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Alfarwan N, Hodkinson A, Panagioti M, Hassan L, Kontopantelis E. Clinical and cost-effectiveness of telemedicine among patients with type 2 diabetes in primary care: A systematic review and meta-analysis. Diabet Med 2024; 41:e15343. [PMID: 38780107 DOI: 10.1111/dme.15343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 04/16/2024] [Accepted: 04/19/2024] [Indexed: 05/25/2024]
Abstract
AIMS Telemedicine has been promoted as an effective way of managing type-2 diabetes (T2DM) in primary care. However, the effectiveness of telemedicine is unclear. We investigated the clinical and cost-effectiveness of different telemedicine interventions for people with T2DM, compared to usual care. METHODS We searched Medline, Embase, Cochrane, CINHAL, ProQuest and EconLit for randomized controlled trials (RCTs) that examined the effectiveness of telemedicine interventions on clinical outcomes (HbA1c, body mass index [BMI], weight, diastolic blood pressure [DBP], systolic blood pressure [SBP], fasting blood glucose, high-density lipoprotein [HDL] cholesterol, low-density lipoprotein [LDL] cholesterol, total cholesterol and triglyceride) in adults with T2DM, published in English from inception until 31 December 2022. Meta-analyses were conducted using random-effects models pooling mean differences, heterogeneity was quantified using the I2 statistic. Publication bias was assessed using funnel plots, Egger tests and trim and fill. Subgroup analyses included type of telemedicine intervention, telemedicine mode of delivery and type of healthcare professionals. This study was registered with PROSPERO, CRD 42022375128. RESULTS Of the 4093 records identified, 21 RCTs, 10,732 participants from seven regions, were included. Reported interventions included telephone (k = 16 studies), internet-based (k = 2), videoconference (k = 2) and telephone and emails (k = 1). We observed no statistically significant differences between synchronous or asynchronous telemedicine interventions compared to usual care for HbA1c (-0.08% (-0.88 mmol/mol); 95% CI: -0.18, 0.02), BMI (0.51 kg/m2; 95% CI: -0.21, 1.22), SBP (-1.48 mmHg; 95% CI: -3.22, 0.26), DBP (3.23 mmHg; 95% CI: -0.89, 7.34), HDL-cholesterol (0.01 mmol/L; 95% CI: -0.03, 0.05), LDL-cholesterol (0.08 mmol/L; 95% CI: -0.22, 0.37), triglycerides (-0.08 mmol/L, 95% CI: -0.31, -0.15), total cholesterol (-0.10 mmol/L; 95% CI: -0.25, 0.04) and weight (-0.50 kg; 95% CI: -1.21, 0.21). CONCLUSIONS Telemedicine was as effective as usual care in improving health outcomes of people with T2DM. They can provide a safe solution in times of rising demands for primary healthcare services, or in extreme events, like a global pandemic. More high-quality RCTs are needed on the cost evaluation of telemedicine.
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Affiliation(s)
- Nawwarah Alfarwan
- Division of Informatics, Imaging & Data Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, School of Health Sciences, University of Manchester, Manchester, UK
| | - Alexander Hodkinson
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, School of Health Sciences, National Institute for Health and Care Research (NIHR) School for Primary Care Research, University of Manchester, Manchester, UK
- Division of Population Health, Health Services Research and Primary Care, National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Maria Panagioti
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, School of Health Sciences, National Institute for Health and Care Research (NIHR) School for Primary Care Research, University of Manchester, Manchester, UK
- Division of Population Health, Health Services Research and Primary Care, National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Lamiece Hassan
- Division of Psychology and Mental Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Evangelos Kontopantelis
- Division of Informatics, Imaging & Data Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, School of Health Sciences, University of Manchester, Manchester, UK
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, School of Health Sciences, National Institute for Health and Care Research (NIHR) School for Primary Care Research, University of Manchester, Manchester, UK
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Zhuang HR, Yu HP, Gu YJ, Li LJ, Yao JL. The Effect of Telemedicine Interventions on Patients with Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Adv Wound Care (New Rochelle) 2024. [PMID: 38618714 DOI: 10.1089/wound.2024.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024] Open
Abstract
Objective: The meta-analysis was performed to evaluate the effectiveness of telemedicine interventions on patients with diabetic foot ulcers (DFU). Approach: The authors conducted a comprehensive search across eight databases. The aim was to identify randomized controlled trials examining the effectiveness of telemedicine for patients with DFU. Methodological qualities of included studies were assessed using Cochrane Handbook for Systematic Reviews of Intervention. Subsequently, a meta-analysis was conducted using RevMan 5.3 to synthesize the findings. Results: Ten studies involving 1,678 patients with DFU were included in the meta-analysis. In comparison to the face-to-face intervention group, telemedicine interventions significantly reduced the amputation rate (risk ratio = 0.64, 95% confidence interval [CI] = 0.44-0.92, p = 0.02), decreased costs (mean difference [MD] = -4158.51, 95% CI = -7304.69 to -1012.34, p = 0.01), better controlled fasting blood glucose (MD = -0.89, 95% CI = -1.43 to -0.36, p = 0.001), and achieved superior glycated hemoglobin control (MD = -0.71, 95% CI = -1.01 to -0.41, p < 0.00001). No significant differences were observed between the telemedicine group and the face-to-face group in terms of healing rate, mortality, and healing time. Innovations: Our study suggests that telemedicine is a viable strategy for managing DFU. Conclusions: The meta-analysis indicates that telemedicine interventions have a positive effect on DFU. Nevertheless, more well-designed and high-quality studies are needed to reach a conclusion with greater confidence.
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Affiliation(s)
- Hui-Ren Zhuang
- Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hai-Ping Yu
- Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ying-Jie Gu
- Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ling-Jun Li
- Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jia-Li Yao
- Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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Tolu-Akinnawo O, Ezekwueme F, Awoyemi T. Telemedicine in Cardiology: Enhancing Access to Care and Improving Patient Outcomes. Cureus 2024; 16:e62852. [PMID: 38912070 PMCID: PMC11192510 DOI: 10.7759/cureus.62852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2024] [Indexed: 06/25/2024] Open
Abstract
Telemedicine has gained significant recognition, particularly since the COVID-19 pandemic. However, its roots date back to its significant role during major epidemic outbreaks such as severe acute respiratory syndrome (SARS), H1N1 and H7N9 influenza, and Middle East respiratory syndrome (MERS), where alternate means of accessing healthcare were adopted to combat the outbreak while limiting the spread of the virus. In Sub-Saharan Africa, telemedicine has supported healthcare delivery, patient and professional health education, disease prevention, and surveillance, starting with its first adoption in Ethiopia in 1980. In the United States, telemedicine has significantly impacted cardiology, particularly at-home monitoring programs, which have proven highly effective for patients with abnormal heart rhythms. Devices such as Holter monitors, blood pressure monitors, and implantable cardioverter-defibrillators have reduced mortality rates and hospital readmissions while improving healthcare efficiency by saving healthcare costs. However, the COVID-19 pandemic accelerated the adoption of telemedicine, as evidenced by a dramatic increase in telemedicine visits at institutions like New York University (NYU) Langone Health during and post-COVID-19 pandemic. In addition, telemedicine has also facilitated cardiac rehabilitation and improved access to specialized cardiology care in rural and underserved areas, reducing disparities in cardiovascular health outcomes. As technology advances, telemedicine is poised to play an increasingly significant role in cardiology and healthcare at large, enhancing patient management, healthcare efficiency, and cost reduction. This review underscores the significance of telemedicine in cardiology, its challenges, and future directions.
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Affiliation(s)
| | - Francis Ezekwueme
- Internal Medicine, University of Pittsburgh Medical Center, Pittsburg, USA
| | - Toluwalase Awoyemi
- Internal Medicine, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, GBR
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Corelhano AR, Hilgenberg-Sydney PB, Bonotto D, Torres-Pereira CC. Telediagnosis as an effective tool for assessment temporomandibular disorders. J Oral Rehabil 2024. [PMID: 38822475 DOI: 10.1111/joor.13760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 02/27/2024] [Accepted: 05/19/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND The use of communication technologies has allowed a substantial improvement in telediagnosis. OBJECTIVES To evaluate the feasibility and diagnostic agreement of synchronous teleconsultation compared to physical standard examination for temporomandibular disorders (TMD) and orofacial pain. METHODS Sixty-one patients (50 women, 11 men) with a mean age of 46.07 years referred to the Orofacial Pain Ambulatory Service (SAMDOF -UFPR) were evaluated remotely. They were then examined in person by another evaluator, blinded for the first evaluation. Data on the experience and level of satisfaction with the teleconsultation were also collected. RESULTS For each type and subtype of TMD, diagnostic agreement values, sensitivity, specificity, positive predictive values and negative predictive values were calculated with a 95% confidence interval. 'Almost perfect' agreement was found for Myalgia (k = 0.915), Arthralgia (k = 0.863), disc displacement without reduction without limited opening (k = 0.955) and no TMD (k = 1.00). 'Substantial' agreement for the subtypes headache attributed to TMD (k = 0.761), disc displacement without reduction with limited opening (k = 0.659) and subluxation (k = 7.82). The diagnoses of local myalgia (k = 0.573), myofascial pain with referral (k = 0.524) and disc displacement with reduction (k = 0.563) obtained 'moderate' agreement. Degenerative joint disease (k = 0.170) and disc displacement with reduction with intermittent locking (k = 0.000) obtained 'weak' and 'no agreement', respectively. More than 90% of the participants were satisfied and reported no discomfort during the assessment, agreeing to participate in another teleconsultation. CONCLUSION Synchronous teleconsultation proved to be feasible and presented adequate diagnostic agreement for the main painful TMDs, especially for the diagnosis of myalgia and arthralgia. This format was also well accepted among patients.
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Affiliation(s)
- Amanda Rossi Corelhano
- Graduate Student, Stomatology Dentistry Department, Federal University of Parana (UFPR), Curitiba, Brazil
| | | | - Daniel Bonotto
- Restorative Dentistry Department, Adjunct Professor, Federal University of Parana (UFPR), Curitiba, Brazil
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Delioğlu K, Unes S, Tuncdemir M, Ozal C, Bıyık KS, Uzumcugil A. Interrater reliability of face-to-face, tele- and video-based assessments with the modified Mallet classification in brachial plexus birth injuries. J Hand Surg Eur Vol 2024; 49:576-582. [PMID: 37684022 DOI: 10.1177/17531934231196118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
The modified Mallet classification is widely used to measure motor function in brachial plexus birth injuries. The aim of the study was to investigate agreement and reliability of this classification under three different evaluation conditions: face-to-face; live tele-assessment; and delayed video-based assessment. A total of 100 children aged 4-15 years were included. Children were assessed by two raters except for live tele-assessment, which was performed by four raters. Agreement between the three different assessment conditions for the same rater were between strong and excellent for both raters 1 and 2. The interrater reliability for raters 1 and 2 under different assessment conditions was strong to excellent. Interrater reliability among the four raters was moderate to strong in tele-assessment. The modified Mallet classification may have appropriate reliability to be used in remote medical follow-up.Level of evidence: III.
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Affiliation(s)
- Kıvanç Delioğlu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Sefa Unes
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Merve Tuncdemir
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Cemil Ozal
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Kubra Seyhan Bıyık
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Akin Uzumcugil
- Department of Orthopedics and Traumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Furness K, Huggins CE, Hanna L, Croagh D, Sarkies M, Haines TP. Comparison of Goal Achievement during an Early, Intensive Nutrition Intervention Delivered to People with Upper Gastrointestinal Cancer by Telephone Compared with Mobile Application. Int J Telemed Appl 2024; 2024:7841826. [PMID: 38567030 PMCID: PMC10987247 DOI: 10.1155/2024/7841826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/09/2024] [Accepted: 03/06/2024] [Indexed: 04/04/2024] Open
Abstract
Objective This study is aimed at exploring whether the mode of nutrition intervention delivery affected participant goal achievement in a three-arm randomised controlled trial of early and intensive nutrition intervention delivered to upper gastrointestinal cancer patients. Methods Newly diagnosed upper gastrointestinal cancer patients were recruited from four tertiary hospitals in Melbourne, Australia. Participants in the intervention groups received a regular nutrition intervention for 18 weeks from an experienced dietitian via telephone or mobile application (app) using behaviour change techniques to assist in goal achievement. Univariate and multiple regression models using STATA determined goal achievement, dose, and frequency of contact between groups. A p value <0.05 was considered statistically significant. Results The telephone group (n = 38) had 1.99 times greater frequency of contact with the research dietitian (95% CI: 1.67 to 2.36, p < 0.001) and 2.37 times higher frequency of goal achievement (95% CI: 1.1 to 5.11, p = 0.03) compared with the mobile app group (n = 36). The higher dose (RR 0.03) of intervention and more behaviour change techniques employed in the telephone group compared with the mobile app group increased participant goal achievement (95% CI: 0.01 to 0.04, p < 0.001). Discussion. Telephone nutrition intervention delivery led to a higher frequency of goal achievement compared to the mobile app intervention. There was also a higher number of behaviour change techniques employed which may have facilitated the greater goal achievement. Mobile app-based delivery may have poorer acceptance in this population with high levels of withdrawal. Practice Implications. We need to ensure that specifically designed technologies for our target populations are fit for purpose, efficacious, and acceptable to both patients and healthcare providers. This trial is registered with ACTRN12617000152325.
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Affiliation(s)
- Kate Furness
- Nutrition and Dietetics, Monash Health, Monash Medical Centre, Clayton, Victoria 3168, Australia
- Dietetics, Department of Nursing and Allied Health, Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria 3199, Australia
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria 3199, Australia
| | - Catherine E. Huggins
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria 3168, Australia
| | - Lauren Hanna
- Nutrition and Dietetics, Monash Health, Monash Medical Centre, Clayton, Victoria 3168, Australia
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria 3168, Australia
| | - Daniel Croagh
- Upper Gastrointestinal and Hepatobiliary Surgery, Monash Medical Centre, Clayton, Victoria 3168, Australia
- Department of Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria 3168, Australia
| | - Mitchell Sarkies
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Terry P. Haines
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria 3199, Australia
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria 3199, Australia
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Rosenberg L, Rigney G, Jemcov A, van Voorst D, Corkum P. Usability of an eHealth sleep education intervention for university students. Digit Health 2024; 10:20552076241260480. [PMID: 38846369 PMCID: PMC11155311 DOI: 10.1177/20552076241260480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 06/09/2024] Open
Abstract
Background It has been estimated that more than one-third of university students suffer from insomnia. Few accessible eHealth sleep education programmes exist for university students and of the ones that do exist, fewer were developed using a user-centred approach, which allows for student input to be systematically collected and utilized to provide students with a programme that they consider to be easy to use and implement and to be effective. Better Nights, Better Days-Youth (BNBD-Youth) is a four-session eHealth sleep education programme designed for youth but previously only evaluated in younger adolescents (ages 14-18 years). Aims The purpose of this study is to evaluate the usability of the BNBD-Youth programme with university students using Morville's User Experience Honeycomb framework to determine if this programme would meet the needs of university students and if so what modifications would be needed. Methods Canadian undergraduate students (n = 46) completed the BNBD-Youth programme. Students completed online usability questionnaires based on the seven dimensions of Morville's User Experience Honeycomb (i.e. useful, usable, valuable, credible, desirable, accessible and findable) after each session and after completion of the programme. Open- and closed-ended questions were used to obtain both quantitative and qualitative responses. Results Average quantitative ratings were positive across user experience dimensions, ranging from 3.43 to 4.46 (out of 5). Qualitative responses indicated overall positive experiences with the programme. The only constructive feedback that met the criteria for revising the programme was to include more interactive features in Session 4. Conclusions This study demonstrates that university students found BNBD-Youth to be a usable programme for older youth. Demonstrating usability is an essential step in developing a programme with a user-centred design that university students will want to use in the future. Once the BNBD-Youth programme is revised to create the BNBD-University (BNBD-Uni) programme, additional usability and effectiveness testing will be conducted.
