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Nymberg P, Bandel I, Bolmsjö BB, Wolff M, Calling S, Leonardsen ACL, MilosNymberg V. How do patients experience and use home blood pressure monitoring? A qualitative analysis with UTAUT 2. Scand J Prim Health Care 2024:1-9. [PMID: 38900545 DOI: 10.1080/02813432.2024.2368849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 06/11/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Hypertension is an important cardiovascular risk factor with potentially harmful consequences. Home blood pressure monitoring is a promising method for following the effect of hypertension treatment. The use of technology-enabled care and increased patient involvement might contribute to more effective treatment methods. However, more knowledge is needed to explain the motivations and consequences of patients engaging in what has been called 'do-it-yourself healthcare'. Aim: This study aimed to investigate patients' experiences of home blood pressure monitoring through the theoretical frame of the Unified Theory of Acceptance and Use of Technology (UTAUT 2). Methods: The study had a qualitative design, with focus group interviews using the web-based platform Zoom. The data were analysed using qualitative deductive content analysis, inspired by Graneheim and Lundman. Results: The results are presented using the seven theoretical constructs of UTAUT 2: Performance Expectancy, Effort Expectancy, Social Influence, Facilitating Conditions, Hedonistic Motivation, Price Value and Habit. We found one overarching theme ‒ 'It's all about the feeling of security'. The patients were influenced by relatives or healthcare personnel and experienced the home monitoring process as being easy to conduct. The patients emphasised that the quality of the blood pressure monitor was more important than the price. Patients reported home monitoring of blood pressure as a feasible method to follow-up care of their hypertension. Discussion: This study indicates that among motivated patients, home blood pressure measurement entails minimal effort, increases security, and leads to better communication about blood pressure between healthcare personnel and patients.
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Affiliation(s)
- Peter Nymberg
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Ida Bandel
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Beata Borgström Bolmsjö
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Moa Wolff
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Susanna Calling
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | | | - Veronica MilosNymberg
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
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Sharma Y, Cheung L, Patterson KK, Iaboni A. Factors influencing the clinical adoption of quantitative gait analysis technology with a focus on clinical efficacy and clinician perspectives: A scoping review. Gait Posture 2024; 108:228-242. [PMID: 38134709 DOI: 10.1016/j.gaitpost.2023.12.003] [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: 08/18/2023] [Revised: 11/14/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION Quantitative gait analysis (QGA) has the potential to support clinician decision-making. However, it is not yet widely accepted in practice. Evidence for clinical efficacy (i.e., efficacy and effectiveness), as well as a users' perspective on using the technology in clinical practice (e.g., ease of use and usefulness) can help impact their widespread adoption. OBJECTIVE To synthesize the literature on the clinical efficacy and clinician perspectives on the use of gait analysis technologies in the clinical care of adult populations. METHODS This scoping review followed the Joanna Briggs Institute (JBI) methodology for scoping reviews. We included peer-reviewed and gray literature (i.e., conference abstracts). A search was conducted in MEDLINE (Ovid), CENTRAL (Ovid), EMBASE (Ovid), CINAHL (EBSCO) and SPORTDiscus (EBSCO). Included full-text studies were critically appraised using the JBI critical appraisal tools. RESULTS A total of 15 full-text studies and two conference abstracts were included in this review. Results suggest that QGA technologies can influence decision-making with some evidence to suggest their role in improving patient outcomes. The main barrier to ease of use was a clinician's lack of data expertise, and main facilitator was receiving support from staff. Barriers to usefulness included challenges finding suitable reference data and data accuracy, while facilitators were enhancing patient care and supporting clinical decision-making. SIGNIFICANCE This review is the first step to understanding how QGA technologies can optimize clinical practice. Many gaps in the literature exist and reveal opportunities to improve the clinical adoption of gait analysis technologies. Further research is needed in two main areas: 1) examining the clinical efficacy of gait analysis technologies and 2) gathering clinician perspectives using a theoretical model like the Technology Acceptance Model to guide study design. Results will inform research aimed at evaluating, developing, or implementing these technologies. FUNDING This work was supported by the Walter and Maria Schroeder Institute for Brain Innovation and Recovery and AGE-WELL Graduate Student Award in Technology and Aging [2021,2022].
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Affiliation(s)
- Yashoda Sharma
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7 Toronto, ON, Canada; KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, 550 University Avenue, M5G 2A2 Toronto, ON, Canada
| | - Lovisa Cheung
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7 Toronto, ON, Canada; KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, 550 University Avenue, M5G 2A2 Toronto, ON, Canada; Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7 Toronto, ON, Canada
| | - Kara K Patterson
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7 Toronto, ON, Canada; KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, 550 University Avenue, M5G 2A2 Toronto, ON, Canada; Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7 Toronto, ON, Canada
| | - Andrea Iaboni
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, M5G 1V7 Toronto, ON, Canada; KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, 550 University Avenue, M5G 2A2 Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, 250 College Street, M5T 1R8 Toronto, ON, Canada.
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Idris H, Nugraheni WP, Rachmawati T, Kusnali A, Yulianti A, Purwatiningsih Y, Nuraini S, Susianti N, Faisal DR, Arifin H, Maharani A. How Is Telehealth Currently Being Utilized to Help in Hypertension Management within Primary Healthcare Settings? A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:90. [PMID: 38248553 PMCID: PMC10815916 DOI: 10.3390/ijerph21010090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/29/2023] [Accepted: 01/10/2024] [Indexed: 01/23/2024]
Abstract
Telehealth has improved patient access to healthcare services and has been shown to have a positive impact in various healthcare settings. In any case, little is understood regarding the utilization of telehealth in hypertension management in primary healthcare (PHC) settings. This study aimed to identify and classify information about the types of interventions and types of telehealth technology in hypertension management in primary healthcare. A scoping review based on PRISMA-ScR was used in this study. We searched for articles in four databases: Pubmed, Scopus, Science Direct, and Embase in English. The selected articles were published in 2013-2023. The data were extracted, categorized, and analyzed using thematic analysis. There were 1142 articles identified and 42 articles included in this study. Regarding the proportions of studies showing varying trends in the last ten years, most studies came from the United States (US) (23.8%), were conducted in urban locations (33.3%), and had a quantitative study approach (69%). Telehealth interventions in hypertension management are dominated by telemonitoring followed by teleconsultation. Asynchronous telehealth is becoming the most widely used technology in managing hypertension in primary care settings. Telehealth in primary care hypertension management involves the use of telecommunications technology to monitor and manage blood pressure and provide medical advice and counselling remotely.
