.460) or the groups over time (p=0.263). No association was found between GSES and TTR (p=0.717) or education level and TTR (p=0.107). No significant difference was found between the self-management groups in usage of the platform (0-6 months p=0.571; 6-12 months p=0.866; 12-18 months p=0.260). The percentage of complications was low in all groups (3.2%; 1.4%; 0%). CONCLUSIONS No differences were found between OAT patients trained by e-learning or by a group course regarding therapeutic control (TTR) and usage of a supporting eHealth platform. The TTR was similar in self-management and regular care patients. With adequate e-learning or group training, self-management seems safe and reliable for a selected proportion of motivated vitamin K antagonist patients. TRIAL REGISTRATION NUMBER NTR3947.
Collapse
Affiliation(s)
- Esther P W A Talboom-Kamp
- Public Health and Primary Care Department, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Thrombosis Service Centre, Saltro Diagnostic Centre, Utrecht, The Netherlands
| | - Noortje A Verdijk
- Public Health and Primary Care Department, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Thrombosis Service Centre, Saltro Diagnostic Centre, Utrecht, The Netherlands
| | - Marise J Kasteleyn
- Public Health and Primary Care Department, Leiden University Medical Centre, Leiden, The Netherlands
| | - Lara M Harmans
- Department of Thrombosis Service Centre, Saltro Diagnostic Centre, Utrecht, The Netherlands
| | - Irvin J S H Talboom
- Department of Information Management, Caregroup DOH, Eindhoven, The Netherlands
| | - Mattijs E Numans
- Public Health and Primary Care Department, Leiden University Medical Centre, Leiden, The Netherlands
| | - Niels H Chavannes
- Public Health and Primary Care Department, Leiden University Medical Centre, Leiden, The Netherlands
| |
Collapse
|
16
|
Talboom-Kamp EP, Verdijk NA, Kasteleyn MJ, Harmans LM, Talboom IJ, Looijmans-van den Akker I, van Geloven N, Numans ME, Chavannes NH. The Effect of Integration of Self-Management Web Platforms on Health Status in Chronic Obstructive Pulmonary Disease Management in Primary Care (e-Vita Study): Interrupted Time Series Design. J Med Internet Res 2017; 19:e291. [PMID: 28814380 PMCID: PMC5577456 DOI: 10.2196/jmir.8262] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 07/24/2017] [Accepted: 07/27/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Worldwide nearly 3 million people die from chronic obstructive pulmonary disease (COPD) every year. Integrated disease management (IDM) improves quality of life for COPD patients and can reduce hospitalization. Self-management of COPD through eHealth is an effective method to improve IDM and clinical outcomes. OBJECTIVES The objective of this implementation study was to investigate the effect of 3 chronic obstructive pulmonary disease eHealth programs applied in primary care on health status. The e-Vita COPD study compares different levels of integration of Web-based self-management platforms in IDM in 3 primary care settings. Patient health status is examined using the Clinical COPD Questionnaire (CCQ). METHODS The parallel cohort design includes 3 levels of integration in IDM (groups 1, 2, 3) and randomization of 2 levels of personal assistance for patients (group A, high assistance, group B, low assistance). Interrupted time series (ITS) design was used to collect CCQ data at multiple time points before and after intervention, and multilevel linear regression modeling was used to analyze CCQ data. RESULTS Of the 702 invited patients, 215 (30.6%) registered to a platform. Of these, 82 participated in group 1 (high integration IDM), 36 in group 1A (high assistance), and 46 in group 1B (low assistance); 96 participated in group 2 (medium integration IDM), 44 in group 2A (high assistance) and 52 in group 2B (low assistance); also, 37 participated in group 3 (no integration IDM). In the total group, no significant difference was found in change in CCQ trend (P=.334) before (-0.47% per month) and after the intervention (-0.084% per month). Also, no significant difference was found in CCQ changes before versus after the intervention between the groups with high versus low personal assistance. In all subgroups, there was no significant change in the CCQ trend before and after the intervention (group 1A, P=.237; 1B, P=.991; 2A, P=.120; 2B, P=.166; 3, P=.945). CONCLUSIONS The e-Vita eHealth-supported COPD programs had no beneficial impact on the health status of COPD patients. Also, no differences were found between the patient groups receiving different levels of personal assistance. TRIAL REGISTRATION Netherlands Trial Registry NTR4098; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4098 (Archived by WebCite at http://www.webcitation.org/6sbM5PayG).
