Effectiveness of a Mobile Health and Self-Management App for High-Risk Patients With Chronic Obstructive Pulmonary Disease in Daily Clinical Practice: Mixed Methods Evaluation Study

Impressions and Perceptions of a Smartphone and Smartwatch Self-Management Tool for Patients With COPD: A Qualitative Study

BACKGROUND

Patients with chronic obstructive pulmonary disease (COPD) often do not seek care until they experience an exacerbation. Improving self-management for these patients may increase health-related quality of life and reduce hospitalizations. Patients are willing to use wearable technology for real-time data reporting and perceive mobile technology as potentially helpful in COPD management, but there are many barriers to the uptake of these technologies.

OBJECTIVE

We aimed to understand patients' experiences using a wearable and mobile app and identify areas for improvement.

METHODS

We conducted semi-structured interviews as part of a larger prospective cohort study wherein patients used a wearable and app for 6 months. We asked which features patients found accessible, acceptable and useful.

RESULTS

We completed 26 interviews. We summarized our research findings into four main themes: (1) information, support and reassurance, (2) barriers to adoption, (3) impact on communication with health care providers, and (4) opportunities for improvement. Most patients found the feedback received through the app to be reassuring and useful. Some patients experienced technical difficulties with the app and found the wearable to be uncomfortable.

CONCLUSIONS

Patients found a wearable device and mobile application to be acceptable and useful for the management of COPD. We identified barriers to adoption and opportunities for improvement to the design of our app. Further research is needed to understand what people with COPD and their healthcare providers want and will use in a mobile app and wearable for COPD management.

User Engagement With mHealth Interventions to Promote Treatment Adherence and Self-Management in People With Chronic Health Conditions: Systematic Review

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.

Videoconferencing interventions and COPD patient outcomes: A systematic review

INTRODUCTION

Videoconferencing circumvents various physical and financial barriers associated with in-person care. Given this technology's potential benefits and timely nature, we conducted a systematic review to understand how videoconferencing for chronic obstructive pulmonary disease (COPD) follow-up care affects patient-related outcomes.

METHODS

We included primary research evaluating the use of bidirectional videoconferencing for COPD patient follow-up. The outcomes of interest were resource utilization, mortality, lifestyle factors, patient satisfaction, barriers, and feasibility. We searched MEDLINE, EMBASE, EBM Reviews, and CINAHL databases for articles published from January 1, 2010, to August 2, 2021. Relevant information was extracted and presented descriptively and common themes and patterns were identified. The risk of bias for each study was assessed using design-specific validated tools.

RESULTS

We included 39 studies of 18,194 patients (22 quantitative, 12 qualitative, and 5 mixed methods). The included studies were grouped by type of intervention; 18 studies explored videoconferencing for exercise, 19 explored videoconferencing for clinical assessment/monitoring, and 2 examined videoconferencing for education. Generally, videoconferencing was associated with high levels of patient satisfaction. There were mixed results in terms of its effects on resource utilization and lifestyle-related factors. Additionally, 12 studies were at high risk of bias, indicating that these results should be interpreted with caution.

CONCLUSIONS

The videoconferencing interventions resulted in high levels of patient satisfaction, despite facing technological issues. Overall, more research is needed to better understand the effects of videoconferencing interventions on resource utilization and other patient outcomes, quantifying their advantages over in-person care.

All Hands on Deck. Transforming the Health System Requires Innovation, Through Individual- and Diffusion Efforts Comment on "Employee-Driven Innovation in Health Organizations: Insights From a Scoping Review"

Employee driven innovation (EDI) is essential in transforming hospitals and other providers, but the challenge is also to have impact on health systems as a whole. Usually a mix from top down measures and bottom up initiatives leads to an innovative culture. An important aspect is the innate difference between types of providers related to initiating, facilitating and rewarding innovation. Second the rewarding system within organisations but also in science and scientific journals. Especially nursing and other non-medical professions can be emancipated in this regard. Further there is a growing interdependence with digitalisation in all its forms and awareness of the related team effort is needed to actually realise innovative projects within a standing organisation. Lastly change the paradigm related to the spread of innovations from "not invented here" to "proudly copied from," create trust and organize collaboration between providers and spend sufficient attention to credible evidence on the effectiveness.

