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Eaton C, Vallejo N, McDonald X, Wu J, Rodríguez R, Muthusamy N, Mathioudakis N, Riekert KA. User Engagement With mHealth Interventions to Promote Treatment Adherence and Self-Management in People With Chronic Health Conditions: Systematic Review. J Med Internet Res 2024; 26:e50508. [PMID: 39316431 PMCID: PMC11462107 DOI: 10.2196/50508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 02/27/2024] [Accepted: 07/29/2024] [Indexed: 09/25/2024] Open
Abstract
BACKGROUND There are numerous mobile health (mHealth) interventions for treatment adherence and self-management; yet, little is known about user engagement or interaction with these technologies. OBJECTIVE This systematic review aimed to answer the following questions: (1) How is user engagement defined and measured in studies of mHealth interventions to promote adherence to prescribed medical or health regimens or self-management among people living with a health condition? (2) To what degree are patients engaging with these mHealth interventions? (3) What is the association between user engagement with mHealth interventions and adherence or self-management outcomes? (4) How often is user engagement a research end point? METHODS Scientific database (Ovid MEDLINE, Embase, Web of Science, PsycINFO, and CINAHL) search results (2016-2021) were screened for inclusion and exclusion criteria. Data were extracted in a standardized electronic form. No risk-of-bias assessment was conducted because this review aimed to characterize user engagement measurement rather than certainty in primary study results. The results were synthesized descriptively and thematically. RESULTS A total of 292 studies were included for data extraction. The median number of participants per study was 77 (IQR 34-164). Most of the mHealth interventions were evaluated in nonrandomized studies (157/292, 53.8%), involved people with diabetes (51/292, 17.5%), targeted medication adherence (98/292, 33.6%), and comprised apps (220/292, 75.3%). The principal findings were as follows: (1) >60 unique terms were used to define user engagement; "use" (102/292, 34.9%) and "engagement" (94/292, 32.2%) were the most common; (2) a total of 11 distinct user engagement measurement approaches were identified; the use of objective user log-in data from an app or web portal (160/292, 54.8%) was the most common; (3) although engagement was inconsistently evaluated, most of the studies (99/195, 50.8%) reported >1 level of engagement due to the use of multiple measurement methods or analyses, decreased engagement across time (76/99, 77%), and results and conclusions suggesting that higher engagement was associated with positive adherence or self-management (60/103, 58.3%); and (4) user engagement was a research end point in only 19.2% (56/292) of the studies. CONCLUSIONS The results revealed major limitations in the literature reviewed, including significant variability in how user engagement is defined, a tendency to rely on user log-in data over other measurements, and critical gaps in how user engagement is evaluated (infrequently evaluated over time or in relation to adherence or self-management outcomes and rarely considered a research end point). Recommendations are outlined in response to our findings with the goal of improving research rigor in this area. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42022289693; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022289693.
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Affiliation(s)
- Cyd Eaton
- Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Natalie Vallejo
- Johns Hopkins School of Medicine, Baltimore, MD, United States
| | | | - Jasmine Wu
- Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Rosa Rodríguez
- Johns Hopkins School of Medicine, Baltimore, MD, United States
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Dodani S, Clarke A, El Moudden I, Gunawardena T, Bedi N. The impact of a Telehealth-based Behavioral Lifestyle Program on hypertension control in African American participants: results from the HEALS Med-Tech randomized controlled trial. Arch Med Sci 2024; 20:309-312. [PMID: 38414475 PMCID: PMC10895937 DOI: 10.5114/aoms/177686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 02/29/2024] Open
Abstract
Introduction The HEALS Med-Tech program offers a unique blend of lifestyle changes and technology to improve hypertension (HTN) management in African Americans (AAs), a group disproportionately affected by cardiovascular disease (CVD).Methods: A randomized controlled trial compared HEALS Med-Tech against usual care for uncontrolled hypertension in AAs, focusing on diet, medication adherence, and telehealth. Results In a study of 61 participants, HEALS Med-Tech significantly reduced systolic blood pressure by 12.95 mm Hg (p = 0.008) and 9.19 mm Hg (p = 0.013) at 3 and 12 months, respectively, demonstrating improved hypertension control. Conclusions HEALS Med-Tech demonstrates potential in HTN management for AAs, advocating for culturally tailored, tech-integrated healthcare expansion.