Collapse
Affiliation(s)
- Esther Pwa Talboom-Kamp
- Leiden University Medical Center, Public Health and Primary Care Department, Leiden, Netherlands
- Saltro Diagnostic Center, Utrecht, Netherlands
| | - Noortje A Verdijk
- Leiden University Medical Center, Public Health and Primary Care Department, Leiden, Netherlands
- Saltro Diagnostic Center, Utrecht, Netherlands
| | - Marise J Kasteleyn
- Leiden University Medical Center, Public Health and Primary Care Department, Leiden, Netherlands
| | | | | | | | - Nan van Geloven
- Leiden University Medical Center, Department of Medical Statistics and Bioinformatics, Leiden, Netherlands
| | - Mattijs E Numans
- Leiden University Medical Center, Public Health and Primary Care Department, Leiden, Netherlands
| | - Niels H Chavannes
- Leiden University Medical Center, Public Health and Primary Care Department, Leiden, Netherlands
| |
Collapse
|
17
|
Melchiorre MG, Papa R, Rijken M, van Ginneken E, Hujala A, Barbabella F. eHealth in integrated care programs for people with multimorbidity in Europe: Insights from the ICARE4EU project. Health Policy 2017; 122:53-63. [PMID: 28899575 DOI: 10.1016/j.healthpol.2017.08.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 06/25/2017] [Accepted: 08/05/2017] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Care for people with multimorbidity requires an integrated approach in order to adequately meet their complex needs. In this respect eHealth could be of help. This paper aims to describe the implementation, as well as benefits and barriers of eHealth applications in integrated care programs targeting people with multimorbidity in European countries, including insights on older people 65+. METHODS Within the framework of the ICARE4EU project, in 2014, expert organizations in 24 European countries identified 101 integrated care programs based on selected inclusion criteria. Managers of these programs completed a related on-line questionnaire addressing various aspects including the use of eHealth. In this paper we analyze data from this questionnaire, in addition to qualitative information from six programs which were selected as 'high potential' for their innovative approach and studied in depth through site visits. RESULTS Out of 101 programs, 85 adopted eHealth applications, of which 42 focused explicitly on older people. In most cases Electronic Health Records (EHRs), registration databases with patients' data and tools for communication between care providers were implemented. Percentages were slightly higher for programs addressing older people. eHealth improves care integration and management processes. Inadequate funding mechanisms, interoperability and technical support represent major barriers. CONCLUSION Findings seems to suggest that eHealth could support integrated care for (older) people with multimorbidity.
Collapse
Affiliation(s)
- Maria Gabriella Melchiorre
- Centre for Socio-Economic Research on Ageing, National Institute of Health and Science on Ageing (INRCA), Ancona, Italy.
