1
|
Nikkhah J, Steinbeck V, Grobe TG, Breitkreuz T, Pross C, Busse R. Evaluating the Population-Based Usage and Benefit of Digitally Collected Patient-Reported Outcomes and Experiences in Patients With Chronic Diseases: The PROMchronic Study Protocol. JMIR Res Protoc 2024; 13:e56487. [PMID: 39102279 PMCID: PMC11333866 DOI: 10.2196/56487] [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] [Received: 01/17/2024] [Revised: 03/28/2024] [Accepted: 04/24/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND Chronic diseases are associated with a high disease burden. Under- and overprovision of care as well as quality variation between health care providers persists, while current quality indicators rarely capture the patients' perspective. Capturing patient-reported outcome measures (PROMs) as well as patient-reported experience measures (PREMs) is becoming more and more important to identify gaps in care provision, prioritize services most valuable to patients, and aid patients' self-management. OBJECTIVE This study aims to measure the potential benefits and effectiveness of using electronic patient-reported outcome measures (ePROMs) and electronic patient-reported experience measures in a structured and population-based manner to enhance health care for chronic disease patients in Germany. METHODS This prospective cohort study aims to evaluate the potential benefits of PROM usage in patients with chronic diseases. We evaluate whether (1) digitally collected PROMs and PREMs can be used for health system performance assessment by generating a representative response of chronically diseased individuals with asthma, chronic obstructive pulmonary disease, diabetes, and coronary artery disease across Germany, and (2) based on the PROMs and PREMs, low-value care can be identified. As patient-reported outcomes (PROs) are rarely presented back to patients, (3) this study also examines patients' reactions to their PROM scores in the form of digital PRO feedback. For these purposes, randomly selected patients from a nationwide German insurer are digitally surveyed with generic and disease-specific PROMs and PREMs, as well as additional questions on their health-related behavior, 4 times over 1 year. Individual PRO feedback is presented back to patients longitudinally and compared to a peer group after each survey period. Patient-reported data is linked with health insurance data. Response rates, changes in health and experience outcomes over time, self-reported changes in health behavior, and health care system usage will be analyzed. RESULTS The PROMchronic study explores the usage of PROMs in patients with chronic diseases. Data collection began in October 2023, after the initial invitation letter. All the 200,000 potential patients have been invited to participate in the study. Data have not yet been analyzed. Publication of the interim results is planned for the autumn of 2024, and the results are planned to be published in 2025. CONCLUSIONS We aim to fill the research gap on the population-based usage of PROMs and PREMs in patients with chronic diseases and add to the current understanding of PROM data-sharing with patients. The study's results can thereby inform whether a health care system-wide approach to collecting PROMs and PREMs can be used to identify low-value care, assess quality variation within and across chronic conditions, and determine whether PRO feedback is helpful and associated with any changes in patients' health behaviors. TRIAL REGISTRATION German Clinical Trials Register DRKS00031656; https://drks.de/search/en/trial/DRKS00031656. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/56487.
Collapse
Affiliation(s)
- Janis Nikkhah
- Department of Healthcare Management, School of Economics and Management, Technical University Berlin, Berlin, Germany
| | - Viktoria Steinbeck
- Department of Healthcare Management, School of Economics and Management, Technical University Berlin, Berlin, Germany
| | | | | | - Christoph Pross
- Department of Healthcare Management, School of Economics and Management, Technical University Berlin, Berlin, Germany
| | - Reinhard Busse
- Department of Healthcare Management, School of Economics and Management, Technical University Berlin, Berlin, Germany
| |
Collapse
|
2
|
Basili P, Farina I, Terrenato I, Centini J, Volpe N, Rizzo V, Agoglia L, Paterniani A, Aprea P, Calignano P, Petrone F, Ciliberto G. Remote Assisted Home Dressing vs. Outpatient Medication of Central Venous Catheter (Peripherally Inserted Central Venous Catheter): Clinical Trial A.R.C.O. (Remote Assistance Oncology Caregiver). NURSING REPORTS 2024; 14:1468-1476. [PMID: 38921720 PMCID: PMC11206720 DOI: 10.3390/nursrep14020110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 06/03/2024] [Accepted: 06/03/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Management of PICC dressing can be performed at home by the patient through adequate training and telenursing. This trial verifies that the incidence of catheter-related complications in home patients, assisted by telenursing, is not greater than that observed in outpatients. METHODS This clinical trial is composed of 72 patients with malignant tumors who underwent long-term chemotherapy with PICC insertion. They were randomly divided into an experimental group (33 cases) and a calibration group (39 cases). The control group received outpatient dressing for the PICC at the hospital, while the experimental group received a telenursing intervention about the management of the PICC. The incidence of catheter-related infections, the ability of self-management, and a rough cost/benefit estimation were compared between the two groups. This trial was performed according to the CONSORT 2010 checklist. RESULTS The two groups do not significantly differ in relation to age, sex, and PICCs in terms of the body side insertion, the type of dressing, and the agents used for cleaning. The analysis of the results showed that in the home-managed group, the clinical events reported during the connection were higher when compared with the outpatient group (p < 0.001). The patients in the homecare group developed frequent complications resulting from skin redness (p < 0.001). CONCLUSION The use of telenursing for patient education in cancer centers can reduce nurses' working time, improving the self-management capacity of patients with a long-term PICC. This trial was retrospectively registered with the Clinical Trial Gov on the 18 May 2023 with registration number NCT05880420.