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Affiliation(s)
- Lindsay Rosenberg
- Department of Psychology & Neuroscience, Faculty of Science, Dalhousie University, Halifax, NS, Canada
| | - Gabrielle Rigney
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Adelaide, South Australia, Australia
| | - Anastasija Jemcov
- Department of Psychology & Neuroscience, Faculty of Science, Dalhousie University, Halifax, NS, Canada
| | - Derek van Voorst
- Department of Psychology & Neuroscience, Faculty of Science, Dalhousie University, Halifax, NS, Canada
| | - Penny Corkum
- Department of Psychology & Neuroscience, Faculty of Science, Dalhousie University, Halifax, NS, Canada
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Department of Pediatrics, IWK Health Centre, Halifax, NS, Canada
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Culmer N, Smith TB, Stager C, Wright A, Fickel A, Tan J, Clark C(T, Meyer H, Grimm K. Asynchronous Telemedicine: A Systematic Literature Review. TELEMEDICINE REPORTS 2023; 4:366-386. [PMID: 38143795 PMCID: PMC10739789 DOI: 10.1089/tmr.2023.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/26/2023]
Abstract
Background Asynchronous telemedicine (ATM), which describes telemedical interaction between a patient and provider where neither party communicates simultaneously, is an important telemedicine modality that is seeing increased use. In this article, we summarize the published peer-reviewed literature specifically related to ATM to (1) identify terms or phrases that are used to describe ATM, (2) ascertain how this research has thus far addressed the various aspects of the quadruple aim of medicine, and (3) assess the methodological rigor of research on ATM. We also divided the literature into pre- and post-COVID-19 onset periods to identify potential variations in the literature between these two periods. Methods This systematic literature review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The literature search, utilizing multiple databases and applying inclusion and exclusion criteria, initially produced 2624 abstracts for review. De-duplication and screening ultimately yielded 104 articles for data extraction. Results "Store-and-forward" and variations of "e-visit" were the most frequently used alternative terms for ATM. Care quality was the most frequently addressed aspect of the Quadruple Aim of Medicine-more than double any other category-followed by patient satisfaction. We separated cost of care into two categories: patients' cost of care and providers' cost to provide care. Patient cost of care was the third most addressed aspect of the Quadruple Aim of Medicine followed by provider well-being and provider's cost to provide care. Methodological rigor of the studies was also addressed, with only 2 quantitative studies ranked "Strong," 5 ranked "Moderate," and 97 ranked "Weak." Qualitative studies were generally acceptable but struggled methodologically with accounting for all participants and articulation of results. Conclusions Although "store-and-forward" is somewhat more frequently used in the studies included in this review, variants of "e-visit," are growing in recent usage. Given the relative newness of modality, it is not surprising that quality of care is the most researched aspect of the Quadruple Aim of Medicine in ATM research. We anticipate more balance between these areas as research in this field matures. Primary areas of research need currently relate to practitioners-specifically their costs of providing care and well-being. Finally, future ATM research needs to address research challenges of selection bias and blinding in quantitative studies and improved participant tracking and articulation of both study design and results in qualitative studies.
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Affiliation(s)
- Nathan Culmer
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Todd Brenton Smith
- Capstone College of Nursing, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Catanya Stager
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Andrea Wright
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
| | | | - Jet Tan
- The University of Alabama, Tuscaloosa, Alabama, USA
| | | | - Hannah Meyer
- The University of Alabama, Tuscaloosa, Alabama, USA
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Rodríguez-Molinero A, Carot-Sans G, Escrig R, Tebé C, Arce J, Pérez-López C, Ballesta S, Verdejo G, Cedeño Á, Riera-Pagespetit M, Vivas-Angeles S, Alarcon JL, Navarro I, Toro S, Mateo L, Torres AJ, Delmás G, Camell H, Chamero A, Gasol M, Piera-Jiménez J. Study protocol of a randomized controlled trial to assess safety of teleconsultation compared with face-to-face consultation: the ECASeT study. Trials 2023; 24:797. [PMID: 38066614 PMCID: PMC10704815 DOI: 10.1186/s13063-023-07679-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/27/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The use of remote consultation modalities has exponentially grown in the past few years, particularly since the onset of the COVID-19 pandemic. Although a huge body of the literature has described the use of phone (tele) and video consultations, very few of the studies correspond to randomized controlled trials, and none of them has assessed the safety of these consultation modalities as the primary objective. The primary objective of this trial was to assess the safety of remote consultations (both video and teleconsultation) in the follow-up of patients in the hospital setting. METHODS Multicenter, randomized controlled trial being conducted in four centers of an administrative healthcare area in Catalonia (North-East Spain). Participants will be screened from all individuals, irrespective of age and sex, who require follow-up in outpatient consultations of any of the departments involved in the study. Eligibility criteria have been established based on the local guidelines for screening patients for remote consultation. Participants will be randomly allocated into one of the two study arms: conventional face-to-face consultation (control) and remote consultation, either teleconsultation or video consultation (intervention). Routine follow-up visits will be scheduled at a frequency determined by the physician based on the diagnostic and therapy of the baseline disease (the one triggering enrollment). The primary outcome will be the number of adverse reactions and complications related to the baseline disease. Secondary outcomes will include non-scheduled visits and hospitalizations, as well as usability features of remote consultations. All data will either be recorded in an electronic clinical report form or retrieved from local electronic health records. Based on the complications and adverse reaction rates reported in the literature, we established a target sample size of 1068 participants per arm. Recruitment started in May 2022 and is expected to end in May 2024. DISCUSSION The scarcity of precedents on the assessment of remote consultation modalities using randomized controlled designs challenges making design decisions, including recruitment, selection criteria, and outcome definition, which are discussed in the manuscript. TRIAL REGISTRATION NCT05094180. The items of the WHO checklist for trial registration are available in Additional file 1. Registered on 24 November 2021.
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Affiliation(s)
- Alejandro Rodríguez-Molinero
- Àrea de Recerca, Consorci Sanitari de L'Alt Penedès I GarrafEspirall, Vilafranca del Penedès, 61 08720, Barcelona, Spain.
| | - Gerard Carot-Sans
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), IDIBELL, Barcelona, Spain
| | - Roser Escrig
- Digitalization for the Sustainability of the Healthcare System (DS3), IDIBELL, Barcelona, Spain
| | - Cristian Tebé
- Biostatistics Unit of the Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jacobo Arce
- Urology Department, Consorci Sanitari de L'Alt Penedès I Garraf, Vilafranca del Penedès, Barcelona, Spain
| | - Carlos Pérez-López
- Àrea de Recerca, Consorci Sanitari de L'Alt Penedès I GarrafEspirall, Vilafranca del Penedès, 61 08720, Barcelona, Spain
| | - Silvia Ballesta
- Endocrinology Department, Consorci Sanitari de L'Alt Penedès I Garraf, Vilafranca del Penedès, Barcelona, Spain
| | - Guillermo Verdejo
- Department of Internal Medicine, Consorci Sanitari de L'Alt Penedès I Garraf, Vilafranca del Penedès, Barcelona, Spain
| | - Ángel Cedeño
- Gastroenterology Department, Consorci Sanitari de L'Alt Penedès I Garraf, Vilafranca del Penedès, Barcelona, Spain
| | - Mar Riera-Pagespetit
- Geriatrics Department, Consorci Sanitari de L'Alt Penedès I Garraf, Vilafranca del Penedès, Barcelona, Spain
| | - Sofia Vivas-Angeles
- Department of Surgery, Consorci Sanitari de L'Alt Penedès I Garraf, Vilafranca del Penedès, Barcelona, Spain
| | - Jose L Alarcon
- Department of Surgery, Consorci Sanitari de L'Alt Penedès I Garraf, Vilafranca del Penedès, Barcelona, Spain
| | - Itziar Navarro
- Nefrology Department, Consorci Sanitari de L'Alt Penedès I Garraf, Vilafranca del Penedès, Barcelona, Spain
| | - Silvia Toro
- Endocrinology Department, Consorci Sanitari de L'Alt Penedès I Garraf, Vilafranca del Penedès, Barcelona, Spain
| | - Llorenç Mateo
- Musculoskeletal Area, Consorci Sanitari de L'Alt Penedès I Garraf, Vilafranca del Penedès, Barcelona, Spain
| | - Ana J Torres
- Maternal-Child Area, Consorci Sanitari de L'Alt Penedès I Garraf, Vilafranca del Penedès, Barcelona, Spain
| | - Gerard Delmás
- Innovation Department, Consorci Sanitari de L'Alt Penedès I Garraf, Vilafranca del Penedès, Barcelona, Spain
| | - Helena Camell
- Department of Internal Medicine, Consorci Sanitari de L'Alt Penedès I Garraf, Vilafranca del Penedès, Barcelona, Spain
| | - Antonio Chamero
- Anesthesiology Department, Consorci Sanitari de L'Alt Penedès I Garraf, Vilafranca del Penedès, Barcelona, Spain
| | - Montse Gasol
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), IDIBELL, Barcelona, Spain
- Department of Pharmacology, Therapeutics, and Toxicology, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Jordi Piera-Jiménez
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), IDIBELL, Barcelona, Spain
- Faculty of Informatics, Telecommunications and Multimedia, Universitat Oberta de Catalunya, Barcelona, Spain
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10
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Ramachandran M, Brinton C, Wiljer D, Upshur R, Gray CS. The impact of eHealth on relationships and trust in primary care: a review of reviews. BMC PRIMARY CARE 2023; 24:228. [PMID: 37919688 PMCID: PMC10623772 DOI: 10.1186/s12875-023-02176-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 10/11/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Given the increasing integration of digital health technologies in team-based primary care, this review aimed at understanding the impact of eHealth on patient-provider and provider-provider relationships. METHODS A review of reviews was conducted on three databases to identify papers published in English from 2008 onwards. The impact of different types of eHealth on relationships and trust and the factors influencing the impact were thematically analyzed. RESULTS A total of 79 reviews were included. Patient-provider relationships were discussed more frequently as compared to provider-provider relationships. Communication systems like telemedicine were the most discussed type of technology. eHealth was found to have both positive and negative impacts on relationships and/or trust. This impact was influenced by a range of patient-related, provider-related, technology-related, and organizational factors, such as patient sociodemographics, provider communication skills, technology design, and organizational technology implementation, respectively. CONCLUSIONS Recommendations are provided for effective and equitable technology selection, application, and training to optimize the impact of eHealth on relationships and trust. The review findings can inform providers' and policymakers' decision-making around the use of eHealth in primary care delivery to facilitate relationship-building.
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Affiliation(s)
- Meena Ramachandran
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada.
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, QC, H3G 1Y5, Canada.
| | - Christopher Brinton
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
- Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - David Wiljer
- Education Technology Innovation, University Health Network, 190 Elizabeth St, Toronto, ON, M5G 2C4, Canada
- Department of Psychiatry, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
- Centre for Addiction and Mental Health, 1000 Queen St W, Toronto, ON, M6J 1H4, Canada
| | - Ross Upshur
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
| | - Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
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11
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Snoswell CL, Chelberg G, De Guzman KR, Haydon HH, Thomas EE, Caffery LJ, Smith AC. The clinical effectiveness of telehealth: A systematic review of meta-analyses from 2010 to 2019. J Telemed Telecare 2023; 29:669-684. [PMID: 34184580 DOI: 10.1177/1357633x211022907] [Citation(s) in RCA: 136] [Impact Index Per Article: 136.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION To promote telehealth implementation and uptake, it is important to assess overall clinical effectiveness to ensure any changes will not adversely affect patient outcomes. The last systematic literature review examining telehealth effectiveness was conducted in 2010. Given the increasing use of telehealth and technological developments in the field, a more contemporary review has been carried out. The aim of this review was to synthesise recent evidence associated with the clinical effectiveness of telehealth services. METHODS A systematic search of 'Pretty Darn Quick'-Evidence portal was carried out in November 2020 for systematic reviews on telehealth, where the primary outcome measure reported was clinical effectiveness. Due to the volume of telehealth articles, only systematic reviews with meta-analyses published between 2010 and 2019 were included in the analysis. RESULTS We found 38 meta-analyses, covering 10 medical disciplines: cardiovascular disease (n = 3), dermatology (n = 1), endocrinology (n = 13), neurology (n = 4), nephrology (n = 2), obstetrics (n = 1), ophthalmology (n = 1), psychiatry and psychology (n = 7), pulmonary (n = 4) and multidisciplinary care (n = 2). The evidence showed that for all disciplines, telehealth across a range of modalities was as effective, if not more, than usual care. DISCUSSION This review demonstrates that telehealth can be equivalent or more clinically effective when compared to usual care. However, the available evidence is very discipline specific, which highlights the need for more clinical effectiveness studies involving telehealth across a wider spectrum of clinical health services. The findings from this review support the view that in the right context, telehealth will not compromise the effectiveness of clinical care when compared with conventional forms of health service delivery.
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Affiliation(s)
- Centaine L Snoswell
- Centre for Online Health, The University of Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Australia
| | - Georgina Chelberg
- Centre for Online Health, The University of Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Australia
- Australian eHealth Research Centre, Commonwealth Scientific and Industrial Research Organisation, Australia
| | - Keshia R De Guzman
- Centre for Online Health, The University of Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Australia
| | - Helen H Haydon
- Centre for Online Health, The University of Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Australia
| | - Emma E Thomas
- Centre for Online Health, The University of Queensland, Australia
| | - Liam J Caffery
- Centre for Online Health, The University of Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Australia
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Australia
- University of Southern Denmark, Denmark
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12
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An Q, Kelley MM, Hanners A, Yen PY. Sustainable Development for Mobile Health Apps Using the Human-Centered Design Process. JMIR Form Res 2023; 7:e45694. [PMID: 37624639 PMCID: PMC10492175 DOI: 10.2196/45694] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/31/2023] [Accepted: 06/28/2023] [Indexed: 08/26/2023] Open
Abstract
Well-documented scientific evidence indicates that mobile health (mHealth) apps can improve the quality of life, relieve symptoms, and restore health for patients. In addition to improving patients' health outcomes, mHealth apps reduce health care use and the cost burdens associated with disease management. Currently, patients and health care providers have a wide variety of choices among commercially available mHealth apps. However, due to the high resource costs and low user adoption of mHealth apps, the cost-benefit relationship remains controversial. When compared to traditional expert-driven approaches, applying human-centered design (HCD) may result in more useable, acceptable, and effective mHealth apps. In this paper, we summarize current HCD practices in mHealth development studies and make recommendations to improve the sustainability of mHealth. These recommendations include consideration of factors regarding culture norms, iterative evaluations on HCD practice, use of novelty in mHealth app, and consideration of privacy and reliability across the entire HCD process. Additionally, we suggest a sociotechnical lens toward HCD practices to promote the sustainability of mHealth apps. Future research should consider standardizing the HCD practice to help mHealth researchers and developers avoid barriers associated with inadequate HCD practices.