Smartphone applications supporting self-management programme for adults with Chronic Obstructive Pulmonary Disease: A Scoping Review

INTRODUCTION

Chronic Obstructive Pulmonary Disease (COPD) significantly impacts on both the quality and quantity of life for patients due to frequent exacerbations requiring hospital admissions resulting in increased morbidity and mortality. A self-management programme purpose is to increase one's knowledge, confidence, and skills to self-manage their chronic illness such as COPD.

OBJECTIVE

The objective of this review will therefore answer the following research question: What is the current literature pertaining to the use of a smartphone app in supporting a comprehensive self-management programme among COPD patients? A preliminary search was conducted in, Medline, Embase and CINAHL databases to ascertain index terms and keywords. Following this a rigorous search was carried out on Medline, Embase, CINAHL, Web of Science and ASSIA. The findings from this search are presented in tabular form using the PRSIMA flow diagram.

RESULTS

In this review, fifteen studies met the inclusion criteria. Across all studies participants engaged with the app and developed self-management skills and knowledge to manage their chronic illness. However, engagement with the app without third party involvement declined over time. Technical issues did not cause harm to participants but in some cases contributed to reduced engagement. Smartphone self-management apps empowered a cohort of COPD participants to engage in managing their chronic illness which proved useful in detecting exacerbations earlier resulting in reducing the need for hospitalisations over a three-to-six-month period. By reducing hospitalisations incurred a cost savings for health care and an improved quality and quantity of life for these participants.

CONCLUSION

It is evident from the literature that smartphone self-management apps may positively influence participants self-management decisions in terms of knowledge, increase physical activity, self-efficacy that may result in reduced hospitalisation and improved quality of life. It is clear that technical issues and sustained engagement over longer periods of time remains a challenge.

A Mobile App for Comprehensive Symptom Management in People With Parkinson's Disease: A Pilot Usability Study

There is an increasing need for highly accessible health management platforms for comprehensive symptoms of Parkinson disease. Mobile apps encompassing nonmotor symptoms have been rarely developed since these symptoms are often subjective and difficult to reflect what individuals actually experience. The study developed an app for comprehensive symptom management and evaluated its usability and feasibility. A single-group repeated measurement experimental design was used. Twenty-two participants used the app for 6 weeks. Monitoring of nonmotor symptoms, games to address motor symptoms, and medication management were incorporated in the app. Quantitative outcomes were self-assessed through an online questionnaire, and one-on-one telephone interviews were conducted to understand the user's point of view. The successful experience of self-monitoring had improved participants' self-efficacy ( Z = -3.634, P < .001) and medication adherence ( Z = -3.371, P = .001). Facilitators included a simple-to-use interface, entertaining content, and medication helps. Barriers included simple forgetfulness and digital literacy, including unfamiliarity with mobile phone manipulation itself. The study suggested insight into the app use related to acceptability of mobile technology. The preliminary effects on self-efficacy and medication adherence will guide future nursing interventions using mobile health. Our approach will contribute to improving the continuum of care for Parkinson disease by promoting self-monitoring of symptoms.

From illness management to quality of life: rethinking consumer health informatics opportunities for progressive, potentially fatal illnesses

OBJECTIVES

Investigate how people with chronic obstructive pulmonary disease (COPD)-an example of a progressive, potentially fatal illness-are using digital technologies (DTs) to address illness experiences, outcomes and social connectedness.

MATERIALS AND METHODS

A transformative mixed methods study was conducted in Canada with people with COPD (n = 77) or with a progressive lung condition (n = 6). Stage-1 interviews (n = 7) informed the stage-2 survey. Survey responses (n = 80) facilitated the identification of participants for stage-3 interviews (n = 13). The interviews were thematically analyzed. Descriptive statistics were calculated for the survey. The integrative mixed method analysis involved mixing between and across the stages.