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Affiliation(s)
- Sunita Dodani
- Center 4 Health Research, University of Illinois, College of Medicine, Illinois, United States
| | - Amanda Clarke
- Healthcare Analytics and Delivery Science Institute (HADSI), Eastern Virginia Medical School, Virginia, United States
| | - Ismail El Moudden
- Healthcare Analytics and Delivery Science Institute (HADSI), Eastern Virginia Medical School, Virginia, United States
| | - Tharidu Gunawardena
- Healthcare Analytics and Delivery Science Institute (HADSI), Eastern Virginia Medical School, Virginia, United States
| | - Navdhit Bedi
- Department of Biological Sciences, Clemson University, South Carolina, United States
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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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Butler L, Zona S, Patel AA, Brittle C, Shea L. How can pharmacists better support patients with chronic diseases? The patient perspective. J Am Pharm Assoc (2003) 2023; 63:1776-1784.e3. [PMID: 37696490 DOI: 10.1016/j.japh.2023.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/18/2023] [Accepted: 08/31/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Patients' perceptions of their interaction with pharmacists can affect how they use this resource for chronic disease care. OBJECTIVE This qualitative study explored pharmacist-patient interactions and patients' perceptions of pharmacists' roles in cardiovascular disease (CVD) and inflammatory bowel disease (IBD). METHODS Patient volunteers, recruited through Janssen's Patient Engagement Research Council program, completed a 15-minute prework survey before a 90-minute live virtual focus group session to provide feedback on pharmacist-patient interactions, the pharmacist's role in patient care, and recommendations for improvement. RESULTS In total, 27 patients participated. Among patients with CVD (n=18), 56% were female, 61% aged ≥65 years, and 39%/39% Black/White. Of those with IBD (n=9), 56% were female, 89% aged 25-44 years, and 33%/56% Black/White. In the CVD cohort, patients conversed with their pharmacists at least monthly, on average. Patients were generally happy with their relationship with their pharmacist, viewing pharmacists as a trusted resource for medication information. Polypharmacy was common in the CVD cohort (mean, 10.8 medications). For patients with IBD, pharmacist-patient interactions were less frequent, relationships were generally perceived as transactional, patients took fewer medications (mean, 3.2), and felt uncomfortable discussing their disease in public. All patients (CVD and IBD) were unaware of pharmacists' medical training/knowledge. Recommendations included private spaces for sensitive conversations, phone/text support, in-depth regular check-ins, and proactive communication to highlight that the pharmacist's role is to provide patient-centered holistic care. CONCLUSION This research demonstrates a lack of understanding of pharmacist training, accessibility and role among patients with chronic disease, and highlights opportunities to amend delivery of care. These insights can be used to inform strategies and approaches tailored to address unique needs of specific patient populations to enhance pharmacist-patient interactions.
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Ng HL, Sellappans R, Loo JSE. A survey of the adoption and perception of mobile health applications among community pharmacists in Malaysia. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2023; 31:489-495. [PMID: 37526297 DOI: 10.1093/ijpp/riad042] [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: 11/24/2022] [Accepted: 06/22/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVES To determine the adoption and perception of mobile health (mHealth) applications among community pharmacists in Malaysia. METHODS A cross-sectional survey using a self-administered questionnaire was conducted with 300 community pharmacists in the Klang Valley, Malaysia using a stratified sampling approach. The questionnaire consisted of 36 questions with three sections: demographic data, adoption of mHealth applications and perception towards mHealth applications. Descriptive and inferential tests as well as exploratory factor analysis were used to analyse the data. KEY FINDINGS Adoption of mHealth applications by community pharmacists for both professional and personal use was relatively high at 79.7%. Utilised mHealth applications were primarily from the medical references category, while applications for patient monitoring, personal care and fitness were used to a lesser degree. Among mHealth application users, only 65.7% recommended them to their patients. Overall perception towards mHealth applications was positive, but perception towards the benefits and favour of mHealth applications for their patients was lower. This was corroborated by the factor analysis, which identified four main factors explaining 59.9% of variance in the dataset. These factors were perception towards use in their own professional practice, perception on benefits and use in their patients, perception on specific features of mHealth applications, and reliability of mHealth applications. CONCLUSIONS Adoption of mHealth applications among community pharmacists in Malaysia is high. Community pharmacists are more likely to use mHealth applications professionally and personally but less likely to recommend them to patients due to less favourable perceptions on how patients will benefit from mHealth applications.