Collapse
Affiliation(s)
- Paolo Basili
- Technical, Rehabilitation, Assistance and Research Direction, Vascular Access Specialist IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (P.B.); (V.R.)
| | - Ilaria Farina
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Irene Terrenato
- Clinical Trial Center-Biostatistics & Bioinformatics, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Jacopo Centini
- Nursing, Technical, Rehabilitation, Assistance and Research Direction IFO, IRCCS Regina Elena, National Cancer Institute, 00144 Rome, Italy; (J.C.); (N.V.); (F.P.)
| | - Nina Volpe
- Nursing, Technical, Rehabilitation, Assistance and Research Direction IFO, IRCCS Regina Elena, National Cancer Institute, 00144 Rome, Italy; (J.C.); (N.V.); (F.P.)
| | - Vanessa Rizzo
- Technical, Rehabilitation, Assistance and Research Direction, Vascular Access Specialist IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (P.B.); (V.R.)
| | | | - Albina Paterniani
- School of Nursing, IRCCS Regina Elena National Cancer, 00144 Rome, Italy;
| | - Pasquale Aprea
- Vascular Access Unit, IRCCS-Fondazione G. Pascale National Cancer Institute, 80131 Napoli, Italy;
| | - Prisco Calignano
- Department of Hematology, IRCCS-Fondazione G. Pascale National Cancer Institute, 80131 Napoli, Italy;
| | - Fabrizio Petrone
- Nursing, Technical, Rehabilitation, Assistance and Research Direction IFO, IRCCS Regina Elena, National Cancer Institute, 00144 Rome, Italy; (J.C.); (N.V.); (F.P.)
| | - Gennaro Ciliberto
- Scientific Directorate, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy;
| |
Collapse
|
3
|
Kaplan C, Christophides AH, Kranidis AM, Saint-Fleur AL, Kier C. All shook up: how the COVID-19 pandemic rocked pediatric asthma care. Curr Opin Pediatr 2024; 36:237-243. [PMID: 38299973 DOI: 10.1097/mop.0000000000001330] [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: 02/02/2024]
Abstract
PURPOSE OF REVIEW Asthma management is a crucial aspect of public health. The landscape of asthma management underwent significant change in the wake of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. These changes greatly affected existing patients, individuals suffering with undiagnosed illness, providers, and the healthcare system as a whole. RECENT FINDINGS Providers had to navigate through the potential risk of exposure while weighing the benefit of office visits for patients. This promoted the rapid uptake of telemedicine and virtual outreach, as well as modifications to acute management and controller therapies. Telehealth allowed for the remote monitoring of these patient populations, increased compliance with home-based self-management, and an emphasis on patient education. Furthermore, the pandemic underscored the importance of proactive asthma management as many individuals were left untreated or undiagnosed for various reasons. It is evident that the SARS-CoV-2 pandemic reshaped the landscape of various components of the healthcare system, including asthma management, necessitating innovative approaches to monitoring and patient education. SUMMARY Understanding the lessons learned from this time period is crucial for enhancing the resilience of our health system in the wake of future challenges that may be posed against our system.
Collapse
Affiliation(s)
| | - Alexa H Christophides
- Department of Anesthesiology, Stony Brook Children's Hospital, Stony Brook, New York
| | | | - Ashley L Saint-Fleur
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | | |
Collapse
|
4
|
Timmermans L, Boeykens D, Sirimsi MM, Van de Velde D, De Vriendt P, Decat P, Foulon V, Van Hecke A, Vermandere M, Schoenmakers B. Self-management support (SMS) in primary care practice: a qualitative focus group study of care professionals' experiences. BMC PRIMARY CARE 2024; 25:76. [PMID: 38429637 PMCID: PMC10908026 DOI: 10.1186/s12875-024-02317-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 02/21/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND To support self-management of chronically ill persons, innovative approaches of care practice are being developed. Unfortunately, many self-management supporting interventions struggle to achieve reliable and consistent improvements at various levels (patient, provider and healthcare system level). One possible strategy to facilitate translating theory into practice, is to consider the healthcare professionals' perspective prior to the development of new interventions. An exploration of their knowledge and opinion about barriers and facilitators is necessary before employing any self-management support (SMS) intervention. Therefore, our study aims to explore care professionals' perspectives about SMS within the Flemish primary care setting. METHODS This study used a qualitative study design to examine SMS in primary care setting. Five focus groups were conducted, grouped into three waves. Participants were healthcare professionals in Flanders representing different disciplines and settings. A maximum variation purposive sampling was used to recruit participants. For the data analysis, the framework of thematic networks by Attride-Stirling was applied. RESULTS A total of 34 healthcare professionals participated. Three global themes related to SMS were derived from the thematic analysis: (1) Characteristics, (2) Support strategies, (3) Barriers and facilitators. SMS was characterised as a collaboration-based and person-centred approach. A variety of supporting strategies were mentioned by the focus group participants. Most strategies consisted of informing and educating patients. Complementary to individual strategies, collaborative strategies were deemed necessary to support self-management. Regarding barriers and facilitators, different patient-related factors were identified. Additionally, competencies of healthcare providers and external factors seem to hinder the implementation of SMS in practice. CONCLUSIONS This focus group study highlights the importance of a collaborative, person-centred approach to SMS in the context of chronic diseases. Our findings point to the need for interventions that raise awareness and address barriers associated with SMS. Since generic SMS does not exist, the road to success is a growth process in which support must be adapted to the individual patient.
Collapse
Affiliation(s)
- Lotte Timmermans
- Academic Centre of General Practice, KU Leuven, Kapucijnenvoer 7, Box 7001, 3000, Leuven, Belgium.