RESULTS

Most COPD participants (87.0%) used DTs. However, few participants frequently used DTs to self-manage COPD. People used DTs to seek online information about COPD symptoms and treatments, but lacked tailored information about illness progression. Few expressed interest in using DTs for self- monitoring and tracking. The regular use of DTs for intergenerational connections may facilitate leaving a legacy and passing on traditions and memories. Use of DTs for leisure activities provided opportunities for connecting socially and for respite, reminiscing, distraction and spontaneity.

DISCUSSION AND CONCLUSION

We advocate reconceptualizing consumer health technologies to prioritize quality of life for people with a progressive, potentially fatal illness. "Quality of life informatics" should focus on reducing stigma regarding illness and disability and taboo towards death, improving access to palliative care resources and encouraging experiences to support social, emotional and mental health. For DTs to support people with fatal, progressive illnesses, we must expand informatics strategies to quality of life.

User experience testing of the mobile pulmonary rehabilitation (m-PR™) app in people with chronic obstructive pulmonary disease

Objective

Mobile health (mHealth) technologies are emerging to support the delivery of pulmonary rehabilitation (PR). This study aimed to explore the ease of use, satisfaction and acceptability of an Australian mobile pulmonary rehabilitation app (m-PR™) in people with chronic obstructive pulmonary disease (COPD).

Methods

In this mixed methods observational study, participants with COPD were recruited following PR assessment. Participants were educated on m-PR™ which contained symptom monitoring, individualised exercise training with exercise videos, education videos, goal setting, health notifications and medication action plan. Participants used m-PR™ for 4-8 weeks. At baseline, participants were surveyed to assess level of technology engagement. At follow-up, participants completed the system usability survey (SUS), a satisfaction survey and a semi-structured interview.

Results

Fifteen participants (mean age 70 [SD 10] years, 53% female) completed the study. Technology usage was high with 73% (n = 11) self-rating their technology competence as good or very good. The SUS score of 71 (SD 16) demonstrated above average perceived usability of m-PR™. The satisfaction survey indicated that 67% (n = 10) enjoyed m-PR™ and 33% (n = 5) were neutral. Most participants found the different m-PR™ components somewhat easy or very easy to use (range 69-100%) and somewhat helpful or very helpful (range 76-100%). Interview responses revealed that m-PR™ elicited divergent feelings among participants, who reported both positive and negative feelings towards the app's features, the effort required to use it and data security.

Conclusion

The majority of participants found m-PR™ enjoyable, easy to use and helpful in managing their COPD. Further research is warranted to understand the effectiveness of mHealth to deliver PR.

Effectiveness of smartphone application in increasing knowledge on COPD and its non-pharmacological management in COPD patients

Chronic obstructive pulmonary disease (COPD) is among top ten of the world's causes of death. The development of the "Paru Sehat" smartphone application is a positive initiative and might have the potential to improve the disease management of COPD, improve patient's quality of life, and reduce complications associated with COPD. However, its effectiveness in improving the knowledge of the COPD patients is unknown. The aim of this study was to determine the effectiveness of "Paru Sehat" in increasing knowledge on COPD and its non-pharmacological management in COPD patients. A quasi-experimental study with a one-group pretest-posttest was conducted among stable COPD patients at Prof. Chairuddin Panusunan Lubis Hospital, Medan, Indonesia. Bristol COPD knowledge questionnaire (BCKQ) was used to assess the knowledge scores of the patients before and after exposure to the "Paru Sehat" twice a week for four weeks. A dependent Student t-test was used to compare the knowledge scores between pre- and post-intervention for both knowledge domains (i.e., knowledge on the disease and non-pharmacological management). Student t-test or one-way ANOVA were used to determine the association between patients' characteristics and the knowledge scores within pre- and posttreatment. Our data indicated a significant improvement of the knowledge scores on disease between pre- and post-treatment (15.92±3.79 vs 19.56±3.68, p<0.001). The knowledge score on non-pharmacological management also increased significantly post-treatment (7.52±2.02) compared to pre-treatment (10.08±2.379), p<0.001. In addition, this study found that educational attainment was associated with the scores of both knowledge domains of which individuals with senior high school or higher education level had significantly improvement of knowledge scores. This study highlights that although "Paru Sehat" application could improve the knowledge on COPD and its non-pharmacological management, its effects are less effective among individuals with low educational attainment.

