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Mirza MB, Baechle JJ, Marincola Smith P, Dillhoff M, Poultsides G, Rocha FG, Cho CS, Winslow ER, Fields RC, Maithel SK, Idrees K. Survival disparities in rural versus urban patients with pancreatic neuroendocrine tumor: A multi-institutional study from the US neuroendocrine tumor study group. Am J Surg 2024; 233:125-131. [PMID: 38492993 DOI: 10.1016/j.amjsurg.2024.03.003] [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: 09/09/2023] [Revised: 02/14/2024] [Accepted: 03/03/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Pancreatic Neuroendocrine Tumors (PNETs) are indolent malignancies that often have a prolonged clinical course. This study assesses disparities in outcomes between PNET patients who live in urban (UA) and rural areas (RA). METHODS A retrospective cohort study was performed using the US Neuroendocrine Tumor Study Group database. PNET patients with a home zip code recorded were included and categorized as RA or UA according to the Federal Office of Rural Health Policy. Overall survival (OS) was analyzed by Kaplan-Meier method, log-rank test, and logistical regression. RESULTS Of the 1176 PNET patients in the database, 1126 (96%) had zip code recorded. While 837 (74%) lived in UA, 289 (26%) lived in RA. RA patients had significantly shorter median OS following primary PNET resection (122 vs 149 months, p = 0.01). After controlling for income, local healthcare access, distance from treatment center, ASA class, BMI, and T/N/M stage, living in a RA remained significantly associated with worse OS (HR 1.60, 95%CI 1.08-2.39, p = 0.02). CONCLUSION Rural patients have significantly shorter OS following PNET resection compared to their urban counterparts.
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Affiliation(s)
- Muhammad Bilal Mirza
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Jordan J Baechle
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, United States; School of Medicine, Meharry Medical College, Nashville, TN, United States
| | - Paula Marincola Smith
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Mary Dillhoff
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States
| | | | - Flavio G Rocha
- Virginia Mason Medical Center, Seattle, WA, United States
| | - Clifford S Cho
- Division of Hepatopancreatobiliary and Advanced Gastrointestinal Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Emily R Winslow
- University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Ryan C Fields
- Washington University School of Medicine, St Louis, MO, United States
| | - Shishir K Maithel
- Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, United States
| | - Kamran Idrees
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, United States.
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Ruggiero C, Macchione IG, Gemo V, Properzi C, Perini F, Bianco A, Ercolani MC, Mencacci M, Manzi P, Pasqualucci A, De Filippis G, Baroni M, Mecocci P. Effectiveness and Satisfaction with Telemedicine in Geriatric Patients at High Risk of Fragility Fractures. Telemed J E Health 2024; 30:e2040-e2049. [PMID: 38656125 DOI: 10.1089/tmj.2023.0708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Background: Telemedicine has increasingly widespread to improve the monitoring of patients with chronic diseases. Secondary prevention of fragility fractures is an urgent matter to be addressed by means of available technology, although supported by little evidence so far. We investigated the feasibility, efficacy, and satisfaction of managing older adults at high risk of fragility fractures during the COVID-19 lockdown. Methods: During the period January to July 2021, a prospective observational study for safety and adherence purposes was conducted among older adults (n = 407) with ongoing treatments for secondary prevention of fragility fractures. The study procedures comply with national and regional resolutions related to telemedicine service (TS), including equipment, staff behaviors, and patient reports. Results: A majority (86.48% [n = 352]) of the eligible patients joined the remote visits, mainly women (88.2%), 81.4 ± 8.8 years of age, 49.6% independent in 5 out of 6 BADL, despite high comorbidity (4.9 ± 1.5), and polypharmacy (4.9 ± 3.1). Almost all were on second-line antifracture treatments (95.58%) due to previous major (84.03%) and minor (42.5%) fragility fractures. About 58% reported good and very good reliability of the internet network, allowing easy access to the TS platform, and 54% declared the degree of satisfaction with TS as good and very good. About 75% of clinicians acknowledged the efficacy of TS and expressed willingness to recommend the use of TS to colleagues. Ultimately, 68% of specialists defined the time allocated for patients' remote visits as acceptable. Conclusion: TS may be an opportunity to improve the availability of appropriate health care services to satisfy patients' needs and optimize health care resource allocation.
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Affiliation(s)
- Carmelinda Ruggiero
- Orthogeriatric Service, Geriatric Unit, Department of Medicine and Surgery, Institute of Gerontology and Geriatrics, University of Perugia, S. Maria Della Misericordia Hospital, Perugia, Italy
| | - Ilaria Giovanna Macchione
- Orthogeriatric Service, Geriatric Unit, Department of Medicine and Surgery, Institute of Gerontology and Geriatrics, University of Perugia, S. Maria Della Misericordia Hospital, Perugia, Italy
| | - Valentina Gemo
- Orthogeriatric Service, Geriatric Unit, Department of Medicine and Surgery, Institute of Gerontology and Geriatrics, University of Perugia, S. Maria Della Misericordia Hospital, Perugia, Italy
| | - Chiara Properzi
- Orthogeriatric Service, Geriatric Unit, Department of Medicine and Surgery, Institute of Gerontology and Geriatrics, University of Perugia, S. Maria Della Misericordia Hospital, Perugia, Italy
| | - Federica Perini
- Orthogeriatric Service, Geriatric Unit, Department of Medicine and Surgery, Institute of Gerontology and Geriatrics, University of Perugia, S. Maria Della Misericordia Hospital, Perugia, Italy
| | - Annarita Bianco
- Orthogeriatric Service, Geriatric Unit, Department of Medicine and Surgery, Institute of Gerontology and Geriatrics, University of Perugia, S. Maria Della Misericordia Hospital, Perugia, Italy
| | - Maria Cristina Ercolani
- IT Systems and Transition to Digital Administration, S. Maria Della Misericordia Hospital, Perugia, Italy
| | - Marco Mencacci
- Technological Infrastructure Development, IT Department, Municipality of Florence, Firenze, Italy
| | - Pietro Manzi
- Medical Direction, S. Maria Hospital, Terni, Italy
| | | | | | - Marta Baroni
- Orthogeriatric Service, Geriatric Unit, Department of Medicine and Surgery, Institute of Gerontology and Geriatrics, University of Perugia, S. Maria Della Misericordia Hospital, Perugia, Italy
| | - Patrizia Mecocci
- Orthogeriatric Service, Geriatric Unit, Department of Medicine and Surgery, Institute of Gerontology and Geriatrics, University of Perugia, S. Maria Della Misericordia Hospital, Perugia, Italy
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Maaitah W, Abdelhay O, Tourkmani A, Azzeh M, Abu-Soud MS, Atiani S. Telemedicine interventions in type 2 diabetes management: a protocol for systematic review and network meta-analysis. BMJ Open 2024; 14:e078100. [PMID: 38388501 PMCID: PMC10884257 DOI: 10.1136/bmjopen-2023-078100] [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] [Received: 07/24/2023] [Accepted: 01/08/2024] [Indexed: 02/24/2024] Open
Abstract
INTRODUCTION The consequences of type 2 diabetes mellitus (T2DM) heavily strain individuals and healthcare systems worldwide. Interventions via telemedicine have become a potential tactic to tackle the difficulties in effectively managing T2DM. However, more research is needed to determine how telemedicine interventions affect T2DM management. This study sets out to systematically analyse and report the effects of telemedicine treatments on T2DM management to gain essential insights into the potential of telemedicine as a cutting-edge strategy to improve the outcomes and care delivery for people with T2DM. METHODS AND ANALYSIS To uncover relevant research, we will perform a comprehensive literature search across six databases (PubMed, IEEE, EMBASE, Web of Science, Google Scholar and Cochrane Library). Each piece of data will be extracted separately, and any discrepancies will be worked out through discussion or by a third reviewer. The studies included are randomised controlled trial. We chose by predefined inclusion standards. After the telemedicine intervention, glycated haemoglobin will be the primary outcome. The Cochrane risk-of-bias approach will be used to evaluate the quality of the included studies. RevMan V.5.3.5 software and RStiduo V.4.3.1 software can be used to analyse the data, including publication bias. ETHICS AND DISSEMINATION Since this research will employ publicly accessible documents, ethical approval is unnecessary. The review is registered prospectively on the PROSPERO database. The study's findings will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42023421719.
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Affiliation(s)
- Wasan Maaitah
- Department of Data Science, Princess Sumaya University for Technology, Amman, Jordan
| | - Osama Abdelhay
- Department of Data Science, Princess Sumaya University for Technology, Amman, Jordan
| | - Ayla Tourkmani
- Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohammad Azzeh
- Department of Data Science, Princess Sumaya University for Technology, Amman, Jordan
| | - Mohammad S Abu-Soud
- Department of Data Science, Princess Sumaya University for Technology, Amman, Jordan
| | - Serin Atiani
- Department of Data Science, Princess Sumaya University for Technology, Amman, Jordan
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Berg IJ, Tveter AT, Bakland G, Hakim S, Kristianslund EK, Lillegraven S, Macfarlane GJ, Moholt E, Provan SA, Sexton J, Thomassen EE, De Thurah A, Gossec L, Haavardsholm EA, Østerås N. Follow-Up of Patients With Axial Spondyloarthritis in Specialist Health Care With Remote Monitoring and Self-Monitoring Compared With Regular Face-to-Face Follow-Up Visits (the ReMonit Study): Protocol for a Randomized, Controlled Open-Label Noninferiority Trial. JMIR Res Protoc 2023; 12:e52872. [PMID: 38150310 PMCID: PMC10782285 DOI: 10.2196/52872] [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: 09/18/2023] [Revised: 11/02/2023] [Accepted: 11/23/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Patients with chronic inflammatory joint diseases such as axial spondyloarthritis have traditionally received regular follow-up in specialist health care to maintain low disease activity. The follow-up has been organized as prescheduled face-to-face visits, which are time-consuming for both patients and health care professionals. Technology has enabled the remote monitoring of disease activity, allowing patients to self-monitor their disease and contact health care professionals when needed. Remote monitoring or self-monitoring may provide a more personalized follow-up, but there is limited research on how these follow-up strategies perform in maintaining low disease activity, patient satisfaction, safety, and cost-effectiveness. OBJECTIVE The Remote Monitoring in Axial Spondyloarthritis (ReMonit) study aimed to assess the effectiveness of digital remote monitoring and self-monitoring in maintaining low disease activity in patients with axial spondyloarthritis. METHODS The ReMonit study is a 3-armed, single-site, randomized, controlled, open-label noninferiority trial including patients with axial spondyloarthritis with low disease activity (Ankylosing Spondylitis Disease Activity Score <2.1) and on stable treatment with a tumor necrosis factor inhibitor. Participants were randomized 1:1:1 to arm A (usual care, face-to-face visits every sixth month), arm B (remote monitoring, monthly digital registration of patient-reported outcomes), or arm C (patient-initiated care, self-monitoring, no planned visits during the study period). The primary end point was disease activity measured with the Ankylosing Spondylitis Disease Activity Score, evaluated at 6, 12, and 18 months. We aimed to include 240 patients, 80 in each arm. Secondary end points included other measures of disease activity, patient satisfaction, safety, and cost-effectiveness. RESULTS The project is funded by the South-Eastern Norway Regional Health Authority and Centre for the treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Norway. Enrollment started in September 2021 and was completed with 242 patients by June 2022. The data collection will be completed in December 2023. CONCLUSIONS To our knowledge, this trial will be among the first to evaluate the effectiveness, safety, and cost-effectiveness of remote digital monitoring and self-monitoring of patients with axial spondyloarthritis compared with usual care. Hence, the ReMonit study will contribute important knowledge to personalized follow-up strategies for patients with axial spondyloarthritis. These results may also be relevant for other patient groups with inflammatory joint diseases. TRIAL REGISTRATION ClinicalTrials.gov NCT05031767; hpps://www.clinicaltrials.gov/study/NCT05031767. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52872.
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Affiliation(s)
- Inger Jorid Berg
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Anne Therese Tveter
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Health Sciences, Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Gunnstein Bakland
- Department of Rheumatology, University Hospital of North Norway, Tromsø, Norway
- Institute of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Tromsø, Tromsø, Norway
| | - Sarah Hakim
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Eirik K Kristianslund
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Siri Lillegraven
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Gary J Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, United Kingdom
| | - Ellen Moholt
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Sella A Provan
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Section for Public Health, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Joseph Sexton
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Emil Ek Thomassen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Annette De Thurah
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Laure Gossec
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
- Rheumatology Department, Assistance Publique des Hopitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Espen A Haavardsholm
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Nina Østerås
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
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5
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McDonagh ST, Dalal H, Moore S, Clark CE, Dean SG, Jolly K, Cowie A, Afzal J, Taylor RS. Home-based versus centre-based cardiac rehabilitation. Cochrane Database Syst Rev 2023; 10:CD007130. [PMID: 37888805 PMCID: PMC10604509 DOI: 10.1002/14651858.cd007130.pub5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
BACKGROUND Cardiovascular disease is the most common cause of death globally. Traditionally, centre-based cardiac rehabilitation programmes are offered to individuals after cardiac events to aid recovery and prevent further cardiac illness. Home-based and technology-supported cardiac rehabilitation programmes have been introduced in an attempt to widen access and participation, especially during the SARS-CoV-2 pandemic. This is an update of a review previously published in 2009, 2015, and 2017. OBJECTIVES To compare the effect of home-based (which may include digital/telehealth interventions) and supervised centre-based cardiac rehabilitation on mortality and morbidity, exercise-capacity, health-related quality of life, and modifiable cardiac risk factors in patients with heart disease SEARCH METHODS: We updated searches from the previous Cochrane Review by searching the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid) and CINAHL (EBSCO) on 16 September 2022. We also searched two clinical trials registers as well as previous systematic reviews and reference lists of included studies. No language restrictions were applied. SELECTION CRITERIA We included randomised controlled trials that compared centre-based cardiac rehabilitation (e.g. hospital, sports/community centre) with home-based programmes (± digital/telehealth platforms) in adults with myocardial infarction, angina, heart failure, or who had undergone revascularisation. DATA COLLECTION AND ANALYSIS Two review authors independently screened all identified references for inclusion based on predefined inclusion criteria. Disagreements were resolved through discussion or by involving a third review author. Two authors independently extracted outcome data and study characteristics and assessed risk of bias. Certainty of evidence was assessed using GRADE. MAIN RESULTS We included three new trials in this update, bringing a total of 24 trials that have randomised a total of 3046 participants undergoing cardiac rehabilitation. A further nine studies were identified and are awaiting classification. Manual searching of trial registers until 16 September 2022 revealed a further 14 clinical trial registrations - these are ongoing. Participants had a history of acute myocardial infarction, revascularisation, or heart failure. Although there was little evidence of high risk of bias, a number of studies provided insufficient detail to enable assessment of potential risk of bias; in particular, details of generation and concealment of random allocation sequencing and blinding of outcome assessment were poorly reported. No evidence of a difference was seen between home- and centre-based cardiac rehabilitation in our primary outcomes up to 12 months of follow-up: total mortality (risk ratio [RR] = 1.19, 95% confidence interval [CI] 0.65 to 2.16; participants = 1647; studies = 12/comparisons = 14; low-certainty evidence) or exercise capacity (standardised mean difference (SMD) = -0.10, 95% CI -0.24 to 0.04; participants = 2343; studies = 24/comparisons = 28; low-certainty evidence). The majority of evidence (N=71 / 77 comparisons of either total or domain scores) showed no significant difference in health-related quality of life up to 24 months follow-up between home- and centre-based cardiac rehabilitation. Trials were generally of short duration, with only three studies reporting outcomes beyond 12 months (exercise capacity: SMD 0.11, 95% CI -0.01 to 0.23; participants = 1074; studies = 3; moderate-certainty evidence). There was a similar level of trial completion (RR 1.03, 95% CI 0.99 to 1.08; participants = 2638; studies = 22/comparisons = 26; low-certainty evidence) between home-based and centre-based participants. The cost per patient of centre- and home-based programmes was similar. AUTHORS' CONCLUSIONS This update supports previous conclusions that home- (± digital/telehealth platforms) and centre-based forms of cardiac rehabilitation formally supported by healthcare staff seem to be similarly effective in improving clinical and health-related quality of life outcomes in patients after myocardial infarction, or revascularisation, or with heart failure. This finding supports the continued expansion of healthcare professional supervised home-based cardiac rehabilitation programmes (± digital/telehealth platforms), especially important in the context of the ongoing global SARS-CoV-2 pandemic that has much limited patients in face-to-face access of hospital and community health services. Where settings are able to provide both supervised centre- and home-based programmes, consideration of the preference of the individual patient would seem appropriate. Although not included in the scope of this review, there is an increasing evidence base supporting the use of hybrid models that combine elements of both centre-based and home-based cardiac rehabilitation delivery. Further data are needed to determine: (1) whether the short-term effects of home/digital-telehealth and centre-based cardiac rehabilitation models of delivery can be confirmed in the longer term; (2) the relative clinical effectiveness and safety of home-based programmes for other heart patients, e.g. post-valve surgery and atrial fibrillation.