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Affiliation(s)
- Qingfan An
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Marjorie M Kelley
- College of Nursing, The Ohio State University, Columbus, OH, United States
| | - Audra Hanners
- College of Nursing, The Ohio State University, Columbus, OH, United States
| | - Po-Yin Yen
- Institute for Informatics, Washington University School of Medicine in St Louis, St Louis, MO, United States
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13
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POLAT TERECE S, YAPAR D, ERTOY KARAGÖL Hİ, KÖKEN G, TEKER DÜZTAŞ D, EĞRİTAŞ GÜRKAN Ö, SARI S, DALGIÇ B, BAKIRTAŞ A. Is the Pediatric Eosinophilic Esophagitis Symptom Score v2.0 reliable for telemedicine? Turk J Med Sci 2023; 53:859-864. [PMID: 38031952 PMCID: PMC10760582 DOI: 10.55730/1300-0144.5649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 08/18/2023] [Accepted: 05/25/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease. Telemedicine is a healthcare technology used when a patient is separated by distance. The reliability of the Pediatric Eosinophilic Esophagitis Symptom Score, version 2.0 (PEESS v2.0) for telemedicine applications, has not been studied yet. Therefore, we aimed to evaluate the reliability of PEESS v2.0 for telemedicine. METHODS We sent a telesurvey using questionnaires via electronic telecommunication as the telemedicine method. Children with EoE and their parents were asked to complete PEESS v2.0 with the telesurvey method (unsynchronized with the physician) and attend in-person visits one week apart. Intraclass correlation (ICC), Wilcoxon, and Bland-Altman tests were used as reliability analyses. Reliability was defined as a strong agreement between the measurements in ICC ≥ 0.8 and a p-value of ≤0.05 and no statistically significant difference between the scores of the two methods in the Wilcoxon and Bland-Altman analyses, i.e. a p-value of >0.05. RESULTS The total scores of children and parents were higher in in-person visits than in the telesurvey (Wilcoxon tests, p ≤ 0.05). Bland- Altman analysis showed that the mean difference in total scores between the two methods was significant for both children and parents (p ≤ 0.05). ICC levels for the children and parent scores for the entire group ranged from 0.595 to 0.763 (moderate agreement). DISCUSSION Unsynchronized telesurvey use of PEESS v2.0 is unreliable both for children and parents. We suggest testing the reliability of chosen telemedicine methods before using them in clinical and research practice.
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Affiliation(s)
- Sinem POLAT TERECE
- Division of Pediatric Allergy, Department of Pediatrics, Faculty of Medicine, Gazi University, Ankara,
Turkiye
| | - Dilek YAPAR
- Muratpaşa District Health Directorate, Antalya,
Turkiye
| | - Hacer İlbilge ERTOY KARAGÖL
- Division of Pediatric Allergy, Department of Pediatrics, Faculty of Medicine, Gazi University, Ankara,
Turkiye
| | - Gizem KÖKEN
- Division of Pediatric Allergy, Department of Pediatrics, Faculty of Medicine, Gazi University, Ankara,
Turkiye
| | - Demet TEKER DÜZTAŞ
- Division of Pediatric Gastroenterology, Department of Pediatrics, Faculty of Medicine, Gazi University, Ankara,
Turkiye
| | - Ödül EĞRİTAŞ GÜRKAN
- Division of Pediatric Gastroenterology, Department of Pediatrics, Faculty of Medicine, Gazi University, Ankara,
Turkiye
| | - Sinan SARI
- Division of Pediatric Gastroenterology, Department of Pediatrics, Faculty of Medicine, Gazi University, Ankara,
Turkiye
| | - Buket DALGIÇ
- Division of Pediatric Gastroenterology, Department of Pediatrics, Faculty of Medicine, Gazi University, Ankara,
Turkiye
| | - Arzu BAKIRTAŞ
- Division of Pediatric Allergy, Department of Pediatrics, Faculty of Medicine, Gazi University, Ankara,
Turkiye
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14
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An Q, Sandlund M, Agnello D, McCaffrey L, Chastin S, Helleday R, Wadell K. A scoping review of co-creation practice in the development of non-pharmacological interventions for people with Chronic Obstructive Pulmonary Disease: A health CASCADE study. Respir Med 2023; 211:107193. [PMID: 36889517 DOI: 10.1016/j.rmed.2023.107193] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/28/2023] [Accepted: 03/04/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Incorporating co-creation processes may improve the quality of outcome interventions. However, there is a lack of synthesis of co-creation practices in the development of Non-Pharmacological Interventions (NPIs) for people with Chronic Obstructive Pulmonary Disease (COPD), that could inform future co-creation practice and research for rigorously improving the quality of care. OBJECTIVE This scoping review aimed to examine the co-creation practice used when developing NPIs for people with COPD. METHODS This review followed Arksey and O'Malley scoping review framework and was reported according to the PRISMA-ScR framework. The search included PubMed, Scopus, CINAHL, and Web of Science Core Collection. Studies reporting on the process and/or analysis of applying co-creation practice in developing NPIs for people with COPD were included. RESULTS 13 articles complied with the inclusion criteria. Limited creative methods were reported in the studies. Facilitators described in the co-creation practices included administrative preparations, diversity of stakeholders, cultural considerations, employment of creative methods, creation of an appreciative environment, and digital assistance. Challenges around the physical limitations of patients, the absence of key stakeholder opinions, a prolonged process, recruitment, and digital illiteracy of co-creators were listed. Most of the studies did not report including implementation considerations as a discussion point in their co-creation workshops. CONCLUSION Evidence-based co-creation in COPD care is critical for guiding future practice and improving the quality of care delivered by NPIs. This review provides evidence for improving systematic and reproducible co-creation. Future research should focus on systematically planning, conducting, evaluating, and reporting co-creation practices in COPD care.
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Affiliation(s)
- Qingfan An
- Department of Community Medicine and Rehabilitation, Umeå University, Sweden.
| | - Marlene Sandlund
- Department of Community Medicine and Rehabilitation, Umeå University, Sweden
| | - Danielle Agnello
- School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Lauren McCaffrey
- School of Health and Life Sciences, Glasgow Caledonian University, UK
| | - Sebastien Chastin
- School of Health and Life Sciences, Glasgow Caledonian University, UK; Department of Movement and Sports Sciences, Ghent University, 9000, Ghent, Belgium
| | - Ragnberth Helleday
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Karin Wadell
- Department of Community Medicine and Rehabilitation, Umeå University, Sweden
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15
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Moschonis G, Siopis G, Jung J, Eweka E, Willems R, Kwasnicka D, Asare BYA, Kodithuwakku V, Verhaeghe N, Vedanthan R, Annemans L, Oldenburg B, Manios Y. Effectiveness, reach, uptake, and feasibility of digital health interventions for adults with type 2 diabetes: a systematic review and meta-analysis of randomised controlled trials. Lancet Digit Health 2023; 5:e125-e143. [PMID: 36828606 DOI: 10.1016/s2589-7500(22)00233-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 02/24/2023]
Abstract
BACKGROUND Digital health interventions have shown promising results for the management of type 2 diabetes, but a comparison of the effectiveness and implementation of the different modes is not currently available. Therefore, this study aimed to compare the effectiveness of SMS, smartphone application, and website-based interventions on improving glycaemia in adults with type 2 diabetes and report on their reach, uptake, and feasibility. METHODS In this systematic review and meta-analysis, we searched CINAHL, Cochrane Central, Embase, MEDLINE, and PsycInfo on May 25, 2022, for randomised controlled trials (RCTs) that examined the effectiveness of digital health interventions in reducing glycated haemoglobin A1c (HbA1c) in adults with type 2 diabetes, published in English from Jan 1, 2009. Screening was carried out using Covidence, and data were extracted following Cochrane's guidelines. The primary endpoint assessed was the change in the mean (and 95% CI) plasma concentration of HbA1c at 3 months or more. Cochrane risk of bias 2 was used to assess risk of bias. Data on reach, uptake, and feasibility were summarised narratively and data on HbA1c reduction were synthesised in a meta-analysis. Grading of Recommendations, Assessment, Development, and Evaluation criteria was used to evaluate the level of evidence. The study was registered with PROSPERO, CRD42021247845. FINDINGS Of the 3236 records identified, 56 RCTs from 24 regions (n=11 486 participants), were included in the narrative synthesis, and 26 studies (n=4546 participants) in the meta-analysis. 20 studies used SMS as the primary mode of delivery of the digital health intervention, 25 used smartphone applications, and 11 implemented interventions via websites. Smartphone application interventions reported higher reach compared with SMS and website-based interventions, but website-based interventions reported higher uptake compared with SMS and smartphone application interventions. Effective interventions, in general, included people with greater severity of their condition at baseline (ie, higher HbA1c) and administration of a higher dose intensity of the intervention, such as more frequent use of smartphone applications. Overall, digital health intervention group participants had a -0·30 (95% CI -0·42 to -0·19) percentage point greater reduction in HbA1c, compared with control group participants. The difference in HbA1c reduction between groups was statistically significant when interventions were delivered through smartphone applications (-0·42% [-0·63 to -0·20]) and via SMS (-0·37% [-0·57 to -0·17]), but not when delivered via websites (-0·09% [-0·64 to 0·46]). Due to the considerable heterogeneity between included studies, the level of evidence was moderate overall. INTERPRETATION Smartphone application and SMS interventions, but not website-based interventions, were associated with better glycaemic control. However, the studies' heterogeneity should be recognised. Considering that both smartphone application and SMS interventions are effective for diabetes management, clinicians should consider factors such as reach, uptake, patient preference, and context of the intervention when deciding on the mode of delivery of the intervention. Nine in ten people worldwide own a feature phone and can receive SMS and four in five people have access to a smartphone, with numerous smartphone applications being available for diabetes management. Clinicians should familiarise themselves with this modality of programme delivery and encourage people with type 2 diabetes to use evidence-based applications for improving their self-management of diabetes. Future research needs to describe in detail the mediators and moderators of the effectiveness and implementation of SMS and smartphone application interventions, such as the optimal dose, frequency, timing, user interface, and communication mode to both further improve their effectiveness and to increase their reach, uptake, and feasibility. FUNDING EU's Horizon 2020 Research and Innovation Programme.
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Affiliation(s)
- George Moschonis
- Department of Food, Nutrition and Dietetics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia.
| | - George Siopis
- Department of Food, Nutrition and Dietetics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia; Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia.
| | - Jenny Jung
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Evette Eweka
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Ruben Willems
- Department of Public Health and Primary Care, Faculty of Medicine, Ghent University, Ghent, Belgium
| | - Dominika Kwasnicka
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | | | - Vimarsha Kodithuwakku
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Nick Verhaeghe
- Department of Public Health and Primary Care, Faculty of Medicine, Ghent University, Ghent, Belgium; Research Institute for Work and Society, HIVA KU Leuven, Leuven, Belgium
| | - Rajesh Vedanthan
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Lieven Annemans
- Department of Public Health and Primary Care, Faculty of Medicine, Ghent University, Ghent, Belgium
| | - Brian Oldenburg
- Academic and Research Collaborative in Health, La Trobe University, Melbourne, VIC, Australia; NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece; Institute of Agri-food and Life Sciences, Hellenic Mediterranean University Research Centre, Heraklion, Greece
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16
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Zhang J, Ji X, Xie J, Lin K, Yao M, Chi C. Effectiveness of synchronous teleconsultation for patients with type 2 diabetes mellitus: a systematic review and meta-analysis. BMJ Open Diabetes Res Care 2023; 11:11/1/e003180. [PMID: 36822665 PMCID: PMC9950897 DOI: 10.1136/bmjdrc-2022-003180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/21/2023] [Indexed: 02/25/2023] Open
Abstract
The popularity of teleconsultation during the COVID-19 pandemic enabled increased accessibility for individuals with type 2 diabetes mellitus (T2DM). However, previous studies did not distinguish between synchronous and asynchronous teleconsultation. We evaluated the effectiveness of synchronous teleconsultation for patients with T2DM. We searched Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Library and Cochrane Database of Systematic Reviews, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform databases from inception to July 2021. All included studies were randomized controlled trials of synchronous teleconsultation for adults with T2DM compared with usual care. Reviewers independently extracted data and used the Cochrane tool to evaluate risk of bias. Meta-analyses were conducted using random-effects models. A pooled mean difference for both HbA1c (%) and body mass index (BMI) (kg/m2), systolic blood pressure (SBP) (mm Hg), diastolic blood pressure (DBP) (mm Hg), and low density lipoprotein cholesterol (LDL-cholesterol) (mg/dL) were calculated. Patient-reported outcomes, such as depression, medication adherence, and quality of life, were also assessed. A total of 9807 abstracts were identified and 27 trials were included. Synchronous teleconsultation significantly resulted in greater decrease in HbA1c compared with usual care group (n=8746, 0.35, 95% CI 0.20 to 0.49, I2=73%, p<0.001). No significant effects on BMI (n=699, 0.08 kg/m2, 95% CI -0.54 to 0.69), SBP (n=5512, 1.32 mm Hg, 95% CI -0.09 to 2.73), DBP (n=2898, 0.17 mm Hg, 95% CI -1.18 to 1.52), or LDL-cholesterol (n=5276, 3.21 mg/dL, 95% CI -1.75 to 8.17) were found. The effect of teleconsultation in improving patient-reported outcomes was uncertain. Thus, synchronous teleconsultation could be an alternative to usual care. Systematic review registration is PROSPERO CRD42021267019.
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Affiliation(s)
- Jianxin Zhang
- General Practice Department, Peking University First Hospital, Beijing, China
| | - Xinxin Ji
- Family Medicine Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Jieying Xie
- Emergency department, Nanfang Hospital Southern Medical University, Guangzhou, Guangdong, China
| | - Kai Lin
- Family Medicine Center, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Mi Yao
- General Practice Department, Peking University First Hospital, Beijing, China
| | - Chunhua Chi
- General Practice Department, Peking University First Hospital, Beijing, China
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17
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Mizokami-Stout K, Presseau J, Booth GL, Lipscombe LL, Perkins I, Perkins BA, Shulman R, Lakhanpal G, Ivers N. Implementation Plan for a High-Frequency, Low-Touch Care Model at Specialized Type 1 Diabetes Clinics: Model Development. JMIR Diabetes 2022; 7:e37715. [PMID: 36480257 PMCID: PMC9782362 DOI: 10.2196/37715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 08/05/2022] [Accepted: 09/01/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Individuals with type 1 diabetes (T1D) are more likely to achieve optimal glycemic management when they have frequent visits with their health care team. There is a potential benefit of frequent, telemedicine interventions as an effective strategy to lower hemoglobin A1c (HbA1c). OBJECTIVE The objective is this study was to understand the provider- and system-level factors affecting the successful implementation of a virtual care intervention in type 1 diabetes (T1D) clinics. METHODS Semistructured interviews were conducted with managers and certified diabetes educators (CDEs) at diabetes clinics across Southern Ontario before the COVID-19 pandemic. Deductive analysis was carried out using the Theoretical Domains Framework, followed by mapping to behavior change techniques to inform potential implementation strategies for high-frequency virtual care for T1D. RESULTS There was considerable intention to deliver high-frequency virtual care to patients with T1D. Participants believed that this model of care could lead to improved patient outcomes and engagement but would likely increase the workload of CDEs. Some felt there were insufficient resources at their site to enable them to participate in the program. Member checking conducted during the pandemic revealed that clinics and staff had already developed strategies to overcome resource barriers to the adoption of virtual care during the pandemic. CONCLUSIONS Existing enablers for high-frequency virtual care for T1D can be leveraged, and barriers can be overcome with targeted clinical incentives and support.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Noah Ivers
- Women's College Hospital, Toronto, ON, Canada
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18
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Kelly M, Fullen B, Martin D, Bradley C, O'Mahony B, McVeigh JG. Design and development of an eHealth intervention to support self-Management in people with musculoskeletal Disorders - ‘eHealth: It’s TIME’: a study protocol. HRB Open Res 2022. [DOI: 10.12688/hrbopenres.13611.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Musculoskeletal disorders (MSDs) are a leading cause of global morbidity, with the burden expected to increase in the near future. Self-management, with the support of healthcare professionals, is recommended for many MSDs. However, frequent clinical contact is not feasible. Previous research has highlighted the need for a co-designed eHealth-mediated self-management follow-up support intervention which integrates remote monitoring and behavioural change. Thus, the current study aims to develop and design a user-centred, eHealth-mediated self-management support prototype for people with MSDs. Methods: A three-step, iterative system development cycle will be utilised to develop and design the “eHealth: It’s TIME prototype”. The three-step process will include creating website features and content using two sequential focus groups with people with MSDs (n = 6 – 8); heuristic testing using the 10 heuristic principles of Nielsen (n = 5); and usability testing through in-person 60-minute interviews with people with MSDs (n = 3 – 5) and musculoskeletal physiotherapists (n = 3 – 5). Conclusion: The eHealth: It’s TIME prototype will be a systematically developed, follow-up self-management support intervention guided by behavioural change theory and the preferences of end users.