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Affiliation(s)
- Haerawati Idris
- Department of Health Administration & Policy, Faculty of Public Health, Sriwijaya University, Indralaya 30662, Indonesia
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Central Jakarta 10340, Indonesia; (W.P.N.); (T.R.); (A.K.); (A.Y.); (Y.P.); (S.N.); (N.S.); (D.R.F.)
| | - Wahyu Pudji Nugraheni
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Central Jakarta 10340, Indonesia; (W.P.N.); (T.R.); (A.K.); (A.Y.); (Y.P.); (S.N.); (N.S.); (D.R.F.)
| | - Tety Rachmawati
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Central Jakarta 10340, Indonesia; (W.P.N.); (T.R.); (A.K.); (A.Y.); (Y.P.); (S.N.); (N.S.); (D.R.F.)
| | - Asep Kusnali
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Central Jakarta 10340, Indonesia; (W.P.N.); (T.R.); (A.K.); (A.Y.); (Y.P.); (S.N.); (N.S.); (D.R.F.)
| | - Anni Yulianti
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Central Jakarta 10340, Indonesia; (W.P.N.); (T.R.); (A.K.); (A.Y.); (Y.P.); (S.N.); (N.S.); (D.R.F.)
| | - Yuni Purwatiningsih
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Central Jakarta 10340, Indonesia; (W.P.N.); (T.R.); (A.K.); (A.Y.); (Y.P.); (S.N.); (N.S.); (D.R.F.)
| | - Syarifah Nuraini
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Central Jakarta 10340, Indonesia; (W.P.N.); (T.R.); (A.K.); (A.Y.); (Y.P.); (S.N.); (N.S.); (D.R.F.)
| | - Novia Susianti
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Central Jakarta 10340, Indonesia; (W.P.N.); (T.R.); (A.K.); (A.Y.); (Y.P.); (S.N.); (N.S.); (D.R.F.)
| | - Debri Rizki Faisal
- Research Center for Public Health and Nutrition, National Research and Innovation Agency, Central Jakarta 10340, Indonesia; (W.P.N.); (T.R.); (A.K.); (A.Y.); (Y.P.); (S.N.); (N.S.); (D.R.F.)
| | - Hidayat Arifin
- Department of Basic Nursing Care, Faculty of Nursing, Universitas Airlangga, Surabaya 60286, Indonesia;
| | - Asri Maharani
- Division of Nursing, Midwifery & Social Work, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK;
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Ahrabi A. Letter to the Editor on "Is remote blood pressure monitoring and management a better approach for patients with hypertension? A narrative review". J Clin Hypertens (Greenwich) 2023; 25:794-795. [PMID: 37477498 PMCID: PMC10423757 DOI: 10.1111/jch.14704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/22/2023]
Affiliation(s)
- Amirali Ahrabi
- School of MedicineTehran University of Medical SciencesTehranIran
- School of Public HealthTehran University of Medical SciencesTehranIran
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Sharma Y, Cheung L, Patterson KK, Iaboni A. Factors Influencing the Clinical Adoption of Quantitative Gait Analysis Technologies for Adult Patient Populations With a Focus on Clinical Efficacy and Clinician Perspectives: Protocol for a Scoping Review. JMIR Res Protoc 2023; 12:e39767. [PMID: 36947120 PMCID: PMC10131694 DOI: 10.2196/39767] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 12/14/2022] [Accepted: 01/24/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Quantitative gait analysis can support clinical decision-making. These analyses can be performed using wearable sensors, nonwearable sensors, or a combination of both. However, to date, they have not been widely adopted in clinical practice. Technology adoption literature has highlighted the clinical efficacy of technology and the users' perspective on the technology (eg, ease of use and usefulness) as some factors that influence their widespread adoption. OBJECTIVE To assist with the clinical adoption of quantitative gait technologies, this scoping review will synthesize the literature on their clinical efficacy and clinician perspectives on their use in the clinical care of adult patient populations. METHODS This scoping review protocol follows the Joanna Briggs Institute methodology for scoping reviews. The review will include both peer-reviewed and gray literature (ie, conference abstracts) regarding the clinical efficacy of quantitative gait technologies and clinician perspectives on their use in the clinical care of adult patient populations. A comprehensive search strategy was created in MEDLINE (Ovid), which was then translated to 4 other databases: CENTRAL (Ovid), Embase (Ovid), CINAHL (EBSCO), and SPORTDiscus (EBSCO). The title and abstract screening, full-text review, and data extraction of relevant articles will be performed independently by 2 reviewers, with a third reviewer involved to support the resolution of conflicts. Data will be analyzed using content analysis and summarized in tabular and diagram formats. RESULTS A search of relevant articles will be conducted in all 5 databases, and through hand-searching in Google Scholar and PEDro, including articles published up until December 2022. The research team plans to submit the final scoping review for publication in a peer-reviewed journal in 2023. CONCLUSIONS The findings of this review will be presented at clinical science conferences and published in a peer-reviewed journal. This review will inform future studies designed to develop, evaluate, or implement quantitative gait analysis technologies in clinical practice. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/39767.
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Affiliation(s)
- Yashoda Sharma
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Lovisa Cheung
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Kara K Patterson
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Andrea Iaboni
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Al-Rousan T, Awad M, Amalia Pesantes M, Kandula NR, Huffman MD, Jaime Miranda J, Vidal-Perez R, Dzudie A, A. M. Anderson C. Healthcare Provider’s Perspectives on Home Blood Pressure Management in Peru and Cameroon: Findings from the BPMONITOR Study. Prev Med Rep 2023; 33:102179. [PMID: 36968516 PMCID: PMC10036923 DOI: 10.1016/j.pmedr.2023.102179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/25/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
Home blood pressure management, including self-monitoring and medication self-titration, is an efficient and cost-effective tool. Although its use is increasing globally, little is known about the feasibility of such interventions in low and middle-income countries. Further, the perspectives and experiences of healthcare providers who play a big role in ensuring the success of home blood pressure management interventions have not been documented. This qualitative study was conducted with a total of 35 healthcare providers (60% female, mean [SD] age = 37.3 [6.9 years] years), through 4 in-depth interviews from Peru, and 8 in-depth interviews and 4 focus groups from Cameroon. Study participants (healthcare providers) include physicians (primary care physicians), specialists (cardiologists and geriatricians), and nurses that were purposively recruited from two hospitals in two of the largest cities in both countries. Results were thematically analyzed by two researchers. Themes derived were related to feasibility and acceptability, and largely reflected providers in both countries endorsing home blood pressure management. Providers' concerns were in three main areas; 1) safety of patients when they self-titrate medications, 2) resources such as healthcare financing, local hospital policies that support communications with patients for home blood pressure management, and 3) sustainability through patient adherence, incorporating home blood pressure management within clinical guidelines and hospital policies, and complementing with continued health education and lifestyle modifications. According to providers, home blood pressure management may be feasible and acceptable if tailored multi-faceted protocols were introduced bearing in mind local contexts.