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Affiliation(s)
- Sinead Tj McDonagh
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Hasnain Dalal
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Sarah Moore
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Christopher E Clark
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Sarah G Dean
- Department of Health and Community Sciences, University of Exeter Medical School, Faculty of Health and Life Sciences, St Luke's Campus, University of Exeter, Exeter, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Aynsley Cowie
- Cardiac Rehabilitation, University Hospital Crosshouse, NHS Ayrshire and Arran, Kilmarnock, UK
| | | | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
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Thompson JA, Hersch D, Miner MH, Melnik TE, Adam P. Remote Patient Monitoring for COVID-19: A Retrospective Study on Health Care Utilization. Telemed J E Health 2023; 29:1179-1185. [PMID: 36706034 PMCID: PMC10440676 DOI: 10.1089/tmj.2022.0299] [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: 07/12/2022] [Revised: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 01/28/2023] Open
Abstract
Introduction: Data are limited on the effectiveness of remote patient monitoring (RPM) for acute illnesses, including COVID-19. We conducted a study to determine if enrollment in a COVID-19 RPM program was associated with better outcomes. Methods: From March through September 2020, patients with respiratory symptoms and presumptive COVID-19 were referred to the health system's COVID-19 RPM program. We conducted a retrospective cohort study comparing outcomes for patients enrolled in the RPM (n = 4,435) with those who declined enrollment (n = 2,742). Primary outcomes were emergency room, hospital, and intensive care unit admissions, and death. We used logistic regression to adjust for demographic differences and known risk factors for severe COVID-19. Results: Patients enrolled in the RPM were less likely to have risk factors for severe COVID-19. There was a significant decrease in the odds of death for the group enrolled in the RPM (adjusted odds ratio [OR] = 0.50; 95% confidence interval [CI], 0.30-0.83) and a nonsignificant decrease in the odds of the other primary outcomes. Increased number of interactions with the RPM significantly decreased the odds of hospital admission (OR = 0.92; 95% CI, 0.88-0.95). Conclusions: COVID-19 RPM enrollment was associated with decreased odds of death, and the more patients interacted with the RPM, the less likely they were to require hospital admission. RPM is a promising tool that has the potential to improve patient outcomes for acute illness, but controlled trials are necessary to confirm these findings.
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Affiliation(s)
- Joshua A. Thompson
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Derek Hersch
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Michael H. Miner
- Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Tanya E. Melnik
- Division of General Internal Medicine, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Patricia Adam
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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Barnett R, Clarke C, Sengupta R, Rouse PC. Protocol for a systematic literature review of smartphone apps to support the self-management of rheumatic and musculoskeletal diseases: development strategies, theoretical underpinnings and barriers to engagement. Syst Rev 2023; 12:129. [PMID: 37516896 PMCID: PMC10385957 DOI: 10.1186/s13643-023-02276-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 06/18/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND Rheumatic and musculoskeletal diseases (RMDs) cause significant burden to the individual and society, requiring lifelong management and specialist healthcare resource use. Costing over 200 billion euros per year in Europe, RMDs are the most expensive of all diseases for European healthcare systems. The incidence and burden of RMDs are projected to rise with the ageing global population and increase in sedentary, obesogenic lifestyles. In parallel, there is a global crisis in the rheumatology workforce, whereby capacity to deliver specialist care is being exceeded by demand. Pervasive, scalable mobile health technologies, such as apps, are being developed to support the self-management of RMDs and reduce pressure on healthcare services. However, it is unknown whether these apps are informed by theory or their use supported by an appropriate evidence base. The purpose of this review is therefore to provide a comprehensive overview of the development strategies, interventional components and theoretical underpinnings of existing smartphone apps, designed to support the self-management of RMDs. METHODS Searches will be conducted within PubMed, Scopus, Web of Science, Embase, MEDLINE and PsycINFO. Reference lists and citing articles of the included studies will be searched. Identified publications will be screened for eligibility by two independent reviewers. Any discrepancies between reviewers will be resolved by consensus, with input from a third reviewer if required. Data will be extracted on study designs, methods, populations, setting, utilised theoretical frameworks, intervention components, behaviour change techniques, methods to evaluate effectiveness and barriers/facilitators to intervention engagement. Exploratory outcomes include reported effectiveness, acceptability and usability. A systematic, narrative synthesis of evidence will be presented. If appropriate (depending on quality and pool of evidence identified), qualitative meta-summary techniques will be used to combine and summarise qualitative findings regarding barriers/facilitators to intervention engagement. DISCUSSION The results of this systematic literature review will provide insights for healthcare professionals, researchers, app designers and policy makers, to inform future development and implementation of smartphone apps to support self-management of RMDs. Evidence gaps for future research will be identified. Findings will be disseminated through a final manuscript/publication of results and via a conference abstract, patient organisations and social media. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022359704.
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Affiliation(s)
- Rosemarie Barnett
- Department for Health, University of Bath, Bath, UK.
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.
| | | | - Raj Sengupta
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
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Doré B, Gaudreault A, Everard G, Ayena JC, Abboud A, Robitaille N, Batcho CS. Acceptability, Feasibility, and Effectiveness of Immersive Virtual Technologies to Promote Exercise in Older Adults: A Systematic Review and Meta-Analysis. SENSORS (BASEL, SWITZERLAND) 2023; 23:2506. [PMID: 36904709 PMCID: PMC10007244 DOI: 10.3390/s23052506] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/16/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
CONTEXT This review aimed to synthesize the literature on the acceptability, feasibility, and effectiveness of immersive virtual technologies to promote physical exercise in older people. METHOD We performed a literature review, based on four databases (PubMed, CINAHL, Embase, and Scopus; last search: 30 January 2023). Eligible studies had to use immersive technology with participants aged 60 years and over. The results regarding acceptability, feasibility, and effectiveness of immersive technology-based interventions in older people were extracted. The standardized mean differences were then computed using a random model effect. RESULTS In total, 54 relevant studies (1853 participants) were identified through search strategies. Concerning the acceptability, most participants reported a pleasant experience and a desire to use the technology again. The average increase in the pre/post Simulator Sickness Questionnaire score was 0.43 in healthy subjects and 3.23 in subjects with neurological disorders, demonstrating this technology's feasibility. Regarding the effectiveness, our meta-analysis showed a positive effect of the use of virtual reality technology on balance (SMD = 1.05; 95% CI: 0.75-1.36; p < 0.001) and gait outcomes (SMD = 0.7; 95% CI: 0.14-0.80; p < 0.001). However, these results suffered from inconsistency and the number of trials dealing with these outcomes remains low, calling for further studies. CONCLUSIONS Virtual reality seems to be well accepted by older people and its use with this population is feasible. However, more studies are needed to conclude its effectiveness in promoting exercise in older people.
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Affiliation(s)
- Benjamin Doré
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, QC G1V 0A6, Canada
| | - Alex Gaudreault
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, QC G1V 0A6, Canada
| | - Gauthier Everard
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, QC G1V 0A6, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale Nationale (CIUSSS-CN), Quebec, QC G1M 2S8, Canada
| | - Johannes C. Ayena
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, QC G1V 0A6, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale Nationale (CIUSSS-CN), Quebec, QC G1M 2S8, Canada
| | - Ahmad Abboud
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, QC G1V 0A6, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale Nationale (CIUSSS-CN), Quebec, QC G1M 2S8, Canada
| | | | - Charles Sebiyo Batcho
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, QC G1V 0A6, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale Nationale (CIUSSS-CN), Quebec, QC G1M 2S8, Canada
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9
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Silva ÍDS, Silva CRDV, Lopes RH, de Araújo AJ, de Figueirêdo RC, Bay ODG, Lapão LV, Xavier PB, Uchôa SADC. Digital health interventions and quality of home-based primary care for older adults: A scoping review protocol. Front Public Health 2023; 10:1022587. [PMID: 36699882 PMCID: PMC9870288 DOI: 10.3389/fpubh.2022.1022587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Introduction The use of digital health interventions has expanded, particularly in home-based primary care (HBPC), following the increase in the older adult population and the need to respond to the higher demand of chronic conditions, weakness and loss of autonomy of this population. There was an even greater demand with COVID-19 and subsequent isolation/social distancing measures for this risk group. The objective of this study is to map and identify the uses and types of digital health interventions and their reported impacts on the quality of HBPC for older adults worldwide. Methods and analysis This is a scoping review protocol which will enable a rigorous, transparent and reliable synthesis of knowledge. The review will be developed from the theoretical perspective of Arksey and O'malley, with updates by Levac and Peters and respective collaborators based on the Joanna Briggs Institute manual, and guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). Data from white literature will be extracted from multidisciplinary health databases such as: the Virtual Health Library, LILACS, MEDLINE/PubMed, Scopus, Web of Science, Cinahl and Embase; while Google Scholar will be used for gray literature. No date limit or language restrictions will be determined. The quantitative data will be analyzed through descriptive statistics and qualitative data through thematic analysis. The results will be submitted to stakeholder consultation for preliminary sharing of the study and will later be disseminated through publication in open access scientific journals, scientific events and academic and community journals. The full scoping review report will present the main impacts, challenges, opportunities and gaps found in publications related to the use of digital technologies in primary home care. Discussion The organization of this protocol will increase the methodological rigor, quality, transparency and accuracy of scoping reviews, reducing the risk of bias.
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Affiliation(s)
- Ísis de Siqueira Silva
- Postgraduate in Collective Health, Federal University of Rio Grande do Norte, Natal, Brazil,*Correspondence: Ísis de Siqueira Silva ✉
| | | | - Rayssa Horácio Lopes
- Postgraduate in Collective Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | | | - Osvaldo de Goes Bay
- Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, Brazil
| | - Luís Velez Lapão
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Pedro Bezerra Xavier
- Postgraduate in Collective Health, Federal University of Rio Grande do Norte, Santa Cruz, Brazil
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10
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Chan A, Cohen R, Robinson KM, Bhardwaj D, Gregson G, Jutai JW, Millar J, Ríos Rincón A, Roshan Fekr A. Evidence and User Considerations of Home Health Monitoring for Older Adults: Scoping Review. JMIR Aging 2022; 5:e40079. [PMID: 36441572 DOI: 10.2196/40079] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 10/03/2022] [Accepted: 10/10/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Home health monitoring shows promise in improving health outcomes; however, navigating the literature remains challenging given the breadth of evidence. There is a need to summarize the effectiveness of monitoring across health domains and identify gaps in the literature. In addition, ethical and user-centered frameworks are important to maximize the acceptability of health monitoring technologies. OBJECTIVE This review aimed to summarize the clinical evidence on home-based health monitoring through a scoping review and outline ethical and user concerns and discuss the challenges of the current user-oriented conceptual frameworks. METHODS A total of 2 literature reviews were conducted. We conducted a scoping review of systematic reviews in Scopus, MEDLINE, Embase, and CINAHL in July 2021. We included reviews examining the effectiveness of home-based health monitoring in older adults. The exclusion criteria included reviews with no clinical outcomes and lack of monitoring interventions (mobile health, telephone, video interventions, virtual reality, and robots). We conducted a quality assessment using the Assessment of Multiple Systematic Reviews (AMSTAR-2). We organized the outcomes by disease and summarized the type of outcomes as positive, inconclusive, or negative. Second, we conducted a literature review including both systematic reviews and original articles to identify ethical concerns and user-centered frameworks for smart home technology. The search was halted after saturation of the basic themes presented. RESULTS The scoping review found 822 systematic reviews, of which 94 (11%) were included and of those, 23 (24%) were of medium or high quality. Of these 23 studies, monitoring for heart failure or chronic obstructive pulmonary disease reduced exacerbations (4/7, 57%) and hospitalizations (5/6, 83%); improved hemoglobin A1c (1/2, 50%); improved safety for older adults at home and detected changing cognitive status (2/3, 66%) reviews; and improved physical activity, motor control in stroke, and pain in arthritis in (3/3, 100%) rehabilitation studies. The second literature review on ethics and user-centered frameworks found 19 papers focused on ethical concerns, with privacy (12/19, 63%), autonomy (12/19, 63%), and control (10/19, 53%) being the most common. An additional 7 user-centered frameworks were studied. CONCLUSIONS Home health monitoring can improve health outcomes in heart failure, chronic obstructive pulmonary disease, and diabetes and increase physical activity, although review quality and consistency were limited. Long-term generalized monitoring has the least amount of evidence and requires further study. The concept of trade-offs between technology usefulness and acceptability is critical to consider, as older adults have a hierarchy of concerns. Implementing user-oriented frameworks can allow long-term and larger studies to be conducted to improve the evidence base for monitoring and increase the receptiveness of clinicians, policy makers, and end users.
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Affiliation(s)
- Andrew Chan
- Faculty of Rehabilitation Medicine, Department of Occupational Therapy, University of Alberta, Edmonton, AB, Canada.,Innovation and Technology Hub, Glenrose Rehabilitation Research, Edmonton, AB, Canada
| | - Rachel Cohen
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Katherine-Marie Robinson
- School of Engineering Design and Teaching Innovation, Faculty of Engineering, University of Ottawa, Ottawa, ON, Canada.,Department of Philosophy, Faculty of Arts, University of Ottawa, Ottawa, ON, Canada
| | - Devvrat Bhardwaj
- Department of Electrical Engineering and Computer Science, Faculty of Engineering, University of Ottawa, Ottawa, ON, Canada
| | - Geoffrey Gregson
- Faculty of Rehabilitation Medicine, Department of Occupational Therapy, University of Alberta, Edmonton, AB, Canada.,Innovation and Technology Hub, Glenrose Rehabilitation Research, Edmonton, AB, Canada
| | - Jeffrey W Jutai
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,LIFE Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Jason Millar
- School of Engineering Design and Teaching Innovation, Faculty of Engineering, University of Ottawa, Ottawa, ON, Canada.,Department of Philosophy, Faculty of Arts, University of Ottawa, Ottawa, ON, Canada
| | - Adriana Ríos Rincón
- Faculty of Rehabilitation Medicine, Department of Occupational Therapy, University of Alberta, Edmonton, AB, Canada.,Innovation and Technology Hub, Glenrose Rehabilitation Research, Edmonton, AB, Canada
| | - Atena Roshan Fekr
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
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11
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Apantaku G, Mitton C, Wong H, Ho K. Home Telemonitoring Technology for Patients With Heart Failure: Cost-Consequence Analysis of a Pilot Study. JMIR Form Res 2022; 6:e32147. [PMID: 35653179 PMCID: PMC9204565 DOI: 10.2196/32147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 01/14/2022] [Accepted: 03/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background Heart failure (HF) is a costly health condition and a major public health problem. It is estimated that 2%-3% of the population in developed countries has HF, and the prevalence increases to 8% among patients aged ≥75 years. Home telemonitoring is a form of noninvasive, remote patient monitoring that aims to improve the care and management of patients with chronic HF. Telehealth for Emergency-Community Continuity of Care Connectivity via Home-Telemonitoring (TEC4Home) is a project that implements and evaluates a comprehensive home monitoring protocol designed to support patients with HF as they transition from the emergency department to home. Objective The aim of this study is to assess the cost of using the home monitoring platform (TEC4Home) relative to usual care for patients with HF. Methods This study is a cost-consequence analysis of the TEC4Home pilot study. The analysis was conducted from a partial societal perspective, including direct and indirect health care costs. The aim is to assess the costs of the home monitoring platform relative to usual care and track costs related to health care utilization during the 90-day postdischarge period. Results Economic analysis of the TEC4Home pilot study showed a positive trend in cost savings for patients using TEC4Home. From both the health system perspective (Pre TEC4Home cost per patient: CAD $2924 vs post TEC4Home cost per patient: CAD $1293; P=.01) and partial societal perspective (Pre TEC4Home cost per patient: CAD $2411 vs post TEC4Home cost per patient: CAD $1108; P=.01), we observed a statistically significant cost saving per patient. Conclusions In line with the advantages of conducting an economic analysis alongside a feasibility study, the economic analysis of the TEC4Home pilot study facilitated the piloting of patient questionnaires and informed the methodology for a full clinical trial.
