Lessons for Vietnam on the use of digital technologies to support patient-centred care in low- and middle-income countries in the Asia Pacific Region: A scoping review (Preprint)

Digital measures in epilepsy in low-resourced environments

INTRODUCTION

Digital measures and digital health-care delivery have been rarely implemented in lower-and-middle-income countries (LMICs), contributing to worsening global disparities and inequities. Sustainable ways to implement and use digital approaches will help to improve time to access, management, and quality of life in persons with epilepsy, goals that remain unreachable in under-resourced communities. As under-resourced environments differ in human and economic resources, no one approach will be appropriate to all LMICs.

AREAS COVERED

Digital health and tools to monitor and measure digital endpoints and metrics of quality of life will need to be developed or adapted to the specific needs of under-resourced areas. Portable technologies may partially address the urban-rural divide. Careful delineation of stakeholders and their engagement and alignment in all efforts is critically important if these initiatives are to be successfully sustained. Privacy issues, neglected in many regions globally, must be purposefully addressed.

EXPERT OPINION

Epilepsy care in under-resourced environments has been limited by the lack of relevant technologies for diagnosis and treatment. Digital biomarkers, and investigative technological advances, may finally make it feasible to sustainably improve care delivery and ultimately quality of life including personalized epilepsy care.

The impact of electronic versus paper-based data capture on data collection logistics and on missing scores in thyroid cancer patients

PURPOSE

The purpose of this study was to investigate the impact of the type of data capture on the time and help needed for collecting patient-reported outcomes as well as on the proportion of missing scores.

METHODS

In a multinational prospective study, thyroid cancer patients from 17 countries completed a validated questionnaire measuring quality of life. Electronic data capture was compared to the paper-based approach using multivariate logistic regression.

RESULTS

A total of 437 patients were included, of whom 13% used electronic data capture. The relation between data capture and time needed was modified by the emotional functioning of the patients. Those with clinical impairments in that respect needed more time to complete the questionnaire when they used electronic data capture compared to paper and pencil (ORadj 24.0; p = 0.006). This was not the case when patients had sub-threshold emotional problems (ORadj 1.9; p = 0.48). The odds of having the researcher reading the questions out (instead of the patient doing this themselves) (ORadj 0.1; p = 0.01) and of needing any help (ORadj 0.1; p = 0.01) were lower when electronic data capture was used. The proportion of missing scores was equivalent in both groups (ORadj 0.4, p = 0.42).

CONCLUSIONS

The advantages of electronic data capture, such as real-time assessment and fewer data entry errors, may come at the price of more time required for data collection when the patients have mental health problems. As this is not uncommon in thyroid cancer, researchers need to choose the type of data capture wisely for their particular research question.

More patient-centered care, better healthcare: the association between patient-centered care and healthcare outcomes in inpatients

Objective

The objective of this study is to explore the association between patient-centered care (PCC) and inpatient healthcare outcomes, including self-reported physical and mental health status, subjective necessity of hospitalization, and physician-induced demand behaviors.

Methods

A cross-sectional survey was conducted to assess patient-centered care among inpatients in comprehensive hospitals through QR codes after discharge from September 2021 to December 2021 and had 5,222 respondents in Jiayuguan, Gansu. The questionnaire included a translated 6-item version of the PCC questionnaire, physician-induced behaviors, and patients' sociodemographic characteristics including gender, household registration, age, and income. Logistic regression analyses were conducted to assess whether PCC promoted self-reported health, the subjective necessity of hospitalization, and decreased physician-induced demand. The interactions between PCC and household registration were implemented to assess the effect of the difference between adequate and inadequate healthcare resources.

Results

PCC promoted the patient's self-reported physical (OR = 4.154, p < 0.001) and mental health (OR = 5.642, p < 0.001) and subjective necessity of hospitalization (OR = 6.160, p < 0.001). Meanwhile, PCC reduced physician-induced demand in advising to buy medicines outside (OR = 0.415, p < 0.001), paying at the outpatient clinic (OR =0.349, p < 0.001), issuing unnecessary or repeated prescriptions and medical tests (OR = 0.320, p < 0.001), and requiring discharge and readmitting (OR = 0.389, p < 0.001).

Conclusion

By improving health outcomes for inpatients and reducing the risk of physician-induced demand, PCC can benefit both patients and health insurance systems. Therefore, PCC should be implemented in healthcare settings.