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2022 Malaysian Working Group Consensus Statement on Renal Denervation for management of arterial hypertension. Hypertens Res 2022; 45:1111-1122. [PMID: 35650248 PMCID: PMC9192347 DOI: 10.1038/s41440-022-00937-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 12/28/2022]
Abstract
Hypertension is highly prevalent and a major contributor to cardiovascular mortality and morbidity. In spite of the availability of efficacious, safe and affordable anti-hypertensive drugs, hypertension remains poorly controlled in the majority of hypertensive patients. Various reasons including non-adherence to the anti-hypertensive drugs, account for the poor control. Resistant hypertension is also one of the reasons for poor control of blood pressure (BP). The sympathetic nervous system (SNS) has long been recognized as one of the determinants in the pathophysiology of a raised BP. Overactivity of the SNS is a contributor to sustained arterial hypertension. Renal denervation (RDN) is increasingly recognized as a safe and effective adjunctive therapy to control BP with or without pharmacotherapy. Hence for patients who remain uncontrolled despite all efforts, renal denervation (RDN) is a novel treatment that can potentially improve BP control, hence reducing the major adverse cardiovascular events (MACE). More recent randomized, sham control trials of RDN have shown that RDN produces a sustained lowering of BP. To date, this lowering of BP through RDN is maintained for at least 3 years. Furthermore, this procedure has been found to be safe. Hence this consensus summarises the science behind RDN and the available clinical data to support the use of this therapy. It is hoped that this consensus will offer guidance on the importance of identifying patients who will benefit most from this therapy. A multidisciplinary team approach in the management of the patient undergoing RDN is recommended. ![]()
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Railey AF, Dillard DA, Fyfe-Johnson A, Todd M, Schaefer K, Rosenman R. Choice of home blood pressure monitoring device: the role of device characteristics among Alaska Native and American Indian peoples. BMC Cardiovasc Disord 2022; 22:19. [PMID: 35090399 PMCID: PMC8796453 DOI: 10.1186/s12872-021-02449-w] [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] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/28/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Home blood pressure monitoring (HBPM) is an effective tool in treatment and long-term management of hypertension. HBPM incorporates more data points to help patients and providers with diagnosis and management. The characteristics of HBPM devices matter to patients, but the relative importance of the characteristics in choosing a device remains unclear. METHODS We used data from a randomized cross-over pilot study with 100 Alaska Native and American Indian (ANAI) people with hypertension to assess the choice of a wrist or arm HBPM device. We use a random utility framework to evaluate the relationship between stated likely use, perceived accuracy, ease of use, comfort, and participant characteristics with choice of device. Additional analyses examined willingness to change to a more accurate device. RESULTS Participants ranked the wrist device higher compared to the arm on a 5-point Likert scale for likely use, ease of use, and comfort (0.3, 0.5, 0.8 percentage points, respectively). Most participants (66%) choose the wrist device. Likely use (wrist and arm devices) was related to the probability of choosing the wrist (0.7 and - 1.4 percentage points, respectively). Independent of characteristics, 75% of participants would be willing to use the more accurate device. Ease of use (wrist device) and comfort (arm device) were associated with the probability of changing to a more accurate device (- 1.1 and 0.5 percentage points, respectively). CONCLUSION Usability, including comfort, ease, and likely use, appeared to discount the relative importance of perceived accuracy in the device choice. Our results contribute evidence that ANAI populations value accurate HBPM, but that the devices should also be easy to use and comfortable to facilitate long-term management.
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Affiliation(s)
- Ashley F Railey
- Department of Sociology, Indiana University, Bloomington, IN, USA.
- Institute for Research and Education to Advance Community Health (IREACH), Elson S. Floyd College of Medicine, Washington State University, Seattle, WA, USA.
| | | | - Amber Fyfe-Johnson
- Institute for Research and Education to Advance Community Health (IREACH), Elson S. Floyd College of Medicine, Washington State University, Seattle, WA, USA
| | | | | | - Robert Rosenman
- Institute for Research and Education to Advance Community Health (IREACH), Elson S. Floyd College of Medicine, Washington State University, Seattle, WA, USA
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Hare AJ, Chokshi N, Adusumalli S. Novel Digital Technologies for Blood Pressure Monitoring and Hypertension Management. CURRENT CARDIOVASCULAR RISK REPORTS 2021; 15:11. [PMID: 34127936 PMCID: PMC8188759 DOI: 10.1007/s12170-021-00672-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW Hypertension is common, impacting an estimated 108 million US adults, and deadly, responsible for the deaths of one in six adults annually. Optimal management includes frequent blood pressure monitoring and antihypertensive medication titration, but in the traditional office-based care delivery model, patients have their blood pressure measured only intermittently and in a way that is subject to misdiagnosis with white coat or masked hypertension. There is a growing opportunity to leverage our expanding repository of digital technology to reimagine hypertension care delivery. This paper reviews existing and emerging digital tools available for hypertension management, as well as behavioral economic insights that could supercharge their impact. RECENT FINDINGS Digitally connected blood pressure monitors offer an alternative to office-based blood pressure monitoring. A number of cuffless blood pressure monitors are in development but require further validation before they can be deployed for widespread clinical use. Patient-facing hubs and applications offer a means to transmit blood pressure data to clinicians. Though artificial intelligence could allow for curation of this data, its clinical use for hypertension remains limited to assessing risk factors at this time. Finally, text-based and telemedicine platforms are increasingly being employed to translate hypertension data into clinical outcomes with promising results. SUMMARY The digital management of hypertension shows potential as an avenue for increasing patient engagement and improving clinical efficiency and outcomes. It is important for clinicians to understand the benefits, limitations, and future directions of digital health to optimize management of hypertension.