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Affiliation(s)
- Hui Leng Ng
- School of Pharmacy, Faculty of Health and Medical Sciences, Taylor's University, No. 1 Jalan Taylor's, 47500 Selangor, Malaysia
| | - Renukha Sellappans
- School of Pharmacy, Faculty of Health and Medical Sciences, Taylor's University, No. 1 Jalan Taylor's, 47500 Selangor, Malaysia
- Active Ageing Impact Lab, Taylor's University, No. 1 Jalan Taylor's, 47500 Selangor, Malaysia
| | - Jason S E Loo
- School of Pharmacy, Faculty of Health and Medical Sciences, Taylor's University, No. 1 Jalan Taylor's, 47500 Selangor, Malaysia
- Medical Advancement for Better Quality of Life Impact Lab, Taylor's University, No.1 Jalan Taylor's, 47500 Selangor, Malaysia
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Creber A, Leo DG, Buckley BJR, Chowdhury M, Harrison SL, Isanejad M, Lane DA. Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis. BMC Cardiovasc Disord 2023; 23:469. [PMID: 37726655 PMCID: PMC10510185 DOI: 10.1186/s12872-023-03486-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Telemonitoring for the remote patient self-management of chronic conditions can be a cost-effective method for delivering care in chronic disease; nonetheless, its implementation in clinical practice remains low. The aim of this meta-synthesis is to explore barriers and facilitators associated with the use of remote patient monitoring of chronic disease, drawing on qualitative research, and assessing participant interactions with this technology. METHOD A meta-synthesis of qualitative studies was performed. MEDLINE, SCOPUS and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from database date of inception to 5 February 2021. The Critical Appraisal Skills Programme (CASP) was used to critically appraise each study. Thematic synthesis was performed to identify user (patients, carers and healthcare professionals) perspectives and experiences of patient remote monitoring of chronic disease (Type 2 diabetes mellitus, chronic obstructive pulmonary disease, and cardiovascular disease). RESULTS Searches returned 10,401 studies and following independent screening by two reviewers, nine studies were included in this meta-synthesis. Data were synthesised and categorised into four key themes: (1) Improved care; (2) Communication; (3) Technology feasibility & acceptability; and (4) Intervention concerns. Most patients using patient remote devices felt motivated in managing their own lifestyles and felt reassured by the close monitoring and increased communication. Barriers identified involved generational differences and difficulties with the technology used. CONCLUSION Most studies showed a positive attitude to telemonitoring, with patients preferring the convenience of telemonitoring in comparison to attending regular clinics. Further research is required to assess the most effective technology for chronic disease management, how to maintain long-term patient adherence, and identify effective approaches to address generational variation in telemonitoring up-take.
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Affiliation(s)
- Anna Creber
- School of Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Donato Giuseppe Leo
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.