Enhancing potential impact of hospital discharge interventions for patients with COPD: a qualitative systematic review

BACKGROUND

Patients with chronic obstructive pulmonary disease (COPD) are frequently readmitted to hospital resulting in avoidable healthcare costs. Many different interventions designed to reduce hospital readmissions are reported with limited evidence for effectiveness. Greater insight into how interventions could be better designed to improve patient outcomes has been recommended.

AIM

To identify areas for optimisation within previously reported interventions provided to reduce COPD rehospitalisation to improve future intervention development.

METHODS

A systematic review was conducted by searching Medline, Embase, CINAHL, PsycINFO, and CENTRAL in June 2022. Inclusion criteria were interventions provided to patients with COPD in the transition from hospital to home or community. Exclusion criteria were lack of empirical qualitative results, reviews, drug trials, and protocols. Study quality was assessed using the Critical Appraisal Skills Programme tool and results were synthesised thematically.

RESULTS

A total of 2,962 studies were screened and nine studies included. Patients with COPD experience difficulties when transitioning from hospital to home. It is therefore important for interventions to facilitate a smooth transition process and give appropriate follow-up post-discharge. Additionally, interventions should be tailored for each patient, especially regarding information provided.

CONCLUSION

Very few studies specifically consider processes underpinning COPD discharge intervention implementation. There is a need to recognise that the transition itself creates problems, which require addressing, before introducing any new intervention. Patients report a preference for interventions to be individually adapted-in particular the provision of patient information. Whilst many intervention aspects were well received, feasibility testing may have enhanced acceptability. Patient and public involvement may address many of these concerns and greater use of process evaluations should enable researchers to learn from each other's experiences.

TRIAL REGISTRATION

The review was registered in PROSPERO with registration number CRD42022339523.

Usability of a mobile application for the clinical follow-up of patients with chronic obstructive pulmonary disease and home oxygen therapy

BACKGROUND

Technological health tools (e-Health) may potentially facilitate the treatment of patients with chronic diseases through development of self-management and -care skills in patients and caregivers. However, these tools are usually marketed without prior analysis and without providing any context to final users, which frequently results in low adherence to their use.

PURPOSE

To determine the usability of and satisfaction toward a mobile app for the clinical monitoring of patients with chronic obstructive pulmonary disease (COPD) receiving oxygen therapy at home.

METHODS

This was a participative-qualitative study focused on final users-with direct intervention by patients and professionals-consisting of three phases as follows: (i) medium-fidelity mockups design, (ii) development of a usability test for each user profile, and (iii) assessment of the satisfaction level regarding the usability of the mobile app. A sample was established and selected through non-probability convenience sampling and was divided into two groups as follows: healthcare professionals (n = 13) and patients (n = 7). Each participant received a smartphone with mockup designs. The "think-aloud" method was applied in the usability test. Participants were audio recorded and the anonymous transcriptions were analyzed, highlighting fragments about mockups characteristics and the usability test. The difficulty level of the tasks was assessed with a scale from 1 (very easy) to 5 (too difficult), and task non-completion was considered a critical mistake. The satisfaction level related to test usability was assessed with a 4-score Likert scale ranging from 4 (totally agree) to 1 (totally disagree).

RESULTS

Regarding the difficulty level, >60% of professionals described most tasks as "very easy" and 70% of patients as "easy." No participant made critical mistakes and both groups reported a high satisfaction level regarding the usability variables. The patient and professionals group required 18 and 11 min to complete all tasks, respectively.

CONCLUSIONS

Participants described the app as intuitive and easy to use. The usability satisfaction results show a high level of satisfaction for both groups. This positive assessment and performance in user tests showed that the mobile application was able to be apprehended and used by participants in the circumstances of use in the usability tests. Usability evaluation through satisfaction surveys and qualitative data analysis allows for greater insight into the use of mobile applications in healthcare.