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Affiliation(s)
- Allison J Hare
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
- Office of the Chief Medical Information Officer, Penn Medicine, Philadelphia, PA USA
- Center for Digital Cardiology, Penn Medicine, Philadelphia, PA USA
| | - Neel Chokshi
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
- Center for Digital Cardiology, Penn Medicine, Philadelphia, PA USA
- Division of Cardiovascular Medicine, Department of Medicine, Penn Medicine, Philadelphia, PA USA
| | - Srinath Adusumalli
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
- Office of the Chief Medical Information Officer, Penn Medicine, Philadelphia, PA USA
- Center for Digital Cardiology, Penn Medicine, Philadelphia, PA USA
- Division of Cardiovascular Medicine, Department of Medicine, Penn Medicine, Philadelphia, PA USA
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Development of a PATIENT-Medication Adherence Instrument (P-MAI) and a HEALTHCARE PROFESSIONAL-Medication Adherence Instrument (H-MAI) using the nominal group technique. PLoS One 2020; 15:e0242051. [PMID: 33175871 PMCID: PMC7657514 DOI: 10.1371/journal.pone.0242051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/27/2020] [Indexed: 11/19/2022] Open
Abstract
To date, several medication adherence instruments have been developed and validated worldwide. However, most instruments have only assessed medication adherence from the patient’s perspective. The aim was to develop and validate the PATIENT-Medication Adherence Instrument (P-MAI) and the HEALTHCARE PROFESSIONAL-Medication Adherence Instrument (H-MAI) to assess medication adherence from the patient’s and healthcare professional (HCP)’s perspectives. The P-MAI-12 and H-MAI-12 were developed using the nominal group technique. The face and content validity was determined by an expert panel and piloted. The initial version of these instruments consisted of 12 items were validated from October-December 2018 at a primary care clinic in Malaysia. Included were patients aged ≥21 years, diagnosed with diabetes mellitus, taking at least one oral hypoglycaemic agent and who could understand English. The HCPs recruited were family medicine specialists or trainees. To assess validity, exploratory factor analysis (EFA) and concurrent validity were performed; internal consistency and test-retest were performed to assess its reliability. A total of 120/158 patients (response rate = 75.9%) and 30/33 HCPs (response rate = 90.9%) agreed to participate. EFA found three problematic items in both instruments, which was then removed. The final version of the P-MAI-9 and the HMAI-9 had 9 items each with two domains (adherence = 2 items and knowledge/belief = 7 items). For concurrent validity, the total score of the P-MAI-9 and the H-MAI-9 were not significantly different (p = 0.091), indicating that medication adherence assessed from both the patient’s and HCP’s perspectives were similar. Both instruments achieved acceptable internal consistency (Cronbach’s α: P-MAI-9 = 0.722; H-MAI-9 = 0.895). For the P-MAI-9, 7/9 items showed no significant difference between test and retest whereas 8/9 items in the H-MAI-9 showed significant difference at test and retest (p>0.05). In conclusion, the P-MAI-9 and H-MAI-9 had low sensitivity and high specificity suggesting that both instruments can be used for identifying patients more likely to be non-adherent to their medications.
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Lang C, Voigt K, Neumann R, Bergmann A, Holthoff-Detto V. Adherence and acceptance of a home-based telemonitoring application used by multi-morbid patients aged 65 years and older. J Telemed Telecare 2020; 28:37-51. [PMID: 32009577 PMCID: PMC8721554 DOI: 10.1177/1357633x20901400] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Currently, there are only a small number of comprehensive study results on adherence and acceptance of telemonitoring applications (TMAs) regarding multi-morbid older patients. The ATMoSPHAERE study aimed to develop an information and communication platform for an intersectoral networking of, for example, general practitioners, therapists, social services and the multi-morbid older patient. Methods The study presented was designed as a longitudinal bicentric intervention study which focused on multi-morbid patients aged ≥65 years using home-based telemedical measurement and input devices. The development and testing of this TMA aimed to optimise patients’ health care through intersectoral networking of all treating actors. Quantitative methods of data collection and analysis were used. Results Patients who completed the study were significantly younger than drop-outs and non-participants. The mental health of study patients significantly improved between the beginning and end of TMA use. The main reason for non-participation in the study was the high time expenditure when participating in the study. No perceived (information) benefits for health and insufficient content variety were the main reasons for drop-out. Appropriateness and handling of TMAs must be aligned with the needs of the heterogeneous user group of multi-morbid patients in order to increase acceptance and the added value of TMAs. Telemonitoring hardware should be oriented on functional capabilities of the older target group. Telemonitoring software content requires an individual, disease-specific approach for patients. The TMA should be unobtrusively integrated into usual daily life and be used to an appropriate extent according to the underlying disease in order to avoid stressing patients. With regard to adherence concerning TMAs, it is crucial to provide a contact person who is always available for patients having problems handling TMAs. Health concerns and questions can thus be addressed early, providing a feeling of safety in the care process. Discussion User acceptance of TMAs is an essential indicator and driver for use and for future implementation efforts in health care. In order to achieve maximum user centricity in development processes, patients must be involved as experts, co-designers and future users, considering their needs and perceptions.