| | - Roberta Papa
- Centre for Socio-Economic Research on Ageing, National Institute of Health and Science on Ageing (INRCA), Ancona, Italy
| | - Mieke Rijken
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Ewout van Ginneken
- European Observatory on Health Systems and Policies, Berlin University of Technology (TUB), Berlin, Germany
| | - Anneli Hujala
- Department of Health and Social Management, University of Eastern Finland (UEF), Kuopio, Finland
| | - Francesco Barbabella
- Centre for Socio-Economic Research on Ageing, National Institute of Health and Science on Ageing (INRCA), Ancona, Italy; Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
| |
Collapse
|
18
|
Alharbi NS, Alsubki N, Jones S, Khunti K, Munro N, de Lusignan S. Impact of Information Technology-Based Interventions for Type 2 Diabetes Mellitus on Glycemic Control: A Systematic Review and Meta-Analysis. J Med Internet Res 2016; 18:e310. [PMID: 27888169 PMCID: PMC5148808 DOI: 10.2196/jmir.5778] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 09/13/2016] [Accepted: 09/30/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Information technology-based interventions are increasingly being used to manage health care. However, there is conflicting evidence regarding whether these interventions improve outcomes in people with type 2 diabetes. OBJECTIVE The objective of this study was to conduct a systematic review and meta-analysis of clinical trials, assessing the impact of information technology on changes in the levels of hemoglobin A1c (HbA1c) and mapping the interventions with chronic care model (CCM) elements. METHODS Electronic databases PubMed and EMBASE were searched to identify relevant studies that were published up until July 2016, a method that was supplemented by identifying articles from the references of the articles already selected using the electronic search tools. The study search and selection were performed by independent reviewers. Of the 1082 articles retrieved, 32 trials (focusing on a total of 40,454 patients) were included. A random-effects model was applied to estimate the pooled results. RESULTS Information technology-based interventions were associated with a statistically significant reduction in HbA1c levels (mean difference -0.33%, 95% CI -0.40 to -0.26, P<.001). Studies focusing on electronic self-management systems demonstrated the largest reduction in HbA1c (0.50%), followed by those with electronic medical records (0.17%), an electronic decision support system (0.15%), and a diabetes registry (0.05%). In addition, the more CCM-incorporated the information technology-based interventions were, the more improvements there were in HbA1c levels. CONCLUSIONS Information technology strategies combined with the other elements of chronic care models are associated with improved glycemic control in people with diabetes. No clinically relevant impact was observed on low-density lipoprotein levels and blood pressure, but there was evidence that the cost of care was lower.
Collapse
Affiliation(s)
- Nouf Sahal Alharbi
- King Saud University, Riyadh, Saudi Arabia.,University of Surrey, Guildford, United Kingdom
| | | | - Simon Jones
- University of Surrey, Guildford, United Kingdom
| | | | - Neil Munro
- University of Surrey, Guildford, United Kingdom
| | | |
Collapse
|
19
|
Haymes LK, Storey K, Maldonado A, Post M, Montgomery J. Using applied behavior analysis and smart technology for meeting the health needs of individuals with intellectual disabilities. Dev Neurorehabil 2016; 18:407-19. [PMID: 24304093 DOI: 10.3109/17518423.2013.850750] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Individuals with intellectual disabilities often have special healthcare concerns such as diabetes, kidney disease, severe allergies, progressive illnesses, respiratory weaknesses, and obesity. Smart technology can be an asset for individuals with intellectual disabilities for better managing their healthcare needs. METHODS A critical review of the literature related to applied behavior analysis, smart technology, and health needs of individuals with intellectual disabilities was conducted. RESULTS This discussion paper describes factors that contribute to the successful use of smart technology for the health issues of individuals with intellectual disabilities. CONCLUSIONS We see key components in developing appropriate access and use of smart technology for the health of people with intellectual disabilities being: (a) systematic instructional methods for consistent and accurate use of the technology, (b) modifying the current technology for people with intellectual disabilities,
Collapse
Affiliation(s)
- Linda K Haymes
- a Graduate School of Education, Touro University California , Vallejo , CA , USA and
| | - Keith Storey
- a Graduate School of Education, Touro University California , Vallejo , CA , USA and
| | - Ana Maldonado
- a Graduate School of Education, Touro University California , Vallejo , CA , USA and
| | - Michal Post
- a Graduate School of Education, Touro University California , Vallejo , CA , USA and
| | | |
Collapse
|
20
|