Telehealth and telemedicine in the management of adult patients after hospitalization for COPD exacerbation: a scoping review

Objective: A substantial number of people with COPD suffer from exacerbations, which are defined as an acute worsening of respiratory symptoms. To minimize exacerbations, telehealth has emerged as an alternative to improve clinical management, access to health care, and support for self-management. Our objective was to map the evidence of telehealth/telemedicine for the monitoring of adult COPD patients after hospitalization due to an exacerbation. Methods: Bibliographic search was carried in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, Scopus, Biblioteca Virtual de Saúde/LILACS and Cochrane Library databases to identify articles describing telehealth and telemonitoring strategies in Portuguese, English, or Spanish published by December of 2021. Results: Thirty-nine articles, using the following concepts (number of articles), were included in this review: telehealth (21); telemonitoring (20); telemedicine (17); teleconsultation (5); teleassistance (4); telehomecare and telerehabilitation (3 each); telecommunication and mobile health (2 each); and e-health management, e-coach, telehome, telehealth care and televideo consultation (1 each). All these concepts describe strategies which use telephone and/or video calls for coaching, data monitoring, and health education leading to self-management or self-care, focusing on providing remote integrated home care with or without telemetry devices. Conclusions: This review demonstrated that telehealth/telemedicine in combination with telemonitoring can be an interesting strategy to benefit COPD patients after discharge from hospitalization for an exacerbation, by improving their quality of life and reducing re-hospitalizations, admissions to emergency services, hospital length of stay, and health care costs.

Telemedicine in the management of chronic obstructive pulmonary disease: A systematic review

Telemedicine is defined as the use of electronic technology for information and communication by healthcare professionals with patients (or care givers) aiming at providing and supporting healthcare to patients away from healthcare institutions. This systematic review over the last decade (2013-2022) investigates the use of telemedicine in patients with chronic obstructive pulmonary disease (COPD). We identified 53 publications related to: (1) home tele-monitorization; (2) tele-education and self-management; (3) telerehabilitation; and (4) mobile health (mHealth). Results showed that, although evidence is still weak in many of these domains, results are positive in terms of improvement of health-status, use of health-care resources, feasibility, and patient satisfaction. Importantly, no safety issues were identified. Thus, telemedicine can be considered today as a potential complement to usual healthcare.

Measuring adherence to inhaled control medication in patients with asthma: Comparison among an asthma app, patient self-report and physician assessment

BACKGROUND

Previous studies have demonstrated the feasibility of using an asthma app to support medication management and adherence but failed to compare with other measures currently used in clinical practice. However, in a clinical setting, any additional adherence measurement must be evaluated in the context of both the patient and physician perspectives so that it can also help improve the process of shared decision making. Thus, we aimed to compare different measures of adherence to asthma control inhalers in clinical practice, namely through an app, patient self-report and physician assessment.

METHODS

This study is a secondary analysis of three prospective multicentre observational studies with patients (≥13 years old) with persistent asthma recruited from 61 primary and secondary care centres in Portugal. Patients were invited to use the InspirerMundi app and register their inhaled medication. Adherence was measured by the app as the number of doses taken divided by the number of doses scheduled each day and two time points were considered for analysis: 1-week and 1-month. At baseline, patients and physicians independently assessed adherence to asthma control inhalers during the previous week using a Visual Analogue Scale (VAS 0-100).

RESULTS

A total of 193 patients (72% female; median [P25-P75] age 28 [19-41] years old) were included in the analysis. Adherence measured by the app was lower (1 week: 31 [0-71]%; 1 month: 18 [0-48]%) than patient self-report (80 [60-95]) and physician assessment (82 [51-94]) (p < 0.001). A negligible non-significant correlation was found between the app and subjective measurements (ρ 0.118-0.156, p > 0.05). There was a moderate correlation between patient self-report and physician assessment (ρ = 0.596, p < 0.001).