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Affiliation(s)
- Caroline Lang
- Department of General Practice, Medical Clinic III, Medical Faculty, Technische Universität Dresden, Germany.,Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Germany
| | - Karen Voigt
- Department of General Practice, Medical Clinic III, Medical Faculty, Technische Universität Dresden, Germany
| | - Robert Neumann
- Institute of Sociology, Philosophical Faculty, Technische Universität Dresden, Germany
| | - Antje Bergmann
- Department of General Practice, Medical Clinic III, Medical Faculty, Technische Universität Dresden, Germany
| | - Vjera Holthoff-Detto
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, Alexianer Hospital Hedwigshöhe, St. Hedwig Hospital Berlin, Germany
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12
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Still CH, Margevicius S, Harwell C, Huang MC, Martin L, Dang PB, Wright Jnr JT. A Community and Technology-Based Approach for Hypertension Self-Management (COACHMAN) to Improve Blood Pressure Control in African Americans: Results from a Pilot Study. Patient Prefer Adherence 2020; 14:2301-2313. [PMID: 33262580 PMCID: PMC7695598 DOI: 10.2147/ppa.s283086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 10/31/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Adoption of technology has increased to support self-managing chronic diseases. However, behavioral interventions evaluating such technology have been understudied in African Americans with hypertension. The aim of this study was to explore a community and technology-based intervention for hypertension self-management (COACHMAN) intervention on blood pressure (BP) control and health-related quality of life (HRQoL) in African Americans with hypertension. METHODS Sixty African Americans (mean age 60; 75% females) who were prescribed antihypertensive medications and owning a smartphone were randomized to the COACHMAN (n = 30) or enhanced usual care (n = 30) group for 12 weeks. COACHMAN is comprised of four components: web-based education, home BP monitoring, medication management application, and nurse counseling. Hypertension knowledge, self-efficacy, technology adoption/use, medication adherence, BP, and HRQoL scores were assessed. RESULTS Mean systolic and diastolic BP at baseline was 150.49 (SD = 13.89) and 86.80 (SD = 13.39), respectively. After completing the 3-month intervention to improve hypertension self-management, the groups did not significantly differ in BP control and HRQoL. Clinically relevant BP reduction was observed in the intervention group. Paired t-test showed that mean medication-taking adherence scores significantly improved in the intervention group (P = 0.023) compared to the control group (P = 0.075). CONCLUSION Using technology may have a positive impact on supporting hypertension self-management, particularly in medication-taking adherence. Further research is warranted in a larger sample and should include standardization of medication management to isolate the effects of behavioral interventions on changes in BP. CLINICALTRIALSGOV IDENTIFIER NCT03722667.
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Affiliation(s)
- Carolyn H Still
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
- Correspondence: Carolyn H Still Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH44106, USATel +1 216 368 6338Fax +1 216 368 3452 Email
| | - Seunghee Margevicius
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Carla Harwell
- Department of Internal Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Ming-Chun Huang
- Department of Electrical Engineering and Computer Science, Case School of Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - LaTonya Martin
- Community Partners, Cleveland Council of Black Nurses, Cleveland, OH, USA
| | - Phuong B Dang
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Jackson T Wright Jnr
- Department of Internal Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Department of Nephrology and Hypertension, Clinical Hypertension Program, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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13
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Correia JC, Lachat S, Lagger G, Chappuis F, Golay A, Beran D. Interventions targeting hypertension and diabetes mellitus at community and primary healthcare level in low- and middle-income countries:a scoping review. BMC Public Health 2019; 19:1542. [PMID: 31752801 PMCID: PMC6873661 DOI: 10.1186/s12889-019-7842-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 10/24/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Hypertension (HTN) and diabetes mellitus (DM) are highly prevalent in low- and middle-income countries (LMIC) and a leading cause of morbidity and mortality. Recent evidence on effectiveness of primary care interventions has attracted renewed calls for their implementation. This review aims to synthesize evidence pertaining to primary care interventions on these two diseases, evaluated and tested in LMICs. METHODS Two reviewers conducted an electronic search of three databases (Pubmed, EMBASE and Web of Science) and screened for eligible articles. Interventions covering health promotion, prevention, treatment, or rehabilitation activities at the PHC or community level were included. Studies published in English, French, Portuguese and Spanish, from January 2007 to January 2017, were included. Key extraction variables included the 12 criteria identified by the Template for Intervention Description and Replication (TIDieR) checklist and guide. The Innovative Care for Chronic Conditions Framework (ICCCF) was used to guide analysis and reporting of results. RESULTS 198 articles were analyzed. The strategies focused on healthcare service organization (76.5%), community level (9.7 %), creating a positive policy environment (3.6%) and strategies covering multiple domains (10.2%). Studies included related to the following topics: description or testing of interventions (n=81; 41.3%), implementation or evaluation projects (n=42; 21.4%), quality improvement initiatives (n=15; 7.7%), screening and prevention efforts (n=26; 13.2%), management of HTN or DM (n=13; 6.6%), integrated health services (n=10; 5.1%), knowledge and attitude surveys (n=5; 2.5%), cost-effective lab tests (n=2; 1%) and policy making efforts (n=2; 1%). Most studies reported interventions by non-specialists (n=86; 43.4%) and multidisciplinary teams (n=49; 25.5%). CONCLUSION Only 198 articles were found over a 10 year period which demonstrates the limited published research on highly prevalent diseases in LMIC. This review shows the variety and complexity of approaches that have been tested to address HTN and DM in LMICs and highlights the elements of interventions needed to be addressed in order to strengthen delivery of care. Most studies reported little information regarding implementation processes to allow replication. Given the need for multi-component complex interventions, study designs and evaluation techniques will need to be adapted by including process evaluations versus simply effectiveness or outcome evaluations.