Gee PM, Greenwood DA, Paterniti DA, Ward D, Miller LMS. The eHealth Enhanced Chronic Care Model: a theory derivation approach. J Med Internet Res 2015; 17:e86. [PMID: 25842005 PMCID: PMC4398883 DOI: 10.2196/jmir.4067] [Citation(s) in RCA: 152] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 01/21/2015] [Accepted: 02/07/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Chronic illnesses are significant to individuals and costly to society. When systematically implemented, the well-established and tested Chronic Care Model (CCM) is shown to improve health outcomes for people with chronic conditions. Since the development of the original CCM, tremendous information management, communication, and technology advancements have been established. An opportunity exists to improve the time-honored CCM with clinically efficacious eHealth tools. OBJECTIVE The first goal of this paper was to review research on eHealth tools that support self-management of chronic disease using the CCM. The second goal was to present a revised model, the eHealth Enhanced Chronic Care Model (eCCM), to show how eHealth tools can be used to increase efficiency of how patients manage their own chronic illnesses. METHODS Using Theory Derivation processes, we identified a "parent theory", the Chronic Care Model, and conducted a thorough review of the literature using CINAHL, Medline, OVID, EMBASE PsychINFO, Science Direct, as well as government reports, industry reports, legislation using search terms "CCM or Chronic Care Model" AND "eHealth" or the specific identified components of eHealth. Additionally, "Chronic Illness Self-management support" AND "Technology" AND several identified eHealth tools were also used as search terms. We then used a review of the literature and specific components of the CCM to create the eCCM. RESULTS We identified 260 papers at the intersection of technology, chronic disease self-management support, the CCM, and eHealth and organized a high-quality subset (n=95) using the components of CCM, self-management support, delivery system design, clinical decision support, and clinical information systems. In general, results showed that eHealth tools make important contributions to chronic care and the CCM but that the model requires modification in several key areas. Specifically, (1) eHealth education is critical for self-care, (2) eHealth support needs to be placed within the context of community and enhanced with the benefits of the eCommunity or virtual communities, and (3) a complete feedback loop is needed to assure productive technology-based interactions between the patient and provider. CONCLUSIONS The revised model, eCCM, offers insight into the role of eHealth tools in self-management support for people with chronic conditions. Additional research and testing of the eCCM are the logical next steps.
Collapse
Affiliation(s)
- Perry M Gee
- School of Nursing, Division of Health Sciences, Idaho State University, Pocatello, ID, United States.
| | | | | | | | | |
Collapse
|
21
|
Gammon D, Berntsen GKR, Koricho AT, Sygna K, Ruland C. The chronic care model and technological research and innovation: a scoping review at the crossroads. J Med Internet Res 2015; 17:e25. [PMID: 25677200 PMCID: PMC4342659 DOI: 10.2196/jmir.3547] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 08/26/2014] [Accepted: 12/13/2014] [Indexed: 12/02/2022] Open
Abstract
Background Information and communication technologies (ICT) are key to optimizing the outcomes of the Chronic Care Model (CCM), currently acknowledged as the best synthesis of available evidence for chronic illness prevention and management. At the same time, CCM can offer a needed framework for increasing the relevance and feasibility of ICT innovation and research in health care. Little is known about how and to what extent CCM and ICT research inform each other to leverage mutual strengths. The current study examines: What characterizes work being done at the crossroads of CCM and ICT research and innovation? Objective Our aim is identify the gaps and potential that lie between the research domains CCM and ICT, thus enabling more substantive questions and opportunities for accelerating improvements in ICT-supported chronic care. Methods Using a scoping study approach, we developed a search strategy applied to medical and technical databases resulting in 1054 titles and abstracts that address CCM and ICT. After iteratively adapting our inclusion/exclusion criteria to balance between breadth and feasibility, 26 publications from 20 studies were found to fulfill our criteria. Following initial coding of each article according to predefined categories (eg, type of article, CCM component, ICT, health issue), a 1st level analysis was conducted resulting in a broad range of categories. These were gradually reduced by constantly comparing them for underlying commonalities and discrepancies. Results None of the studies included were from technical databases and interventions relied mostly on “old-fashioned” technologies. Technologies supporting “productive interactions” were often one-way (provider to patient), and it was sometimes difficult to decipher how CCM was guiding intervention design. In particular, the major focus on ICT to support providers did not appear unique to the challenges of chronic care. Challenges in facilitating CCM components through ICT included poorly designed user interfaces, digital divide issues, and lack of integration with existing infrastructure. Conclusions The CCM is a highly influential guide for health care development, which recognizes the need for alignment of system tools such as ICT. Yet, there seem to be alarmingly few touch points between the subject fields of “health service development” and “ICT-innovation”. Bridging these gaps needs explicit and urgent attention as the synergies between these domains have enormous potential. Policy makers and funding agencies need to facilitate the joining of forces between high-tech innovative expertise and experts in the chronic care system redesign that is required for tackling the current epidemic of long-term multiple conditions.