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19
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Muacevic A, Adler JR. Effectiveness of Telemedicine for the Management of Foot Ulcers in People With Diabetes: A Meta-Analysis. Cureus 2022; 14:e30634. [PMID: 36439575 PMCID: PMC9683114 DOI: 10.7759/cureus.30634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2022] [Indexed: 01/25/2023] Open
Abstract
Treatment of diabetes-related foot ulcers presents great pressure on the healthcare system in terms of management strategy and allocation of resources. Telemedicine can be used to treat diabetic foot ulcers more effectively. This meta-analysis aims to evaluate the impacts of telemedicine on the treatment of diabetic foot ulcers. The current meta-analysis was conducted as per the reported guidelines of the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Two reviewers independently searched for relevant articles using PubMed, EMBASE, and the Cochrane Database of Systematic Reviews from inception to 31 August 2022, assessing the impacts of telemedicine on the treatment of diabetic foot ulcers. The primary outcomes assessed in the current meta-analysis included the percentage of foot ulcers healed and the time of healing foot ulcers within 12 months. Secondary outcomes included the percentage of amputation (minor and major) and all-cause mortality. A total of six studies were included in the current meta-analysis enrolling 1876 patients with diabetic foot ulcers. No difference was there between the two groups in terms of the number of patients whose ulcer healed (risk ratio (RR): 1.01, 95% confidence interval (CI): 0.93-1.09), time to healing of wound within 12 months (mean difference: -0.07, 95% CI: -0.31-0.17), the incidence of amputation (RR: 0.73, 95% CI: 0.54-1.00), and all-cause mortality (RR: 0.99, 95% CI: 0.42-2.37). In conclusion, the study found that telemedicine is non-inferior to standard care in terms of reducing healing time and the number of patients with ulcer healing within 12 months. The study also found that the incidence of amputation is also lower in patients assigned to the telemedicine group compared to patients in the control group and no significant differences were reported in terms of mortality.
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Leal-Costa C, Lopez-Villegas A, Perez-Heredia M, Baena-Lopez MA, Hernandez-Montoya CJ, Lopez-Liria R. Patients' Experiences and Communication with Teledermatology versus Face-to-Face Dermatology. J Clin Med 2022; 11:jcm11195528. [PMID: 36233398 PMCID: PMC9573490 DOI: 10.3390/jcm11195528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/12/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Teledermatology (TD) has exponentially grown since the onset of COVID-19, as the Face-to-Face Dermatology (F-F/D) modality changed within Public Health Systems. Although studies have been conducted on health results, we did not find any that analyzed the experiences of individuals who received care through TD. Therefore, the main objective of the study was to analyze the experiences of dermatology patients and the communication with health personnel. (2) Methods: A multicenter, controlled, randomized, non-blinded clinical trial was designed. Data were collected during the six months of follow-up. Four-hundred and fifty patients participated in the present study, who were assigned to two different groups: TD and F-F/D. The sociodemographic and clinical characteristics of the participants were collected. The ‘Generic Short Patient Experiences Questionnaire’ (GS-PEQ) was used to assess patients’ experiences, and the Healthcare Communication Questionnaire (HCCQ) was used to measure the communication of patients with healthcare professionals. (3) Results: After six months of follow-up, 450 patients completed the study (TD = 225; F-F/D = 225) of which 53.3% were women, with an average age of 52.16 (SD = 19.97). The main reasons for the consultations were skin lesions (51.56%) located on the head and neck (46.8%), followed by the legs (20.7%). According to the GS-PEQ, TD users indicated having a greater confidence in the professional skills of the doctors (p < 0.01). However, the F-F/D group indicated having received more adequate information about their diagnosis/afflictions (p < 0.01), were more involved in the decisions related to their treatment (p < 0.01), and more satisfied with the help and treatment received (p < 0.01). Regarding the HCCQ, the TD group obtained better assessments with respect to if the patients had been treated in a rude and hasty manner, if the health professionals had addressed them with a smile, and if these could adequately manage the reason for the consultation (p < 0.01). (4) Conclusions: The results of the study generally showed positive experiences and communication. The TD group indicated having received less information about the diagnosis, were less involved in the decisions, and were less satisfied with the help and treatment received. However, they indicated having more confidence on the professional skills of the doctors, and that the work at the institution was better organized. In addition, they perceived better communication skills of the health professionals, although less respect for their privacy.
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Affiliation(s)
| | - Antonio Lopez-Villegas
- Laboratory for Research, Education and Planning in Critical and Intensive Care Medicine, CTS-609 Research Group, Poniente University Hospital, 04700 El Ejido-Almeria, Spain
- Correspondence:
| | - Mercedes Perez-Heredia
- Research Management Department, Primary Care District Poniente of Almería, 04700 El Ejido-Almeria, Spain
| | | | | | - Remedios Lopez-Liria
- Health Research Centre, Department of Nursing, Physiotherapy and Medicine, University of Almería, La Cañada de San Urbano, 04120 Almeria, Spain
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Agarwal S, Simmonds I, Myers AK. The Use of Diabetes Technology to Address Inequity in Health Outcomes: Limitations and Opportunities. Curr Diab Rep 2022; 22:275-281. [PMID: 35648277 PMCID: PMC9157044 DOI: 10.1007/s11892-022-01470-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE OF REVIEW The management of diabetes has been revolutionized by the introduction of novel technological treatments and modalities of care, such as continuous glucose monitoring, insulin pump therapy, and telehealth. While these technologies have demonstrated improvement in health outcomes, it remains unclear whether they have reduced inequities from racial/ethnic minority or socioeconomic status. We review the current literature to discuss evidence of benefit, current limitations, and future opportunities of diabetes technologies. FINDINGS While there is ample evidence of the health and psychological benefit of diabetes technologies in large populations of people with type 1 and type 2 diabetes, there remain wide disparities in the use of diabetes technologies, which may be perpetuating or widening inequities. Multilevel barriers include inequitable prescribing practices, lack of support for social determinants of health, mismatch of patient preferences and care models, and cost. We provide a review of disparities in diabetes technology use, possible root causes of continued inequity in outcomes, and insight into ways to overcome remaining gaps.
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Affiliation(s)
- Shivani Agarwal
- Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine-Montefiore Medical Center, Bronx, NY USA
- NY Regional Center for Diabetes Translational Research, Albert Einstein College of Medicine, Bronx, NY USA
| | - Iman Simmonds
- Department of Cardiology, CORE Yale, New Haven, CT 06510 USA
| | - Alyson K. Myers
- Department of Medicine, Division of Endocrinology, North Shore University Hospital, Manhasset, NY USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY USA
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22
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G S, Tan WA, Lee ARYB, Chen MZ. Behavioral Interventions for the Patient-Caregiver Unit in Patients with Chronic Heart Failure: A Systematic Review of Caregiver Outcomes. J Multidiscip Healthc 2022; 15:921-939. [PMID: 35519152 PMCID: PMC9064481 DOI: 10.2147/jmdh.s357179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background Chronic heart failure (CHF) is a debilitating condition that affects millions worldwide. It is accompanied by a myriad of adverse consequences, such asdiminishing of quality of life and deterioration of mental health. Caregivers play a pivotal role in helping CHF patients manage their conditions and symptoms, as a result the physical, mental and emotional state of caregivers have a direct impact on CHF patients and the management of this condition. Purpose This systematic review aims to synthesize data about the effectiveness of behavioral interventions targeted at patients with chronic heart failure (CHF) and/or informal caregivers of CHF patients to improve overall management and treatment of CHF in the population. Patients and Methods Three databases were searched for published studies and studies that included evaluated outcomes of interventions that targeted CHF patients or informal caregivers. All randomized controlled trials, trials of either experimental or quasi-experimental design were included. Studies that only involved formal caregivers, patient populations of adolescents/young adults and patients with non-chronic conditions were excluded. Results Across the 21 included studies, no study reported a significant improvement in all three domains of quality of life (QoL), depression and loneliness of caregivers while only three studies reported a significant improvement in two outcomes. Within each domain, heterogeneity in measures limited quantitative pooling. Conclusion This review provides data on the efficacy of interventions targeted at CHF patients and/or informal caregivers. It also highlights successful interventions and its features. Following this, additional resources need to be invested and directed towards implementing these interventions.
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Affiliation(s)
- Suthershinii G
- Department of Biological Sciences, National University of Singapore, Singapore, Singapore
| | - Weiling Amanda Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Matthew Zhixuan Chen
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore
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Yamano T, Kotani K, Kitano N, Morimoto J, Emori H, Takahata M, Fujita S, Wada T, Ota S, Satogami K, Kashiwagi M, Shiono Y, Kuroi A, Tanimoto T, Tanaka A. Telecardiology in Rural Practice: Global Trends. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074335. [PMID: 35410012 PMCID: PMC8998494 DOI: 10.3390/ijerph19074335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 11/21/2022]
Abstract
The management of cardiovascular diseases in rural areas is plagued by the limited access of rural residents to medical facilities and specialists. The development of telecardiology using information and communication technology may overcome such limitation. To shed light on the global trend of telecardiology, we summarized the available literature on rural telecardiology. Using PubMed databases, we conducted a literature review of articles published from January 2010 to December 2020. The contents and focus of each paper were then classified. Our search yielded nineteen original papers from various countries: nine in Asia, seven in Europe, two in North America, and one in Africa. The papers were divided into classified fields as follows: seven in tele-consultation, four in the telemedical system, four in the monitoring system, two in prehospital triage, and two in tele-training. Six of the seven tele-consultation papers reported the consultation from rural doctors to urban specialists. More reports of tele-consultations might be a characteristic of telecardiology specific to rural practice. Further work is necessary to clarify the improvement of cardiovascular outcomes for rural residents.
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Affiliation(s)
- Takashi Yamano
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
- Correspondence:
| | - Kazuhiko Kotani
- Division of Community and Family Medicine, Jichi Medical University, Shimotsuke 329-0498, Japan;
| | - Naomi Kitano
- Health Administration Center, Wakayama Medical University, Wakayama 641-0012, Japan;
| | - Junko Morimoto
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Hiroki Emori
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Masahiro Takahata
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Suwako Fujita
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Teruaki Wada
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Shingo Ota
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Keisuke Satogami
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Manabu Kashiwagi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Akio Kuroi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Takashi Tanimoto
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
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Selvaraju S, Malaisamy M, Dolla CK, Murali L, Karikalan N, Saravanan B, Tholkappian AS, Tripathy SP. Application of mobile phone technology as intervention for the management of tuberculosis patients diagnosed through community survey. Indian J Med Res 2022; 155:301-305. [PMID: 35946208 PMCID: PMC9629519 DOI: 10.4103/ijmr.ijmr_75_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background & objectives The delay in communicating the results to tuberculosis (TB) patients leads to increased rates of initial loss to follow up of treatment. The gap in communication among healthcare providers requires application of new tools that will address the challenges. Mobile phone technologies could be a useful tool in this context for the delivery of information. The objective was thus to evaluate communication by mobile applications such as the WhatsApp Messenger to decrease initial loss to follow up after initial treatment for TB. Methods Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India undertook a community prevalence survey to find the burden of TB. During this survey, mobile phone-based technology (WhatsApp messenger) was employed as an intervention among the healthcare providers and researchers involved for communicating. This was further evaluated for its usefulness by examining the initial loss to follow up and patients initiated on treatment. Results The study covered four blocks of Thiruvallur district of Tamil Nadu, South India, namely Kadambathur, Poondi, Thiruvalangadu and Periyapalayam. The survey population was around 20,000 from each block, and the average patients diagnosed by community TB prevalence survey were 30 patients from each block. Among the patients diagnosed through this survey, in the first block, only 55 per cent were initiated on treatment; subsequently, with the intervention, the initial loss to follow up was significantly reduced from 45 to zero per cent. Interpretation & conclusions After integrating of WhatsApp messenger application for communication among healthcare providers and researchers, the initial loss to follow up among patients being treated for TB was significantly decreased.
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Affiliation(s)
- Sriram Selvaraju
- Department of Epidemiology, ICMR-NIRT, Chetput, Chennai, Tamil Nadu, India
| | - Muniyandi Malaisamy
- Department of Health Economics, ICMR-NIRT, Chetput, Chennai, Tamil Nadu, India
| | | | - Lakshmi Murali
- District TB Center, Poonamallee, Thiruvallur, Tamil Nadu, India
| | - Nagarajan Karikalan
- Department of Health Economics, ICMR-NIRT, Chetput, Chennai, Tamil Nadu, India
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Kip H, Keizer J, da Silva MC, Beerlage-de Jong N, Köhle N, Kelders SM. Methods for Human-Centered eHealth Development: Narrative Scoping Review. J Med Internet Res 2022; 24:e31858. [PMID: 35084359 PMCID: PMC8832261 DOI: 10.2196/31858] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/29/2021] [Accepted: 11/15/2021] [Indexed: 12/16/2022] Open
Abstract
Background Thorough holistic development of eHealth can contribute to a good fit among the technology, its users, and the context. However, despite the availability of frameworks, not much is known about specific research activities for different aims, phases, and settings. This results in researchers having to reinvent the wheel. Consequently, there is a need to synthesize existing knowledge on research activities for participatory eHealth development processes. Objective The 3 main goals of this review are to create an overview of the development strategies used in studies based on the CeHRes (Center for eHealth Research) Roadmap, create an overview of the goals for which these methods can be used, and provide insight into the lessons learned about these methods. Methods We included eHealth development studies that were based on the phases and/or principles of the CeHRes Roadmap. This framework was selected because of its focus on participatory, iterative eHealth design in context and to limit the scope of this review. Data were extracted about the type of strategy used, rationale for using the strategy, research questions, and reported information on lessons learned. The most frequently mentioned lessons learned were summarized using a narrative, inductive approach. Results In the included 160 papers, a distinction was made between overarching development methods (n=10) and products (n=7). Methods are used to gather new data, whereas products can be used to synthesize previously collected data and support the collection of new data. The identified methods were focus groups, interviews, questionnaires, usability tests, literature studies, desk research, log data analyses, card sorting, Delphi studies, and experience sampling. The identified products were prototypes, requirements, stakeholder maps, values, behavior change strategies, personas, and business models. Examples of how these methods and products were applied in the development process and information about lessons learned were provided. Conclusions This study shows that there is a plethora of methods and products that can be used at different points in the development process and in different settings. To do justice to the complexity of eHealth development, it seems that multiple strategies should be combined. In addition, we found no evidence for an optimal single step-by-step approach to develop eHealth. Rather, researchers need to select the most suitable research methods for their research objectives, the context in which data are collected, and the characteristics of the participants. This study serves as a first step toward creating a toolkit to support researchers in applying the CeHRes Roadmap to practice. In this way, they can shape the most suitable and efficient eHealth development process.