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Affiliation(s)
- Jorge César Correia
- Division of Tropical and Humanitarian Medicine, Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - Sarah Lachat
- Division of Tropical and Humanitarian Medicine, Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - Grégoire Lagger
- Division of Therapeutic Patient Education for Chronic Diseases. Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - Alain Golay
- Division of Therapeutic Patient Education for Chronic Diseases. Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | - David Beran
- Division of Tropical and Humanitarian Medicine, Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
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14
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Palacholla RS, Fischer N, Coleman A, Agboola S, Kirley K, Felsted J, Katz C, Lloyd S, Jethwani K. Provider- and Patient-Related Barriers to and Facilitators of Digital Health Technology Adoption for Hypertension Management: Scoping Review. JMIR Cardio 2019; 3:e11951. [PMID: 31758771 PMCID: PMC6834226 DOI: 10.2196/11951] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/13/2018] [Accepted: 01/16/2019] [Indexed: 01/14/2023] Open
Abstract
Background The uptake of digital health technology (DHT) has been surprisingly low in clinical practice. Despite showing great promise to improve patient outcomes and disease management, there is limited information on the factors that contribute to the limited adoption of DHT, particularly for hypertension management. Objective This scoping review provides a comprehensive summary of barriers to and facilitators of DHT adoption for hypertension management reported in the published literature with a focus on provider- and patient-related barriers and facilitators. Methods This review followed the methodological framework developed by Arskey and O’Malley. Systematic literature searches were conducted on PubMed or Medical Literature Analysis and Retrieval System Online, Cumulative Index to Nursing and Allied Health Literature, and Excerpta Medica database. Articles that reported on barriers to and/or facilitators of digital health adoption for hypertension management published in English between 2008 and 2017 were eligible. Studies not reporting on barriers or facilitators to DHT adoption for management of hypertension were excluded. A total of 2299 articles were identified based on the above criteria after removing duplicates, and they were assessed for eligibility. Of these, 2165 references did not meet the inclusion criteria. After assessing 134 studies in full text, 98 studies were excluded (full texts were either unavailable or studies did not fulfill the inclusion criteria), resulting in a final set of 32 articles. In addition, 4 handpicked articles were also included in the review, making it a total of 36 studies. Results A total of 36 studies were selected for data extraction after abstract and full-text screening by 2 independent reviewers. All conflicts were resolved by a third reviewer. Thematic analysis was conducted to identify major themes pertaining to barriers and facilitators of DHT from both provider and patient perspectives. The key facilitators of DHT adoption by physicians that were identified include ease of integration with clinical workflow, improvement in patient outcomes, and technology usability and technical support. Technology usability and timely technical support improved self-management and patient experience, and positive impact on patient-provider communication were most frequently reported facilitators for patients. Barriers to use of DHTs reported by physicians include lack of integration with clinical workflow, lack of validation of technology, and lack of technology usability and technical support. Finally, lack of technology usability and technical support, interference with patient-provider relationship, and lack of validation of technology were the most commonly reported barriers by patients. Conclusions Findings suggest the settings and context in which DHTs are implemented and individuals involved in implementation influence adoption. Finally, to fully realize the potential of digitally enabled hypertension management, there is a greater need to validate these technologies to provide patients and providers with reliable and accurate information on both clinical outcomes and cost effectiveness.
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Affiliation(s)
- Ramya Sita Palacholla
- Partners HealthCare Pivot Labs, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States.,Massachusetts General Hospital, Boston, MA, United States
| | - Nils Fischer
- Partners HealthCare Pivot Labs, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Amanda Coleman
- American Medical Association, Chicago, IL, United States
| | - Stephen Agboola
- Partners HealthCare Pivot Labs, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States.,Massachusetts General Hospital, Boston, MA, United States
| | | | - Jennifer Felsted
- Partners HealthCare Pivot Labs, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Chelsea Katz
- American Medical Association, Chicago, IL, United States
| | - Stacy Lloyd
- American Medical Association, Chicago, IL, United States
| | - Kamal Jethwani
- Partners HealthCare Pivot Labs, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States.,Massachusetts General Hospital, Boston, MA, United States
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15
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Lang C, Scheibe M, Voigt K, Hübsch G, Mocke L, Schmitt J, Bergmann A, Holthoff-Detto V. [Reasons for non-acceptance and non-use of a home telemonitoring application by multimorbid patients aged 65 years and over]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2019; 141-142:76-88. [PMID: 30910624 DOI: 10.1016/j.zefq.2019.02.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/18/2019] [Accepted: 02/18/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND User acceptance is a key indicator and driver for the use and implementation of telemonitoring applications (TMA) in healthcare. Despite various positive effects that previous studies have revealed for users of TMA, there are always patients who discontinue their participation in a telemedicine study or even decline participation. There is little evidence for the reasons for non-acceptance and non-use of TMA, especially in multimorbid patients at the age of 65 and over in their home environment. To close this research gap, this sub-study focuses on patient-reported reasons for non-acceptance and non-use of TMA in the home environment. METHODS This study follows a mixed-method approach and focuses on patients' perspective. Quantitative data collection took place via computer-assisted telephone interviews among all drop-outs and non-participants. Qualitative data were collected via semi-structured interviews with drop-out patients and non-users. Eligible patients were recruited consecutively by general practitioners, informed and included in the study according to the inclusion criteria. Amongst others, patients measured their vital signs (blood pressure, heart frequency, oxygen saturation, weight) via telemedical measures and sent them via tablet to a Care Coordination Center to ascertain the need for intervention. Collected data on non-acceptance and non-use of TMA were analyzed quantitatively and qualitatively. RESULTS Nine general practices in two German cities included a total of 177 patients according to the inclusion criteria. During the study, 61 study participants (34.5 %) dropped out, 80 patients (31.1 %) declined participation in the study. Drop-outs and non-participants were significantly older than active participants (p=.004 and p=.001, respectively). Predominant reasons for drop-out were the lack of the perceived added value and the content-related variety of the program on the patient's tablet, the missing interest/need for telemedical monitoring as well as the time spent participating in the study. Patients living alone, single and widowed patients reported significantly more difficulties in handling the hardware (tablet) (p=.040) and the program (Motiva) (p=.013) than married and cohabiting patients. These reasons were also reported mainly by female patients, patients aged 75 years and over, and those with a low level of education. CONCLUSION In order to increase the acceptance and the added value of TMA for patients, the individual needs of the future target group should be analyzed at the beginning of the development. To ensure maximum user centricity, individual development steps should be continuously evaluated by the target group. TMA should be adapted to the functional abilities of elderly, multimorbid patients through, e. g., an appropriate design of the content, which is tailored to patients' individual needs. TMA should be used to an appropriate degree to avoid overburdening and should fit unobtrusively into patients' usual daily routine. For patient-specific acceptance of TMA, easy handling of the telemedical measuring and input devices is as important as the variety of offers on the platform and personal contact for technical queries. Special attention should be paid to patients who live alone, women, elderly patients over 75 years of age, and poorly educated patients in order to ensure full and easy access to technology-based telemonitoring for their own healthcare.