| | - Dagje Boeykens
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | | | - Dominique Van de Velde
- Department of Rehabilitation Sciences, Occupational Therapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Occupational Therapy, Artevelde University of Applied Sciences, Ghent, Belgium
| | - Patricia De Vriendt
- Department of Rehabilitation Sciences, Occupational Therapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Occupational Therapy, Artevelde University of Applied Sciences, Ghent, Belgium
- Frailty in Ageing (FRIA) Research Group, Department of Gerontology and Mental Health and Wellbeing (MENT) Research Group, Faculty of Medicine and Pharmacy, Vrije Universiteit, Brussels, Belgium
| | - Peter Decat
- General Practice and Primary Health Care, Ghent University, Ghent, Belgium
| | - Veerle Foulon
- Clinical Pharmacology and Pharmacotherapy, KU Leuven, Leuven, Belgium
| | - Ann Van Hecke
- University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
- Department Nursing Director, Ghent University Hospital, Ghent, Belgium
| | - Mieke Vermandere
- Academic Centre of General Practice, KU Leuven, Kapucijnenvoer 7, Box 7001, 3000, Leuven, Belgium
| | - Birgitte Schoenmakers
- Academic Centre of General Practice, KU Leuven, Kapucijnenvoer 7, Box 7001, 3000, Leuven, Belgium
| |
Collapse
|
5
|
de Bell S, Zhelev Z, Shaw N, Bethel A, Anderson R, Thompson Coon J. Remote monitoring for long-term physical health conditions: an evidence and gap map. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-74. [PMID: 38014553 DOI: 10.3310/bvcf6192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Background Remote monitoring involves the measurement of an aspect of a patient's health without that person being seen face to face. It could benefit the individual and aid the efficient provision of health services. However, remote monitoring can be used to monitor different aspects of health in different ways. This evidence map allows users to find evidence on different forms of remote monitoring for different conditions easily to support the commissioning and implementation of interventions. Objectives The aim of this map was to provide an overview of the volume, diversity and nature of recent systematic reviews on the effectiveness, acceptability and implementation of remote monitoring for adults with long-term physical health conditions. Data sources We searched MEDLINE, nine further databases and Epistemonikos for systematic reviews published between 2018 and March 2022, PROSPERO for continuing reviews, and completed citation chasing on included studies. Review methods (Study selection and Study appraisal): Included systematic reviews focused on adult populations with a long-term physical health condition and reported on the effectiveness, acceptability or implementation of remote monitoring. All forms of remote monitoring where data were passed to a healthcare professional as part of the intervention were included. Data were extracted on the characteristics of the remote monitoring intervention and outcomes assessed in the review. AMSTAR 2 was used to assess quality. Results were presented in an interactive evidence and gap map and summarised narratively. Stakeholder and public and patient involvement groups provided feedback throughout the project. Results We included 72 systematic reviews. Of these, 61 focus on the effectiveness of remote monitoring and 24 on its acceptability and/or implementation, with some reviews reporting on both. The majority contained studies from North America and Europe (38 included studies from the United Kingdom). Patients with cardiovascular disease, diabetes and respiratory conditions were the most studied populations. Data were collected predominantly using common devices such as blood pressure monitors and transmitted via applications, websites, e-mail or patient portals, feedback provided via telephone call and by nurses. In terms of outcomes, most reviews focused on physical health, mental health and well-being, health service use, acceptability or implementation. Few reviews reported on less common conditions or on the views of carers or healthcare professionals. Most reviews were of low or critically low quality. Limitations Many terms are used to describe remote monitoring; we searched as widely as possible but may have missed some relevant reviews. Poor reporting of remote monitoring interventions may mean some included reviews contain interventions that do not meet our definition, while relevant reviews might have been excluded. This also made the interpretation of results difficult. Conclusions and future work The map provides an interactive, visual representation of evidence on the effectiveness of remote monitoring and its acceptability and successful implementation. This evidence could support the commissioning and delivery of remote monitoring interventions, while the limitations and gaps could inform further research and technological development. Future reviews should follow the guidelines for conducting and reporting systematic reviews and investigate the application of remote monitoring in less common conditions. Review registration A protocol was registered on the OSF registry (https://doi.org/10.17605/OSF.IO/6Q7P4). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Services and Delivery Research programme (NIHR award ref: NIHR135450) as part of a series of evidence syntheses under award NIHR130538. For more information, visit https://fundingawards.nihr.ac.uk/award/NIHR135450 and https://fundingawards.nihr.ac.uk/award/NIHR130538. The report is published in full in Health and Social Care Delivery Research; Vol. 11, No. 22. See the NIHR Funding and Awards website for further project information.
Collapse
Affiliation(s)
- Siân de Bell
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Zhivko Zhelev
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Naomi Shaw
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Alison Bethel
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Rob Anderson
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Jo Thompson Coon
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| |
Collapse
|
6
|
Allende-Richter S, Benitez AD, Ramirez M, Rivera W, Liu S, Gray KP, Bourgeois F. A Patient Portal Intervention to Promote Adolescent and Young Adult Self-Management Skills. Acad Pediatr 2023; 23:1252-1258. [PMID: 36764579 DOI: 10.1016/j.acap.2023.02.003] [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: 09/10/2022] [Revised: 01/31/2023] [Accepted: 02/04/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE Failure to transfer care to adult medicine is associated with gaps in health care access and poor health outcomes among young adults. We examined whether a patient portal educational intervention is acceptable and can improve adolescent and young adult (AYA) self-management skills toward transition readiness to adult care. METHODS We conducted a single site feasibility study using a mixed research method consisting of 1) a patient portal one-on-one educational intervention with pre- and postsurveys adapted from the Transition Readiness Assessment Questionnaire to assess participant self-management skills and portal user activity; 2) portal user experience was assessed through semistructured interviews until thematic saturation was reached. Study participants were 13 to 25 years old and received care at an academic-affiliated community pediatric clinic. Descriptive statistics were used to describe participant characteristics, paired t tests, or Wilcoxon signed-rank tests to assess outcomes of survey response changes pre- versus postintervention. RESULTS Sixty percent of enrolled participants (N = 78) completed the surveys. Following the educational intervention, we observed an increase in participants self-reporting knowing how to access their protected health information P < .0001, (95%, confidence interval [CI], 1-2) and in the proportion of participants self-reporting to strongly agree to know their medication P = .025 (95%, CI 0-1). We also observed an increase in portal user access at 3 weeks; the median number of logins was 2 per participant (range 1-36, P < .0001). The Portal user experience was strongly positive. CONCLUSION Our patient portal educational intervention suggests that AYAs welcome a patient portal to access protected health information and is associated with an increase in the proportion of participants self-reporting to strongly agree with knowing their medication. While these results are encouraging, this is a quasiexperimental study designed on the frame of feasibility. Our study was not adequately powered, limiting our findings' significance. Future interventions would benefit from a larger sample size with a comparison group to ascertain the effect of a patient portal on self-management skills in a diverse AYA population and inform best practices.