| | - Benjamin J R Buckley
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- School of Sport and Exercise Sciences, Faculty of Science, Liverpool John Moores University, Liverpool, UK
| | - Mahin Chowdhury
- School of Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Stephanie L Harrison
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Masoud Isanejad
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Musculoskeletal Ageing, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Deirdre A Lane
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Brewer LC, Jones C, Slusser JP, Pasha M, Lalika M, Chacon M, Takawira P, Shanedling S, Erickson P, Woods C, Krogman A, Ferdinand D, Underwood P, Cooper LA, Patten CA, Hayes SN. mHealth Intervention for Promoting Hypertension Self-management Among African American Patients Receiving Care at a Community Health Center: Formative Evaluation of the FAITH! Hypertension App. JMIR Form Res 2023; 7:e45061. [PMID: 37115658 PMCID: PMC10337371 DOI: 10.2196/45061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/20/2023] [Accepted: 04/27/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND African American individuals are at a higher risk of premature death from cardiovascular diseases than White American individuals, with disproportionate attributable risk from uncontrolled hypertension. Given their high use among African American individuals, mobile technologies, including smartphones, show promise in increasing reliable health information access. Culturally tailored mobile health (mHealth) interventions may promote hypertension self-management among this population. OBJECTIVE This formative study aimed to assess the feasibility of integrating an innovative mHealth intervention into clinical and community settings to improve blood pressure (BP) control among African American patients. METHODS A mixed methods study of African American patients with uncontrolled hypertension was conducted over 2 consecutive phases. In phase 1, patients and clinicians from 2 federally qualified health centers (FQHCs) in the Minneapolis-St Paul, Minnesota area, provided input through focus groups to refine an existing culturally tailored mHealth app (Fostering African-American Improvement in Total Health! [FAITH!] App) for promoting hypertension self-management among African American patients with uncontrolled hypertension (renamed as FAITH! Hypertension App). Phase 2 was a single-arm pre-post intervention pilot study assessing feasibility and patient satisfaction. Patients receiving care at an FQHC participated in a 10-week intervention using the FAITH! Hypertension App synchronized with a wireless BP monitor and community health worker (CHW) support to address social determinants of health-related social needs. The multimedia app consisted of a 10-module educational series focused on hypertension and cardiovascular risk factors with interactive self-assessments, medication and BP self-monitoring, and social networking. Primary outcomes were feasibility (app engagement and satisfaction) and preliminary efficacy (change in BP) at an immediate postintervention assessment. RESULTS In phase 1, thirteen African American patients (n=9, 69% aged ≥50 years and n=10, 77% women) and 16 clinicians (n=11, 69% aged ≥50 years; n=14, 88% women; and n=10, 63% African American) participated in focus groups. Their feedback informed app modifications, including the addition of BP and medication tracking, BP self-care task reminders, and culturally sensitive contexts. In phase 2, sixteen African American patients were enrolled (mean age 52.6, SD 12.3 years; 12/16, 75% women). Overall, 38% (6/16) completed ≥50% of the 10 education modules, and 44% (7/16) completed the postintervention assessment. These patients rated the intervention a 9 (out of 10) on its helpfulness in hypertension self-management. Qualitative data revealed that they viewed the app as user-friendly, engaging, and informative, and CHWs were perceived as providing accountability and support. The mean systolic and diastolic BPs of the 7 patients decreased by 6.5 mm Hg (P=.15) and 2.8 mm Hg (P=.78), respectively, at the immediate postintervention assessment. CONCLUSIONS A culturally tailored mHealth app reinforced by CHW support may improve hypertension self-management among underresourced African American individuals receiving care at FQHCs. A future randomized efficacy trial of this intervention is warranted. TRIAL REGISTRATION ClinicalTrials.gov NCT04554147; https://clinicaltrials.gov/ct2/show/NCT04554147.