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Affiliation(s)
- Glory Apantaku
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Craig Mitton
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Hubert Wong
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Kendall Ho
- Digital Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
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12
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de Thurah A, Bosch P, Marques A, Meissner Y, Mukhtyar CB, Knitza J, Najm A, Østerås N, Pelle T, Knudsen LR, Šmucrová H, Berenbaum F, Jani M, Geenen R, Krusche M, Pchelnikova P, de Souza S, Badreh S, Wiek D, Piantoni S, Gwinnutt JM, Duftner C, Canhão HM, Quartuccio L, Stoilov N, Prior Y, Bijlsma JW, Zabotti A, Stamm TA, Dejaco C. 2022 EULAR points to consider for remote care in rheumatic and musculoskeletal diseases. Ann Rheum Dis 2022; 81:1065-1071. [PMID: 35470160 DOI: 10.1136/annrheumdis-2022-222341] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Remote care and telehealth have the potential to expand healthcare access, and the COVID-19 pandemic has called for alternative solutions to conventional face-to-face follow-up and monitoring. However, guidance is needed on the integration of telehealth into clinical care of people with rheumatic and musculoskeletal diseases (RMD). OBJECTIVE To develop EULAR points to consider (PtC) for the development, prioritisation and implementation of telehealth for people with RMD. METHODS A multidisciplinary EULAR task force (TF) of 30 members from 14 European countries was established, and the EULAR standardised operating procedures for development of PtC were followed. A systematic literature review was conducted to support the TF in formulating the PtC. The level of agreement among the TF was established by anonymous online voting. RESULTS Four overarching principles and nine PtC were formulated. The use of telehealth should be tailored to patient's needs and preferences. The healthcare team should have adequate equipment and training and have telecommunication skills. Telehealth can be used in screening for RMD as preassessment in the referral process, for disease monitoring and regulation of medication dosages and in some non-pharmacological interventions. People with RMD should be offered training in using telehealth, and barriers should be resolved whenever possible.The level of agreement to each statement ranged from 8.5 to 9.8/10. CONCLUSION The PtC have identified areas where telehealth could improve quality of care and increase healthcare access. Knowing about drivers and barriers of telehealth is a prerequisite to successfully establish remote care approaches in rheumatologic clinical practice.
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Affiliation(s)
- Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark .,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Philipp Bosch
- Department of Rheumatology and Immunology, Medizinische Universitat Graz, Graz, Austria
| | - Andrea Marques
- Health Sciences Research Unit Nursing, Higher School of Nursing of Coimbra, Coimbra, Portugal.,Rheumatology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Yvette Meissner
- Epidemiology and Health Services Research, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Chetan B Mukhtyar
- Vasculitis Service, Rheumatology Department, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Johannes Knitza
- Department of Internal Medicine 3, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany
| | - Aurélie Najm
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Nina Østerås
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet University College and Hospital, Oslo, Norway
| | - Tim Pelle
- Department of Rheumatic Diseases, Radboud University, Nijmegen, The Netherlands.,Department of Primary and Community Care, Radboud University, Nijmegen, The Netherlands
| | - Line Raunsbæk Knudsen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Hana Šmucrová
- Institute of Rheumatology, Centre of Medical Rehabilitation, Praha, Czech Republic
| | | | - Meghna Jani
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Rinie Geenen
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Martin Krusche
- Division of Rheumatology and Systemic Inflammatory Diseases, University Hospital Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - Savia de Souza
- Centre for Rheumatic Diseases, King's College London, London, UK.,Patient Research Partner, EULAR, London, UK
| | - Sara Badreh
- Patient Research Partner, EULAR, Stockholm, Sweden
| | - Dieter Wiek
- Patient Research Partner, EULAR, Bonn, Germany
| | - Silvia Piantoni
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST Spedali Civili di Brescia, Brescia, Italy
| | - James M Gwinnutt
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Christina Duftner
- Department of Internal Medicine, Clinical Division of Internal Medicine II, Medical University Innsbruck/Tirol Kliniken GmbH, Innsbruck, Austria
| | - Helena M Canhão
- Comprehensive Research Center, CHRC, EpicDoC Unit, CEDOC-NOVA Medical School-NOVA University of Lisbon, Portugal, Lisboa, Portugal
| | - Luca Quartuccio
- Department of Medical and Biological Sciences, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Nikolay Stoilov
- Faculty of Medicine, University Hospital St. Ivan Rilski, Medical University of Sofia, Sofia, Bulgaria
| | - Yeliz Prior
- Centre for Health Sciences Research, School of Health and Society, University of Salford, Salford, UK
| | - Johannes Wj Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alen Zabotti
- Department of Medical and Biological Sciences, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Tanja A Stamm
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria.,Section for Outcomes Research, Medical University of Vienna, Vienna, Austria
| | - Christian Dejaco
- Department of Rheumatology and Immunology, Medizinische Universitat Graz, Graz, Austria.,Department of Rheumatology, Hospital of Bruneck (ASAA-SABES), Bruneck, Italy
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13
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Telemedicine application in patients with chronic disease: a systematic review and meta-analysis. BMC Med Inform Decis Mak 2022; 22:105. [PMID: 35440082 PMCID: PMC9017076 DOI: 10.1186/s12911-022-01845-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 04/11/2022] [Indexed: 01/12/2023] Open
Abstract
Background Telemedicine has been widely used for long-term care and self-management in patients with chronic disease, but there is no consensus regarding the effect of telemedicine on chronic disease management. The aim of this study is to review and analyse the effect of telemedicine on the management of chronic diseases such as hypertension, diabetes, and rheumatoid arthritis using a systematic review and meta-analysis. Methods We performed a comprehensive literature search of the Web of Science, PubMed, MEDLINE, EMBASE, CNKI (Chinese database), VIP (Chinese database), WanFang (Chinese database), and SinoMed (Chinese database) databases from their inception until December 31, 2021. The retrieved literature was screened and assessed independently by two authors. We used the risk-of-bias assessment tool recommended by the Cochrane Handbook for Systematic Reviews of Interventions 5.0.2 for assessing literature quality and Revman 5.3 software to conduct the meta-analysis. Results Fifteen articles were included in this study. The results of the systematic review indicated that telemedicine consultation and telemonitoring are the most commonly used intervention methods. Telemedicine is helpful for improving self-management in patients with rheumatoid arthritis. The results of the meta-analysis showed patients’ index of glycosylated hemoglobin (HbA1c) improved after 12 months of intervention (MD = − 0.84; 95% CI = − 1.53, − 0.16; Z = 2.42; P = 0.02), and no significant differences in fasting blood glucose (FBG) levels were observed after 6 months of intervention (MD = − 0.35; 95% CI = − 0.75,0.06; Z = 1.69; P = 0.09). The results also showed that systolic blood pressure (MD = − 6.71; 95% CI = − 11.40, − 2.02; Z = 2.81; P = 0.005) was reduced after 6 months of intervention. Conclusion Telemedicine had a positive effect on the management of diabetes, hypertension, and rheumatoid arthritis, especially when telemedicine consultation and telemonitoring method were used. When telemedicine was used as a disease management tool for patients with diabetes, the optimal intervention time is 12 months. Telemedicine improved the systolic blood pressure in hypertensive patients while also reducing negative emotions and enhancing medication adherence in rheumatoid arthritis patients.
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14
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Kinley E, Skene I, Steed E, Pinnock H, McClatchey K. Delivery of supported self-management in remote asthma reviews: A systematic rapid realist review. Health Expect 2022; 25:1200-1214. [PMID: 35411670 PMCID: PMC9327809 DOI: 10.1111/hex.13441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 01/07/2022] [Accepted: 01/09/2022] [Indexed: 11/29/2022] Open
Abstract
Background The COVID‐19 pandemic forced health care systems globally to adapt quickly to remote modes of health care delivery, including for routine asthma reviews. A core component of asthma care is supporting self‐management, a guideline‐recommended intervention that reduces the risk of acute attacks, and improves asthma control and quality of life. Objective We aimed to explore context and mechanisms for the outcomes of clinical effectiveness, acceptability and safety of supported self‐management delivery within remote asthma consultations. Design The review followed standard methodology for rapid realist reviews. An External Reference Group (ERG) provided expert advice and guidance throughout the study. We systematically searched four electronic databases and, with ERG advice, selected 18 papers that explored self‐management delivery during routine asthma reviews. Setting, Participants and Intervention Health care professional delivery of supported self‐management for asthma patients during remote (specifically including telephone and video) consultations. Main Outcome Measures Data were extracted using Context‐Mechanism‐Outcome (C‐M‐O) configurations and synthesised into overarching themes using the PRISMS taxonomy of supported self‐management as a framework to structure the findings. Results The review findings identified how support for self‐management delivered remotely was acceptable (often more acceptable than in‐person consultations), and was a safe and effective alternative to face‐to‐face reviews. In addition, remote delivery of supported self‐management was associated with; increased patient convenience, improved access to and attendance at remote reviews, and offered continuity of care. Discussion Remote delivery of supported self‐management for asthma was generally found to be clinically effective, acceptable, and safe with the added advantage of increasing accessibility. Remote reviews could provide the core content of an asthma review, including remote completion of asthma action plans. Conclusion Our findings support the option of remote delivery of routine asthma care for those who have this preference, and offer healthcare professionals guidance on embedding supported self‐management into remote asthma reviews. Patient and Public Contribution Patient and public contribution was provided by a representative of the Asthma UK Centre for Applied Research (AUKCAR) patient and public involvement (PPI) group. The PPI representative reviewed the findings, and feedback and comments were considered. This lead to further interpretations of the data which were included in the final manuscript.
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Affiliation(s)
- Emma Kinley
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, Scotland
| | - Imogen Skene
- Asthma UK Centre for Applied Research, Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University London, London, England
| | - Elizabeth Steed
- Asthma UK Centre for Applied Research, Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University London, London, England
| | - Hilary Pinnock
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, Scotland
| | - Kirstie McClatchey
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, Scotland
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15
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Liu K, Or CK, So M, Cheung B, Chan B, Tiwari A, Tan J. A longitudinal examination of tablet self-management technology acceptance by patients with chronic diseases: Integrating perceived hand function, perceived visual function, and perceived home space adequacy with the TAM and TPB. APPLIED ERGONOMICS 2022; 100:103667. [PMID: 34920356 DOI: 10.1016/j.apergo.2021.103667] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/18/2021] [Accepted: 12/08/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Health information technologies (HITs) are increasingly being used to support the self-management of chronic diseases. However, patients' initial or continued acceptance of such technologies is not always achieved. OBJECTIVE The aim of this study was to develop a theory-driven HIT acceptance model to examine factors affecting acceptance of HIT (measured by behavioral intention; BI) for disease self-management among patients with chronic diseases, in which we also focused on three additional, previously unexplored factors related to perceived hand function (PHF), perceived visual function (PVF), and perceived space adequacy (PSA) and a longitudinal scrutinization of changes in the effects of these factors on acceptance over time. METHODS The theoretical basis of our acceptance model was drawn from the technology acceptance model and the theory of planned behavior. The model was further extended by including patients' PHF, PVF (related to patients with chronic diseases who are mostly elderly), and PSA (related to the patients' home environment). The model was tested in the context of type 2 diabetes and hypertension self-management via a touchscreen tablet-based system over a 24-week period. A questionnaire was administered at four time points (baseline and 8, 16, and 24 weeks after implementation) to collect data from 151 patients with coexisting type 2 diabetes and hypertension. We tested the model at each time point using partial least squares structural equation modeling. RESULTS Perceived usefulness of the self-management system influenced BI directly at 8 and 24 weeks and indirectly at 8, 16, and 24 weeks. Perceived ease of use indirectly affected BI at 8, 16, and 24 weeks. Attitude directly affected BI at 8, 16, and 24 weeks. Perceived behavioral control directly influenced BI at baseline and 8 and 16 weeks. Subjective norms indirectly influenced BI at 8, 16, and 24 weeks. PHF and PVF indirectly influenced BI over the entire study period. PSA influenced BI directly at 16 weeks and indirectly at 8, 16, and 24 weeks. CONCLUSION The effects of the proposed factors in our model on patient-focused HIT acceptance changed over a longer time period, emphasizing the importance of further investigation of the longitudinal mechanisms influencing technology acceptance behavior. It is recommended that healthcare practitioners consider such changes when implementing comparable technologies. Moreover, beyond technology attributes, the characteristics, needs, and limitations of older adults and elderly patient users and their home environments should also be considered in the design and implementation of patient-focused HIT systems for chronic disease self-management at home.
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Affiliation(s)
- Kaifeng Liu
- Academy of Medical Engineering and Translational Medicine, Medical College, Tianjin University, Tianjin, China
| | - Calvin Kalun Or
- Department of Industrial and Manufacturing Systems Engineering, University of Hong Kong, Hong Kong, China.
| | - Mike So
- Department of Information Systems, Business Statistics and Operations Management, Hong Kong University of Science and Technology, Hong Kong, China
| | - Bernard Cheung
- Department of Medicine, University of Hong Kong, Hong Kong, China
| | - Bill Chan
- Department of Industrial and Manufacturing Systems Engineering, University of Hong Kong, Hong Kong, China
| | - Agnes Tiwari
- School of Nursing, Hong Kong Sanatorium & Hospital, Hong Kong, China
| | - Joseph Tan
- DeGroote School of Business, McMaster University, Canada
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16
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Okpechi IG, Zaidi D, Ye F, Fradette M, Schick-Makaroff K, Berendonk C, Abdulrahman A, Braam B, Ghimire A, Hariramani VK, Jindal K, Khan M, Klarenbach S, Muneer S, Ringrose J, Scott-Douglas N, Shojai S, Slabu D, Sultana N, Tinwala MM, Thompson S, Padwal R, Bello AK. Telemonitoring and Case Management for Hypertensive and Remote-Dwelling Patients With Chronic Kidney Disease—The Telemonitoring for Improved Kidney Outcomes Study (TIKO): A Clinical Research Protocol. Can J Kidney Health Dis 2022; 9:20543581221077500. [PMID: 35186305 PMCID: PMC8848092 DOI: 10.1177/20543581221077500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/05/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Hypertension, together with poorly controlled blood pressure (BP) are known risk factors for kidney disease and progression to kidney failure as well as increased cardiovascular (CV) morbidity and mortality. Several studies in patients without kidney disease have demonstrated the efficacy of home BP telemonitoring (HBPT) for BP control. Objective: The primary aim of this study is to assess the mean difference in systolic BP (SBP) at 12 months, from baseline in remote dwelling patients with hypertension and chronic kidney disease (CKD) in Northern Alberta, Canada, comparing HBPT + usual care versus HBPT + a case manager. Other secondary objectives, including cost-effectiveness and acceptability of HBPT as well as occurrence of adverse events will also be assessed. Methods Design: This study is designed as a pragmatic randomized controlled trial (RCT) of HBPT plus clinical case management compared to HBPT with usual care. Setting: Peace River region in Northern Alberta Region, Canada. Patients: Primary care patients with CKD and hypertension. Measurements: Eligible patients will be randomized 1:1 to HBPT + BP case management versus HBPT + usual care. In the intervention arm, BP will be measured 4 times daily for 1 week, with medications titrated up or down by the study case manager until guideline targets (systolic BP [SBP]: <130 mmHg) are achieved. Once BP is controlled, (ie, to guideline-concordant targets), this 1-week protocol will be repeated every 3 months for 1 year. Patients in the control arm will also follow the same BP measurement protocol; however, there will be no interactions with the case manager; they will share their BP readings with their primary care physicians or nurse practitioners at scheduled visits. Limitations: Potential limitations of this study include the relatively short duration of follow-up, possible technological pitfalls, and need for patients to own a smartphone and have access to the internet to participate. Conclusions: As this study will focus on a high-risk population that has been characterized by a large care gap, it will generate important evidence that would allow targeted and effective population-level strategies to be implemented to improve health outcomes for high-risk hypertensive CKD patients in Canada’s remote communities. Trial Registration: www.clinicaltrials.gov (NCT number: NCT04098354)
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Affiliation(s)
- Ikechi G. Okpechi
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Deenaz Zaidi
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Feng Ye
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Miriam Fradette
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | | | | | - Abdullah Abdulrahman
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Branko Braam
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Anukul Ghimire
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Vinash Kumar Hariramani
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Kailash Jindal
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | | | - Scott Klarenbach
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Shezel Muneer
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Jennifer Ringrose
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Nairne Scott-Douglas
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Soroush Shojai
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Dan Slabu
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Naima Sultana
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Mohammed M. Tinwala
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Stephanie Thompson
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Raj Padwal
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Aminu K. Bello
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Canada
- Aminu K. Bello, Faculty of Medicine and Dentistry, Division of Nephrology and Immunology, University of Alberta, Edmonton, AB T6G 2R7 Canada.