Collapse
Affiliation(s)
- Sophie Allende-Richter
- Division of General Pediatrics, Department of Medicine (S Allende-Richter, AD Benitez, M Ramirez, W Rivera, KP Gray, F Bourgeois) Boston Children's Hospital, Boston, Mass; Department of Pediatrics (S Allende-Richter, KP Gray, F Bourgeois) Harvard Medical School, Boston, Mass.
| | - Ashley D Benitez
- Division of General Pediatrics, Department of Medicine (S Allende-Richter, AD Benitez, M Ramirez, W Rivera, KP Gray, F Bourgeois) Boston Children's Hospital, Boston, Mass; Department of Community Health (AD Benitez, M Ramirez), Tufts University, Boston, Mass
| | - Melanie Ramirez
- Division of General Pediatrics, Department of Medicine (S Allende-Richter, AD Benitez, M Ramirez, W Rivera, KP Gray, F Bourgeois) Boston Children's Hospital, Boston, Mass; Department of Community Health (AD Benitez, M Ramirez), Tufts University, Boston, Mass
| | - William Rivera
- Division of General Pediatrics, Department of Medicine (S Allende-Richter, AD Benitez, M Ramirez, W Rivera, KP Gray, F Bourgeois) Boston Children's Hospital, Boston, Mass
| | - Shanshan Liu
- Biostatistics and Research Design Core (S Liu, KP Gray), Institutional Centers of Clinical and Translational Research, Boston Children's Hospital, Boston, Mass
| | - Kathryn P Gray
- Division of General Pediatrics, Department of Medicine (S Allende-Richter, AD Benitez, M Ramirez, W Rivera, KP Gray, F Bourgeois) Boston Children's Hospital, Boston, Mass; Department of Pediatrics (S Allende-Richter, KP Gray, F Bourgeois) Harvard Medical School, Boston, Mass; Biostatistics and Research Design Core (S Liu, KP Gray), Institutional Centers of Clinical and Translational Research, Boston Children's Hospital, Boston, Mass
| | - Fabienne Bourgeois
- Division of General Pediatrics, Department of Medicine (S Allende-Richter, AD Benitez, M Ramirez, W Rivera, KP Gray, F Bourgeois) Boston Children's Hospital, Boston, Mass; Department of Pediatrics (S Allende-Richter, KP Gray, F Bourgeois) Harvard Medical School, Boston, Mass
| |
Collapse
|
7
|
Nyberg A, Sondell A, Lundell S, Marklund S, Tistad M, Wadell K. Experiences of Using an Electronic Health Tool Among Health Care Professionals Involved in Chronic Obstructive Pulmonary Disease Management: Qualitative Analysis. JMIR Hum Factors 2023; 10:e43269. [PMID: 36995743 PMCID: PMC10131608 DOI: 10.2196/43269] [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: 10/07/2022] [Revised: 12/13/2022] [Accepted: 02/26/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is one of the most common and deadliest chronic diseases of the 21st century. eHealth tools are seen as a promising way of supporting health care professionals in providing evidence-based COPD care, for example, by reinforcing information and interventions provided to the patients and providing easier access and support to the health care professional themselves. Still, knowledge is scarce on the experience of using eHealth tools from the perspective of the health care professional involved in COPD management. OBJECTIVE The study explored the experiences of using an eHealth tool among health care professionals that worked with patients with COPD in their daily clinical practice. METHODS This exploratory qualitative study is part of a process evaluation in a parallel group, controlled, pragmatic pilot trial. Semistructured interviews were performed with 10 health care professionals 3 and 12 months after getting access to an eHealth tool, the COPD Web. The COPD Web, developed using cocreation, is an interactive web-based platform that aims to help health care professionals provide health-promoting strategies. Data from the interviews were analyzed using qualitative content analysis with an inductive approach. RESULTS The main results reflected health care professionals' experiences in 3 categories: receiving competence support and adjusting practice, improving quality of care, and efforts required for implementation. These categories highlighted that using an eHealth tool such as the COPD Web was experienced to provide knowledge support for health care professionals that led to adaptation and facilitation of working procedures and person-centered care. Taken together, these changes were perceived to improve the quality of care through enhanced patient contact and encouragement of interprofessional collaboration. In addition, health care professionals expressed that patients using the COPD Web were better equipped to tackle their disease and adhered better to provided treatment, increasing their self-management ability. However, structural and external barriers bar the successful implementation of an eHealth tool in daily praxis. CONCLUSIONS This study is among the first to explore experiences of using an eHealth tool among health care professionals involved in COPD management. Our novel findings highlight that using an eHealth tool such as the COPD Web may improve the quality of care for patients with COPD (eg, by providing knowledge support for health care professionals and adapting and facilitating working procedures). Our results also indicate that an eHealth tool fosters collaborative interactions between patients and health care professionals, which explains why eHealth is a valuable means of encouraging well-informed and autonomous patients. However, structural and external barriers requiring time, support, and education must be addressed to ensure that an eHealth tool can be successfully implemented in daily praxis. TRIAL REGISTRATION ClinicalTrials.gov NCT02696187; https://clinicaltrials.gov/ct2/show/NCT02696187.