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Affiliation(s)
- LaPrincess C Brewer
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, MN, United States
| | | | - Joshua P Slusser
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, United States
| | - Maarya Pasha
- Department of Internal Medicine, Hennepin Healthcare, Minneapolis, MN, United States
| | - Mathias Lalika
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Megan Chacon
- Cardiovascular Health Unit, Minnesota Department of Health, St. Paul, MN, United States
| | - Patricia Takawira
- Cardiovascular Health Unit, Minnesota Department of Health, St. Paul, MN, United States
| | - Stanton Shanedling
- Cardiovascular Health Unit, Minnesota Department of Health, St. Paul, MN, United States
| | - Paul Erickson
- NorthPoint Health and Wellness Center, Minneapolis, MN, United States
| | - Cynthia Woods
- Open Cities Health Center, St. Paul, MN, United States
| | - Ashton Krogman
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Daphne Ferdinand
- Healthy Heart Community Prevention Project, Inc., New Orleans, LA, United States
| | - Paul Underwood
- Interventional Cardiology/Structural Heart, Boston Scientific Corporation, Marlborough, MA, United States
| | - Lisa A Cooper
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Christi A Patten
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Sharonne N Hayes
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States
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Leo DG, Buckley BJR, Chowdhury M, Harrison SL, Isanejad M, Lip GYH, Wright DJ, Lane DA. Interactive Remote Patient Monitoring Devices for Managing Chronic Health Conditions: Systematic Review and Meta-analysis. J Med Internet Res 2022; 24:e35508. [PMID: 36326818 PMCID: PMC9673001 DOI: 10.2196/35508] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/07/2022] [Accepted: 04/29/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Telemedicine is an expanding and feasible approach to improve medical care for patients with long-term conditions. However, there is a poor understanding of patients' acceptability of this technology and their rate of uptake. OBJECTIVE The aim of this study was to systematically review the current evidence on telemonitoring in the management of patients with long-term conditions and evaluate the patients' uptake and acceptability of this technology. METHODS MEDLINE, Scopus, and CENTRAL (the Cochrane Central Register of Controlled Trials) were searched from the date of inception to February 5, 2021, with no language restrictions. Studies were eligible for inclusion if they reported any of the following outcomes: intervention uptake and adherence; study retention; patient acceptability, satisfaction, and experience using the intervention; changes in physiological values; all-cause and cardiovascular-related hospitalization; all-cause and disease-specific mortality; patient-reported outcome measures; and quality of life. In total, 2 reviewers independently assessed the articles for eligibility. RESULTS A total of 96 studies were included, and 58 (60%) were pooled for the meta-analyses. Meta-analyses showed a reduction in mortality (risk ratio=0.71, 95% CI 0.56-0.89; P=.003; I2=0%) and improvements in blood pressure (mean difference [MD]=-3.85 mm Hg, 95% CI -7.03 to -0.68; P=.02; I2=100%) and glycated hemoglobin (MD=-0.33, 95% CI -0.57 to -0.09; P=.008; I2=99%) but no significant improvements in quality of life (MD=1.45, 95% CI -0.10 to 3; P=.07; I2=80%) and an increased risk of hospitalization (risk ratio=1.02, 95% CI 0.85-1.23; P=.81; I2=79%) with telemonitoring compared with usual care. A total of 12% (12/96) of the studies reported adherence outcomes, and 9% (9/96) reported on satisfaction and acceptance outcomes; however, heterogeneity in the assessment methods meant that a meta-analysis could not be performed. CONCLUSIONS Telemonitoring is a valid alternative to usual care, reducing mortality and improving self-management of the disease, with patients reporting good satisfaction and adherence. Further studies are required to address some potential concerns regarding higher hospitalization rates and a lack of positive impact on patients' quality of life. TRIAL REGISTRATION PROSPERO CRD42021236291; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=236291.
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Affiliation(s)
- Donato Giuseppe Leo
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Benjamin J R Buckley
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Mahin Chowdhury
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Stephanie L Harrison
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Masoud Isanejad
- Department of Musculoskeletal Ageing, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Gregory Y H Lip
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - David J Wright
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Deirdre A Lane
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
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Peacock E, Craig LS, Krousel-Wood M. Electronic health strategies to improve medication adherence in patients with cardiometabolic disease: current status and future directions. Curr Opin Cardiol 2022; 37:307-316. [PMID: 35731675 PMCID: PMC9228772 DOI: 10.1097/hco.0000000000000971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Enabled by widespread technological advancements, electronic health (eHealth) strategies have expanded rapidly over the last decade, presenting opportunities to support self-management including medication adherence for cardiometabolic disease control. eHealth can minimize access barriers to medications, enable timely assessment and shared decision-making, and provide medication reminders and health data feedback. This review summarizes current evidence for effectiveness of eHealth strategies for improving medication adherence in patients with hypertension, type 2 diabetes, and/or hyperlipidemia, and identifies priorities for future research. RECENT FINDINGS Current research supports the effectiveness of eHealth strategies to improve medication adherence and clinical outcomes for cardiometabolic disease. Although patient acceptability of eHealth strategies is generally high, engagement may decline over time. In addition, differences in effectiveness across intervention characteristics and sociodemographic groups are understudied, limiting generalizability and tailoring of interventions to local health system resources, culture, and patient needs or preferences. SUMMARY eHealth is a promising tool for addressing low medication adherence. Further work incorporating rigorous evaluation, assessment of patient engagement over time and effectiveness of intervention characteristics and components, and a health equity lens addressing eHealth use in vulnerable groups will increase understanding of the full potential of eHealth for improving medication adherence in diverse patients with cardiometabolic disease.