Collapse
Affiliation(s)
- Deede Gammon
- Norwegian Center for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsoe, Norway.
| | | | | | | | | |
Collapse
|
22
|
Niksch AL. mHealth in pediatrics-finding healthcare solutions for the next generation. Mhealth 2015; 1:7. [PMID: 28293567 PMCID: PMC5344144 DOI: 10.3978/j.issn.2306-9740.2015.03.09] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 03/12/2015] [Indexed: 11/14/2022] Open
Abstract
Mobile health (mHealth) technologies have begun to transform the way clinicians deliver healthcare, with goals of greater patient engagement and improved health outcomes. However, the unique needs of pediatric populations are commonly neglected when novel technologies are designed. Constantly changing size and evolving developmental capabilities present a challenge for development of effective mHealth solutions for children. Parents and the greater healthcare community have a greater role in child health, placing demands on new technology to provide connected models of care. This summary provides the landscape of challenges and opportunities presented by the growing population of children who could be optimal candidates for properly tailored mHealth solutions.
Collapse
Affiliation(s)
- Alisa L Niksch
- Pediatric Electrophysiology and Cardiopulmonary Exercise Lab, Tufts University Medical Center, Boston, MA 02111, USA
| |
Collapse
|
23
|
Cocosila M, Archer N. Perceptions of chronically ill and healthy consumers about electronic personal health records: a comparative empirical investigation. BMJ Open 2014; 4:e005304. [PMID: 25056975 PMCID: PMC4120338 DOI: 10.1136/bmjopen-2014-005304] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To develop a model of consumer perceptions of electronic personal health records (PHRs) and validate it in a comparative study between consumers who report having a chronic illness and those who report being well. MATERIALS AND METHODS A model of PHR use motivators and barriers was built and tested through a national survey across Canada. Data were collected from 800 individuals, 18 years or older. Half reported having a chronic illness or disability and half reported being well. Analyses were performed with structural equation modelling techniques. RESULTS A total of 389 answers from chronically ill and 383 from well participants were collected. Perceived usefulness was the key explanation of the intention to use PHRs for both ill and well people (total effect of 0.601 and 0.565, respectively) followed by security, privacy and trust in PHRs (total effect of 0.377 and 0.479, respectively). Conversely, computer anxiety was perceived as a significant barrier (total effect of -0.327 for ill individuals and -0.212 for well individuals). DISCUSSION The model proposed was appropriate in explaining key consumer positive and negative perceptions on electronic PHR use. We found little difference in perceptions of electronic PHRs between chronically ill and well individuals, although self-reporting their health status might have influenced the results. CONCLUSIONS To increase the adoption rate of electronic PHRs among both chronically ill and well consumers it is necessary to reinforce consumer perceptions of the usefulness of and trust in these eHealth technologies while mitigating their anxieties about computer use in general.
Collapse
Affiliation(s)
- Mihail Cocosila
- Faculty of Business, Athabasca University, Athabasca, Alberta, Canada
| | - Norm Archer
- DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
24
|
Archer N, Keshavjee K, Demers C, Lee R. Online self-management interventions for chronically ill patients: Cognitive impairment and technology issues. Int J Med Inform 2014; 83:264-72. [DOI: 10.1016/j.ijmedinf.2014.01.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 11/11/2013] [Accepted: 01/10/2014] [Indexed: 12/31/2022]
|
25
|
Abstract
The concept of the pediatric patient-centered medical home (PCMH) as a theory has been evolving since it was initially conceived more than 40 years ago. When the American Academy of Pediatrics' (AAP) Council on Pediatric Practice first wrote about this model, "medical home" was defined solely as the central location of a pediatric patient's medical records. Approximately two decades later, the AAP published its inaugural policy statement on this topic. Through this policy statement, the medical home was defined as a place where care for pediatric patients would be accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective. Although the lack of access to providers, especially in rural communities, may inhibit the adoption of the PCMH or chronic care models, technology has evolved to the point where many of the gaps in care can be bridged. mHealth, defined by the National Institutes of Health (NIH) as the use of mobile and wireless devices to improve health outcomes, health care services, and health research, can be one specific example of how technology can address these issues. One early study has shown that patients who use mHealth tools are more likely to adhere to self-monitoring requirements and, in turn, have significantly improved outcomes. A rapidly evolving and scalable mHealth technology that has the ability to address these issues are self-management mobile applications, or apps. It has been estimated that there are currently more than 40,000 health care-related apps available. Furthermore, use of these apps is growing, as more than 50% of smartphone users surveyed responded that they have used their device to gather health information, and almost 20% of this population has at least one health care app on their device.