Collapse
Affiliation(s)
- André Nyberg
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
| | - Anna Sondell
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
| | - Sara Lundell
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
| | - Sarah Marklund
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
| | - Malin Tistad
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Karin Wadell
- Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
| |
Collapse
|
8
|
Rosenlund M, Kinnunen UM, Saranto K. The Use of Digital Health Services Among Patients and Citizens Living at Home: Scoping Review. J Med Internet Res 2023; 25:e44711. [PMID: 36972122 PMCID: PMC10131924 DOI: 10.2196/44711] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/31/2023] [Accepted: 03/07/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND The development of digital health services reflects not only the technical development of services but also a change in attitude and the way of thinking. It has become a cornerstone for engaging and activating patients and citizens in health management while living at home. Digital health services are also aimed at enhancing the efficiency and quality of services, while simultaneously providing services more cost-effectively. In 2020, the COVID-19 pandemic accelerated worldwide the development and use of digital services in response to requirements for social distancing and other regulations. OBJECTIVE The aim of this review is to identify and summarize how digital health services are being used among patients and citizens while living at home. METHODS The Joanna Briggs Institute (JBI) methodology for scoping reviews was used as guidance. A search conducted in 3 databases (CINAHL, PubMed, Scopus) resulted in 419 papers. The reporting was conducted by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review (PRISMA-ScR), and the analysis of the included papers was performed using a framework consisting of 5 clusters describing the use of digital health services. After screening and excluding papers that did not match the inclusion criteria, 88 (21%) papers from 2010 to 2022 were included in the final analysis. RESULTS Results indicated that digital health services are used in different situations and among different kinds of populations. In most studies, digital health services were used in the form of video visits or consultations. The telephone was also used regularly for consultations. Other services, such as remote monitoring and transmitting of recorded information and the use the of internet or portals for searching information, were observed as well. Alerts, emergency systems, and reminders were observed to offer possibilities of use, for example, among older people. The digital health services also showed to have potential for use in patient education. CONCLUSIONS The development of digital services reflects a shift toward the provision of care regardless of time and place. It also reflects a shift toward emphasis on patient-centered care, meaning activating and engaging patients in their own care as they use digital services for various health-related purposes. Despite the development of digital services, many challenges (eg, adequate infrastructure) still prevail worldwide.
Collapse
Affiliation(s)
- Milla Rosenlund
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Ulla-Mari Kinnunen
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence, Helsinki, Finland
| | - Kaija Saranto
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
- The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute Centre of Excellence, Helsinki, Finland
| |
Collapse
|
9
|
Noser AE, Lancaster BD, Hommel KA, Roberts CM, King JA, Alt E, Fredericks EM, Ramsey RR. Use of Behavior Change Techniques and Quality of Commercially Available Inflammatory Bowel Disease Apps. Dig Dis Sci 2023:10.1007/s10620-023-07884-7. [PMID: 36933116 DOI: 10.1007/s10620-023-07884-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 02/15/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Inclusion of evidence-based behavior change techniques (e.g., self-monitoring) in mobile health apps has the potential to promote adherence to inflammatory bowel disease treatment. While inflammatory bowel disease management apps exist, the extent to which they incorporate behavior change techniques remains unknown. AIMS The present study systematically evaluated the content and quality of free, commercially available inflammatory bowel disease management apps. METHODS Apps were identified using a systematic search of the Apple App and Google Play stores. Apps were evaluated using Abraham and Michie's taxonomy of 26 behavior change techniques. A literature search was conducted to identify behavior change techniques specific and relevant for people with inflammatory bowel disease. App quality was assessed using the Mobile App Rating Scale with scores ranging from 1 (Inadequate) to 5 (Excellent). RESULTS A total of 51 inflammatory bowel disease management apps were evaluated. Apps included 0-16 behavior change techniques (Mean = 4.55) and 0-10 inflammatory bowel disease management behavior change techniques (Mean = 3.43). App quality ranged from 2.03 to 4.62 (Mean = 3.39) out of 5.00. Two apps, My IBD Care: Crohn's & Colitis and MyGiHealth GI Symptom Tracker, included the highest number of overall and inflammatory bowel disease management behavior change techniques along with high-quality scores. Bezzy IBD was the only app with a high number of overall and inflammatory bowel disease management behavior change techniques with a primary focus on social support/change. CONCLUSION Most inflammatory bowel disease management apps reviewed included evidence-based inflammatory bowel disease management behavior change techniques.
Collapse
Affiliation(s)
- Amy E Noser
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware Street SE, Minneapolis, MN, 55414, USA.
| | - Brittany D Lancaster
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kevin A Hommel
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Caroline M Roberts
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jessica A King
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Elizabeth Alt
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Rachelle R Ramsey
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| |
Collapse
|
10
|
Mathijssen E, de Lange W, Bleijenberg N, van Houwelingen T, Jaarsma T, Trappenburg J, Westland H. Factors That Influence the Use of eHealth in Home Care: Scoping Review and Cross-sectional Survey. J Med Internet Res 2023; 25:e41768. [PMID: 36892935 PMCID: PMC10037173 DOI: 10.2196/41768] [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] [Received: 08/08/2022] [Revised: 11/30/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In home care, eHealth implementation requires health care professionals and home care clients to change their behavior because they have to incorporate the use of eHealth into their daily routines. Knowledge of factors that influence the use of eHealth in home care is needed to optimize implementation strategies. However, a comprehensive overview of such factors is lacking. OBJECTIVE The aims of this study were to (1) provide insight into the types of eHealth that are used and preferred in home care and (2) identify factors that influence the use of eHealth in home care according to health care professionals and home care clients. METHODS A scoping review and online, cross-sectional survey were conducted sequentially. The survey was conducted among Dutch health care professionals with a nursing background who were working for a home care organization at the time. The capability, opportunity, motivation, behavior (COM-B) model, which posits that for any behavior (B) to occur, a person must have the capability (C), opportunity (O), and motivation (M) to perform the behavior, was used to identify influencing factors. The use of a theoretical model may contribute to a better understanding of how to achieve and sustain behavior change in clinical practice. RESULTS We included 30 studies in the scoping review. The most frequently studied type of eHealth was a telecommunication/telemonitoring system. The survey was completed by 102 participants. The most frequently used types of eHealth were electronic health records, social alarms, and online client portals. A health app was the most frequently preferred type of eHealth. We identified 22 factors that influence the use of eHealth in home care according to health care professionals and home care clients. Influencing factors were organized into the components of the COM-B model, namely capability (n=6), opportunity (n=10), and motivation (n=6). We found that there is no single influencing factor that is key to the complexity of eHealth implementation. CONCLUSIONS Different types of eHealth are used, and many types of eHealth are preferred by health care professionals. The identified factors that influence the use of eHealth in home care relate to all components of the COM-B model. These factors need to be addressed and embedded in implementation strategies of eHealth to optimize the use of eHealth in home care.