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Affiliation(s)
- Hanneke Kip
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands.,Department of Research, Transfore, Deventer, Netherlands
| | - Julia Keizer
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Marcia C da Silva
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Nienke Beerlage-de Jong
- Department of Health Technology & Services Research, University of Twente, Enschede, Netherlands
| | - Nadine Köhle
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Saskia M Kelders
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands.,Optentia Research Focus Area, North-West University, Vanderbijlpark, South Africa
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26
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Raes S, Trybou J, Annemans L. How to Pay for Telemedicine: A Comparison of Ten Health Systems. Health Syst Reform 2022; 8:2116088. [PMID: 36084277 DOI: 10.1080/23288604.2022.2116088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Telemedicine has the opportunity to improve clinical effectiveness, health care access, cost-savings, and patient care. However, payment systems may form important obstacles to optimally use telemedicine and enable its opportunities. Little is known about payment systems for telemedicine. Therefore, this research aims to increase knowledge on paying for telemedicine by comparing payment systems for telemedicine and identifying similarities and differences. Based on the countries' official physician fee schedules, listing all reimbursed medical services performed by physicians, a comparative analysis of telemedicine payment systems in ten countries was conducted. Findings show that many countries lacked tele-expertise and telemonitoring payment, with the exception for some specific payments such as for telemonitoring in patients with cardiac implantable electronic devices. Moreover, a wide variety of benefit specifications were implemented in all countries to specify which type of clinician contact should be used (remote versus physical) in which circumstances. Payment parity between video and in-person visits was established only in a few countries. Furthermore, fee-for-service was the dominant payment system, although two countries used a capitation-based or hybrid system. The results imply several potential payment challenges when implementing telemedicine: complex benefit specifications, payment parity discussions, and risk of overconsumption due to the dominant fee-for-service system. These challenges appear to be less present in capitation-based or hybrid systems. However, the latter needs to be further explored to harness the full potential of telemedicine.
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Affiliation(s)
- Sarah Raes
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Jeroen Trybou
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Lieven Annemans
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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27
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Hafdi M, Eggink E, Hoevenaar-Blom MP, Witvliet MP, Andrieu S, Barnes L, Brayne C, Brooks R, Coley N, Georges J, van der Groep A, van Marwijk H, van der Meijden M, Song L, Song M, Wang Y, Wang W, Wang W, Wimo A, Ye X, Moll van Charante EP, Richard E. Design and Development of a Mobile Health (mHealth) Platform for Dementia Prevention in the Prevention of Dementia by Mobile Phone Applications (PRODEMOS) Project. Front Neurol 2021; 12:733878. [PMID: 34975710 PMCID: PMC8716458 DOI: 10.3389/fneur.2021.733878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/22/2021] [Indexed: 01/28/2023] Open
Abstract
Background: Mobile health (mHealth) has the potential to bring preventive healthcare within reach of populations with limited access to preventive services, by delivering personalized support at low cost. Although numerous mHealth interventions are available, very few have been developed following an evidence-based rationale or have been tested for efficacy. This article describes the systematic development of a coach-supported mHealth application to improve healthy lifestyles for the prevention of dementia and cardiovascular disease in the United Kingdom (UK) and China. Methods: Development of the Prevention of Dementia by Mobile Phone applications (PRODEMOS) platform built upon the experiences with the Healthy Aging Through Internet Counseling in the Elderly (HATICE) eHealth platform. In the conceptualization phase, experiences from the HATICE trial and needs and wishes of the PRODEMOS target population were assessed through semi-structured interviews and focus group sessions. Initial technical development of the platform was based on these findings and took place in consecutive sprint sessions. Finally, during the evaluation and adaptation phase, functionality and usability of the platform were evaluated during pilot studies in UK and China. Results: The PRODEMOS mHealth platform facilitates self-management of a healthy lifestyle by goal setting, progress monitoring, and educational materials on healthy lifestyles. Participants receive remote coaching through a chat functionality. Based on lessons learned from the HATICE study and end-users, we made the intervention easy-to-use and included features to personalize the intervention. Following the pilot studies, in which in total 77 people used the mobile application for 6 weeks, the application was made more intuitive, and we improved its functionalities. Conclusion: Early involvement of end-users in the development process and during evaluation phases improved acceptability of the mHealth intervention. The actual use and usability of the PRODEMOS intervention will be assessed during the ongoing PRODEMOS randomized controlled trial, taking a dual focus on effectiveness and implementation outcomes.
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Affiliation(s)
- Melanie Hafdi
- Department of Neurology, Amsterdam University Medical Center (UMC) Location Academic Medical Center (AMC), Amsterdam, Netherlands,*Correspondence: Melanie Hafdi
| | - Esmé Eggink
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Marieke P. Hoevenaar-Blom
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - M. Patrick Witvliet
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Sandrine Andrieu
- Center for Epidemiology and Research in Population Health (CERPOP), University of Toulouse-INSERM UMR1295, Toulouse, France,Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
| | - Linda Barnes
- Cambridge Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Rachael Brooks
- Cambridge Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Nicola Coley
- Center for Epidemiology and Research in Population Health (CERPOP), University of Toulouse-INSERM UMR1295, Toulouse, France,Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
| | | | | | - Harm van Marwijk
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, United Kingdom
| | | | - Libin Song
- Fuzhou Comvee Network &Technology Co., Ltd, Fuzhou, China
| | - Manshu Song
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China,School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Youxin Wang
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China,School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Wenzhi Wang
- Department of Neuroepidemiology, Beijing Neurosurgical Institute, Beijing, China
| | - Wei Wang
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing, China,School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia,School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, China,Centre for Precision Health, Edith Cowan University, Perth, WA, Australia
| | - Anders Wimo
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Xiaoyan Ye
- Fuzhou Comvee Network &Technology Co., Ltd, Fuzhou, China
| | - Eric P. Moll van Charante
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, Netherlands,Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Edo Richard
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, Netherlands,Department of Neurology, Radboud University Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
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Rozga M, Handu D, Kelley K, Jimenez EY, Martin H, Schofield M, Steiber A. Telehealth During the COVID-19 Pandemic: A Cross-Sectional Survey of Registered Dietitian Nutritionists. J Acad Nutr Diet 2021; 121:2524-2535. [PMID: 33612436 PMCID: PMC7834621 DOI: 10.1016/j.jand.2021.01.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/21/2020] [Accepted: 01/12/2021] [Indexed: 01/12/2023]
Abstract
During the current coronavirus disease 2019 (COVID-19) pandemic, health care practices have shifted to minimize virus transmission, with unprecedented expansion of telehealth. This study describes self-reported changes in registered dietitian nutritionist (RDN) practice related to delivery of nutrition care via telehealth shortly after the onset of the COVID-19 pandemic in the United States. This cross-sectional, anonymous online survey was administered from mid-April to mid-May 2020 to RDNs in the United States providing face-to-face nutrition care prior to the COVID-19 pandemic. This survey included 54 questions about practitioner demographics and experience and current practices providing nutrition care via telehealth, including billing procedures, and was completed by 2016 RDNs with a median (interquartile range) of 15 (6-27) years of experience in dietetics practice. Although 37% of respondents reported that they provided nutrition care via telehealth prior to the COVID-19 pandemic, this proportion was 78% at the time of the survey. Respondents reported spending a median (interquartile range) of 30 (20-45) minutes in direct contact with the individual/group per telehealth session. The most frequently reported barriers to delivering nutrition care via telehealth were lack of client interest (29%) and Internet access (26%) and inability to conduct or evaluate typical nutrition assessment or monitoring/evaluation activities (28%). Frequently reported benefits included promoting compliance with social distancing (66%) and scheduling flexibility (50%). About half of RDNs or their employers sometimes or always bill for telehealth services, and of those, 61% are sometimes or always reimbursed. Based on RDN needs, the Academy of Nutrition and Dietetics continues to advocate and provide resources for providing effective telehealth and receiving reimbursement via appropriate coding and billing. Moving forward, it will be important for RDNs to participate fully in health care delivered by telehealth and telehealth research both during and after the COVID-19 public health emergency.
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Affiliation(s)
- Mary Rozga
- Academy of Nutrition and Dietetics Evidence Analysis Center, Chicago, IL.
| | - Deepa Handu
- Academy of Nutrition and Dietetics Evidence Analysis Center, Chicago, IL
| | - Kathryn Kelley
- Academy of Nutrition and Dietetics Nutrition Research Network, Chicago, IL
| | - Elizabeth Yakes Jimenez
- Departments of Pediatrics and Internal Medicine and College of Population Health, University of New Mexico Health Sciences Center, Chicago, IL
| | - Hannah Martin
- Legislative and Government Affairs, Academy of Nutrition and Dietetics, Washington, DC
| | - Marsha Schofield
- Governance and Nutrition Services Coverage, Academy of Nutrition and Dietetics, Chicago, IL
| | - Alison Steiber
- Academy of Nutrition and Dietetics Nutrition Research Network, Chicago, IL
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29
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Coma E, Miró Q, Medina M, Marin-Gomez FX, Cos X, Benítez M, Mas A, Fàbregas M, Fina F, Lejardi Y, Vidal-Alaball J. Association between the reduction of face-to-face appointments and the control of patients with type 2 diabetes mellitus during the Covid-19 pandemic in Catalonia. Diabetes Res Clin Pract 2021; 182:109127. [PMID: 34752800 PMCID: PMC8592525 DOI: 10.1016/j.diabres.2021.109127] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/20/2021] [Accepted: 11/02/2021] [Indexed: 11/23/2022]
Abstract
AIM To analyse the relation between face-to-face appointments and management of patients with type 2 diabetes mellitus (T2DM) visited in primary care practices (PCP). METHODS Retrospective study in 287 primary care practices (PCPs) attending>300,000 patients with T2DM. We analysed the results of 9 diabetes-related indicators of the Healthcare quality standard, comprising foot and retinopathy screening, blood pressure (BP) and glycemic control; and the incidence of T2DM. We calculated each indicator's percentage of change in 2020 with respect to the results of 2019. RESULTS Indicators' results were reduced in 2020 compared to 2019, highlighting the indicators of foot and retinopathy screening (-51.6% and -25.7%, respectively); the glycemic control indicator (-21.2%); the BP control indicator (-33.7%) and the incidence of T2DM (-25.6%). Conversely, the percentage of type 2 diabetes patients with HbA1c > 10% increased by 34%. PCPs with<11 weekly face-to-face appointments offered per professional had greater reductions than those PCPs with more than 40. For instance, a reduction of -60.7% vs -38.2% (p-value < 0.001) in the foot screening's indicator; -27.5% vs -12.5% (p-value < 0.001) in glycemic control and -40.2 vs -24.3% (p-value < 0.001) in BP control. CONCLUSIONS Reducing face-to-face visits offered may impact T2DM patients' follow-up and thus worsen their control.
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Affiliation(s)
- Ermengol Coma
- Primary Care Services Information Systems, Institut Català de la Salut, Barcelona, Spain.
| | - Queralt Miró
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Spain
| | - Manuel Medina
- Primary Care Services Information Systems, Institut Català de la Salut, Barcelona, Spain
| | - Francesc X Marin-Gomez
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Spain; Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Spain; Faculty of Medicine. University of Vic - Central University of Catalonia, Vic, Spain
| | - Xavier Cos
- DAP_Cat Research Group, Gerencia Territorial Barcelona Ciutat, Institut Català de la Salut, Spain; Foundation University Institute for Primary Health Care Research Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Universitat Autonoma de Barcelona, Spain; Institut Català de la Salut, Spain
| | - Mència Benítez
- Primary Care Services Information Systems, Institut Català de la Salut, Barcelona, Spain; Equip d'Atenció Primària de Gòtic, Institut Català de la Salut, Barcelona, Spain
| | | | - Mireia Fàbregas
- Primary Care Services Information Systems, Institut Català de la Salut, Barcelona, Spain
| | - Francesc Fina
- Primary Care Services Information Systems, Institut Català de la Salut, Barcelona, Spain
| | | | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Spain; Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Spain; Faculty of Medicine. University of Vic - Central University of Catalonia, Vic, Spain
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30
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Yu CH, Medleg F, Choi D, Spagnuolo CM, Pinnaduwage L, Straus SE, Cantarutti P, Chu K, Frydrych P, Hoang-Kim A, Ivers N, Kaplan D, Leung FH, Maxted J, Rezmovitz J, Sale J, Sodhi S, Stacey D, Telner D. Integrating shared decision-making into primary care: lessons learned from a multi-centre feasibility randomized controlled trial. BMC Med Inform Decis Mak 2021; 21:323. [PMID: 34809626 PMCID: PMC8609876 DOI: 10.1186/s12911-021-01673-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/25/2021] [Indexed: 11/25/2022] Open
Abstract
Background MyDiabetesPlan is a web-based, interactive patient decision aid that facilitates patient-centred, diabetes-specific, goal-setting and shared decision-making (SDM) with interprofessional health care teams. Objective Assess the feasibility of (1) conducting a cluster randomized controlled trial (RCT) and (2) integrating MyDiabetesPlan into interprofessional primary care clinics. Methods We conducted a cluster RCT in 10 interprofessional primary care clinics with patients living with diabetes and at least two other comorbidities; half of the clinics were assigned to MyDiabetesPlan and half were assigned to usual care. To assess recruitment, retention, and resource use, we used RCT conduct logs and financial account summaries. To assess intervention fidelity, we used RCT conduct logs and website usage logs. To identify barriers and facilitators to integration of MyDiabetesPlan into clinical care across the IP team, we used audiotapes of clinical encounters in the intervention groups. Results One thousand five hundred and ninety-seven potentially eligible patients were identified through searches of electronic medical records, of which 1113 patients met the eligibility criteria upon detailed chart review. A total of 425 patients were randomly selected; of these, 213 were able to participate and were allocated (intervention: n = 102; control: n = 111), for a recruitment rate of 50.1%. One hundred and fifty-one patients completed the study, for a retention rate of 70.9%. A total of 5745 personnel-hours and $6104 CAD were attributed to recruitment and retention activities. A total of 179 appointments occurred (out of 204 expected appointments—two per participant over the 12-month study period; 87.7%). Forty (36%), 25 (23%), and 32 (29%) patients completed MyDiabetesPlan at least twice, once, and zero times, respectively. Mean time for completion of MyDiabetesPlan by the clinician and the patient during initial appointments was 37 min. From the clinical encounter transcripts, we identified diverse strategies used by clinicians and patients to integrate MyDiabetesPlan into the appointment, characterized by rapport building and individualization. Barriers to use included clinician-related, patient-related, and technical factors. Conclusion An interprofessional approach to SDM using a decision aid was feasible. Lower than expected numbers of diabetes-specific appointments and use of MyDiabetesPlan were observed. Addressing facilitators and barriers identified in this study will promote more seamless integration into clinical care. Trial registration Clinicaltrials.gov Identifier: NCT02379078. Date of Registration: February 11, 2015. Protocol version: Version 1; February 26, 2015. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01673-w.