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Affiliation(s)
- Erin Peacock
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Leslie S. Craig
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Marie Krousel-Wood
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Center for Outcomes and Health Services Research, Ochsner Health System, New Orleans, Louisiana
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Melton T, Jasmin H, Johnson HF, Coley A, Duffey S, Renfro CP. Describing the delivery of clinical pharmacy services via telehealth: A systematic review. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Tyler Melton
- University of Tennessee Health Science Center College of Pharmacy Knoxville Tennessee USA
| | - Hilary Jasmin
- University of Tennessee Health Science Center Health Sciences Library Memphis Tennessee USA
| | - Haden F. Johnson
- University of Tennessee Health Science Center College of Pharmacy Memphis Tennessee USA
| | - Annika Coley
- University of Tennessee Health Science Center College of Pharmacy Memphis Tennessee USA
| | - Sawyer Duffey
- University of Tennessee Health Science Center College of Pharmacy Memphis Tennessee USA
| | - Chelsea P. Renfro
- University of Tennessee Health Science Center College of Pharmacy Memphis Tennessee USA
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Pinho S, Cruz M, Ferreira F, Ramalho A, Sampaio R. Improving medication adherence in hypertensive patients: A scoping review. Prev Med 2021; 146:106467. [PMID: 33636195 DOI: 10.1016/j.ypmed.2021.106467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/23/2021] [Accepted: 02/20/2021] [Indexed: 11/17/2022]
Abstract
In recent years, interest in medication adherence has greatly increased. Adherence has been particularly well studied in the context of arterial hypertension treatment. Numerous interventions have addressed this issue, however, the effort to improve adherence has been often frustrating and frequently disorganized. The aim of present study was to perform a scoping review of medication adherence interventions in hypertensive patients, so that a clear overview was achieved. Moreover, an evidence-based categorization of interventions was developed. The review was performed according to the PRISMA-ScR statement. MEDLINE and Web of Science were searched, and studies published from database inception until August 17, 2020 were included. A total of 2994 non-duplicate studies were retrieved. After screening and eligibility phases, a total of 45 articles were included. Studies were analyzed regarding their design, participant characteristics and management of adherence strategies employed. Furthermore, medication adherence and blood pressure outcomes, as well as adherence measuring tools were evaluated. Each study's intervention was then categorized using a novel evidence-based system of categorization, derived from the conceptual clustering framework used in machine learning. This work is an important step in pushing for better informed and more efficient future research efforts, both by providing an overview of the research field and by creating a new, evidence-based intervention categorization tool. It also provides valuable information to clinicians about medication adherence to antihypertensive therapy.
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Affiliation(s)
- Simão Pinho
- Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Hernâni Monteiro, 4200-319 Porto, Portugal.
| | - Mariana Cruz
- Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Filipa Ferreira
- Department of Anatomy, Instituto de Ciências Biomédicas Abel Salazar - ICBAS, University of Porto, R. Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal
| | - André Ramalho
- CINTESIS - Centre for Health Technology and Services Research, R. Dr. Plácido da Costa, 4200-450 Porto, Portugal; MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, 4200-450 Porto, Portugal.
| | - Rute Sampaio
- Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Hernâni Monteiro, 4200-319 Porto, Portugal; CINTESIS - Centre for Health Technology and Services Research, R. Dr. Plácido da Costa, 4200-450 Porto, Portugal.
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