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17
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Neher M, Nygårdh A, Broström A, Lundgren J, Johansson P. Perspectives of Policy Makers and Service Users Concerning the Implementation of eHealth in Sweden: Interview Study. J Med Internet Res 2022; 24:e28870. [PMID: 35089139 PMCID: PMC8838545 DOI: 10.2196/28870] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 10/01/2021] [Accepted: 10/14/2021] [Indexed: 12/20/2022] Open
Abstract
Background Increasing life spans of populations and a growing demand for more advanced care make effective and cost-efficient provision of health care necessary. eHealth technology is often proposed, although research on barriers to and facilitators of the implementation of eHealth technology is still scarce and fragmented. Objective The aim of this study is to explore the perceptions concerning barriers to and facilitators of the implementation of eHealth among policy makers and service users and explore the ways in which their perceptions converge and differ. Methods This study used interview data from policy makers at different levels of health care (n=7) and service users enrolled in eHealth interventions (n=25). The analysis included separate qualitative content analyses for the 2 groups and then a second qualitative content analysis to explore differences and commonalities. Results Implementation barriers perceived by policy makers were that not all service users benefit from eHealth and that there is uncertainty about the impact of eHealth on the work of health care professionals. Policy makers also perceived political decision-making as complex; this included problems related to provision of technical infrastructure and lack of extra resources for health care digitalization. Facilitators were policy makers’ conviction that eHealth is what citizens want, their belief in eHealth solutions as beneficial for health care practice, and their belief in the importance of health care digitalization. Barriers for service users comprised capability limitations and varied preferences of service users and a mismatch of technology with user needs, lack of data protection, and their perception of eHealth as being more time consuming. Facilitators for service users were eHealth technology design and match with their skill set, personal feedback and staff support, a sense of privacy, a credible sender, and flexible use of time.There were several commonalities between the 2 stakeholder groups. Facilitators for both groups were the strong impetus toward technology adoption in society and expectations of time flexibility. Both groups perceived barriers in the difficulties of tailoring eHealth, and both groups expressed uncertainty about the care burden distribution. There were also differences: policy makers perceived that their decision-making was very complex and that resources for implementation were limited. Service users highlighted their need to feel that their digital data were protected and that they needed to trust the eHealth sender. Conclusions Perceptions about barriers to and facilitators of eHealth implementation varied among stakeholders in different parts of the health care system. The study points to the need to reach an enhanced mutual understanding of priorities and overcome challenges at both the micro and macro levels of the health care system. More well-balanced decisions at the policy-maker level may lead to more effective and sustainable development and future implementation of eHealth.
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Affiliation(s)
- Margit Neher
- Department of Rehabilitation, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Annette Nygårdh
- Department of Nursing Sciences, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Anders Broström
- Department of Nursing Sciences, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden
| | - Johan Lundgren
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Peter Johansson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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18
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Ware P, Shah A, Ross HJ, Logan AG, Segal P, Cafazzo JA, Szacun-Shimizu K, Resnick M, Vattaparambil T, Seto E. Challenges of Telemonitoring Programs for Complex Chronic Conditions: Randomized Controlled Trial With an Embedded Qualitative Study. J Med Internet Res 2022; 24:e31754. [PMID: 35080502 PMCID: PMC8829695 DOI: 10.2196/31754] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/22/2021] [Accepted: 12/03/2021] [Indexed: 01/22/2023] Open
Abstract
Background Despite the growing prevalence of people with complex conditions and evidence of the positive impact of telemonitoring for single conditions, little research exists on telemonitoring for this population. Objective This randomized controlled trial and embedded qualitative study aims to evaluate the impact on and experiences of patients and health care providers (HCPs) using a telemonitoring system with decision support to manage patients with complex conditions, including those with multiple chronic conditions, compared with the standard of care. Methods A pragmatic, unblinded, 6-month randomized controlled trial sought to recruit 146 patients with ≥1 diagnosis of heart failure (HF), uncontrolled hypertension (HT), and insulin-requiring diabetes mellitus (DM) from outpatient specialty settings in Toronto, Ontario, Canada. Participants were randomized into the control and telemonitoring groups, with the latter being instructed to take readings relevant to their conditions. The telemonitoring system contained an algorithm that generated decision support in the form of actionable self-care directives to patients and alerts to HCPs. The primary outcome was health status (36-Item Short Form Health Survey questionnaire). Secondary outcomes included anxiety and depression, self-efficacy in chronic disease management, and self-reported health service use. HF-related quality of life and self-care measures were also collected from patients followed for HF. Within- and between-group change scores were analyzed for statistical significance (P<.05). A convenience sample of HCPs and patients in the intervention group was interviewed about their experiences. Results A total of 96 patients were recruited and randomized. Recruitment was terminated early because of implementation challenges and the onset of the COVID-19 pandemic. No significant within- and between-group differences were found for the main primary and secondary outcomes. However, a within-group analysis of patients with HF found improvements in self-care maintenance (P=.04) and physical quality of life (P=.046). Opinions expressed by the 5 HCPs and 13 patients who were interviewed differed based on the monitored conditions. Although patients with HF reported benefitting from actionable self-care guidance and meaningful interactions with their HCPs, patient and HCP users of the DM and HT modules did not think telemonitoring improved the clinical management of those conditions to the same degree. These differing experiences were largely attributed to the siloed nature of specialty care and the design of the decision support, whereby fluctuations in the status of HT and DM typically required less urgent interventions compared with patients with HF. Conclusions We recommend that future research conceive telemonitoring as a program and that self-management and clinical decision support are necessary but not sufficient components of such programs for patients with complex conditions and lower acuity. We conclude that telemonitoring for patients with complex conditions or within multidisciplinary care settings may be best operationalized through nurse-led models of care. Trial Registration ClinicalTrials.gov NCT03127852; https://clinicaltrials.gov/ct2/show/NCT03127852 International Registered Report Identifier (IRRID) RR2-10.2196/resprot.8367
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Affiliation(s)
- Patrick Ware
- Centre for Global eHealth Innovation, University Health Network, Toronto, ON, Canada
| | - Amika Shah
- Centre for Global eHealth Innovation, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Heather Joan Ross
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.,Ted Rogers Centre for Heart Research, University Health Network, Toronto, ON, Canada
| | - Alexander Gordon Logan
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.,Division of Nephrology, Mount Sinai Hospital, Toronto, ON, Canada.,Division of Nephrology, University Health Network, Toronto, ON, Canada
| | - Phillip Segal
- Division of Endocrinology, University Health Network, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Joseph Antony Cafazzo
- Centre for Global eHealth Innovation, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | | | - Myles Resnick
- Centre for Global eHealth Innovation, University Health Network, Toronto, ON, Canada
| | - Tessy Vattaparambil
- Centre for Global eHealth Innovation, University Health Network, Toronto, ON, Canada
| | - Emily Seto
- Centre for Global eHealth Innovation, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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19
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Passardi A, Serra P, Caffo O, Masini C, Brugugnoli E, Vespignani R, Giardino V, Petracci E, Bartolini G, Sullo F, Anesi C, Dianti M, Eccher C, Piras EM, Gios L, Campomori A, Oberosler V, Forti S. Use of the ONCO-TreC electronic diary compared with a standard paper diary to improve adherence to oral cancer therapy in patients with solid and haematological tumours: protocol for a randomised controlled trial. BMJ Open 2022; 12:e055814. [PMID: 35017254 PMCID: PMC8753414 DOI: 10.1136/bmjopen-2021-055814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION ONCO-TreC platform consists of a mobile application delivered to patients as electronic diary and a web-based dashboard managed by healthcare professionals. We aim to compare the effectiveness of ONCO-TreC electronic diary with a standard paper diary, in improving adherence to oral cancer therapy in patients with solid and haematological tumours. METHODS AND ANALYSIS This is an open label, superiority, randomised controlled trial conducted in two Italian oncology units. Patients will be randomised with a 1:1 ratio to electronic or paper diary. For both groups a counsellor will be responsible for drug and diary delivery. The evaluation period will end after six cycles of therapy. The primary aim is to compare the proportion of non-adherent patients in the two arms. Adherence will be measured through pill count; anyone who takes less than 90% of the total prescribed drug dose will be considered non-adherent. Assuming a percentage of non-adherent patients to oral therapy of 40% in arm B, and a 60% reduction in this percentage in arm A, a sample of 124 patients will provide 80% power to identify an absolute difference greater than 24 percentage points using a bilateral Fisher's exact test with a significance level of 0.05. Considering a dropout rate of 10%, approximately 136 patients will have to be enrolled. The primary analysis will be performed on the intention-to-treat population. Secondary aims are to describe the reasons for non-adherence, the level of satisfaction of patients and healthcare professionals with the paper and electronic diary, and the impact of non-adherence in terms of healthcare costs. ETHICS AND DISSEMINATION Ethical approval was obtained from Romagna Ethics Committee (CEROM), study ID 2108, prot. n. IRST 100.28 of 10/04/2020. Informed consent will be obtained from all study participants. Findings will be disseminated through peer-reviewed journals, conferences and event presentations. PROTOCOL VERSION Version 2, 6 April 2021. TRIAL REGISTRATION NUMBER NCT04826458.
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Affiliation(s)
- Alessandro Passardi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Patrizia Serra
- Unit of Biostatistic and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Orazio Caffo
- Department of Medical Oncology, Provincia autonoma di Trento Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Carla Masini
- Oncology Pharmacy Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Erika Brugugnoli
- Oncology Pharmacy Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Roberto Vespignani
- IT Service, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Valeria Giardino
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Elisabetta Petracci
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Giulia Bartolini
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Francesco Sullo
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Cecilia Anesi
- Department of Medical Oncology, Provincia autonoma di Trento Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Marco Dianti
- eHealth Unit, Bruno Kessler Foundation, Trento, Italy
| | | | | | - Lorenzo Gios
- Competence Center for Digital Health, TrentinoSalute 4.0, Trento, Italy
| | - Annalisa Campomori
- Hospital Pharmacy Unit, Presidio Ospedaliero Santa Chiara, Trento, Italy
| | | | - Stefano Forti
- eHealth Unit, Bruno Kessler Foundation, Trento, Italy
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20
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Metting E, Dassen L, Aardoom J, Versluis A, Chavannes N. Effectiveness of Telemonitoring for Respiratory and Systemic Symptoms of Asthma and COPD: A Narrative Review. Life (Basel) 2021; 11:1215. [PMID: 34833091 PMCID: PMC8624095 DOI: 10.3390/life11111215] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/20/2021] [Accepted: 10/28/2021] [Indexed: 12/25/2022] Open
Abstract
Asthma and chronic obstructive pulmonary diseases (COPD) are highly prevalent chronic lung diseases that require ongoing self-management, which itself is often suboptimal. Therefore, telemonitoring has been used to help patients measure their symptoms, share data with healthcare providers and receive education and feedback to improve disease management. In this study, we conducted a narrative review of recent evidence on the effectiveness of telemonitoring for asthma and COPD in adults. Of the thirteen identified studies, eleven focused on COPD and two focused on asthma. All studies were reviewed, and effects were compared between intervention and care as usual groups. Of the study interventions, seven showed a positive outcome on at least one outcome measure, and six had no significant results on any of the outcome measures. All of the interventions with a positive outcome included an educational component, while only one of the six interventions without positive outcomes included an educational component. We conclude that telemonitoring interventions for asthma and COPD seem more effective if they included an educational component regarding different aspects of self-management.
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Affiliation(s)
- Esther Metting
- Data Science Center in Health, University of Groningen, University Medical Center Groningen, 9713 BZ Groningen, The Netherlands
- Department of Operations, Faculty of Economics and Business, University of Groningen, 9724 AV Groningen, The Netherlands;
- National eHealth Living Lab, Medical Center, Leiden University, 2233 ZD Leiden, The Netherlands; (J.A.); (A.V.); (N.C.)
| | - Lizayra Dassen
- Department of Operations, Faculty of Economics and Business, University of Groningen, 9724 AV Groningen, The Netherlands;
| | - Jiska Aardoom
- National eHealth Living Lab, Medical Center, Leiden University, 2233 ZD Leiden, The Netherlands; (J.A.); (A.V.); (N.C.)
- Public Health and Primary Care, Medical Center, Leiden University, 2233 ZD Leiden, The Netherlands
| | - Anke Versluis
- National eHealth Living Lab, Medical Center, Leiden University, 2233 ZD Leiden, The Netherlands; (J.A.); (A.V.); (N.C.)
- Public Health and Primary Care, Medical Center, Leiden University, 2233 ZD Leiden, The Netherlands
| | - Niels Chavannes
- National eHealth Living Lab, Medical Center, Leiden University, 2233 ZD Leiden, The Netherlands; (J.A.); (A.V.); (N.C.)
- Public Health and Primary Care, Medical Center, Leiden University, 2233 ZD Leiden, The Netherlands
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21
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Winward S, Patel T, Al-Saffar M, Noble M. The Effect of 24/7, Digital-First, NHS Primary Care on Acute Hospital Spending: Retrospective Observational Analysis. J Med Internet Res 2021; 23:e24917. [PMID: 34292160 PMCID: PMC8367118 DOI: 10.2196/24917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/27/2020] [Accepted: 06/04/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Digital health has the potential to revolutionize health care by improving accessibility, patient experience, outcomes, productivity, safety, and cost efficiency. In England, the NHS (National Health Service) Long Term Plan promised the right to access digital-first primary care by March 31, 2024. However, there are few global, fully digital-first providers and limited research into their effects on cost from a health system perspective. OBJECTIVE The aim of this study was to evaluate the impact of highly accessible, digital-first primary care on acute hospital spending. METHODS A retrospective, observational analysis compared acute hospital spending on patients registered to a 24/7, digital-first model of NHS primary care with that on patients registered to all other practices in North West London Collaboration of Clinical Commissioning Groups. Acute hospital spending data per practice were obtained under a freedom of information request. Three versions of NHS techniques designed to fairly allocate funding according to need were used to standardize or "weight" the practice populations; hence, there are 3 results for each year. The weighting adjusted the populations for characteristics that impact health care spending, such as age, sex, and deprivation. The total spending was divided by the number of standardized or weighted patients to give the spending per weighted patient, which was used to compare the 2 groups in the NHS financial years (FY) 2018-2019 (FY18/19) and 2019-2020 (FY19/20). FY18/19 costs were adjusted for inflation, so they were comparable with the values of FY19/20. RESULTS The NHS spending on acute hospital care for 2.43 million and 2.54 million people (FY18/19 and FY19/20) across 358 practices and 49 primary care networks was £1.6 billion and £1.65 billion (a currency exchange rate of £1=US $1.38 is applicable), respectively. The spending on acute care per weighted patient for Babylon GP at Hand members was 12%, 31%, and 54% (£93, P=.047; £223, P<.001; and £389, P<.001) lower than the regional average in FY18/19 for the 3 weighting methodologies used. In FY19/20, it was 15%, 35%, and 51% (£114, P=.006; £246, P<.001; and £362, P<.001) lower. This amounted to lower costs for the Babylon GP at Hand population of £1.37, £4.40 million, and £11.6 million, respectively, in FY18/19; and £3.26 million, £9.54 million, and £18.8 million, respectively, in FY19/20. CONCLUSIONS Patients with access to 24/7, digital-first primary care incurred significantly lower acute hospital costs.
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Pikkemaat M, Thulesius H, Milos Nymberg V. Swedish Primary Care Physicians' Intentions to Use Telemedicine: A Survey Using a New Questionnaire - Physician Attitudes and Intentions to Use Telemedicine (PAIT). Int J Gen Med 2021; 14:3445-3455. [PMID: 34295177 PMCID: PMC8290350 DOI: 10.2147/ijgm.s319497] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/14/2021] [Indexed: 02/02/2023] Open
Abstract
Background Research on intentions to use telemedicine in primary care is sparse. This survey study explored primary care physicians' intentions to use telemedicine by using a newly developed questionnaire: Physician Attitudes and Intentions to use Telemedicine. Methods An anonymous web-survey with questions focusing on theory-based predictors of behavioral intentions such as Attitudes, Subjective norms and Perceived behavioral control was designed, validated, and sent to all primary care physicians at 160 primary health care centers in southern Sweden from May to August 2019. The questionnaire had 29 subject items (including 49 multiple-choice sub-items). Main outcome measures were intentions to use three domains of telemedicine and correlation between theory-based predictors and behavioral intentions for using telemedicine. Results The survey was validated by an expert group, amended, and then tested and retested. A majority of the 198 physicians who returned the web-surveys reported that they did not use e-mails (68%), nor video consultations (78%), chat (81%), or text messages (86%) in their everyday patient work. Yet, most physicians described a positive intention to use telemedicine in patient care for all three studied domains with Attitudes and Perceived behavioral control being significant predictors (p<0.01) for Intentions to use digital contacts (R2 = 0.54), chronic disease monitoring with digital tools (R2 = 0.47) and artificial intelligence (R2 = 0.54). A structural validation of a preliminary instrument - Physician Attitudes and Intention to use Telemedicine (PAIT) - containing 28 sub-items was done by exploratory factor analysis with acceptable explanatory, reliability and sampling adequacy measures. Five factors emerged with Eigenvalues between 1.6 and 11.1 explaining 72% of the variance. Total Cronbach's alpha was 0.91 and Kaiser-Meyer-Olkirk 0.79. Conclusion Before the covid-19 pandemic, Swedish primary care physicians reported a low use yet high behavioral intention to use telemedicine in a study where we developed the preliminary instrument Physician Attitudes and Intention to use Telemedicine. Perceived behavioral control had the largest predictive value of behavioral intention to use telemedicine. Thus, interventions aiming to increase the use of digital tools in primary care should possibly focus on empowering physicians' self-efficacy towards using them.