Collapse
Affiliation(s)
- Elke Mathijssen
- The Healthcare Innovation Center, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Wendela de Lange
- The Healthcare Innovation Center, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Nienke Bleijenberg
- Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- Research Group Proactive Care for Older People Living at Home, University of Applied Sciences Utrecht, Utrecht, Netherlands
| | - Thijs van Houwelingen
- Research Group Technology for Innovations in Healthcare, University of Applied Sciences Utrecht, Utrecht, Netherlands
| | - Tiny Jaarsma
- Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jaap Trappenburg
- The Healthcare Innovation Center, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Heleen Westland
- Department of Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| |
Collapse
|
11
|
Costa-García Á, Okajima S, Yang N, Shimoda S. Artifact removal from sEMG signals recorded during fully unsupervised daily activities. Digit Health 2023; 9:20552076231164239. [PMID: 36960030 PMCID: PMC10028668 DOI: 10.1177/20552076231164239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 03/01/2023] [Indexed: 03/25/2023] Open
Abstract
Objective In this study, we propose a method for removing artifacts from superficial electromyography (sEMG) data, which have been widely proposed for health monitoring because they encompass the basic neuromuscular processes underlying human motion. Methods Our method is based on a spectral source decomposition from single-channel data using a non-negative matrix factorization. The algorithm is validated with two data sets: the first contained muscle activity coupled to artificially generated noises and the second comprised signals recorded under fully unsupervised conditions. Algorithm performance was further assessed by comparison with other state-of-the-art approaches for noise removal using a single channel. Results The comparison of methods shows that the proposed algorithm achieves the highest performance on the noise-removal process in terms of signal-to-noise ratio reconstruction, root means square error, and correlation coefficient with the original muscle activity. Moreover, the spectral distribution of the extracted sources shows high correlation with the noise sources traditionally associated to sEMG recordings. Conclusion This research shows the ability of spectral source separation to detect and remove noise sources coupled to sEMG signals recorded during unsupervised daily activities which opens the door to the implementation of sEMG recording during daily activities for motor and health monitoring.
Collapse
Affiliation(s)
- Álvaro Costa-García
- Intelligent Behavior Control Unit, RIKEN Institute, Nagoya,
Japan
- Álvaro Costa-García, Intelligent Behavior
Control Unit, RIKEN Institute, Nagoya, Japan.
| | - Shotaro Okajima
- Intelligent Behavior Control Unit, RIKEN Institute, Nagoya,
Japan
| | - Ningjia Yang
- Intelligent Behavior Control Unit, RIKEN Institute, Nagoya,
Japan
| | - Shingo Shimoda
- Intelligent Behavior Control Unit, RIKEN Institute, Nagoya,
Japan
| |
Collapse
|
12
|
Sala I, Rodrigues A. EQ-5D in dialysis units: a PROM with a view. BULLETIN DE LA DIALYSE À DOMICILE 2022. [DOI: 10.25796/bdd.v4i4.69733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Summary
Chronic kidney disease (CKD) is a silent worldwide epidemic responsible for a high clinical and socioeconomic burden. Beyond disease-related outcomes, there is an urgent need for clinicians to focus on implementation of validated patient-reported outcome measures (PROMs) in routine care practice. This updated concept of high-quality renal care implies a changing paradigm, with a focus on patient experiences and health-related quality of life (HRQL) measures. This is even more crucial in end-stage renal disease, where adequate dialysis should aim at a multidimensional approach instead of only analytical targets. It is vital to emphasize interventions that positively affect the quality of life of the patient with CKD beyond improving their survival. Although the importance of using HRQL measures is well established, there has been resistance to their use in routine care. There are numerous tools to assess HRQL, but not all are easy to apply. It is essential to overcome these possible barriers and better adequate the HRQL tools to the patients. The shorter and simpler instruments are more appealing, as well as the electronic health questionnaires. The EuroQol-5 Dimensions tool (EQ5D) is a standardized measure of health status, is simple and quick, and provides information that can be used in economic assessments of healthcare.In this era of limited health resources, cost analysis and economic evaluations are becoming increasingly relevant. In dialysis units, sustainability management should include a pathway of integrated care, including home and center dialysis, that values the better adjustment of prescriptions to the individual patient. The authors advocate using the EQ5D to support this pathway of quality in dialysis units toward global health gains. The EQ5D is a PROM with a view centered on patient and sustainable health services.