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Affiliation(s)
- Caroline Lang
- Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Dresden, Deutschland; Medizinische Fakultät und Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Medizinische Klinik III, Bereich Allgemeinmedizin, Dresden, Deutschland.
| | - Madlen Scheibe
- Medizinische Fakultät und Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Zentrum für Evidenzbasierte Gesundheitsversorgung, Dresden, Deutschland
| | - Karen Voigt
- Medizinische Fakultät und Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Medizinische Klinik III, Bereich Allgemeinmedizin, Dresden, Deutschland
| | - Grit Hübsch
- Medizinische Fakultät und Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Medizinische Klinik III, Bereich Allgemeinmedizin, Dresden, Deutschland
| | - Luise Mocke
- Medizinische Fakultät und Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Zentrum für Evidenzbasierte Gesundheitsversorgung, Dresden, Deutschland
| | - Jochen Schmitt
- Medizinische Fakultät und Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Zentrum für Evidenzbasierte Gesundheitsversorgung, Dresden, Deutschland
| | - Antje Bergmann
- Medizinische Fakultät und Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Medizinische Klinik III, Bereich Allgemeinmedizin, Dresden, Deutschland
| | - Vjera Holthoff-Detto
- Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Dresden, Deutschland; St. Hedwig Kliniken Berlin, Alexianer Krankenhaus Hedwigshöhe, Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Berlin, Deutschland
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16
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Still CH, Jones LM, Moss KO, Variath M, Wright KD. African American Older Adults' Perceived Use of Technology for Hypertension Self-Management. Res Gerontol Nurs 2018; 11:249-256. [PMID: 30230518 DOI: 10.3928/19404921-20180809-02] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 06/06/2018] [Indexed: 12/26/2022]
Abstract
With the unprecedented growth of technology for disease prevention and management, little is known about the experience and adoption of such technology in African American older adults with hypertension. A 90-minute focus group session was used to explore African American older adults' (N = 21) experiences with using technology (mobile devices and applications) for hypertension self-management. Twenty participants reported owning smartphones and used this technology to communicate; seek, acquire, and share information; engage in entertainment; and organize and manage time. Participants expressed concerns about not being informed or trained sufficiently to integrate technology for hypertension self-management. There is a need to develop novel hypertension self-management interventions that integrate technology and training programs for this marginalized population that may help improve blood pressure control and address important clinical and public health priorities of uncontrolled hypertension. [Res Gerontol Nurs. 2018; 11(5):249-256.].
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17
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Albrecht L, Wood PW, Fradette M, McAlister FA, Rabi D, Boulanger P, Padwal R. Usability and Acceptability of a Home Blood Pressure Telemonitoring Device Among Community-Dwelling Senior Citizens With Hypertension: Qualitative Study. JMIR Aging 2018; 1:e10975. [PMID: 31518242 PMCID: PMC6716488 DOI: 10.2196/10975] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/14/2018] [Accepted: 06/21/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Hypertension is a major cause of cardiovascular disease in older individuals. To ensure that blood pressure (BP) levels are within the optimal range, accurate BP monitoring is required. Contemporary hypertension clinical practice guidelines strongly endorse the use of home BP measurement as a preferred method of BP monitoring for individuals with hypertension. The benefits of home BP monitoring may be optimized when measurements are telemonitored to care providers; however, this may be challenging for older individuals with less technological capabilities. OBJECTIVE The objective of this qualitative study was to examine the usability and acceptability of a home BP telemonitoring device among senior citizens. METHODS We conducted a qualitative descriptive study. Following a 1-week period of device use, individual, semistructured interviews were conducted. Interview audio recordings were anonymized, de-identified, and transcribed verbatim. We performed thematic analysis on interview transcripts. RESULTS Seven senior citizens participated in the usability testing of the home BP telemonitoring device. Participants comprised females (n=4) and males (n=3) with a mean age of 86 years (range, 70-95 years). Overall, eight main themes were identified from the interviews: (1) positive features of the device; (2) difficulties or problems with the device; (3) device was simple to use; (4) comments about wireless capability and components; (5) would recommend device to someone else; (6) would use device in future; (7) suggestions for improving the device; and (8) assistance to use device. Additional subthemes were also identified. CONCLUSIONS Overall, the home BP telemonitoring device had very good usability and acceptability among community-dwelling senior citizens with hypertension. To enhance its long-term use, few improvements were noted that may mitigate some of the relatively minor challenges encountered by the target population.
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Affiliation(s)
- Lauren Albrecht
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Peter W Wood
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Miriam Fradette
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | | | - Doreen Rabi
- Departments of Medicine, Community Health and Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Pierre Boulanger
- Department of Computing Science, University of Alberta, Edmonton, AB, Canada
| | - Raj Padwal
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
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18
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Rahimi B, Nadri H, Lotfnezhad Afshar H, Timpka T. A Systematic Review of the Technology Acceptance Model in Health Informatics. Appl Clin Inform 2018; 9:604-634. [PMID: 30112741 PMCID: PMC6094026 DOI: 10.1055/s-0038-1668091] [Citation(s) in RCA: 196] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 06/24/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND One common model utilized to understand clinical staff and patients' technology adoption is the technology acceptance model (TAM). OBJECTIVE This article reviews published research on TAM use in health information systems development and implementation with regard to application areas and model extensions after its initial introduction. METHOD An electronic literature search supplemented by citation searching was conducted on February 2017 of the Web of Science, PubMed, and Scopus databases, yielding a total of 492 references. Upon eliminating duplicates and applying inclusion and exclusion criteria, 134 articles were retained. These articles were appraised and divided into three categories according to research topic: studies using the original TAM, studies using an extended TAM, and acceptance model comparisons including the TAM. RESULTS The review identified three main information and communication technology (ICT) application areas for the TAM in health services: telemedicine, electronic health records, and mobile applications. The original TAM was found to have been extended to fit dynamic health service environments by integration of components from theoretical frameworks such as the theory of planned behavior and unified theory of acceptance and use of technology, as well as by adding variables in specific contextual settings. These variables frequently reflected the concepts subjective norm and self-efficacy, but also compatibility, experience, training, anxiety, habit, and facilitators were considered. CONCLUSION Telemedicine applications were between 1999 and 2017, the ICT application area most frequently studied using the TAM, implying that acceptance of this technology was a major challenge when exploiting ICT to develop health service organizations during this period. A majority of the reviewed articles reported extensions of the original TAM, suggesting that no optimal TAM version for use in health services has been established. Although the review results indicate a continuous progress, there are still areas that can be expanded and improved to increase the predictive performance of the TAM.