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Affiliation(s)
- Miriam Pikkemaat
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,CPF, Centre for Primary Healthcare Research, Malmö, Sweden
| | - Hans Thulesius
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Linnaeus University, Kalmar, Sweden
| | - Veronica Milos Nymberg
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,CPF, Centre for Primary Healthcare Research, Malmö, Sweden
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Arain MA, Ahmad A, Chiu V, Kembel L. Medication adherence support of an in-home electronic medication dispensing system for individuals living with chronic conditions: a pilot randomized controlled trial. BMC Geriatr 2021; 21:56. [PMID: 33446126 PMCID: PMC7807760 DOI: 10.1186/s12877-020-01979-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medication adherence is challenging for older adults due to factors such as the number of medications, dosing schedule, and the duration of drug therapy. The objective of this study was to examine the effectiveness of an in-home electronic medication dispensing system (MDS) on improving medication adherence and health perception in older adults with chronic conditions. METHODS A pilot Randomized Controlled Trial (RCT) was conducted using a two-arm parallel assignment model. The intervention group used an MDS as their medication management method. The control group continued to use their current methods of medication management. Block randomization was used to assign participants into the intervention or control group. The inclusion criteria included 1) English speaking 2) age 50 and over 3) diagnosed with one or more chronic condition(s) 4) currently taking five or more oral medications 5) City of Calgary resident. Participants were recruited from a primary care clinic in Alberta, Canada. The study was open-label where knowledge about group assigned to participants after randomization was not withheld. Medication adherence was captured over a continuous, six-month period and analyzed using Intention-to-Treat (ITT) analysis. RESULTS A total of 91 participants were assessed for eligibility and 50 were randomized into the two groups. The number of participants analyzed for ITT was 23 and 25 in the intervention and control group, respectively. Most of the demographic characteristics were comparable in the two groups except the mean age of the intervention group, which was higher compared to the control group (63.96 ± 7.86 versus 59.52 ± 5.93, p-value = 0.03). The average recorded adherence over 26 weeks was significantly higher in the intervention group than the control group (98.35% ± 2.15% versus 91.17% ± 9.76%, p < 0.01). The self-rated medication adherence in the intervention group also showed a significant increase from baseline to 6-month (Z=-2.65, p < 0.01). The control group showed a non-significant increase (Z=-1.79, p = 0.07). CONCLUSION The MDS can be an effective, long-term solution to medication non-adherence in older adults experiencing chronic conditions and taking multiple medications. The technology induces better consistency and improvement in medication taking behaviour than simple, non-technological intervention. TRIAL REGISTRATION Registered with ClinicalTrials.gov on April 09, 2020 with identifier NCT04339296 .
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Affiliation(s)
- Mubashir Aslam Arain
- Health Systems Evaluation and Evidence, Alberta Health Services, 10301 Southport Lane SW, Calgary, Alberta, Canada.
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | - Armghan Ahmad
- Health Systems Evaluation and Evidence, Alberta Health Services, 10301 Southport Lane SW, Calgary, Alberta, Canada
| | - Venus Chiu
- Health Systems Evaluation and Evidence, Alberta Health Services, 10301 Southport Lane SW, Calgary, Alberta, Canada
| | - Lorena Kembel
- Health Systems Evaluation and Evidence, Alberta Health Services, 10301 Southport Lane SW, Calgary, Alberta, Canada
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Gordon K, Dainty KN, Steele Gray C, DeLacy J, Shah A, Resnick M, Seto E. Experiences of Complex Patients With Telemonitoring in a Nurse-Led Model of Care: Multimethod Feasibility Study. JMIR Nurs 2020; 3:e22118. [PMID: 34406972 PMCID: PMC8408315 DOI: 10.2196/22118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/17/2020] [Accepted: 08/23/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Telemonitoring (TM) interventions have been designed to support care delivery and engage patients in their care at home, but little research exists on TM of complex chronic conditions (CCCs). Given the growing prevalence of complex patients, an evaluation of multi-condition TM is needed to expand TM interventions and tailor opportunities to manage complex chronic care needs. OBJECTIVE This study aims to evaluate the feasibility and patients' perceived usefulness of a multi-condition TM platform in a nurse-led model of care. METHODS A pragmatic, multimethod feasibility study was conducted with patients with heart failure (HF), hypertension (HTN), and/or diabetes. Patients were asked to take physiological readings at home via a smartphone-based TM app for 6 months. The recommended frequency of taking readings was dependent on the condition, and adherence data were obtained through the TM system database. Patient questionnaires were administered, and patient interviews were conducted at the end of the study. An inductive analysis was performed, and codes were then mapped to the normalization process theory and Implementation Outcomes constructs by Proctor. RESULTS In total, 26 participants were recruited, 17 of whom used the TM app for 6 months. Qualitative interviews were conducted with 14 patients, and 8 patients were interviewed with their informal caregiver present. Patient adherence was high, with patients with HF taking readings on average 76.6% (141/184) of the days they were asked to use the system and patients with diabetes taking readings on average 72% (19/26) of the days. The HTN adherence rate was 55% (29/52) of the days they were asked to use the system. The qualitative findings of the patient experience can be grouped into 4 main themes and 13 subthemes. The main themes were (1) making sense of the purpose of TM, (2) engaging and investing in TM, (3) implementing and adopting TM, and (4) perceived usefulness and the perceived benefits of TM in CCCs. CONCLUSIONS Multi-condition TM in nurse-led care was found to be feasible and was perceived as useful. Patients accepted and adopted the technology by demonstrating a moderate to high level of adherence across conditions. These results demonstrate how TM can address the needs of patients with CCCs through virtual TM assessments in a nurse-led care model by supporting patient self-care and keeping patients connected to their clinical team.
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Affiliation(s)
- Kayleigh Gordon
- Dalla Lana School of Public Health, University of Toronto, Institute for Health Policy, Management, & Evaluation, Toronto, ON, Canada
- Center for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Katie N Dainty
- Dalla Lana School of Public Health, University of Toronto, Institute for Health Policy, Management, & Evaluation, Toronto, ON, Canada
- North York General Hospital, North York, ON, Canada
| | - Carolyn Steele Gray
- Dalla Lana School of Public Health, University of Toronto, Institute for Health Policy, Management, & Evaluation, Toronto, ON, Canada
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
| | - Jane DeLacy
- William Osler Health System, Brampton, ON, Canada
| | - Amika Shah
- Dalla Lana School of Public Health, University of Toronto, Institute for Health Policy, Management, & Evaluation, Toronto, ON, Canada
- Center for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Myles Resnick
- Center for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Emily Seto
- Dalla Lana School of Public Health, University of Toronto, Institute for Health Policy, Management, & Evaluation, Toronto, ON, Canada
- Center for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
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Buis LR, Roberson DN, Kadri R, Rockey NG, Plegue MA, Danak SU, Guetterman TC, Johnson MG, Choe HM, Richardson CR. Understanding the Feasibility, Acceptability, and Efficacy of a Clinical Pharmacist-led Mobile Approach (BPTrack) to Hypertension Management: Mixed Methods Pilot Study. J Med Internet Res 2020; 22:e19882. [PMID: 32780026 PMCID: PMC7448180 DOI: 10.2196/19882] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/08/2020] [Accepted: 06/13/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Hypertension is a prevalent and costly burden in the United States. Clinical pharmacists within care teams provide effective management of hypertension, as does home blood pressure monitoring; however, concerns about data quality and latency are widespread. One approach to close the gap between clinical pharmacist intervention and home blood pressure monitoring is the use of mobile health (mHealth) technology. OBJECTIVE We sought to investigate the feasibility, acceptability, and preliminary effectiveness of BPTrack, a clinical pharmacist-led intervention that incorporates patient- and clinician-facing apps to make electronically collected, patient-generated data available to providers in real time for hypertension management. The patient app also included customizable daily medication reminders and educational messages. Additionally, this study sought to understand barriers to adoption and areas for improvement identified by key stakeholders, so more widespread use of such interventions may be achieved. METHODS We conducted a mixed methods pilot study of BPTrack, to improve blood pressure control in patients with uncontrolled hypertension through a 12-week pre-post intervention. All patients were recruited from a primary care setting where they worked with a clinical pharmacist for hypertension management. Participants completed a baseline visit, then spent 12 weeks utilizing BPTrack before returning to the clinic for follow-up. Collected data from patient participants included surveys pre- and postintervention, clinical measures (for establishing effectiveness, with the primary outcome being a change in blood pressure and the secondary outcome being a change in medication adherence), utilization of the BPTrack app, interviews at follow-up, and chart review. We also conducted interviews with key stakeholders. RESULTS A total of 15 patient participants were included (13 remained through follow-up for an 86.7% retention rate) in a single group, pre-post assessment pilot study. Data supported the hypothesis that BPTrack was feasible and acceptable for use by patient and provider participants and was effective at reducing patient blood pressure. At the 12-week follow-up, patients exhibited significant reductions in both systolic blood pressure (baseline mean 137.3 mm Hg, SD 11.1 mm Hg; follow-up mean 131.0 mm Hg, SD 9.9 mm Hg; P=.02) and diastolic blood pressure (baseline mean 89.4 mm Hg, SD 7.7 mm Hg; follow-up mean 82.5 mm Hg, SD 8.2 mm Hg; P<.001). On average, patients uploaded at least one blood pressure measurement on 75% (SD 25%) of study days. No improvements in medication adherence were noted. Interview data revealed areas of improvement and refinement for the patient experience. Furthermore, stakeholders require integration into the electronic health record and a modified clinical workflow for BPTrack to be truly useful; however, both patients and stakeholders perceived benefits of BPTrack when used within the context of a clinical relationship. CONCLUSIONS Results demonstrate that a pharmacist-led mHealth intervention promoting home blood pressure monitoring and clinical pharmacist management of hypertension can be effective at reducing blood pressure in primary care patients with uncontrolled hypertension. Our data also support the feasibility and acceptability of these types of interventions for patients and providers. TRIAL REGISTRATION ClinicalTrials.gov NCT02898584; https://clinicaltrials.gov/ct2/show/NCT02898584. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/resprot.8059.
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Affiliation(s)
- Lorraine R Buis
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Dana N Roberson
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Reema Kadri
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Nicole G Rockey
- Pharmacy Innovations and Partnerships, University of Michigan Medical Group, Ann Arbor, MI, United States
- College of Pharmacy, University of Michigan, Ann Arbor, MI, United States
| | - Melissa A Plegue
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Shivang U Danak
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Timothy C Guetterman
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Melanie G Johnson
- College of Pharmacy, University of Michigan, Ann Arbor, MI, United States
| | - Hae Mi Choe
- Pharmacy Innovations and Partnerships, University of Michigan Medical Group, Ann Arbor, MI, United States
- College of Pharmacy, University of Michigan, Ann Arbor, MI, United States
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Omboni S, Campolo L, Panzeri E. Telehealth in chronic disease management and the role of the Internet-of-Medical-Things: the Tholomeus® experience. Expert Rev Med Devices 2020; 17:659-670. [DOI: 10.1080/17434440.2020.1782734] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Stefano Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy
- Scientific Research Department of Cardiology, Science and Technology Park for Biomedicine, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Luca Campolo
- Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy
| | - Edoardo Panzeri
- Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy
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Zhang H, Sun Y, Lin Z, Yang G, Liu J, Mo L, Geng X, Song Y, Zeng H, Zhao M, Li G, Liu Z, Yang P. CARsomes inhibit airway allergic inflammation in mice by inducing antigen-specific Th2 cell apoptosis. Allergy 2020; 75:1205-1216. [PMID: 31846514 DOI: 10.1111/all.14157] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 10/20/2019] [Accepted: 10/27/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Skewed T helper (Th)2 response plays a crucial role in the pathogenesis of allergic diseases. The therapeutic efficacy for allergic diseases is unsatisfactory currently. This study aims to regulate the skewed Th2 response with CARsomes. METHODS The CARsome consisted of an epitope of Dermatophagoides farina-1 (Derf1), a segment of the anti-DEC205 antibody, the scFv, and an open reading frame of perforin. This fusion protein binds to DEC205 molecule on the surface of exosomes derived from dendritic cells (DC). The effects of CARsome on inducing antigen (Ag)-specific Th2 cell apoptosis were assessed both in vivo and in vitro. RESULTS Exposure to CARsomes in the culture induced Ag-specific Th2 cell apoptosis. Injection of CARsomes through the vein puncture also induced Ag-specific Th2 cell apoptosis in the lungs of sensitized mice. CARsomes could induce Ag-specific regulatory T cells. Administration of CARsomes efficiently inhibited experimental allergic airway inflammation. CONCLUSIONS The CARsomes can inhibit allergic airway inflammation by inducing Ag-specific Th2 cell apoptosis and induce Ag-specific regulatory T cells. The data suggest that CARsomes have the translational potential to be used to treat allergic airway inflammation.
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Affiliation(s)
- Huan‐Ping Zhang
- Department of Pulmonary and Critical Care Medicine (PCCM) First Hospital of Shanxi Medical University Taiyuan China
| | - Ying‐Xue Sun
- Department of Microbiology & Immunobiology University of Western Ontario London ON Canada
| | - Zhi Lin
- Department of Pulmonary and Critical Care Medicine (PCCM) First Hospital of Shanxi Medical University Taiyuan China
| | - Gui Yang
- ENT Institute of the Research Center of Allergy and Immunology Shenzhen University School of Medicine Shenzhen China
| | - Jiang‐Qi Liu
- ENT Institute of the Research Center of Allergy and Immunology Shenzhen University School of Medicine Shenzhen China
| | - Li‐Hua Mo
- Department of Pediatric Otolaryngology Shenzhen Hospital Southern Medical University Shenzhen China
| | - Xiao‐Rui Geng
- ENT Institute of the Research Center of Allergy and Immunology Shenzhen University School of Medicine Shenzhen China
| | - Yan‐Nan Song
- ENT Institute of the Research Center of Allergy and Immunology Shenzhen University School of Medicine Shenzhen China
| | - Hao‐Tao Zeng
- ENT Institute of the Research Center of Allergy and Immunology Shenzhen University School of Medicine Shenzhen China
| | - Miao Zhao
- ENT Institute of the Research Center of Allergy and Immunology Shenzhen University School of Medicine Shenzhen China
| | - Guo‐Shun Li
- Department of Pulmonary and Critical Care Medicine (PCCM) First Hospital of Shanxi Medical University Taiyuan China
| | - Zhi‐Gang Liu
- ENT Institute of the Research Center of Allergy and Immunology Shenzhen University School of Medicine Shenzhen China
| | - Ping‐Chang Yang
- ENT Institute of the Research Center of Allergy and Immunology Shenzhen University School of Medicine Shenzhen China
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Timpel P, Oswald S, Schwarz PEH, Harst L. Mapping the Evidence on the Effectiveness of Telemedicine Interventions in Diabetes, Dyslipidemia, and Hypertension: An Umbrella Review of Systematic Reviews and Meta-Analyses. J Med Internet Res 2020; 22:e16791. [PMID: 32186516 PMCID: PMC7113804 DOI: 10.2196/16791] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 11/26/2019] [Accepted: 12/15/2019] [Indexed: 12/22/2022] Open
Abstract
Background Telemedicine is defined by three characteristics: (1) using information and communication technologies, (2) covering a geographical distance, and (3) involving professionals who deliver care directly to a patient or a group of patients. It is said to improve chronic care management and self-management in patients with chronic diseases. However, currently available guidelines for the care of patients with diabetes, hypertension, or dyslipidemia do not include evidence-based guidance on which components of telemedicine are most effective for which patient populations. Objective The primary aim of this study was to identify, synthesize, and critically appraise evidence on the effectiveness of telemedicine solutions and their components on clinical outcomes in patients with diabetes, hypertension, or dyslipidemia. Methods We conducted an umbrella review of high-level evidence, including systematic reviews and meta-analyses of randomized controlled trials. On the basis of predefined eligibility criteria, extensive automated and manual searches of the databases PubMed, EMBASE, and Cochrane Library were conducted. Two authors independently screened the studies, extracted data, and carried out the quality assessments. Extracted data were presented according to intervention components and patient characteristics using defined thresholds of clinical relevance. Overall certainty of outcomes was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool. Results Overall, 3564 references were identified, of which 46 records were included after applying eligibility criteria. The majority of included studies were published after 2015. Significant and clinically relevant reduction rates for glycated hemoglobin (HbA1c; ≤−0.5%) were found in patients with diabetes. Higher reduction rates were found for recently diagnosed patients and those with higher baseline HbA1c (>8%). Telemedicine was not found to have a significant and clinically meaningful impact on blood pressure. Only reviews or meta-analyses reporting lipid outcomes in patients with diabetes were found. GRADE assessment revealed that the overall quality of the evidence was low to very low. Conclusions The results of this umbrella review indicate that telemedicine has the potential to improve clinical outcomes in patients with diabetes. Although subgroup-specific effectiveness rates favoring certain intervention and population characteristics were found, the low GRADE ratings indicate that evidence can be considered as limited. Future updates of clinical care and practice guidelines should carefully assess the methodological quality of studies and the overall certainty of subgroup-specific outcomes before recommending telemedicine interventions for certain patient populations.