Collapse
|
13
|
Mavragani A, Gouw SC, Beestrum M, Cronin RM, Fijnvandraat K, Badawy SM. Patient-Centered Digital Health Records and Their Effects on Health Outcomes: Systematic Review. J Med Internet Res 2022; 24:e43086. [PMID: 36548034 PMCID: PMC9816956 DOI: 10.2196/43086] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND eHealth tools such as patient portals and personal health records, also known as patient-centered digital health records, can engage and empower individuals with chronic health conditions. Patients who are highly engaged in their care have improved disease knowledge, self-management skills, and clinical outcomes. OBJECTIVE We aimed to systematically review the effects of patient-centered digital health records on clinical and patient-reported outcomes, health care utilization, and satisfaction among patients with chronic conditions and to assess the feasibility and acceptability of their use. METHODS We searched MEDLINE, Cochrane, CINAHL, Embase, and PsycINFO databases between January 2000 and December 2021. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Eligible studies were those evaluating digital health records intended for nonhospitalized adult or pediatric patients with a chronic condition. Patients with a high disease burden were a subgroup of interest. Primary outcomes included clinical and patient-reported health outcomes and health care utilization. Secondary outcomes included satisfaction, feasibility, and acceptability. Joanna Briggs Institute critical appraisal tools were used for quality assessment. Two reviewers screened titles, abstracts, and full texts. Associations between health record use and outcomes were categorized as beneficial, neutral or clinically nonrelevant, or undesired. RESULTS Of the 7716 unique publications examined, 81 (1%) met the eligibility criteria, with a total of 1,639,556 participants across all studies. The most commonly studied diseases included diabetes mellitus (37/81, 46%), cardiopulmonary conditions (21/81, 26%), and hematology-oncology conditions (14/81, 17%). One-third (24/81, 30%) of the studies were randomized controlled trials. Of the 81 studies that met the eligibility criteria, 16 (20%) were of high methodological quality. Reported outcomes varied across studies. The benefits of patient-centered digital health records were most frequently reported in the category health care utilization on the "use of recommended care services" (10/13, 77%), on the patient-reported outcomes "disease knowledge" (7/10, 70%), "patient engagement" (13/28, 56%), "treatment adherence" (10/18, 56%), and "self-management and self-efficacy" (10/19, 53%), and on the clinical outcome "laboratory parameters," including HbA1c and low-density lipoprotein (LDL; 16/33, 48%). Beneficial effects on "health-related quality of life" were seen in only 27% (4/15) of studies. Patient satisfaction (28/30, 93%), feasibility (15/19, 97%), and acceptability (23/26, 88%) were positively evaluated. More beneficial effects were reported for digital health records that predominantly focus on active features. Beneficial effects were less frequently observed among patients with a high disease burden and among high-quality studies. No unfavorable effects were observed. CONCLUSIONS The use of patient-centered digital health records in nonhospitalized individuals with chronic health conditions is potentially associated with considerable beneficial effects on health care utilization, treatment adherence, and self-management or self-efficacy. However, for firm conclusions, more studies of high methodological quality are required. TRIAL REGISTRATION PROSPERO (International Prospective Register of Systematic Reviews) CRD42020213285; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=213285.
Collapse
Affiliation(s)
| | - Samantha C Gouw
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam Reproduction & Development, Public Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Molly Beestrum
- Galter Health Sciences Library at Northwestern University, Chicago, IL, United States
| | - Robert M Cronin
- Department of Medicine, The Ohio State University, Columbus, OH, United States
| | - Karin Fijnvandraat
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam Reproduction & Development, Public Health, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands.,Department of Molecular Cellular Hemostasis, Sanquin Research and Landsteiner Laboratory, Amsterdam, Netherlands
| | - Sherif M Badawy
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Division of Hematology, Oncology, and Stem Cell Transplant, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
| |
Collapse
|
14
|
Chen K, Davoodi NM, Strauss DH, Li M, Jiménez FN, Guthrie KM, Goldberg EM. Strategies to Ensure Continuity of Care Using Telemedicine with Older Adults during COVID-19: A Qualitative Study of Physicians in Primary Care and Geriatrics. J Appl Gerontol 2022; 41:2282-2295. [PMID: 35711106 PMCID: PMC9207584 DOI: 10.1177/07334648221109728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 05/24/2022] [Accepted: 06/06/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives: Our objective was to interview primary care physicians (PCPs) and geriatricians on their experiences using telemedicine during the COVID-19 pandemic to examine strategies used to maintain continuity of care with their patients, ages 65 and older. Methods: Using purposive sampling, we selected physicians based on community size (metro/suburban/rural) and practice setting (academic/community) and conducted semi-structured interviews via Zoom (mean: 30 minutes). Interviews were recorded, transcribed, coded, and analyzed using framework analysis. Results: We enrolled 33 physicians (15 PCPs and 18 geriatricians) from July to November 2020. Findings indicate that many physicians successfully bridged the digital divide by: assessing patients' technological readiness in advance, being flexible with telehealth modes, using available home or facility-based staff, educating patients on telehealth privacy and usefulness, making accommodations for disabilities, and involving caregivers. Discussion: These findings can inform future policy and practice and assist physicians in resolving addressable barriers to telehealth use among older patients.
Collapse
Affiliation(s)
- Kevin Chen
- The Warren Alpert Medical School of
Brown University, Providence, RI, USA
| | - Natalie M. Davoodi
- Department of Emergency Medicine, The Warren Alpert Medical School of
Brown University, Providence, RI, USA
| | - Daniel H. Strauss
- The Warren Alpert Medical School of
Brown University, Providence, RI, USA
| | | | | | - Kate M. Guthrie
- Department of Psychiatry and Human
Behavior, The Warren Alpert Medical School of
Brown University, Providence, RI, USA
| | - Elizabeth M. Goldberg
- Department of Emergency Medicine, The Warren Alpert Medical School of
Brown University, Providence, RI, USA
- Department of Health Services,
Policy and Practice, Brown University School of Public
Health, Providence, RI, USA
| |
Collapse
|
15
|
Farhane‐Medina NZ, Castillo‐Mayén R, Tabernero C, Rubio SJ, Gutiérrez‐Domingo T, Cuadrado E, Arenas A, Luque B. Effectiveness of an eHealth intervention to improve subjective well-being and self-efficacy in cardiovascular disaease patients: A pilot non-randomized controlled trial. Nurs Open 2022; 10:1503-1516. [PMID: 36208471 PMCID: PMC9912451 DOI: 10.1002/nop2.1400] [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: 01/12/2022] [Revised: 06/03/2022] [Accepted: 09/14/2022] [Indexed: 02/11/2023] Open
Abstract
AIM To evaluate the effectiveness of a multicomponent, eHealth-based self-efficacy intervention to promote subjective well-being and self-efficacy in patients with cardiovascular disease, exploring sex differences. DESIGN A pilot study of a two-arm non-randomized controlled trial. METHODS Forty-two cardiovascular patients (31% women) participated in the study. The experimental group received a personalized psychoeducational session and a 14-days eHealth intervention. Subjective well-being (positive and negative affect) and self-efficacy (chronic and cardiac) were assessed at baseline, post-psychoeducational session, post-eHealth intervention and at two follow-ups. RESULTS The levels of the experimental group in positive affect, at post-eHealth and follow-up 1, and self-efficacy, at post-eHealth, and both follow-ups, were statistically significantly higher compared to the control group (all ps < .05). When considering sex, the intervention was effective only for men. The results highlight the potential of eHealth interventions for cardiac patients and underline the importance of considering a gender perspective in their treatment.