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Affiliation(s)
- Catherine H Yu
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. .,Department of Medicine, University of Toronto, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada.
| | - Farid Medleg
- Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin, D02 YN77, Ireland
| | - Dorothy Choi
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Catherine M Spagnuolo
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,School of Medicine, Queen's University, 99 University Ave, Kingston, ON, K7L 3N6, Canada
| | - Lakmini Pinnaduwage
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Department of Medicine, University of Toronto, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Department of Medicine, University of Toronto, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
| | - Paul Cantarutti
- Southlake Regional Health Centre, 596 Davis Dr, Newmarket, ON, 3Y 2P9, Canada
| | - Karen Chu
- Bridgepoint Active Healthcare (Sinai Health System), 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
| | - Paul Frydrych
- Mount Dennis Weston Health Centre, Humber River Family Health Team, 2050 Weston Rd, York, ON, M9N 3M4, Canada
| | - Amy Hoang-Kim
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Noah Ivers
- Department of Family Medicine, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada.,University of Toronto, 1 King's College Cir, Toronto, ON, M5S 1A8, Canada
| | - David Kaplan
- University of Toronto, 1 King's College Cir, Toronto, ON, M5S 1A8, Canada.,North York Family Health Team, 240 Duncan Mill Rd, North York, ON, M3B 3S6, Canada
| | - Fok-Han Leung
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - John Maxted
- Markham Stouffville Hospital, 381 Church St, Markham, ON, L3P 7P3, Canada
| | - Jeremy Rezmovitz
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Joanna Sale
- Musculoskeletal Health and Outcomes Research - Li Ka Shing Knowledge Institute of St. Michael's Hospital, 209 Victoria St, Toronto, ON, M5B 1T8, Canada
| | - Sumeet Sodhi
- Toronto Western Family Health Team, Toronto General Hospital Research Institute, University Health Network, 440 Bathurst St, Toronto, ON, M5T 2S8, Canada
| | - Dawn Stacey
- School of Nursing, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada.,Ottawa Hospital Research Institute, 501 Smyth, Ottawa, ON, K1H 8L6, Canada
| | - Deanna Telner
- South East Toronto Family Health Team (Toronto East Health Network), 833 Coxwell Avenue, Toronto, ON, M4C 3E8, Canada
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Ghozali MT, Satibi S, Ikawati Z, Lazuardi L. Asthma self-management app for Indonesian asthmatics: A patient-centered design. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 211:106392. [PMID: 34530390 DOI: 10.1016/j.cmpb.2021.106392] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 08/30/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND A proper education on asthma self-management helps asthmatics to improve health outcomes, such as better asthma knowledge and self-efficacy, increased frequency of symptom-free days, reduced unscheduled healthcare visits and absence from school or work days. In this modern digital era, the use of smartphone apps is increasing rapidly and reaching almost all aspects of our life, including health promotion and patient education on asthma self-management. Studies found that the apps make it easier for asthmatics to receive the education. OBJECTIVE The aim of this study was to describe the systematic design, development, and implementation process of a Google Android OS asthma self-management smartphone app according to the Patient-Centered Design approach. METHODS The design, development, and implementation process of the app adopted the Patient-Centered Design approach, including: (1) user needs assessment, (2) design of the app prototype, (3) development of the app prototype, (4) usability test, and (5) product launch. For better results, the study involved end-users (asthmatics and health professionals) during the development of the app. RESULTS The study resulted in a Google Android OS asthma self-management app, namely AsmaDroid. The app was developed to feature 8 contents and functions, namely: asthma education, a list of asthma medications, asthma diary or journal, peak flow record, asthma control test, asthma action plan, a chat box, and a map of nearest local hospitals or health centers. It was also found that the average success rate of the app was as follow: "completed with ease" was 88.15%, "completed with difficulty" was 7.78%, and "failed to complete" was 4.07%. It means that the success rate of app was "very high". CONCLUSION The implementation of Patient-Centered Design approach has been successfully completed for the development of AsmaDroid. However, additional research into the use of the app in the actual clinical world is highly required to demonstrate its effectiveness in improving the level of asthma knowledge, the quality of asthma control, and other health outcomes.
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Affiliation(s)
- M T Ghozali
- Doctoral Graduate Program, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia; School of Pharmacy, Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta, Jl. Lingkar Selatan 55183, Indonesia.
| | - Satibi Satibi
- Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Zullies Ikawati
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Lutfan Lazuardi
- Department of Health Policy and Management, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
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Anthony SJ, Pol SJ, Lin J, Barwick M, Brudno M, Manase D, Parekh RS, Silva A, Stinson J. Creation of an electronic patient-reported outcome measure platform Voxe: a mixed methods study protocol in paediatric solid organ transplantation. BMJ Open 2021; 11:e053119. [PMID: 34667013 PMCID: PMC8527113 DOI: 10.1136/bmjopen-2021-053119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 09/29/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Patient-reported outcome measures (PROMs) provide an opportunity for meaningful patient engagement and shared decision-making. The objective of this research programme is to improve health outcomes for paediatric solid organ transplant patients by implementing PROMs into clinical care. The current study aims to create Voxe, a paediatric user-centred electronic PROM platform, by engaging patients and healthcare providers throughout the design and development process. METHODS AND ANALYSIS The creation of Voxe will occur over two phases that build on previous research. The user interface design phase employs a 'user-centric' approach to identify end-users' needs and iteratively refine the look and layout of Voxe to meet these needs. Transplant recipients, aged 10-17, and healthcare providers will participate in three rounds of testing (24 participants total). Participants will: (1) complete task-based activities (outcomes-effectiveness and efficiency), (2) complete questionnaires (outcome-satisfaction) and (3) participate in a semi-structured interview. The following phase involves software development and Voxe usability testing. Transplant recipients, aged 8-17, and healthcare providers will participate in four rounds of iterative testing (24-40 participants total). The think-aloud technique will be employed, and participants will describe their thoughts and feelings while interacting with a Voxe prototype. Participants will: (1) log into Voxe and complete tasks (outcomes-time on task, successful task completion, frequency of critical and non-critical errors and error-free rate), (2) complete questionnaires (outcome-satisfaction) and (3) participate in a semi-structured interview. Findings will result in the creation and launch of a user-centred electronic PROM platform. ETHICS AND DISSEMINATION Research ethics board approval has been provided by The Hospital for Sick Children. This research is critical to answering methodological and operational questions to inform Voxe implementation in paediatric clinical settings and facilitate PROM data collection. Future investigations will include an implementation-effectiveness evaluation.
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Affiliation(s)
- Samantha J Anthony
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sarah J Pol
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jia Lin
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Melanie Barwick
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Michael Brudno
- Data Aggregation, Translation and Architecture, University Health Network, Toronto, Ontario, Canada
- Faculty of Arts and Science, University of Toronto, Toronto, Ontario, Canada
| | - Dorin Manase
- Data Aggregation, Translation and Architecture, University Health Network, Toronto, Ontario, Canada
| | - Rulan Savita Parekh
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Amanda Silva
- Data Aggregation, Translation and Architecture, University Health Network, Toronto, Ontario, Canada
| | - Jennifer Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Lim HM, Abdullah A, Ng CJ, Teo CH, Valliyappan IG, Abdul Hadi H, Ng WL, Noor Azhar AM, Chiew TK, Liew CS, Chan CS. Utility and usability of an automated COVID-19 symptom monitoring system (CoSMoS) in primary care during COVID-19 pandemic: A qualitative feasibility study. Int J Med Inform 2021; 155:104567. [PMID: 34536808 PMCID: PMC8420087 DOI: 10.1016/j.ijmedinf.2021.104567] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 07/27/2021] [Accepted: 08/26/2021] [Indexed: 11/26/2022]
Abstract
Background COVID-19 telemonitoring applications have been developed and used in primary care to monitor patients quarantined at home. There is a lack of evidence on the utility and usability of telemonitoring applications from end-users’ perspective. Objectives This study aimed to evaluate the feasibility of a COVID-19 symptom monitoring system (CoSMoS) by exploring its utility and usability with end-users. Methods This was a qualitative study using in-depth interviews. Patients with suspected COVID-19 infection who used CoSMoS Telegram bot to monitor their COVID-19 symptoms and doctors who conducted the telemonitoring via CoSMoS dashboard were recruited. Universal sampling was used in this study. We stopped the recruitment when data saturation was reached. Patients and doctors shared their experiences using CoSMoS, its utility and usability for COVID-19 symptoms monitoring. Data were coded and analysed using thematic analysis. Results A total of 11 patients and 4 doctors were recruited into this study. For utility, CoSMoS was useful in providing close monitoring and continuity of care, supporting patients’ decision making, ensuring adherence to reporting, and reducing healthcare workers’ burden during the pandemic. In terms of usability, patients expressed that CoSMoS was convenient and easy to use. The use of the existing social media application for symptom monitoring was acceptable for the patients. The content in the Telegram bot was easy to understand, although revision was needed to keep the content updated. Doctors preferred to integrate CoSMoS into the electronic medical record. Conclusion CoSMoS is feasible and useful to patients and doctors in providing remote monitoring and teleconsultation during the COVID-19 pandemic. The utility and usability evaluation enables the refinement of CoSMoS to be a patient-centred monitoring system.
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Affiliation(s)
- Hooi Min Lim
- Department of Primary Care Medicine, University of Malaya Medical Centre, 59100 Kuala Lumpur, Malaysia; University of Malaya eHealth Unit, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia; Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Adina Abdullah
- University of Malaya eHealth Unit, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia; Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
| | - Chirk Jenn Ng
- University of Malaya eHealth Unit, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia; Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Chin Hai Teo
- University of Malaya eHealth Unit, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Indra Gayatri Valliyappan
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Haireen Abdul Hadi
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Wei Leik Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Abdul Muhaimin Noor Azhar
- Department of Emergency Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Thiam Kian Chiew
- University of Malaya eHealth Unit, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia; Department of Software Engineering, Faculty of Computer Science & Information Technology, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Chee Sun Liew
- University of Malaya eHealth Unit, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia; Department of Computer System & Technology, Faculty of Computer Science & Information Technology, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Chee Seng Chan
- University of Malaya eHealth Unit, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia; Department of Artificial Intelligence, Faculty of Computer Science & Information Technology, University of Malaya, 50603 Kuala Lumpur, Malaysia
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34
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Houlding E, Mate KKV, Engler K, Ortiz-Paredes D, Pomey MP, Cox J, Hijal T, Lebouché B. Barriers to Use of Remote Monitoring Technologies Used to Support Patients With COVID-19: Rapid Review. JMIR Mhealth Uhealth 2021; 9:e24743. [PMID: 33769943 PMCID: PMC8059785 DOI: 10.2196/24743] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 03/03/2021] [Accepted: 03/22/2021] [Indexed: 02/06/2023] Open
Abstract
Background The COVID-19 pandemic has acted as a catalyst for the development and adoption of a broad range of remote monitoring technologies (RMTs) in health care delivery. It is important to demonstrate how these technologies were implemented during the early stages of this pandemic to identify their application and barriers to adoption, particularly among vulnerable populations. Objective The purpose of this knowledge synthesis was to present the range of RMTs used in delivering care to patients with COVID-19 and to identify perceived benefits of and barriers to their use. The review placed a special emphasis on health equity considerations. Methods A rapid review of published research was conducted using Embase, MEDLINE, and QxMD for records published from the inception of COVID-19 (December 2019) to July 6, 2020. Synthesis involved content analysis of reported benefits of and barriers to the use of RMTs when delivering health care to patients with COVID-19, in addition to health equity considerations. Results Of 491 records identified, 48 publications that described 35 distinct RMTs were included in this review. RMTs included use of existing technologies (eg, videoconferencing) and development of new ones that have COVID-19–specific applications. Content analysis of perceived benefits generated 34 distinct codes describing advantages of RMTs, mapped to 10 themes overall. Further, 52 distinct codes describing barriers to use of RMTs were mapped to 18 themes. Prominent themes associated with perceived benefits included a lower burden of care (eg, for hospitals, health care practitioners; 28 records), reduced infection risk (n=33), and support for vulnerable populations (n=14). Prominent themes reflecting barriers to use of RMTs included equity-related barriers (eg, affordability of technology for users, poor internet connectivity, poor health literacy; n=16), the need for quality “best practice” guidelines for use of RMTs in clinical care (n=12), and the need for additional resources to develop and support new technologies (n=11). Overall, 23 of 48 records commented on equity characteristics that stratify health opportunities and outcomes, including general characteristics that vary over time (eg, age, comorbidities; n=17), place of residence (n=11), and socioeconomic status (n=7). Conclusions Results of this rapid review highlight the breadth of RMTs being used to monitor and inform treatment of COVID-19, the potential benefits of using these technologies, and existing barriers to their use. Results can be used to prioritize further efforts in the implementation of RMTs (eg, developing “best practice” guidelines for use of RMTs and generating strategies to improve equitable access for marginalized populations).
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Affiliation(s)
- Elizabeth Houlding
- Chronic Viral Illness Service, Royal Victoria Hospital, McGill University Health Centre, Montréal, QC, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Kedar K V Mate
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Kim Engler
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - David Ortiz-Paredes
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Marie-Pascale Pomey
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.,Département de gestion, évaluation et politique de santé, École de santé publique de l'Université de Montréal, Montréal, QC, Canada
| | - Joseph Cox
- Chronic Viral Illness Service, Royal Victoria Hospital, McGill University Health Centre, Montréal, QC, Canada.,Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC, Canada.,Department of Epidemiology and Biostatistics, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - Tarek Hijal
- Division of Radiation Oncology, McGill University Health Centre, Montréal, QC, Canada
| | - Bertrand Lebouché
- Chronic Viral Illness Service, Royal Victoria Hospital, McGill University Health Centre, Montréal, QC, Canada.,Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC, Canada.,Department of Family Medicine, McGill University, Montréal, QC, Canada
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Mitchell EG, Maimone R, Cassells A, Tobin JN, Davidson P, Smaldone AM, Mamykina L. Automated vs. Human Health Coaching: Exploring Participant and Practitioner Experiences. PROCEEDINGS OF THE ACM ON HUMAN-COMPUTER INTERACTION 2021; 5:99. [PMID: 36304916 PMCID: PMC9605038 DOI: 10.1145/3449173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Health coaching can be an effective intervention to support self-management of chronic conditions like diabetes, but there are not enough coaching practitioners to reach the growing population in need of support. Conversational technology, like chatbots, presents an opportunity to extend health coaching support to broader and more diverse populations. However, some have suggested that the human element is essential to health coaching and cannot be replicated with technology. In this research, we examine automated health coaching using a theory-grounded, wizard-of-oz chatbot, in comparison with text-based virtual coaching from human practitioners who start with the same protocol as the chatbot but have the freedom to embellish and adjust as needed. We found that even a scripted chatbot can create a coach-like experience for participants. While human coaches displayed advantages expressing empathy and using probing questions to tailor their support, they also encountered tremendous barriers and frustrations adapting to text-based virtual coaching. The chatbot coach had advantages in being persistent, as well as more consistently giving choices and options to foster client autonomy. We discuss implications for the design of virtual health coaching interventions.
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Affiliation(s)
| | | | | | - Jonathan N Tobin
- Clinical Directors Network (CDN) and The Rockefeller University, USA
| | | | | | - Lena Mamykina
- Columbia University, Department of Biomedical Informatics, USA
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Gallo G, Grossi U, Sturiale A, Di Tanna GL, Picciariello A, Pillon S, Mascagni D, Altomare DF, Naldini G, Perinotti R. E-consensus on telemedicine in proctology: A RAND/UCLA-modified study. Surgery 2021; 170:405-411. [PMID: 33766426 DOI: 10.1016/j.surg.2021.01.049] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/17/2021] [Accepted: 01/29/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Coronavirus disease 2019 is revolutionizing healthcare delivery. The aim of this study was to reach a consensus among experts as to the possible applications of telemedicine in the proctologic field. METHODS A group of 55 clinical practice recommendations was developed by a clinical guidance group based on coalescence of evidence and expert opinion. The Telemedicine in Proctology Italian Working Group included 47 Italian Society of Colorectal Surgery nominated experts evaluating the appropriateness of each clinical practice recommendations based on published RAND/UCLA methodology in 2 rounds. RESULTS Stakeholder median age was 53 years (interquartile range limits 40-60), and 38 (81%) were men. Nine (19%) panelists reported no experience with telemedicine before the pandemic. Agreement was obtained on a minimum of 3 to 5 years of practice in the proctologic field before starting teleconsultations, which should be regularly paid, with advice and prescriptions incorporated into a formal report sent to the patient by e-mail along with a receipt. Of the panelists, 35 of 47 (74%) agreed that teleconsultation carries the risk of misdiagnosis of cancer, thus recommending an in-person assessment before scheduling any surgery. Fifteen additional clinical practice recommendations were re-elaborated in the second round and assessed by 44 of 47 (93.6%) panelists. The application of telemedicine for the diagnosis of common proctologic conditions (eg, hemorrhoidal disease, anal abscess and fistula, anal condylomas, and anal fissure) and functional pelvic floor disorders was generally considered inappropriate. Teleconsultation was instead deemed appropriate for the diagnosis and management of pilonidal disease. CONCLUSION This e-consensus revealed the boundaries of telemedicine in Italy. Standardization of infrastructures, logistics, and legality remain to be better elucidated.