CONCLUSIONS

Adherence measured by the app was lower than that reported by the patient or the physician. This was expected as objective measurements are commonly lower than subjective evaluations, which tend to overestimate adherence. Nevertheless, the low adherence measured by the app may also be influenced by the use of the app itself and this needs to be considered in future studies.

Features and characteristics of publicly available mHealth apps for self-management in chronic obstructive pulmonary disease

Mobile health applications (mHealth apps) may be able to support people living with chronic obstructive pulmonary disease (COPD) to develop the appropriate skills and routines for adequate self-management. Given the wide variety of publicly available mHealth apps, it is important to be aware of their characteristics to optimize their use and mitigate potential harms.

Objective

To report the characteristics and features of publicly available apps for COPD self-management.

Methods

MHealth apps designed for patients' COPD self-management were searched in the Google Play and Apple app stores. Two reviewers trialed and assessed the eligible apps using the MHealth Index and Navigation Database framework to describe the characteristics, qualities, and features of mHealth apps across five domains.

Results

From the Google Play and Apple stores, thirteen apps were identified and eligible for further evaluation. All thirteen apps were available for Android devices, but only seven were available for Apple devices. Most apps were developed by for-profit organizations (8/13), non-profit organizations (2/13), and unknown developers (3/13). Many apps had privacy policies (9/13), but only three apps described their security systems and two mentioned compliance with local health information and data usage laws. Education was the common app feature; additional features were medication reminders, symptom tracking, journaling, and action planning. None provided clinical evidence to support their use.

Conclusions

Publicly available COPD apps vary in their designs, features, and overall quality. These apps lack evidence to support their clinical use and cannot be recommended at this time.

Smart dry powder inhalers and intelligent adherence management

Adherence to inhaled treatments is a complex challenge for patients with chronic obstructive pulmonary disease (COPD) and asthma, it not only involves following the prescribed treatment plans but also administering the medications correctly. When using a dry powder inhaler (DPI), the inhalation flow is particularly critical. Patients frequently fail to use a rapid enough onset and fast enough inhalation when using DPIs. At the same time, there is increasing pressure on physicians to switch patients to DPIs, to minimise the environmental impact of pMDI propellants. This makes it critical to understand whether a patient will maintain or improve disease control by using their new inhaler correctly. However, it is challenging for health care professionals to understand how a patient behaves away from the clinic. Therefore, it would be beneficial to obtain real-world data through the use of monitoring tools, i.e., "smart inhalers". This paper reviews the technologies used to monitor DPIs, how effective they have been in a clinical setting, and how well these have been adopted by patients and health care providers.

Patients, caregivers, and healthcare professionals' needs when designing the content of a mobile application for the clinical monitoring of patients with chronic obstructive pulmonary disease and home oxygen therapy: A user-centered design

Background

Patients with chronic respiratory diseases require oxygen supply in a considerable amount to reduce their symptoms and increase their survival. The development of abilities for the self-management of chronic diseases has been shown to be essential to decrease exacerbation of symptoms. Therefore, the design and development of health mobile applications (apps) that aid in educating and training for disease self-management are cost-effective strategies.

Objective

The purpose of this research was to describe the main characteristics that, according to final users, should be included in a mobile application for monitoring patients prescribed home oxygen therapy.

Methods

A participative-qualitative design was used, involving direct participation of patients, caregivers, and healthcare professionals. Focus groups were conducted to identify the needs and perspectives related to the app. A card sorting method was used to determine the contents and basic architecture of the app.

Results

By means of the focus groups, we could identify nine basic functions of the app for the clinical monitoring of patients under home oxygen therapy. For both profiles, the app structure was determined by identifying the most frequent contents among participants.

Conclusions

The implementation of a user-centered design allowed for the detection of the functions, contents, and basic architecture of the app by identifying healthcare professionals and patients' needs and preferences regarding the self-management and monitoring of home oxygen prescriptions.

Trial Registration

The study is registered in ClinicalTrials.gov: NCT04820790.