Collapse
|
26
|
Towards designing for equity: active citizen participation in eHealth. TRANSFORMING GOVERNMENT- PEOPLE PROCESS AND POLICY 2012. [DOI: 10.1108/17506161211267400] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
27
|
Technology and Care for Patients with Chronic Conditions: The Chronic Care Model as a Framework for the Integration of ICT. ICT CRITICAL INFRASTRUCTURES AND SOCIETY 2012. [DOI: 10.1007/978-3-642-33332-3_12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
28
|
Kaufman ND, Woodley PDP. Self-management support interventions that are clinically linked and technology enabled: can they successfully prevent and treat diabetes? J Diabetes Sci Technol 2011; 5:798-803. [PMID: 21722596 PMCID: PMC3192647 DOI: 10.1177/193229681100500335] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Patients with diabetes need a complex set of services and supports. The challenge of integrating these services into the diabetes regimen can be successfully overcome through self-management support interventions that are clinically linked and technology enabled: self-management support because patients need help mastering the knowledge, attitudes, skills, and behaviors so necessary for good outcomes; interventions because comprehensive theory-based, evidence-proven, long-term, longitudinal interventions work better than direct-to-consumer or nonplanned health promotion approaches; clinically linked because patients are more likely to adopt new behaviors when the approach is in the context of a trusted therapeutic relationship and within an effective medical care system; and technology enabled because capitalizing on the amazing power of information technology leads to the delivery of cost-effective, scalable, engaging solutions that prevent and manage diabetes.
Collapse
|
29
|
Kuo S, Bryce CL, Zgibor JC, Wolf DL, Roberts MS, Smith KJ. Cost-effectiveness of implementing the chronic care model for diabetes care in a military population. J Diabetes Sci Technol 2011; 5:501-13. [PMID: 21722566 PMCID: PMC3192617 DOI: 10.1177/193229681100500305] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Applying the chronic care model (CCM) for diabetes management helps improve health outcomes and patient care. The CCM was implemented at U.S. Air Force Wilford Hall Medical Center through the Diabetes Outreach Clinic (DOC) in 2006, but its cost-effectiveness in this setting is unknown. METHODS We constructed a Markov decision model to estimate DOC cost-effectiveness compared with usual care (UC) over a 20-year period. Based on empirical, post-intervention demographic and clinical data, we applied United Kingdom Prospective Diabetes Study risk equations to predict long-term probabilities of developing microvascular or macrovascular complications. Health care system and societal perspectives were considered, discounting costs and benefits at 3% annually. Intervention costs and outcomes were obtained from military data, while other costs, disease progression data, and utilities were drawn from published literature. RESULTS From a health care system perspective, the DOC cost $45,495 per quality-adjusted life-year (QALY) compared with UC; from a societal perspective, the DOC compared with UC cost $42,051/QALY (when the model started with the uncomplicated diabetes cohort), $61,243/QALY (when starting with the DOC cohort), or $61,813/QALY (when starting with the UC cohort). In one-way sensitivity analyses, results were most sensitive to yearly costs for specialty care visits. In probabilistic sensitivity analysis, the DOC was favored in 51% of model iterations using an acceptability threshold of $50,000/QALY and in 72% at a threshold of $100,000/QALY. CONCLUSIONS The DOC strategy for diabetes care, performed with the CCM methodology in a military population, appears to be economically reasonable compared with UC.
Collapse
Affiliation(s)
- Shihchen Kuo
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
| | | | | | | | | | | |
Collapse
|