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Affiliation(s)
- Bahlol Rahimi
- Department of Health Information Technology, School of Allied Medical Sciences, Urmia University of Medical Sciences, Urmia, Iran
| | - Hamed Nadri
- Department of Health Information Technology, School of Allied Medical Sciences, Urmia University of Medical Sciences, Urmia, Iran
- Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
| | - Hadi Lotfnezhad Afshar
- Department of Health Information Technology, School of Allied Medical Sciences, Urmia University of Medical Sciences, Urmia, Iran
| | - Toomas Timpka
- Department of Computer and Information Sciences, Linköping University, Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Nguyen KT, Olgin JE, Pletcher MJ, Ng M, Kaye L, Moturu S, Gladstone RA, Malladi C, Fann AH, Maguire C, Bettencourt L, Christensen MA, Marcus GM. Smartphone-Based Geofencing to Ascertain Hospitalizations. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.116.003326. [PMID: 28325751 DOI: 10.1161/circoutcomes.116.003326] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 01/13/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Ascertainment of hospitalizations is critical to assess quality of care and the effectiveness and adverse effects of various therapies. Smartphones, mobile geolocators that are ubiquitous, have not been leveraged to ascertain hospitalizations. Therefore, we evaluated the use of smartphone-based geofencing to track hospitalizations. METHODS AND RESULTS Participants aged ≥18 years installed a mobile application programmed to geofence all hospitals using global positioning systems and cell phone tower triangulation and to trigger a smartphone-based questionnaire when located in a hospital for ≥4 hours. An in-person study included consecutive consenting patients scheduled for electrophysiology and cardiac catheterization procedures. A remote arm invited Health eHeart Study participants who consented and engaged with the study via the internet only. The accuracy of application-detected hospitalizations was confirmed by medical record review as the reference standard. Of 22 eligible in-person patients, 17 hospitalizations were detected (sensitivity 77%; 95% confidence interval, 55%-92%). The length of stay according to the application was positively correlated with the length of stay ascertained via the electronic medical record (r=0.53; P=0.03). In the remote arm, the application was downloaded by 3443 participants residing in all 50 US states; 243 hospital visits at 119 different hospitals were detected through the application. The positive predictive value for an application-reported hospitalization was 65% (95% confidence interval, 57%-72%). CONCLUSIONS Mobile application-based ascertainment of hospitalizations can be achieved with modest accuracy. This first proof of concept may ultimately be applicable to geofencing other types of prespecified locations to facilitate healthcare research and patient care.
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Affiliation(s)
- Kaylin T Nguyen
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.)
| | - Jeffrey E Olgin
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.)
| | - Mark J Pletcher
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.)
| | - Madelena Ng
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.)
| | - Leanne Kaye
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.)
| | - Sai Moturu
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.)
| | - Rachel A Gladstone
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.)
| | - Chaitanya Malladi
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.)
| | - Amy H Fann
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.)
| | - Carol Maguire
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.)
| | - Laura Bettencourt
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.)
| | - Matthew A Christensen
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.)
| | - Gregory M Marcus
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.).
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20
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Chia YC, Buranakitjaroen P, Chen CH, Divinagracia R, Hoshide S, Park S, Shin J, Siddique S, Sison J, Soenarta AA, Sogunuru GP, Tay JC, Turana Y, Wang JG, Wong L, Zhang Y, Kario K. Current status of home blood pressure monitoring in Asia: Statement from the HOPE Asia Network. J Clin Hypertens (Greenwich) 2017; 19:1192-1201. [PMID: 28815840 DOI: 10.1111/jch.13058] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 05/25/2017] [Accepted: 05/29/2017] [Indexed: 12/15/2022]
Abstract
Hypertension represents a major burden in Asia, with a high prevalence rate but poor level of awareness and control reported in many countries in the region. Home blood pressure monitoring has been validated as an accurate and reliable measure of blood pressure that can help guide hypertension treatment as well as identify masked and white-coat hypertension. Despite its benefits, there has been limited research into home blood pressure monitoring in Asia. The authors reviewed the current evidence on home blood pressure monitoring in Asia, including but not limited to published literature, data presented at congresses, and national hypertension management guidelines to determine the current utilization of home blood pressure monitoring in clinical practice in the region. Public policies to enable greater access to home blood pressure monitoring and its use in clinical care would add considerably to improving hypertension outcomes in Asia.
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Affiliation(s)
- Yook-Chin Chia
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Sunway lnstitute for Healthcare Development, Sunway University, Selangor Darul Ehsan, Malaysia
| | - Peera Buranakitjaroen
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chen-Huan Chen
- Department of Medicine, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Romeo Divinagracia
- University of the East Ramon Magsaysay Memorial Medical Center Inc, Quezon City, Philippines
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Sungha Park
- Division of Cardiology, Cardiovascular Hospital, Yonsei Health System, Seoul, Korea
| | - Jinho Shin
- Faculty of Cardiology Service, Hanyang University Medical Center, Seongdong, Seoul, Korea
| | | | - Jorge Sison
- Department of Medicine, Medical Center Manila, Ermita, Manila, Philippines
| | - Arieska Ann Soenarta
- Department Cardiology and Vascular Medicine, Faculty of Medicine, Harapan Kita, University of Indonesia-National Cardiovascular Center, Jakarta, Indonesia
| | - Guru Prasad Sogunuru
- Apollo Hospitals, Chennai, India.,College of Medical Sciences, Kathmandu University, Bharatpur, Nepal
| | - Jam Chin Tay
- Department of General Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Yuda Turana
- Department of Neurology, Faculty of Medicine, Atma Jaya Catholic University of Indonesia, North Jakarta, Jakarta, Indonesia
| | - Ji-Guang Wang
- Department of Hypertension, Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lawrence Wong
- Department of Medicine & Therapeutics, Division of Neurology, Chinese University of Hong Kong, Hong Kong
| | - Yuqing Zhang
- Divisions of Hypertension and Heart Failure, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
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21
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Barriers to Patient-Centered Care in Hypertension. Can J Cardiol 2017; 33:586-590. [DOI: 10.1016/j.cjca.2017.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 03/04/2017] [Accepted: 03/05/2017] [Indexed: 11/19/2022] Open
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22
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Rashid A. Yonder: Communication with hospitals, telemonitoring, chronic pain, and 'sexting'. Br J Gen Pract 2016; 66:432. [PMID: 27481977 PMCID: PMC4979951 DOI: 10.3399/bjgp16x686413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Ahmed Rashid
- NIHR Academic Clinical Fellow in General Practice, University of Cambridge, Cambridge. E-mail: mar74@Dr_A_Rashid
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