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Affiliation(s)
- Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy.
| | - Ugo Grossi
- IV Surgery Unit, Treviso Regional Hospital, DISCOG, University of Padua, Italy
| | - Alessandro Sturiale
- Proctology and Pelvic Floor Clinical Centre, Cisanello University Hospital, Pisa, Italy
| | - Gian Luca Di Tanna
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, NSW, Australia
| | - Arcangelo Picciariello
- Surgical Unit 'M. Rubino', Department of Emergency and Organ Transplantation, Bari, Italy; Apulian Breath Analysis Centre (CeRBA), Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Tumori Giovanni Paolo II, Bari, Italy
| | | | - Domenico Mascagni
- Department of Surgical Sciences, Policlinico Umberto I, "Sapienza" University of Roma, Roma, Italy
| | - Donato Francesco Altomare
- Surgical Unit 'M. Rubino', Department of Emergency and Organ Transplantation, Bari, Italy; Apulian Breath Analysis Centre (CeRBA), Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Tumori Giovanni Paolo II, Bari, Italy
| | - Gabriele Naldini
- Proctology and Pelvic Floor Clinical Centre, Cisanello University Hospital, Pisa, Italy
| | - Roberto Perinotti
- Colorectal Surgical Unit, Department of Surgery, Infermi Hospital, Biella, Italy
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Eberle C, Stichling S. Telemetric Interventions Offer New Opportunities for Managing Type 1 Diabetes Mellitus: Systematic Meta-review. JMIR Diabetes 2021; 6:e20270. [PMID: 33724201 PMCID: PMC8080418 DOI: 10.2196/20270] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/20/2020] [Accepted: 02/16/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The prevalence of diabetes mellitus (DM) is increasing rapidly worldwide. Simultaneously, technological advances are offering new opportunities for better management of type 1 diabetes mellitus (T1DM). Telemetry, the remote acquisition of patient data via a telecommunication system, is a promising field of application in eHealth and is rapidly gaining importance. OBJECTIVE The aim of this study was to summarize the current evidences available on the effectiveness of telemetric approaches in T1DM management. This systematic meta-review examined different types of interventions of the technologies used in communication between health care professionals and patients as well as the key outcomes. METHODS We performed a systematic search in Web of Science Core Collection, EMBASE, Cochrane Library, MEDLINE via PubMed, and CINAHL databases in April 2020 with regard to the effectiveness of telemetric interventions for T1DM. We classified the interventions into 4 categories according to the technology used: (1) real-time video communication, (2) real-time audio communication, (3) asynchronous communication, and (4) combined forms of communication (real-time and asynchronous). We considered various study designs such as systematic reviews, clinical trials, meta-analyses, and randomized controlled trials and focused on the key outcomes. Additionally, a funnel plot based on hemoglobin A1c (HbA1c) values and different quality assessments were performed. RESULTS We identified 17 (6 high quality and 9 moderate quality) eligible publications: randomized controlled trials (n=9), systematic reviews and meta-analyses (n=5), cohort studies (n=2), and qualitative publications (n=1). Of 12 studies, 8 (67%) indicated a (significant or nonsignificant) reduction in HbA1c levels; 65% (11/17) of the studies reported overall (mildly) positive effects of telemetric interventions by addressing all the measured outcomes. Asynchronous interventions were the most successful for patients diagnosed with T1DM, but no technology was clearly superior. However, there were many nonsignificant results and not sustained effects, and in some studies, the control group benefited from telemetric support or increased frequency of contacts. CONCLUSIONS Based on the currently available literature, this systematic meta-review shows that telemetric interventions cause significant reduction in HbA1c levels and result in overall positive effects in T1DM management. However, more specified effects of telemetric approaches in T1DM management should be analyzed in detail in larger cohorts.
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Affiliation(s)
- Claudia Eberle
- Medicine with Specialization in Internal Medicine and General Medicine, Hochschule Fulda - University of Applied Sciences, Fulda, Germany
| | - Stefanie Stichling
- Medicine with Specialization in Internal Medicine and General Medicine, Hochschule Fulda - University of Applied Sciences, Fulda, Germany
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Perdoncini NN, Schussel JL, Amenábar JM, Torres-Pereira CC. Use of smartphone video calls in the diagnosis of oral lesions: Teleconsultations between a specialist and patients assisted by a general dentist. J Am Dent Assoc 2021; 152:127-135. [PMID: 33494867 DOI: 10.1016/j.adaj.2020.10.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/14/2020] [Accepted: 10/20/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Teleassistance in dentistry enables the support of dentists in areas without access to specialists. The aim of this study was to assess the feasibility and accuracy of synchronous teleconsultation in oral medicine. METHODS Patients referred for specialized care owing to oral lesions were evaluated in person by a general dentist who obtained photographs of the lesions with a smartphone. The images were sent via a mobile application to an oral medicine specialist, with whom a video call was initiated on the same instant messaging application. After interviewing the patient, the specialist formulated a diagnostic hypothesis and suggestions for case management. Then a second specialist, blinded to the first evaluation, assessed the oral lesion in person and defined a diagnosis, which was considered as the reference standard. Diagnoses from the remote and the face-to-face consultations were compared in percentage levels of agreement and κ coefficient. RESULTS Thirty-three patients, 25 through 83 years old, had 41 oral lesions. The average teleconsultation length was approximately 10 minutes. In 92.7% of the cases, there was concordance between the telediagnosis and the reference standard (κ = 0.922). CONCLUSIONS Synchronous teleconsultation can provide reliable remote diagnosis through the support to primary care health care professionals in management of oral lesions. PRACTICAL IMPLICATIONS Earlier diagnosis of malignancies, improvement of access for unassisted populations, and reduction of unnecessary referrals are possible practical implications of remote support of a specialist in the management and diagnosis of oral lesions.
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Iversen MM, Igland J, Smith-Strøm H, Østbye T, Tell GS, Skeie S, Cooper JG, Peyrot M, Graue M. Effect of a telemedicine intervention for diabetes-related foot ulcers on health, well-being and quality of life: secondary outcomes from a cluster randomized controlled trial (DiaFOTo). BMC Endocr Disord 2020; 20:157. [PMID: 33087074 PMCID: PMC7580005 DOI: 10.1186/s12902-020-00637-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 10/13/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Follow-up care provided via telemedicine (TM) is intended to be a more integrated care pathway to manage diabetes-related foot ulcers (DFU) than traditionally-delivered healthcare. However, knowledge of the effect of TM follow-up on PROMs including self-reported health, well-being and QOL in patients with DFUs is lacking and often neglected in RCT reports in general. Therefore, in this study of secondary outcomes from the DiaFOTo trial, the aim was to compare changes in self-reported health, well-being and QOL between patients with DFUs receiving telemedicine follow-up care in primary healthcare in collaboration with specialist healthcare, and patients receiving standard outpatient care. METHODS The current study reports secondary endpoints from a cluster randomized controlled trial whose primary endpoint was ulcer healing time. The trial included 182 adults with diabetes-related foot ulcers (94/88 in the telemedicine/standard care groups) in 42 municipalities/districts, recruited from three clinical sites in Western Norway. Mean (SD) diabetes duration for the study population was 20.8 (15.0). The intervention group received care in the community in collaboration with specialist healthcare using an asynchronous telemedicine intervention. The intervention included an interactive web-based ulcer record and a mobile phone enabling counseling and communication between the community nurses and specialist healthcare; the control group received standard outpatient care. In total 156 participants (78/78) reported on secondary endpoints: self-reported health, well-being and quality of life evaluated by generic and disease-specific patient-reported outcome measures (e.g. Euro-QOL, the Hospital Anxiety and Depression Scale (HADS), Problem Areas in Diabetes (PAID), Neuropathy and Foot Ulcer-Specific Quality of Life Instrument (NeuroQOL)). Linear mixed-effects regression was used to investigate possible differences in changes in the scores between the intervention and control group at the end of follow-up. RESULTS In intention to treat analyses, differences between treatment groups were small and non-significant for the health and well-being scale scores, as well as for diabetes-related distress and foot ulcer-specific quality of life. CONCLUSIONS There were no significant differences in changes in scores for the patient reported outcomes between the intervention and control group, indicating that the intervention did not affect the participants' health, well-being and quality of life. TRIAL REGISTRATION Clinicaltrials.gov , NCT01710774 . Registered October 19th, 2012.
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Affiliation(s)
- Marjolein M Iversen
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, N-5020, Bergen, Norway.
- Department of Medicine, Section of Endocrinology, Stavanger University Hospital, Stavanger, Norway.
| | - Jannicke Igland
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, N-5020, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Hilde Smith-Strøm
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, N-5020, Bergen, Norway
- Department of Medicine, Section of Endocrinology, Stavanger University Hospital, Stavanger, Norway
| | - Truls Østbye
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Svein Skeie
- Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - John G Cooper
- Department of Medicine, Section of Endocrinology, Stavanger University Hospital, Stavanger, Norway
| | - Mark Peyrot
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, N-5020, Bergen, Norway
- Department of Sociology, Loyola University Maryland, Baltimore, MD, USA
| | - Marit Graue
- Faculty of Health and Social Sciences, Department of Health and Caring Sciences, Western Norway University of Applied Sciences, N-5020, Bergen, Norway
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Innamuri R, Madhuri S, George DE, Ramaswamy D. Telepsychiatry Through Email Mode: Current Status and Consensus Guidelines. Indian J Psychol Med 2020; 42:464-468. [PMID: 33414594 PMCID: PMC7750858 DOI: 10.1177/0253717620952323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- Raviteja Innamuri
- Dept. of Psychiatry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Swetha Madhuri
- Dept. of Psychiatry, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Deepa Ramaswamy
- Dept. of Psychiatry, Christian Medical College, Vellore, Tamil Nadu, India
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Farao J, Malila B, Conrad N, Mutsvangwa T, Rangaka MX, Douglas TS. A user-centred design framework for mHealth. PLoS One 2020; 15:e0237910. [PMID: 32813711 PMCID: PMC7444488 DOI: 10.1371/journal.pone.0237910] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 08/05/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) has the potential to improve access to healthcare, especially in developing countries. The proliferation of mHealth has not been accompanied by a corresponding growth in design guidelines for mHealth applications. This paper proposes a framework for mHealth application design that combines the Information Systems Research (ISR) framework and design thinking. We demonstrate a use case for the proposed framework in the form of an app to read the result of the tuberculin skin test (TST), which is used to screen for latent tuberculosis infection. The framework was used in the re-design of the TST reading app but could also be used in earlier stages of mHealth app design. METHODS The ISR framework and design thinking were merged based on how the modes of design thinking integrate with the cycles of the ISR framework. Using the combined framework, we re-designed an mHealth app for TST reading, intended to be used primarily in a developing context by healthcare workers. Using the proposed framework, the app was iterated upon and developed with the aid of personas, observations, prototyping and questionnaires. RESULT The combined framework was applied through engagement with end-users, namely ten healthcare workers and ten graduate students. Through review of the literature and iterations of the app prototype, we identified various usability requirements and limitations. These included challenges related to image capture and a misunderstanding of instructions. These insights influenced the development and improvement of the app. CONCLUSION The combined framework allowed for engagement with end-users and for low-cost, rapid development of the app while addressing contextual challenges and needs. The integration of design thinking modes with the ISR cycles was effective in achieving the objectives of each approach. The combined framework acknowledges the importance of engaging users when implementing mHealth technologies, especially in developing and under-resourced contexts. Findings from this study support the use of this framework as a guide in the design of user-centred mHealth interventions.
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Affiliation(s)
- Jaydon Farao
- Medical Imaging Research Unit, Division of Biomedical Engineering, University of Cape Town, Cape Town, South Africa
| | - Bessie Malila
- Medical Imaging Research Unit, Division of Biomedical Engineering, University of Cape Town, Cape Town, South Africa
| | - Nailah Conrad
- Medical Imaging Research Unit, Division of Biomedical Engineering, University of Cape Town, Cape Town, South Africa
| | - Tinashe Mutsvangwa
- Medical Imaging Research Unit, Division of Biomedical Engineering, University of Cape Town, Cape Town, South Africa
| | - Molebogeng X. Rangaka
- Division of Epidemiology and Biostatistics, School of Public Health and CIDRI-AFRICA, Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Institute for Global Health, University College London, London, United Kingdom
| | - Tania S. Douglas
- Medical Imaging Research Unit, Division of Biomedical Engineering, University of Cape Town, Cape Town, South Africa
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Furness K, Sarkies MN, Huggins CE, Croagh D, Haines TP. Impact of the Method of Delivering Electronic Health Behavior Change Interventions in Survivors of Cancer on Engagement, Health Behaviors, and Health Outcomes: Systematic Review and Meta-Analysis. J Med Internet Res 2020; 22:e16112. [PMID: 32574147 PMCID: PMC7381039 DOI: 10.2196/16112] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/19/2019] [Accepted: 04/09/2020] [Indexed: 12/14/2022] Open
Abstract
Background Increased accessibility to the internet and mobile devices has seen a rapid expansion in electronic health (eHealth) behavior change interventions delivered to patients with cancer and survivors using synchronous, asynchronous, and combined delivery methods. Characterizing effective delivery methods of eHealth interventions is required to enable improved design and implementation of evidence-based health behavior change interventions. Objective This study aims to systematically review the literature and synthesize evidence on the success of eHealth behavior change interventions in patients with cancer and survivors delivered by synchronous, asynchronous, or combined methods compared with a control group. Engagement with the intervention, behavior change, and health outcomes, including quality of life, fatigue, depression, and anxiety, were examined. Methods A search of Scopus, Ovid MEDLINE, Excerpta Medica dataBASE, Cumulative Index to Nursing and Allied Health Literature Plus, PsycINFO, Cochrane CENTRAL, and PubMed was conducted for studies published between March 2007 and March 2019. We looked for randomized controlled trials (RCTs) examining interventions delivered to adult cancer survivors via eHealth methods with a measure of health behavior change. Random-effects meta-analysis was performed to examine whether the method of eHealth delivery impacted the level of engagement, behavior change, and health outcomes. Results A total of 24 RCTs were included predominantly examining dietary and physical activity behavior change interventions. There were 11 studies that used a synchronous approach and 11 studies that used an asynchronous approach, whereas 2 studies used a combined delivery method. Use of eHealth interventions improved exercise behavior (standardized mean difference [SMD] 0.34, 95% CI 0.21-0.48), diet behavior (SMD 0.44, 95% CI 0.18-0.70), fatigue (SMD 0.21, 95% CI −0.08 to 0.50; SMD change 0.22, 95% CI 0.09-0.35), anxiety (SMD 1.21, 95% CI: 0.36-2.07; SMD change 0.15, 95% CI −0.09 to 0.40), depression (SMD 0.15, 95% CI 0.00-0.30), and quality of life (SMD 0.12, 95% CI −0.10 to 0.34; SMD change 0.14, 95% CI 0.04-0.24). The mode of delivery did not influence the amount of dietary and physical activity behavior change observed. Conclusions Physical activity and dietary behavior change eHealth interventions delivered to patients with cancer or survivors have a small to moderate impact on behavior change and a small to very small benefit to quality of life, fatigue, depression, and anxiety. There is insufficient evidence to determine whether asynchronous or synchronous delivery modes yield superior results. Three-arm RCTs comparing delivery modes with a control with robust engagement reporting are required to determine the most successful delivery method for promoting behavior change and ultimately favorable health outcomes.