Feasibility of Electronic Health Record Integration of a SMART Application to Facilitate Patient-Provider Communication for Medication Management

Increased treatment complexity in patients with diabetes contributes to medication nonadherence. Patient portals that are accessible through electronic health records may offer improved patient-provider communication and better medication management in patients with diabetes and uncontrolled hypertension. We conducted a prospective, mixed-methods evaluation of the Duke PillBox application, a SMART-on-FHIR medication management application integrated into the electronic health record patient portal. Adults with active portal status, diabetes, and uncontrolled hypertension participated in a usability/feasibility survey and communicated with a pharmacist via the portal-based application who conducted medication reconciliation and discussed medication indications, side effects, and barriers to use with patients. Of the eligible patients (n = 285), 29 (10%) were interested, and 12 (8%) participated. Challenges to usability were due to the electronic health record-portal communication interface (91%), browser access and compatibility (55%), and persistent lists of unused medications in the electronic health record (27%). The findings of this study suggest that electronic health record-integrated medication applications are desirable as indicated in patient interactions at the outset and conclusion of the study. Persistent challenges included electronic health record integration, interoperability, user interface, and browser connectivity for both patients and providers.

Evaluation of m‐Health‐rehabilitation for respiratory disorders: A systematic review

Background and Aims

Chronic respiratory diseases are prominent causes of morbidity worldwide that impose significant social and economic burdens on individuals and communities. Pulmonary rehabilitation is one of the main aspects of medical rehabilitation. Nowadays, mobile health apps deliver pulmonary rehabilitation support via smartphones. This article presents a systematic review of the literature on m‐Health apps used in respiration disorders rehabilitation.

Methods

A systematic search was performed on MEDLINE (through PubMed), Web of Science, and Scopus in May 2021 without any date limitation. This study was using a combination of keywords and MeSH terms associated with pulmonary rehabilitation. Relevant studies were selected by two independents and were categorized studies results. The inclusion criterion was m‐Health apps for pulmonary rehabilitation and exclusion criteria mobile‐based interventions, by voice call or short message service and cardiopulmonary articles.

Results

Searching scientific databases yielded 161 relevant articles. Then, 27 articles were included in the study with a complete evaluation of the articles. Sixty percent of them were related to patients with chronic obstructive pulmonary disease (COPD). Rehabilitation aiming to improve the quality of life, promote self‐management, encourage physical activity, and reduce the symptoms as the most common goals of pulmonary rehabilitation using m‐Health apps; 89% of these studies showed that m‐Health apps can be effective in improving pulmonary rehabilitation. In addition, 37% of studies reported high usability and acceptance. However, the results of some studies show that adherence to apps decreases in the long run.

Conclusion

Our study shows that m‐Health pulmonary rehabilitation apps are effective in improving the quality of life, self‐management, and physical activity. According to the results, it seems that using the m‐Health apps for pulmonary rehabilitation can be useful in the COVID‐19 pandemic and help reduce respiratory disorders in patients with COVID‐19 disease.

Using Telemedicine to Provide Education for the Symptomatic Patient with Chronic Respiratory Disease

Technology-enabled learning, using computers, smartphones, and tablets, to educate patients on their respiratory disease and management has grown over the last decade. This shift has been accelerated by the global COVID-19 pandemic and the need to socially distance for public health. Thirteen recently published papers examined experience, knowledge, skills and attitude acquisition, behaviour change, and impact on health outcomes of patient education using technology (websites and mobile device applications) for people with chronic respiratory disease. Technology-enabled patient education that includes relevant information, with activities that encourage the patient to interact with the digital platform, appears to lead to better patient experience and may increase learning and behaviour change with improved quality of life. Developing online relationships with healthcare providers, lower digital capabilities, and poor access to a computer/smartphone/tablet, appear to be barriers that need to be overcome for equity in access. Maintaining the principles of quality educational design, ensuring interactive experiences for patient involvement in the educational activities, patient co-design, healthcare professionals connecting with experts in the field of technology-enabled learning for development of education models, and ongoing research lead to the best patient outcomes in technology-enabled education for respiratory disease.