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Affiliation(s)
- Patrick Timpel
- Department for Prevention and Care of Diabetes, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Sarah Oswald
- Master Program Health Sciences / Public Health at the Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine at the University Clinic Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Peter E H Schwarz
- Department for Prevention and Care of Diabetes, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Paul Langerhans Institute Dresden, Helmholtz Center Munich, University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.,German Center for Diabetes Research (DZD e V), Neuherberg, Germany
| | - Lorenz Harst
- Research Association Public Health Saxony / Center for Evidence-Based Healthcare, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Huang R, Liu N, Nicdao MA, Mikaheal M, Baldacchino T, Albeos A, Petoumenos K, Sud K, Kim J. Emotion sharing in remote patient monitoring of patients with chronic kidney disease. J Am Med Inform Assoc 2020; 27:185-193. [PMID: 31633755 PMCID: PMC7647270 DOI: 10.1093/jamia/ocz183] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 09/15/2019] [Accepted: 09/30/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To investigate the relationship between emotion sharing and technically troubled dialysis (TTD) in a remote patient monitoring (RPM) setting. MATERIALS AND METHODS A custom software system was developed for home hemodialysis patients to use in an RPM setting, with focus on emoticon sharing and sentiment analysis of patients' text data. We analyzed the outcome of emoticon and sentiment against TTD. Logistic regression was used to assess the relationship between patients' emotions (emoticon and sentiment) and TTD. RESULTS Usage data were collected from January 1, 2015 to June 1, 2018 from 156 patients that actively used the app system, with a total of 31 159 dialysis sessions recorded. Overall, 122 patients (78%) made use of the emoticon feature while 146 patients (94%) wrote at least 1 or more session notes for sentiment analysis. In total, 4087 (13%) sessions were classified as TTD. In the multivariate model, when compared to sessions with self-reported very happy emoticons, those with sad emoticons showed significantly higher associations to TTD (aOR 4.97; 95% CI 4.13-5.99; P = < .001). Similarly, negative sentiments also revealed significant associations to TTD (aOR 1.56; 95% CI 1.22-2; P = .003) when compared to positive sentiments. DISCUSSION The distribution of emoticons varied greatly when compared to sentiment analysis outcomes due to the differences in the design features. The emoticon feature was generally easier to understand and quicker to input while the sentiment analysis required patients to manually input their personal thoughts. CONCLUSION Patients on home hemodialysis actively expressed their emotions during RPM. Negative emotions were found to have significant associations with TTD. The use of emoticons and sentimental analysis may be used as a predictive indicator for prolonged TTD.
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Affiliation(s)
- Robin Huang
- School of Computer Science, The University of Sydney, Camperdown, Australia
| | - Na Liu
- School of Computer Science, The University of Sydney, Camperdown, Australia
| | - Mary Ann Nicdao
- Home Hemodialysis Unit, Regional Dialysis Centre, Blacktown Hospital, Sydney, Australia
| | - Mary Mikaheal
- Home Hemodialysis Unit, Regional Dialysis Centre, Blacktown Hospital, Sydney, Australia
| | - Tanya Baldacchino
- Home Hemodialysis Unit, Regional Dialysis Centre, Blacktown Hospital, Sydney, Australia
| | - Annabelle Albeos
- Home Hemodialysis Unit, Regional Dialysis Centre, Blacktown Hospital, Sydney, Australia
| | | | - Kamal Sud
- Home Hemodialysis Unit, Regional Dialysis Centre, Blacktown Hospital, Sydney, Australia
- Department of Renal Medicine, Nepean Hospital, Sydney, Australia
- The University of Sydney Medical School, Sydney, Australia
| | - Jinman Kim
- School of Computer Science, The University of Sydney, Camperdown, Australia
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Gordon K, Steele Gray C, Dainty KN, DeLacy J, Ware P, Seto E. Exploring an Innovative Care Model and Telemonitoring for the Management of Patients With Complex Chronic Needs: Qualitative Description Study. JMIR Nurs 2020; 3:e15691. [PMID: 34345777 PMCID: PMC8279442 DOI: 10.2196/15691] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/31/2019] [Accepted: 01/23/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The growing number of patients with complex chronic conditions presents an urgent challenge across the Canadian health care system. Current care delivery models are overburdened, struggling to monitor and stabilize the complex needs of this growing patient population. OBJECTIVE This qualitative study aimed to explore the needs and perspectives of patients and members of the care team to inform the development of an innovative integrated model of care and the needs of telemonitoring (TM) for patients with complex chronic conditions. Furthermore, we explored how these needs could be successfully embedded to support this novel model of complex chronic care. METHODS A qualitative description design was utilized to conduct and analyze 29 semistructured interviews with patients (n=16) and care team members (CTM) (n=13) involved in developing the model of care in an ambulatory care facility in Southern Ontario. Participants were identified through purposive sampling. Two researchers performed an iterative thematic analysis using NVivo 12 (QSR International; Melbourne, Australia) to gain insights from examining multiple perspectives of different participants on complex chronic care needs. RESULTS The analysis revealed 3 themes and 13 subthemes, including the following: (1) adequate health care delivery remains challenging for patients with complex care needs, (2) insights into how to structure an integrated care model, and (3) opportunities for TM in an integrated model of care. Participants not only identified continued challenges in accessing and navigating care in a fragmented and disconnected delivery system but also identified the need for more self-management support. Patients and CTM described the structure of an integrated model of care, including the need for a clear referral and triage processes and composing a tight-knit circle of collaborating interdisciplinary providers led by a nurse practitioner (NP). Finally, opportunities for TM in an integrated model of care were identified, including increasing access and communication, the ability to monitor specific signs and symptoms, and building a clinical workflow around TM-enabled care. CONCLUSIONS Despite entrenched health care service delivery models, a new model of care is acutely needed to care for patients with complex chronic needs (CCN). NPs are in a unique position to lead TM-enabled integrated models of care. TM can facilitate frequent and necessary monitoring of patients with CCN with more than one condition in integrated models of care.
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Affiliation(s)
- Kayleigh Gordon
- University of Toronto Toronto, ON Canada
- Centre for Global eHealth Innovation Techna Institute University Health Network Toronto, ON Canada
| | - Carolyn Steele Gray
- University of Toronto Toronto, ON Canada
- Bridgepoint Collaboratory for Research and Innovation Lunenfeld-Tanenbaum Research Institute Sinai Health System Toronto, ON Canada
| | - Katie N Dainty
- University of Toronto Toronto, ON Canada
- North York General Hospital North York, ON Canada
| | - Jane DeLacy
- William Osler Health System Brampton, ON Canada
| | - Patrick Ware
- Centre for Global eHealth Innovation Techna Institute University Health Network Toronto, ON Canada
| | - Emily Seto
- University of Toronto Toronto, ON Canada
- Centre for Global eHealth Innovation Techna Institute University Health Network Toronto, ON Canada
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Lee JY, Chan CKY, Chua SS, Ng CJ, Paraidathathu T, Lee KKC, Lee SWH. Telemonitoring and Team-Based Management of Glycemic Control on People with Type 2 Diabetes: a Cluster-Randomized Controlled Trial. J Gen Intern Med 2020; 35:87-94. [PMID: 31512187 PMCID: PMC6957608 DOI: 10.1007/s11606-019-05316-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 06/25/2019] [Accepted: 08/01/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Connected devices that allow people with diabetes to monitor their blood glucose levels remotely with data visualization have been shown to improve self-care behavior in diabetes management. However, their effectiveness and usability for a low-middle-income, racially diverse population are unknown. OBJECTIVE This study aims to evaluate the effects of remote telemonitoring with team-based management on people with uncontrolled type 2 diabetes. DESIGN This was a pragmatic 52-week cluster-randomized controlled study among 11 primary care government practices in Malaysia. PARTICIPANTS People with type 2 diabetes aged 18 and above, who had hemoglobin A1c ≥ 7.5% but less than 11.0% within the past 3 months and resided in the state of Selangor. INTERVENTION The intervention group received home gluco-telemonitors and transmitted glucose data to a care team who could adjust therapy accordingly. The team also facilitated self-management by supporting participants to improve medication adherence, and encourage healthier lifestyle and use of resources to reduce risk factors. Usual care group received routine healthcare service. MAIN MEASURE The primary outcome was the change in HbA1c at 24 weeks and 52 weeks. Secondary outcomes included change in fasting plasma glucose, blood pressure, lipid levels, health-related quality of life, and diabetes self-efficacy. RESULTS A total of 240 participants were recruited in this study. The telemonitoring group reported larger improvements in glycemic control compared with control at the end of study (week 24, - 0.05%; 95% CI - 0.10 to 0.00%) and at follow-up (week 52, - 0.03%; - 0.07 to 0.02%, p = 0.226). Similarly, no differences in other secondary outcomes were observed, including the number of adverse events and health-related quality of life. CONCLUSION This study indicates that there is limited benefit of replacing telemedicine with the current practice of self-monitoring of blood glucose. Further innovative methods to improve patient engagement in diabetes care are needed. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02466880.
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Affiliation(s)
- Jun Yang Lee
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Selangor, Malaysia
| | - Carina Ka Yee Chan
- School of Psychology and Public Health, La Trobe University, Edwards Road, Flora Hill, VIC, 3551, Australia
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Selangor, Malaysia
| | - Siew Siang Chua
- School of Pharmacy, Faculty of Health and Medical Sciences, Taylor's University Lakeside Campus, No. 1 Jalan Taylor's, 47500, Subang Jaya, Selangor, Malaysia
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University Malaya, 50603, Kuala Lumpur, Malaysia
| | - Thomas Paraidathathu
- School of Pharmacy, Faculty of Health and Medical Sciences, Taylor's University Lakeside Campus, No. 1 Jalan Taylor's, 47500, Subang Jaya, Selangor, Malaysia
| | - Kenneth Kwing Chin Lee
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Selangor, Malaysia
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Selangor, Malaysia.
- School of Pharmacy, Faculty of Health and Medical Sciences, Taylor's University Lakeside Campus, No. 1 Jalan Taylor's, 47500, Subang Jaya, Selangor, Malaysia.
- Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia.
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Aerosol Inhalation-mediated Delivery of an Adeno-associated Virus 5-expressed Antagonistic Interleukin-4 Mutant Ameliorates Experimental Murine Asthma. Arch Med Res 2019; 50:384-392. [PMID: 31678897 DOI: 10.1016/j.arcmed.2019.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/19/2019] [Accepted: 10/14/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND T helper 2 (Th2) lymphocytes and associated interleukin (IL) 4 and IL-13 play crucial roles in asthma pathogenesis. In this study, we explored an adeno-associated virus 5 (AAV5) based gene therapy by delivering truncated IL-4 protein to antagonize IL-4 receptor α chain and interrupt asthmatic signal pathway. RESULTS A recombinant adeno-associated virus 5 (AAV5) vector harboring a truncated mouse IL-4 gene (AAV5-mIL-4ΔC22) was prepared. Western blotting showed that the IL-4 mutant protein lacking the C-terminal 22 amino acids was expressed well in AAV5-mIL-4ΔC22 infected 16HBE and BEAS-2B cells. AAV5-drivn green fluorescent protein (AAV5-GFP) served as a control. The biodistribution of vector DNA after AAV5 vector aerosol inhalation was examined by PCR and the result showed that foreign DNA was detectable in the lungs but not in other organs including gonads. The aerosol inhalation-mediated delivery of AAV5-expressed antagonistic IL-4 mutant protein improved the lung function of ovalbumin-induced asthma mice. CONCLUSIONS The inhalation of aerosolized AAV5-mIL-4ΔC22 significantly improved the lung function and modulated the immune cell infiltration and associated cytokine expression in the bronchoalveolar lavage fluid (BALF) of ovalbumin-induced asthma mice.
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Lee JY, Chan CKY, Chua SS, Paraidathathu T, Lee KKC, Tan CSS, Nasir N, Lee SWH. Using telemedicine to support care for people with type 2 diabetes mellitus: a qualitative analysis of patients' perspectives. BMJ Open 2019; 9:e026575. [PMID: 31640990 PMCID: PMC6830613 DOI: 10.1136/bmjopen-2018-026575] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 09/16/2019] [Accepted: 09/27/2019] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE Telemedicine has been promoted as an economical and effective way to enhance patient care, but its acceptance among patients in low-income and middle-income countries is poorly understood. This study is aimed to explore the experiences and perspectives of people with type 2 diabetes mellitus that used telemedicine to manage their condition. DESIGN In-depth and focus group interviews were conducted with participants who have engaged in telemedicine. Questions included were participants' perception on the programme being used, satisfaction as well as engagement with the telemedicine programme. All interviews and focus groups were audio-recorded and transcribed verbatim. Data were analysed using a thematic approach. PARTICIPANTS AND SETTING People with type 2 diabetes (n=48) who participated in a randomised controlled study which examined the use of telemedicine for diabetes management were recruited from 11 primary care clinics located within the Klang Valley. RESULTS Twelve focus groups and two in-depth interviews were conducted. Four themes emerged from the analysis: (1) generational difference; (2) independence and convenience, (3) sharing of health data and privacy and (4) concerns and challenges. The main obstacles found in patients using the telemedicine systems were related to internet connectivity and difficulties experienced with system interface. Cost was also another significant concern raised by participants. Participants in this study were primarily positive about the benefits of telemedicine, including its ability to provide real-time data and disease monitoring and the reduction in clinic visits. CONCLUSION Despite the potential benefits of telemedicine in the long-term care of diabetes, there are several perceived barriers that may limit the effectiveness of this technology. As such, collaboration between educators, healthcare providers, telecommunication service providers and patients are required to stimulate the adoption and the use of telemedicine.NCT0246680.
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Affiliation(s)
- Jun Yang Lee
- School of Pharmacy, Monash University - Malaysia Campus, Bandar Sunway, Malaysia
- SEGi University Kota Damansara, Petaling Jaya, Malaysia
| | - Carina Ka Yee Chan
- La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
| | - Siew Siang Chua
- School of Pharmacy, Taylor's University - Lakeside Campus, Subang Jaya, Malaysia
| | - Thomas Paraidathathu
- School of Pharmacy, Taylor's University - Lakeside Campus, Subang Jaya, Malaysia
| | | | | | | | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University - Malaysia Campus, Bandar Sunway, Malaysia
- School of Pharmacy, Taylor's University - Lakeside Campus, Subang Jaya, Malaysia
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Choi WS, Choi JH, Oh J, Shin IS, Yang JS. Effects of Remote Monitoring of Blood Pressure in Management of Urban Hypertensive Patients: A Systematic Review and Meta-Analysis. Telemed J E Health 2019; 26:744-759. [PMID: 31532328 DOI: 10.1089/tmj.2019.0028] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: Remote home blood pressure monitoring (RBPM) has been shown as effective in managing hypertension in underserved areas. Effects on urban patients, who are more easily provided with high-quality medical services, are still unclear. We systematically review previously published randomized controlled trials on the effect of RBPM for urban hypertensive patients. Methods: We searched electronic databases for studies published in English up to October 2018. Studies comparing the use of RBPM to face-to-face care were included. Outcome measures were changes in office blood pressure (BP) and the rate of BP control. Results: We identified 1,433 potential references for screening, of which 27 were eligible for review. Substantial heterogeneity was evident for the investigated variables. A significant standardized mean difference (SMD) was observed for RBPM for systolic BP, but the effect size was small compared to face-to-face care and was clinically irrelevant in avoiding cardiovascular events (0.212, 95% confidence interval 0.148-0.275; p < 0.001). For diastolic BP, the SMD between the two groups was small (0.170, p < 0.001) and the effect of RBPM was irrelevant in preventing cardiovascular events. The effect on the rate of BP control was significantly high for the intervention group (relative risk: 1.136; p = 0.018). Conclusions: This review demonstrates that RBPM performed on urban hypertensive patients has limited value and seems not to be superior to ordinary care in avoidance of cardiovascular events. Further studies are needed to provide more reliable information about the effectiveness of RBPM in preventing hypertensive cardiovascular complications.