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Affiliation(s)
- Kate Furness
- Nutrition and Dietetics, Monash Medical Centre, Monash Health, Melbourne, Australia.,School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Mitchell N Sarkies
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Australia.,Centre for Healthcare Resilience and Implementation Science Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Catherine E Huggins
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Daniel Croagh
- Upper Gastrointestinal and Hepatobiliary Surgery, Monash Medical Centre, Monash Health, Melbourne, Australia.,Department of Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Terry P Haines
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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Duruturk N. Telerehabilitation intervention for type 2 diabetes. World J Diabetes 2020; 11:218-226. [PMID: 32547696 PMCID: PMC7284018 DOI: 10.4239/wjd.v11.i6.218] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/02/2020] [Accepted: 04/19/2020] [Indexed: 02/05/2023] Open
Abstract
Diabetes has become an increasingly important health problem worldwide due to its prevalence. Although effective treatments for diabetes management have been developed, many patients have difficulty in achieving their therapeutic goals. Regular exercise training is suggested to prevent or delay the symptoms and complications of type 2 diabetes along with other medical treatments. It has become necessary to develop new rehabilitation models and practices in order to cope with the changing needs of the population. Treatment models using technology can be effective in disease management. Telerehabilitation may be effective as part of the rehabilitation program in the home environment, especially for patients who are unable to participate in conventional center-based rehabilitation due to transport difficulties or work resumption. Telerehabilitation is defined as the delivery of rehabilitation services via telecommunication technology, including phone, internet, and videoconference communications between the patient and health care provider. It is possible that telerehabilitation may benefit people with type 2 diabetes in similar ways with telemonitoring and interactive health communication systems. Although the applicability of telehealth methods has been proven in previous studies, telerehabi-litation studies in type 2 diabetes are inadequate in the literature. With larger, multi-centered randomized controlled studies, established clinical guidelines can be developed that will ultimately improve patient outcomes.
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Affiliation(s)
- Neslihan Duruturk
- Department of Physiotherapy and Rehabilitation, Baskent University, Faculty of Health Sciences, Ankara 06790, Turkey
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Behmanesh A, Sadoughi F, Mazhar FN, Joghataei MT, Yazdani S. Tele-orthopaedics: A systematic mapping study. J Telemed Telecare 2020; 28:3-23. [PMID: 32393139 DOI: 10.1177/1357633x20919308] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION The use of telemedicine in orthopaedics can provide high-quality orthopaedic services to patients in remote areas. Tele-orthopaedics is widely acknowledged for decreasing travel, time and cost, increasing accessibility and quality of care. In the absence of a comprehensive review on tele-orthopaedics applications and services, here, we systematically identify and classify the tele-orthopaedic applications and services and provide an overview of the trends in the field. METHODS In this study, a systematic mapping was conducted to answer six research questions, we searched the databases Scopus, PubMed, IEEE Digital Library and Web of Science up to 2019. Consequently, 77 papers were screened and selected on the basis of specific inclusion and exclusion criteria. RESULTS We found that mobile-based teleconsultation was mostly asynchronous, while non-mobile teleconsultation was synchronous. The results showed that the physician-patient relationship was more common than other interactions, such as physician-physician and physician-robot interactions. In addition, more than half of the services provided by tele-orthopaedics have been used for orthopaedic diseases/traumas in which joint replacement and fracture reduction have been the most important orthopaedic procedures. It has been noted that more attention has been paid to tele-orthopaedics in developed countries such as the USA, Australia, Canada and Finland. DISCUSSION Telemonitoring (teleconsultation and telemetry) and telesurgery (telerobotics and telementoring) were found to be the two major forms of tele-orthopaedics. Mobile phones were used asynchronously in most of the teleconsultations. The development of different applications may result in the use of multiple smartphones applications in real-time teleconsultation. The use of smartphones is expected to increase in the near future.
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Affiliation(s)
- Ali Behmanesh
- Student Research Committee, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Farahnaz Sadoughi
- Health Management and Economics Research Centre, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Farid Najd Mazhar
- Bone and Joint Reconstruction Research Centre, Shafa Orthopaedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Shahram Yazdani
- School of Management and Medical Education Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Desruisseaux M, Stamenova V, Bhatia RS, Bhattacharyya O. Channel management in virtual care. NPJ Digit Med 2020; 3:44. [PMID: 32219185 PMCID: PMC7096521 DOI: 10.1038/s41746-020-0252-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 02/28/2020] [Indexed: 11/09/2022] Open
Abstract
Many virtual care initiatives focus heavily on video visits, essentially mimicking face-to-face visits. Meanwhile, clinicians in established settings continue to use the oldest modality, phone calls, and some use the most ubiquitous, asynchronous messaging. The latter, along with live chat and chatbots, could be transformative if workflows were redesigned to incorporate it. With multiple modalities now available for use in virtual care, the central problem is to direct patient-provider interactions to the channels generating the most value. Marketers call this channel management and use sophisticated approaches to implement it. We propose an adaptation of channel management to virtual care and discuss anticipated challenges to its implementation.
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Affiliation(s)
| | - Vess Stamenova
- Women’s College Hospital Institute for Health Systems Solutions and Virtual Care, University of Toronto, Toronto, ON Canada
| | - R. Sacha Bhatia
- Women’s College Hospital Institute for Health Systems Solutions and Virtual Care, University of Toronto, Toronto, ON Canada
- University Health Network, Toronto, ON Canada
| | - Onil Bhattacharyya
- Women’s College Hospital Institute for Health Systems Solutions and Virtual Care, University of Toronto, Toronto, ON Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON Canada
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Duruturk N, Özköslü MA. Effect of tele-rehabilitation on glucose control, exercise capacity, physical fitness, muscle strength and psychosocial status in patients with type 2 diabetes: A double blind randomized controlled trial. Prim Care Diabetes 2019; 13:542-548. [PMID: 31014938 DOI: 10.1016/j.pcd.2019.03.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/04/2019] [Accepted: 03/25/2019] [Indexed: 12/14/2022]
Abstract
AIM To determine the effect of a tele-rehabilitation (TR) program on glucose control, exercise capacity, physical fitness, muscle strength and psychosocial status in patients with type 2 diabetes mellitus (DM). METHOD Fifty type 2 DM participants were enrolled in the study and divided randomly into two groups; TR (n = 25, mean age: 52.82 ± 11.86) or control (n = 25, mean age: 53.04 ± 10.45) group. Participants in the TR group performed breathing and callisthenic exercises, three times a week, for 6 weeks, at home by internet based video conferences. Outcome measures including, HbA1c level, 6 min walk testing, physical fitness and muscle strength dynamometer measurement, Beck Depression Inventory were performed before and after the 6 weeks. RESULTS HbA1c (p = 0.00), 6 min walking distance (p = 0.00), physical fitness subparameters; sit-up (p = 0.00), sit-and-reach (p = 0.04), back scratch (p = 0.00), lateral flexion right (p = 0.04), left (p = 0.00) and time up go tests (p = 0.00), muscles strength (p = 0.00); deltoideus-anterior, middle, quadriceps femoris and gluteus maximus, and depression levels (p = 0.00) changed significantly (p = 0.00) in TR groups. There were no significant improvements in control group (p > 0.05). CONCLUSION Our findings suggest that TR interventions found to be safe and effective, and may be an alternative treatment model for type 2 DM management. In addition to these health benefits, patients and rehabilitation team may save time, labor and treatment costs by using TR.
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Affiliation(s)
- Neslihan Duruturk
- Baskent University, Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Ankara, Turkey.
| | - Manolya Acar Özköslü
- Baskent University, Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Ankara, Turkey
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47
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Chudner I, Drach-Zahavy A, Karkabi K. Choosing Video Instead of In-Clinic Consultations in Primary Care in Israel: Discrete Choice Experiment Among Key Stakeholders-Patients, Primary Care Physicians, and Policy Makers. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:1187-1196. [PMID: 31563262 DOI: 10.1016/j.jval.2019.05.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 04/27/2019] [Accepted: 05/01/2019] [Indexed: 05/27/2023]
Abstract
BACKGROUND Despite its innovative benefits, the adoption of video consultations (VCs) in primary care settings is complex and slow. OBJECTIVES To quantify the preferences of key stakeholders in Israel's primary care-patients, primary care practitioners, and policy makers-regarding VCs compared with traditional in-clinic consultations (ICC) in nonurgent conditions. METHODS Discrete choice experiment surveys were completed by 508 patients, 311 physicians, and 141 policy makers. These consisted of 12 choice tasks of 2 labeled alternatives (VC or ICC), with the 4 attributes most relevant to each stakeholder group. A random effects logit model analysis was used to estimate stakeholders' preferences. RESULTS All 4 experiments' attributes were significantly important in choosing VC versus ICC for the patient group and the physician group. Three out of 4 attributes were significantly important to policy makers. Differences and similarities between stakeholders were identified in attribute rank order, trade-offs, and VC uptake probabilities. Policy makers' VC uptake rate was 86%. Patients' preferences suggested that 68% of ICCs could be replaced by VCs. Physicians' VC uptake was 30% in cases in which the consultation purpose was to diagnose and provide treatment and 48% in cases in which the consultation purpose was follow-up. CONCLUSIONS Our findings show key stakeholders' preferences about VC integration, to be considered when these systems are introduced into primary care and optimize the implementation process. Although there is a stronger preference for ICC among physicians and patients, alternative combinations of attribute levels might be used to compensate and reconfigure a more preferred VC service.
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Affiliation(s)
- Irit Chudner
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
| | | | - Khaled Karkabi
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel; Department of Family Medicine, Clalit Heath Services, Haifa, Israel
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48
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Marcolino MS, Alkmim MB, Pessoa CG, Maia JX, Cardoso CS. Development and Implementation of a Methodology for Quality Assessment of Asynchronous Teleconsultations. Telemed J E Health 2019; 26:651-658. [PMID: 31386601 DOI: 10.1089/tmj.2019.0049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: There is a lack of evidence regarding audits or quality analysis of telehealth strategies in clinical practice. Our aim is to develop and implement a methodology for quality assessment of asynchronous teleconsultations. Materials and Methods: A random sample of asynchronous teleconsultations performed by the specialists from the Telehealth Network of Minas Gerais (TNMG), a public telehealth service in Brazil, was selected. The responses were evaluated regarding size, objectivity, quality, ethics, courtesy, and grammar, and received a score for each category: 1 = fair, 2 = moderate, and 3 = good. As each domain has a different importance in rating the overall quality of teleconsultation, each one was assigned a different weight, and a final score was calculated. Results: A total of 576 teleconsultations were assessed. Overall, the scores were good or moderate for all items. Only a few cases were classified as fair. Among medical specialties, pediatrics was the one that proportionally received the highest number of fair classifications, and the item "quality of the answers" was the one with highest number of worse classifications for this specialty. Corrective actions were implemented. With regard to the nonmedical specialties, the majority of the items were classified as good or moderate, and in rare cases some items received the fair rating. Conclusion: The methodology showed to be useful to evaluate the teleconsultation service. We established six domains that we considered important components to be assessed. This assessment was essential to identify the priority areas to receive correct actions. It may be easily replicated in other services worldwide.
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Affiliation(s)
- Milena Soriano Marcolino
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Telehealth Network of Minas Gerais, Belo Horizonte, Brazil
| | - Maria Beatriz Alkmim
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Telehealth Network of Minas Gerais, Belo Horizonte, Brazil
| | - Cristiane Guimarães Pessoa
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Telehealth Network of Minas Gerais, Belo Horizonte, Brazil
| | - Junia Xavier Maia
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Telehealth Network of Minas Gerais, Belo Horizonte, Brazil
| | - Clareci Silva Cardoso
- Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Telehealth Network of Minas Gerais, Belo Horizonte, Brazil.,Department of Medicine, Universidade Federal de São João del-Rei, Divinópolis, Brazil
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49
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Shah SJ, Schwamm LH, Cohen AB, Simoni MR, Estrada J, Matiello M, Venkataramani A, Rao SK. Virtual Visits Partially Replaced In-Person Visits In An ACO-Based Medical Specialty Practice. Health Aff (Millwood) 2019; 37:2045-2051. [PMID: 30633681 DOI: 10.1377/hlthaff.2018.05105] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Specialty care contributes significantly to total medical expenditures, for which accountable care organizations (ACOs) are responsible. ACOs have sought to replace costly in-person visits with lower-cost alternatives such as virtual visits (videoconferencing with physicians). In fee-for-service environments, virtual visits appear to add to in-person visits instead of replacing them. While this may be less of a problem within ACOs, whether virtual visits reduce in-person visits in an ACO is not known. Using data from over 35,000 patients in the period 2014-17 within a Massachusetts-based ACO, we found that the use of virtual visits reduced in-person visits by 33 percent but increased total visits (virtual plus in-person visits) by 80 percent over 1.5 years. While the use of virtual visits reduced in-person visits soon after registering with the program, the effect did not endure beyond a year. Whether and how virtual visits can substitute for in-person care in the long term are open questions.
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Affiliation(s)
- Sachin J Shah
- Sachin J. Shah ( ) is an assistant professor of medicine at the University of California San Francisco
| | - Lee H Schwamm
- Lee H. Schwamm is executive vice chair of neurology and director of the Center for TeleHealth at Massachusetts General Hospital, and a professor of neurology at Harvard Medical School, both in Boston
| | - Adam B Cohen
- Adam B. Cohen is health technologies program manager at the Johns Hopkins University Applied Physics Laboratory, in Laurel, and an assistant professor of neurology in the Johns Hopkins Hospital and Health System, in Baltimore, both in Maryland
| | - Marcy R Simoni
- Marcy R. Simoni is director of the Virtual Visit Program at the Center for TeleHealth, Massachusetts General Hospital
| | - Juan Estrada
- Juan Estrada is senior director of the Virtual Consult Program at the Center for TeleHealth, Massachusetts General Hospital
| | - Marcelo Matiello
- Marcelo Matiello is director of Neurology Inpatient Services and Routine and Urgent Teleneurology Program at Massachusetts General Hospital and an assistant professor of neurology at Harvard Medical School, in Boston
| | - Atheendar Venkataramani
- Atheendar Venkataramani is an assistant professor of medical ethics and of health policy at the University of Pennsylvania Perelman School of Medicine, in Philadelphia
| | - Sandhya K Rao
- Sandhya K. Rao is senior medical director for population health management at Partners Healthcare and an assistant professor of medicine at Harvard Medical School, both in Boston
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50
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Kuipers E, Poot CC, Wensing M, Chavannes NH, de Smet PA, Teichert M. Self-Management Maintenance Inhalation Therapy With eHealth (SELFIE): Observational Study on the Use of an Electronic Monitoring Device in Respiratory Patient Care and Research. J Med Internet Res 2019; 21:e13551. [PMID: 31148542 PMCID: PMC6658221 DOI: 10.2196/13551] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/20/2019] [Accepted: 03/23/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Electronic inhalation monitoring devices (EIMDs) are available to remind patients with respiratory diseases to take their medication and register inhalations for feedback to patients and health care providers as well as for data collection in research settings. OBJECTIVE This study aimed to assess the validity as well as the patient-reported usability and acceptability of an EIMD. METHODS This observational study planned to include 21 community pharmacies in the Netherlands. Patient-reported inhalations were collected and compared to EIMD registrations to evaluate the positive predictive value of these registrations as actual patient inhalations. Patients received questionnaires on their experiences and acceptance. RESULTS A convenience sample of 32 patients was included from across 18 pharmacies, and 932 medication doses were validated. Of these, 796 registrations matched with patient-reported use (true-positive, 85.4%), and 33 inhalation registrations did not match with patient-reported use (false-positive, 3.5%). The positive predictive value was 96.0%, and 103 patient-reported inhalations were not recorded in the database (false-negative, 11.1%). Overall, patients considered the EIMD to be acceptable and easy to use, but many hesitated to continue its use. Reminders and motivational messages were not appreciated by all users, and more user-tailored features in the app were desired. CONCLUSIONS Patients' interaction with the device in real-world settings is critical for objective measurement of medication adherence. The positive predictive value of this EIMD was found to be acceptable. However, patients reported false-negative registrations and a desire to include more user-tailored features to increase the usability and acceptability of the EIMD.
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Affiliation(s)
- Esther Kuipers
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands.,BENU Apotheek Zeist West, Zeist, Netherlands
| | - Charlotte C Poot
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Michel Wensing
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands.,Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Peter Agm de Smet
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands.,Department of Clinical Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Martina Teichert
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Centre, Leiden, Netherlands
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