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Affiliation(s)
- Woo Seok Choi
- Moon Soul Graduate School of Future Strategy, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea.,Keyu Internal Medicine Clinic, Daejeon, Republic of Korea
| | - Jin Hyuk Choi
- Department of Philosophy, University of Warwick, Coventry, United Kingdom
| | - Jiwon Oh
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - In-Soo Shin
- Department of Education, Jeonju University, Jeonju, Republic of Korea
| | - Jae-Suk Yang
- Moon Soul Graduate School of Future Strategy, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
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35
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Skougaard M, Bliddal H, Christensen R, Ellegaard K, Nielsen SM, Zavada J, Oreska S, Krogh NS, Holm CC, Hetland ML, Vencovsky J, Røgind H, Taylor PC, Gudbergsen H. Patients with Rheumatoid Arthritis Acquire Sustainable Skills for Home Monitoring: A Prospective Dual-country Cohort Study (ELECTOR Clinical Trial I). J Rheumatol 2019; 47:658-667. [PMID: 31416921 DOI: 10.3899/jrheum.181362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE In an eHealth setting, to investigate intra- and interrater reliability and agreement of joint assessments and Disease Activity Score using C-reactive protein (DAS28-CRP) in patients with rheumatoid arthritis (RA) and test the effect of repeated joint assessment training. METHODS Patients with DAS28-CRP ≤ 5.1 were included in a prospective cohort study (clinicaltrials.gov: NCT02317939). Intrarater reliability and agreement of patient-performed joint counts were assessed through completion of 5 joint assessments over a 2-month period. All patients received training on joint assessment at baseline; only half of the patients received repeated training. A subset of patients was included in an appraisal of interrater reliability and agreement comparing joint assessments completed by patients, healthcare professionals (HCP), and ultrasonography. Cohen's κ coefficients and intraclass correlation coefficients (ICC) were used for quantifying of reliability of joint assessments and DAS28-CRP. Agreement was assessed using Bland-Altman plots. RESULTS Intrarater reliability was excellent with ICC of 0.87 (95% CI 0.83-0.90) and minimal detectable change of 1.13. ICC for interrater reliability ranged between 0.69 and 0.90 (good to excellent). Patients tended to rate DAS28-CRP slightly higher than HCP. In patients receiving repeated training, a mean difference in DAS28-CRP of -0.08 was observed (limits of agreements of -1.06 and 0.90). After 2 months, reliability between patients and HCP was similar between groups receiving single or repeated training. CONCLUSION Patient-performed assessments of joints and DAS28-CRP in an eHealth home-monitoring solution were reliable and comparable with HCP. Patients can acquire the necessary skills to conduct a correct joint assessment after initial and thorough training. [clinicaltrials.gov (NCT02317939)].
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Affiliation(s)
- Marie Skougaard
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Henning Bliddal
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Robin Christensen
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Karen Ellegaard
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Sabrina M Nielsen
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Jakub Zavada
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Sabina Oreska
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Niels S Krogh
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Christian C Holm
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Merete L Hetland
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Jiri Vencovsky
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Henrik Røgind
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Peter C Taylor
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform.,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg
| | - Henrik Gudbergsen
- From The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense; Zitelab ApS, Copenhagen, Denmark; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Institute of Rheumatology, Prague; Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK. .,N.S. Krogh is CEO of Zitelab ApS and developer of the ELECTOR online platform. .,M. Skougaard, MD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; H. Bliddal, MD, DMSc, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; R. Christensen, BSc, MSc, PhD, Professor, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; K. Ellegaard, PT, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; S.M. Nielsen, BSc, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, and Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital; J. Zavada, MD, PhD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; S. Oreska, MD, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; N.S. Krogh, CEO, Zitelab ApS; C.C. Holm, MSc, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg; M.L. Hetland, MD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen; J. Vencovsky, Professor, Institute of Rheumatology, and Department of Rheumatology, First Faculty of Medicine, Charles University; H. Røgind, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet; P.C. Taylor, Professor, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford; H. Gudbergsen, MD, PhD, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg.
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Tschan CA, Velazquez Sanchez VF, Heckelmann M, Antes S. Home telemonitoring of intracranial pressure. Acta Neurochir (Wien) 2019; 161:1605-1617. [PMID: 31168730 DOI: 10.1007/s00701-019-03959-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 03/30/2019] [Accepted: 05/24/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND As technical progress advances, telemonitoring has become an important part of patient care in many areas of medical treatment. However, distanced surveillance of intracranial pressure (ICP) could not be established so far. With the recent introduction of a telemetric ICP measurement probe, new possibilities arise. Here, we report on a new home setup enabling home telemonitoring of intracranial pressure. METHODS Twenty patients suffering from disturbances of cerebrospinal fluid circulation, who underwent insertion of a telemetric ICP measurement probe, were provided with medical equipment to read ICP at home and save the data on an internet-enabled computer. Training in handling the equipment was performed during in-patient stay; recorded and uploaded ICP data was then analyzed online. Therefore, the treating medical team was able to access the ICP data via a secure internet connection while telephone conferencing with the patient. RESULTS Almost 7400 h of ICP data were recorded at home and evaluated via an internet connection according to the telemonitoring setup. This corresponds to an average record time of about 370 h per patient. ICP profiles were observed following endoscopic treatment, shunting procedures, or valve adjustments. The mean distance between the patients' residence and the consulting hospital was 172 km (range, 16-649 km). CONCLUSIONS ICP measurements have become accessible for telemonitoring purposes. This new management of hydrocephalus reflects an alternative method in patient care, especially for those who live far away from specialized centers.
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Affiliation(s)
- Christoph A Tschan
- Department of Neurosurgery, Hospital Ludmillenstift, Ludmillenstr. 4-6, 49716, Meppen, Germany.
| | | | - Michael Heckelmann
- Department of Neurosurgery, Hospital Ludmillenstift, Ludmillenstr. 4-6, 49716, Meppen, Germany
| | - Sebastian Antes
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Saar, Germany
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Buysse H, Coremans P, Pouwer F, Ruige J. Sustainable improvement of HbA 1c and satisfaction with diabetes care after adding telemedicine in patients on adaptable insulin regimens: Results of the TeleDiabetes randomized controlled trial. Health Informatics J 2019; 26:628-641. [PMID: 31046527 DOI: 10.1177/1460458219844369] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This 2-year study evaluates whether tele-education adds to improvement and maintenance of good glycemic control and patient satisfaction. Adult patients were randomly assigned to study, getting immediate access to tele-education, or control group, getting this surplus education after 3 months. At several moments, clinical data were retrieved and patients completed questionnaires. Multivariate analyses of covariance and repeated measures analysis of variance were conducted. Implementation of tele-education in between face-to-face contacts improved glycemic control for both groups, which was maintained over a 2-year period. Tele-education did not have an influence on glucose measurements or on hypoglycemic events. Patients were satisfied with this tele-educational tool and appreciated use of personal messages. Further research should focus on the possible influence of "life changes" and influence on "need for more tele-educational feedback," and consequently on the provision of (mobile) platforms adaptable to patient's (changing life) situations.
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Negarandeh R, Zolfaghari M, Bashi N, Kiarsi M. Evaluating the Effect of Monitoring through Telephone (Tele-Monitoring) on Self-Care Behaviors and Readmission of Patients with Heart Failure after Discharge. Appl Clin Inform 2019; 10:261-268. [PMID: 30995686 DOI: 10.1055/s-0039-1685167] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Heart failure is one of the serious cardiovascular diseases, which poses a global pandemic and places a heavy burden on health care systems worldwide. The incidence of this disease in Iran is higher than in other Asian countries. To reduce patients' complications, readmission rates, and health care expenditures, it is necessary to design interventions, which are culturally appropriate and based on community needs. METHODS In 2016, a randomized clinical trial (IRCT2017010731804N1) was initiated to compare tailored tele-monitoring intervention with usual care. In total, 80 patients completed the study after a follow-up period of 8 weeks. The primary end point was heart failure self-care, which was measured using the Iranian version of the European Heart Failure self-care questionnaire. Secondary end points were heart failure related readmission rates. RESULTS The mean scores for self-care behaviors of the two groups showed significant difference at the baseline (p = 0.045). The results of the analysis of covariance that was used to control the differences in the pretest scores of self-care behaviors showed that the difference between both groups after the intervention was still significant (p < 0.001). The percentage of patients' readmissions in the intervention group (20%) was less than that in the control group (42.2%); however, the results were not statistically significant (p = 0/066). CONCLUSION This study showed that tele-monitoring improved self-care behaviors in Iranian patients with heart failure but did not reduce their readmission rates.
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Affiliation(s)
- Reza Negarandeh
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mitra Zolfaghari
- Department of E-Learning in Medical Education, Tehran University of Medical Sciences, Virtual School, Tehran, Iran
| | - Nazli Bashi
- The Australian E-Health Research Center, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - Maryam Kiarsi
- Department of Nursing & Emergency Medicine, Dezful University of Medical Sciences, Dezful, Iran
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Dang S, Ruiz DI, Klepac L, Morse S, Becker P, Levy CR, Kinosian B, Edes TE. Key Characteristics for Successful Adoption and Implementation of Home Telehealth Technology in Veterans Affairs Home-Based Primary Care: An Exploratory Study. Telemed J E Health 2019; 25:309-318. [DOI: 10.1089/tmj.2018.0009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stuti Dang
- Miami Veterans Affairs Healthcare System, Miami, Florida
- Miami Veterans Affairs Geriatric Research Education and Clinical Center, Miami, Florida
- Division of Geriatrics and Palliative Care, University of Miami Miller School of Medicine, Miami, Florida
| | - Diana I. Ruiz
- Miami Veterans Affairs Healthcare System, Miami, Florida
- Miami Veterans Affairs Geriatric Research Education and Clinical Center, Miami, Florida
| | - Lauren Klepac
- Geriatrics and Extended Care, Office of Clinical Operations and Management, U.S. Department of Veterans Affairs, Washington, District of Columbia
| | - Susan Morse
- Home & Community Based Care, Stratton Veterans Affairs Medical Center, Albany, New York
| | - Peggy Becker
- Geriatrics and Extended Care, New England Veterans Health Care System, Bedford, Massachusetts
| | - Cari R. Levy
- Denver-Seattle Center of Innovation, Denver Veterans Affairs Medical Center, Denver, Colorado
- Division of Health Care Policy and Research, School of Medicine, University of Colorado, Aurora, Colorado
| | - Bruce Kinosian
- Division of Geriatrics, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Geriatrics and Extended Care Data Analysis Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Thomas E. Edes
- Geriatrics and Extended Care, Office of Clinical Operations and Management, U.S. Department of Veterans Affairs, Washington, District of Columbia
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Ando H, Ashcroft-Kelso H, Halhead R, Young CA, Chakrabarti B, Levene P, Cousins R, Angus RM. Incorporating self-reported questions for telemonitoring to optimize care of patients with MND on noninvasive ventilation (MND OptNIVent). Amyotroph Lateral Scler Frontotemporal Degener 2019; 20:336-347. [PMID: 30912468 DOI: 10.1080/21678421.2019.1587630] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective: Previous studies suggest a positive impact of telehealth in the care of people with motor neuron disease/amyotrophic lateral sclerosis (MND/ALS). This study reports the development of self-reported questions for telemonitoring, using a tablet-based device Careportal®, in the care of patients with MND on noninvasive ventilation (NIV) and its initial impact. Methods: The study consisted of a question development phase and an evaluation phase of the use of Careportal®. The development phase employed a modified Delphi process. The evaluation phase involved a 24-week pilot study with 13 patients (median age = 66; median illness duration = 14 m), who were using NIV. The participants completed overnight oximetry and self-report questions via Careportal® each week, generating interventions where required. Patient-ventilator interaction (PVI) data were monitored and the revised ALS functional rating scale (ALSFRS-R) was completed. Results: Telemonitoring encompassing the newly developed 26-item symptom questions showed good feasibility and validity. During the evaluation phase, 61 interventions were made for 10 patients, including seven patients who had routine clinic appointments during the trial to optimize care. ALSFRS-R showed significant illness deteriorations. Blood oxygen saturation (SpO2) levels were maintained, time ventilated and inspiratory pressures increased during the trial. Conclusions: The MND OptNIVent question set together with weekly ventilator and oximetry monitoring facilitated the maintenance of ventilation and SpO2 levels despite illness progression. The use of the question set, and devices, such as Careportal®, facilitate care and may further enable a single point of contact for patients from which clinicians may offer proactive interventions to optimize care.
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Affiliation(s)
- Hikari Ando
- a Department of Respiratory Medicine , Aintree University Hospitals NHS Foundation Trust , Liverpool , UK
| | - Helen Ashcroft-Kelso
- b Physiotherapist Department , Aintree University Hospital NHS Foundation Trust , Liverpool , UK
| | | | | | - Biswajit Chakrabarti
- e Chest Centre, Aintree University Hospitals NHS Foundation Trust , Liverpool , UK , and
| | | | - Rosanna Cousins
- f Department of Psychology , Liverpool Hope University , Liverpool , UK
| | - Robert M Angus
- e Chest Centre, Aintree University Hospitals NHS Foundation Trust , Liverpool , UK , and
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Harting MT, Wheeler A, Ponsky T, Nwomeh B, Snyder CL, Bruns NE, Lesher A, Pandya S, Dickie B, Shah SR. Telemedicine in pediatric surgery. J Pediatr Surg 2019; 54:587-594. [PMID: 29801660 DOI: 10.1016/j.jpedsurg.2018.04.038] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/13/2018] [Accepted: 04/28/2018] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Telemedicine is an emerging strategy for healthcare delivery that has the potential to expand access, optimize efficiency, minimize cost, and enhance patient satisfaction. OBJECTIVE To review the current spectrum, potential strategies, and implementation process of telemedicine in pediatric surgery. DESIGN Review and opinion design. SETTING n/a. PARTICIPANTS n/a. MAIN OUTCOMES AND MEASURES: n/a. RESULTS n/a. CONCLUSIONS AND RELEVANCE Telemedicine is an emerging approach with the potential to facilitate efficient, cost-effective delivery of pediatric surgical services. BRIEF ABSTRACT Telemedicine is an emerging strategy for healthcare delivery that has the potential to expand access, optimize efficiency, minimize cost, and enhance patient satisfaction. The objectives of this review are to explore common terms in telemedicine, provide an overview of current legislative and billing guidelines, review the current state of telemedicine in surgery and pediatric surgery, and provide basic themes for successful implementation of a pediatric surgical telemedicine program. TYPE OF STUDY Review. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Matthew T Harting
- Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth) and Children's Memorial Hermann Hospital, Houston, TX.
| | - Austin Wheeler
- Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth) and Children's Memorial Hermann Hospital, Houston, TX
| | - Todd Ponsky
- Division of Pediatric Surgery, Akron Children's Hospital, Akron, OH
| | - Benedict Nwomeh
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Chuck L Snyder
- Department of Pediatric Surgery, Childrens Mercy Hospital, Kansas City, MO
| | - Nicholas E Bruns
- Department of General Surgery, Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Aaron Lesher
- Division of Pediatric Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Samir Pandya
- Division of Pediatric Surgery, Department of Surgery, UT Southwestern Medical Center and Children's Medical Center, Dallas, TX
| | - Belinda Dickie
- Department of Surgery, Boston Children's Hospital, Boston, MA
| | - Sohail R Shah
- Division of Pediatric Surgery, Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
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42
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Gilbert AW, Jaggi A, May CR. What is the acceptability of real time 1:1 videoconferencing between clinicians and patients for a follow-up consultation for multi-directional shoulder instability? Shoulder Elbow 2019; 11:53-59. [PMID: 30719098 PMCID: PMC6348581 DOI: 10.1177/1758573218796815] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/17/2018] [Accepted: 07/08/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND The use of real time 1:1 videoconferencing is growing in popularity in clinical practice. Authors have explored the effectiveness and acceptability of videoconferencing for patients; however, little research exists on the viewpoints of clinicians. METHODS Patients with atraumatic shoulder instability attending a tertiary treatment centre were offered the choice of videoconferencing or a face-to-face consultation for their follow-up session. Immediately after the consultation a semi-structured interview was conducted to explore the underlying reasons behind its use and acceptability. RESULTS All clinicians found the use of videoconferencing acceptable provided the patients were aware of its benefits and limitations. Of the 13 patients included in this study, seven chose to undergo a videoconferencing consultation. It was acceptable provided the clinical practice could be modified to achieve the objectives of the consultation. The use of videoconferencing required access to a quiet room with the appropriate technology. CONCLUSION Videoconferencing is not acceptable to all. Benefits included not having to travel and the opportunity to assess and treat patients in their home environment. The use of videoconferencing did not allow for 'hands-on' assessment which was important for less experienced clinicians.
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Affiliation(s)
- Anthony W Gilbert
- Therapies Department, Royal National Orthopaedic Hospital, Stanmore, UK,Anthony W Gilbert, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore HA74LP, UK.
| | - Anju Jaggi
- Therapies Department, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Carl R May
- Faculty of Health Sciences, University of Southampton, Southampton, UK
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43
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Carpenter R, DiChiacchio T, Barker K. Interventions for self-management of type 2 diabetes: An integrative review. Int J Nurs Sci 2019; 6:70-91. [PMID: 31406872 PMCID: PMC6608673 DOI: 10.1016/j.ijnss.2018.12.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/17/2018] [Accepted: 12/14/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus has been identified as one of the most challenging chronic illnesses to manage. Since the management of diabetes is mainly accomplished by patients and families, self-management has become the mainstay of diabetes care. However, a significant proportion of patients fail to engage in adequate self-management. A priority research question is how do interventions affect the self-management behaviors of persons with Type 2 diabetes? PURPOSE/OBJECTIVES The purpose of this integrative review is to provide a summary and critique of interventions that support diabetes self-management in the patient with Type II diabetes mellitus. DESIGN An integrative review design, with a comprehensive methodological approach of reviews, allowing inclusion of experimental and non-experimental studies. PROCEDURES A comprehensive search was conducted via Ebscohost using databases of Academic Search Complete, CINAHL, Health Source: Nursing/Academic Edition, MEDLINE, PsycArtiCLES, and PsycInfo. The final number of papers used for this review were: motivational interviewing (6), peer support/coaching (10), problem solving therapy (3), technology-based interventions (30), lifestyle modification programs (7), patient education (11), mindfulness (3), and cognitive behavioral therapy (5). RESULTS Studies were examined from seventeen countries including a broad range of cultures and ethnicities. While interventions have shown mixed results in all interventional categories, many studies do support small to modest improvements in physiologic, behavioral, and psychological outcome measures. Considerable heterogeneity of interventions exists. The most commonly reported physiologic measure was HbA1c level. Outcome measures were collected mostly at 6 and 12 months. Duration of most research was limited to one year. CONCLUSIONS Research exploring the impact of interventions for self-management has made major contributions to the care of persons with type 2 diabetes, from offering suggestions for improving care, to stimulating new questions for research. However, implications for clinical practice remain inconclusive, and limitations in existing research suggest caution in interpreting results of studies.
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Affiliation(s)
- Roger Carpenter
- West Virginia University School of Nursing, Morgantown, WV, 26506, USA
| | - Toni DiChiacchio
- Faculty Practice & Community Engagement, West Virginia University, Morgantown, WV, 26506, USA
| | - Kendra Barker
- West Virginia University School of Nursing, Morgantown, WV, 26506, USA
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44
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Warner BE, Velardo C, Salvi D, Lafferty K, Crosbie S, Herrington WG, Haynes R. Feasibility of Telemonitoring Blood Pressure in Patients With Kidney Disease (Oxford Heart and Renal Protection Study-1): Observational Study. JMIR Cardio 2018; 2. [PMID: 30596204 PMCID: PMC6309686 DOI: 10.2196/11332] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Blood pressure (BP) is a key modifiable risk factor for patients with chronic kidney disease (CKD), with current guidelines recommending strict control to reduce the risk of progression of both CKD and cardiovascular disease. Trials involving BP lowering require multiple visits to achieve target BP, which increases the costs of such trials, and in routine care, BP measured in the clinic may not accurately reflect the usual BP. Objective We sought to assess whether a telemonitoring system for BP (using a Bluetooth-enabled BP machine that could transmit BP measurements to a tablet device installed with a bespoke app to guide the measurement of BP and collect questionnaire data) was acceptable to patients with CKD and whether patients would provide sufficient BP readings to assess variability and guide treatment. Methods A total of 25 participants with CKD were trained to use the telemonitoring equipment and asked to record BP daily for 30 days, attend a study visit, and then record BP on alternate days for the next 60 days. They were also offered a wrist-worn applanation tonometry device (BPro) which measures BP every 15 minutes over a 24-hour period. Participants were given questionnaires at the 1- and 3-month time points; the questionnaires were derived from the System Usability Scale and Technology Acceptance Model. All eligible participants completed the study. Results Mean participant age was 58 (SD 11) years, and mean estimated glomerular filtration rate was 36 (SD 13) mL/min/1.73m2. 13/25 (52%) participants provided >90% of the expected data and 18/25 (72%) provided >80% of the expected data. The usability of the telemonitoring system was rated highly, with mean scores of 84.9/100 (SE 2.8) after 30 days and 84.2/100 (SE 4.1) after 90 days. The coefficient of variation for the variability of systolic BP telemonitoring was 9.4% (95% CI 7.8-10.9) compared with 7.9% (95% CI 6.4-9.5) for the BPro device, P=.05 (and was 9.0% over 1 year in a recently completed trial with identical eligibility criteria), indicating that most variation in BP was short term. Conclusions Telemonitoring is acceptable for patients with CKD and provides sufficient data to inform titration of antihypertensive therapies in either a randomized trial setting (comparing BP among different targets) or routine clinical practice. Such methods could be employed in both scenarios and reduce costs currently associated with such activities. Trial Registration International Standard Randomized Controlled Trial Number ISRCTN13725286; http://www.isrctn.com/ISRCTN13725286 (Archived by WebCite at http://www.webcitation.org/74PAX51Ji).
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Affiliation(s)
- B E Warner
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - C Velardo
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - D Salvi
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - K Lafferty
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - S Crosbie
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - W G Herrington
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.,Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - R Haynes
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.,Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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45
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Jung Y, Kim J, Park DA. [Effectiveness of Telemonitoring Intervention in Children and Adolescents with Asthma: A Systematic Review and Meta-Analysis]. J Korean Acad Nurs 2018; 48:389-406. [PMID: 30206191 DOI: 10.4040/jkan.2018.48.4.389] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 07/26/2018] [Accepted: 08/01/2018] [Indexed: 11/09/2022]
Abstract
PURPOSE This review aimed to evaluate the effectiveness of telemonitoring (TM) in the management of children and adolescents with asthma. METHODS We searched Ovid-MEDLINE, Ovid-EMBASE, CENTRAL (Cochrane Central Register of Controlled Trials), CINAHL (Cumulative Index to Nursing and Allied Health Literature), and 5 domestic databases to identify randomized controlled trials (RCTs) published through December 2017. Two reviewers independently selected relevant studies, assessed methodological quality and extracted data. We performed a meta-analysis of TM versus usual care and summarized the intervention characteristics of included studies. RESULTS Of the 3,095 articles identified, 8 RCTs (9 articles) were included in this review. The type of TM intervention of included studies was varying across studies (transmitted data, transmission frequency, data review, etc.). The pooled asthma control score was not significantly different between TM and usual care (standardized mean difference 0.04, 95% confidence interval (CI) -0.20~0.28). Another pooled analysis demonstrated no statistically significant difference in asthma exacerbation between TM and usual care (odds ratio 0.95, 95% CI 0.43~2.09). Overall, the pooled results from these studies revealed that TM did not lead to clinically significant improvements in health outcomes, but some studies in our analysis suggested that TM increased patient medication adherence and intervention adherence. CONCLUSION The current evidence base does not demonstrate any differences between TM intervention and usual care, but TM intervention might be considered a promising strategy for the delivery of self-management support for children and adolescents with asthma. Further well-designed studies are needed to assess the effects on clinical outcomes.
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Affiliation(s)
- Youjin Jung
- National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea.,College of Nursing, Korea University, Seoul, Korea
| | - Jimin Kim
- National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Dong Ah Park
- National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea.
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46
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Wang L, Yu Y, Tao T, Zhang J, Gao W. The self-care dilemma of type 2 diabetic patients: The mechanism of self-regulation resource depletion. PLoS One 2018; 13:e0208690. [PMID: 30521626 PMCID: PMC6283625 DOI: 10.1371/journal.pone.0208690] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 11/21/2018] [Indexed: 11/29/2022] Open
Abstract
Self-care is important for type 2 diabetes mellitus (T2DM) patients’ disease prognosis, but there is a common phenomenon of self-regulation failure in T2DMs. In order to figure this problem out, the current study explored the interaction between self-regulation resource depletion and diabetes self-care based on the limited resource model of self-regulation. 104 patients were surveyed using the Self-Regulatory Fatigue Scale (SRF-S) and the Diabetes Self-care Scale (DSCS) in study 1. Study 2 recruited 30 T2DM patients and 30 healthy controls, and used a sequential-task paradigm to test the effect of self-regulation resource depletion on them. Participants in study 3 were 60 T2DM patients under different levels of self-regulation resource depletion manipulation, and their self-regulation performance was recorded and compared. Study 1 indicated that the correlation between self-regulation resource depletion and exercise and diet was significant and negative, suggesting that patients with greater self-regulation resource depletion performed poorly in exercise and diet. In Study 2, T2DM patients exhibited a poorer performance on the Spatial Incompatibility Task than the participants in the control group, suggesting that their self-regulation resource was insufficient. Study 3 indicated that there was no difference in Spatial Incompatibility Task performance, reaction time or error number among patients who were requested to complete a dietary record for one week and patients who were only requested to record eating times. This research demonstrated that low levels of diabetes self-care execution was associated with patients’ deficiency in self-regulatory resource, and self-care as a series of goal-directed behaviors consumed patients’ self-regulatory resources before these behaviors became a habit.
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Affiliation(s)
- Ligang Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Yan Yu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Ting Tao
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Jingyi Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Wenbin Gao
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
- * E-mail:
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47
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Bertoncello C, Colucci M, Baldovin T, Buja A, Baldo V. How does it work? Factors involved in telemedicine home-interventions effectiveness: A review of reviews. PLoS One 2018; 13:e0207332. [PMID: 30440004 PMCID: PMC6237381 DOI: 10.1371/journal.pone.0207332] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 10/30/2018] [Indexed: 12/28/2022] Open
Abstract
Introduction Definitive evidence of the effectiveness and cost-effectiveness of telemedicine home-interventions for the management of chronic diseases is still lacking. This study examines whether and how published reviews consider and discuss the influence on outcomes of different factors, including: setting, target, and intensity of intervention; patient engagement; the perspective of patients, caregivers and health professionals; the organizational model; patient education and support. Included reviews were also assessed in terms of economic and ethical issues. Methods Two search algorithms were developed to scan PubMed for reviews published between 2000 and 2015, about ICT-based interventions for the management of hypertension, diabetes, heart failure, asthma, chronic obstructive pulmonary disease, or for the care of elderly patients. Based on our inclusion criteria, 25 reviews were selected for analysis. Results None of the included reviews covered all the above-mentioned factors. They mostly considered target (44%) and intervention intensity (24%). Setting, ethical issues, patient engagement, and caregiver perspective were the most neglected factors (considered in 0–4% of the reviews). Only 4 reviews (16%) considered at least 4 of the 11 factors, the maximum number of factors considered in a review is 5. Conclusions Factors that may be involved in ICT-based interventions, affecting their effectiveness or cost-effectiveness, are not enough studied in the literature. This research suggests to consider mostly the role of each one, comparing not only disease-related outcomes, but also patients and healthcare organizations outcomes, and patient engagement, in order to understand how interventions work.
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Affiliation(s)
- Chiara Bertoncello
- Department of Cardiac, Thoracic, Vascular, and Public Health, Hygiene and Public Health Unit, University of Padova, Padova, Italy
| | | | - Tatjana Baldovin
- Department of Cardiac, Thoracic, Vascular, and Public Health, Hygiene and Public Health Unit, University of Padova, Padova, Italy
| | - Alessandra Buja
- Department of Cardiac, Thoracic, Vascular, and Public Health, Hygiene and Public Health Unit, University of Padova, Padova, Italy
| | - Vincenzo Baldo
- Department of Cardiac, Thoracic, Vascular, and Public Health, Hygiene and Public Health Unit, University of Padova, Padova, Italy
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48
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Su D, Michaud TL, Estabrooks P, Schwab RJ, Eiland LA, Hansen G, DeVany M, Zhang D, Li Y, Pagán JA, Siahpush M. Diabetes Management Through Remote Patient Monitoring: The Importance of Patient Activation and Engagement with the Technology. Telemed J E Health 2018; 25:952-959. [PMID: 30372366 DOI: 10.1089/tmj.2018.0205] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The documented efficacy and promise of telemedicine in diabetes management does not necessarily mean that it can be easily translated into clinical practice. An important barrier concerns patient activation and engagement with telemedicine technology. Objective: To assess the importance of patient activation and engagement with remote patient monitoring technology in diabetes management among patients with type 2 diabetes. Methods: Ordinary least squares and logistic regression analyses were used to examine how patient activation and engagement with remote patient monitoring technology were related to changes in hemoglobin A1c (HbA1c) for 1,354 patients with type 2 diabetes monitored remotely for 3 months between 2015 and 2017. Results: Patients with more frequent and regular participation in remote monitoring had lower HbA1c levels at the end of the program. Compared to patients who uploaded their biometric data every 2 days or less frequently, patients who maintained an average frequency of one upload per day were less likely to have a postmonitoring HbA1c > 9% after adjusting for selected covariates on baseline demographics and health conditions. Conclusions: Higher levels of patient activation and engagement with remote patient monitoring technology were associated with better glycemic control outcomes. Developing targeted interventions for different groups of patients to promote their activation and engagement levels would be important to improve the effectiveness of remote patient monitoring in diabetes management.
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Affiliation(s)
- Dejun Su
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska.,Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Tzeyu L Michaud
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska.,Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Paul Estabrooks
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Robert J Schwab
- Divisions of General Internal Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Leslie A Eiland
- Divisions of Diabetes, Endocrine and Metabolism, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Geri Hansen
- TeleHealth Program, Nebraska Medicine, Omaha, Nebraska
| | - Mary DeVany
- TeleHealth Program, Nebraska Medicine, Omaha, Nebraska
| | - Donglan Zhang
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia
| | - Yan Li
- Center for Health Innovation, The New York Academy of Medicine, New York, New York
| | - José A Pagán
- Center for Health Innovation, The New York Academy of Medicine, New York, New York.,Department of Public Health Policy and Management, College of Global Public Health, New York University, New York, New York.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mohammad Siahpush
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
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49
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Sherifali D, Berard LD, Gucciardi E, MacDonald B, MacNeill G. Self-Management Education and Support. Can J Diabetes 2018; 42 Suppl 1:S36-S41. [PMID: 29650109 DOI: 10.1016/j.jcjd.2017.10.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Indexed: 12/16/2022]
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50
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Jaana M, Sherrard H, Paré G. A prospective evaluation of telemonitoring use by seniors with chronic heart failure: Adoption, self-care, and empowerment. Health Informatics J 2018; 25:1800-1814. [DOI: 10.1177/1460458218799458] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Telemonitoring leverages technology for the follow-up of patients with heart failure. Limited evidence exists on how telemonitoring influences senior patients’ attitudes and self-care practices. This study examines telemonitoring impacts on patient empowerment and self-care, and explores adoption factors among senior patients. A longitudinal study design was used, involving three surveys of elderly with chronic heart failure (n = 23) 1 week, 3 months, and 6 months after beginning telemonitoring use. Self-care, patient empowerment, and adoption factors were assessed using existing scales. The patients involved in this study perceived value of using telemonitoring, did not expect it to be difficult to use, and did not encounter adoption barriers. There was a significant improvement in patients’ confidence in their ability to evaluate their symptoms, address them, and evaluate the effectiveness of the measures taken to address these symptoms. Yet, patients performed less self-care maintenance activities, and the capability of involvement in the decision-making related to their condition decreased. Telemonitoring can improve seniors’ confidence in evaluating and addressing their symptoms in relation to heart failure. This patient management approach should be coupled with targeted education geared toward self-maintenance and self-management practices.
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