Collapse
Affiliation(s)
- Naima Z. Farhane‐Medina
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC)CórdobaSpain,Department of PsychologyUniversity of CordobaCórdobaSpain
| | - Rosario Castillo‐Mayén
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC)CórdobaSpain,Department of PsychologyUniversity of CordobaCórdobaSpain
| | - Carmen Tabernero
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC)CórdobaSpain,Instituto de Neurociencias de Castilla y León (INCYL)University of SalamancaSalamancaSpain
| | - Sebastián J. Rubio
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC)CórdobaSpain,Department of Specific DidacticsUniversity of CordobaCórdobaSpain
| | - Tamara Gutiérrez‐Domingo
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC)CórdobaSpain,Department of PsychologyUniversity of CordobaCórdobaSpain
| | - Esther Cuadrado
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC)CórdobaSpain,Department of PsychologyUniversity of CordobaCórdobaSpain
| | - Alicia Arenas
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC)CórdobaSpain,Department of Social PsychologyUniversity of SevilleSevilleSpain
| | - Bárbara Luque
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC)CórdobaSpain,Department of PsychologyUniversity of CordobaCórdobaSpain
| |
Collapse
|
16
|
Vera-Varela C, Manrique Mirón PC, Barrigón ML, Álvarez-García R, Portillo P, Chamorro J, Baca-García E. Low Level of Agreement Between Self-Report and Clinical Assessment of Passive Suicidal Ideation. Arch Suicide Res 2022; 26:1895-1910. [PMID: 34223799 DOI: 10.1080/13811118.2021.1945984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Discrepancies between patient reports during clinical evaluations and self-reported suicide ideation are of vital importance. We study the agreement in passive suicidal ideation between reports made by clinicians and patients' self-reports. METHOD Wish of death in 648 outpatients was assessed by attending clinicians. Within 24 h after clinical evaluation, patients completed a self-report questionnaire in which they were asked whether they had no desire to live. We used cluster analysis to determine the clinical profile of a population of patients according to the concordance between reports made by clinicians and self-reported information. RESULTS A low level of agreement (kappa = 0.072) was found between clinicians and patients, as 56.4% (n = 366) of clinician reports classified as containing no death-related ideas although on self-report the patient did state that they had no desire to live. In this group containing discrepancies between the two reports, two clusters were found to have shared characteristics: female sex, middle age, cohabitation, active employment, no history of suicidal behavior, and diagnosis of neurotic, stress-related, and somatoform disorders. In a third, more severe cluster, patients self-reported sleep disturbances, less appetite, poor treatment adherence, and aggressiveness. CONCLUSIONS We found low agreement between self-reports and clinician assessments regarding the death wish. Self-reporting may be useful in assessing suicide risk. HIGHLIGHTSLow agreement was found between self-reports and clinician assessments regarding passive suicidal ideation.Most patients in whom the clinician underestimated the risk of suicide were women.Our results suggest that clinicians require adequate documentation of suicidal risk assessment to identify the high-risk population.
Collapse
|
17
|
MacKinnon M, Moloney M, Bullock E, Morra A, To T, Lemiere C, Lougheed MD. Implementation of a Work-Related Asthma Screening Questionnaire in Clinical Settings: Multimethods Study. JMIR Form Res 2022; 6:e37503. [PMID: 35964327 PMCID: PMC9523520 DOI: 10.2196/37503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 08/03/2022] [Accepted: 08/10/2022] [Indexed: 11/24/2022] Open
Abstract
Background A work-related asthma (WRA) screening questionnaire is currently being validated for implementation in clinical settings. To minimize barriers to integrating tools into clinical practice, a discussion of strategies for the implementation of the questionnaire has begun. Objective This study aimed to understand the benefits, feasibility, barriers, and limitations of implementing the Work-related Asthma Screening Questionnaire–Long version (WRASQ[L]) and asthma e-tools in clinical settings and propose dissemination and implementation strategies for the WRASQ(L). Methods This study was conducted in Kingston, Ontario, Canada, from September 2019 to August 2021. A workshop and 2 questionnaires were used to understand the benefits of and barriers to implementing the questionnaire in clinical settings. An expert advisory committee was established to develop the implementation and dissemination strategies. Workshops were semistructured and used thematic qualitative analysis to identify themes that provided an understanding of the benefits and limitations of and barriers to using the WRASQ(L), and e-tools in general, in clinical settings. Workshop participants included patients and health care providers, including physicians, nurses, and asthma educators, who were implementation specialists and expert electronic medical record users. A questionnaire focusing on providers’ knowledge and awareness of WRA and another focusing on WRASQ(L) feedback was administered at the workshops. Advisory committee members from relevant stakeholders met 3 times to strategize implementation opportunities. Results A total of 6 themes were identified in the workshop: involving and addressing patient needs, novel data collection, knowledge translation, time considerations, functional and practical barriers, and human limitations. Questionnaire responses yielded positive feedback on the utility of the WRASQ(L) in clinical settings. All participants agreed that it is an easy way of collecting information on occupational and exposure history and could prompt a discussion between the health care provider and patient on how the workplace and exposures could affect one’s asthma, increase awareness of WRA in patients and providers, and increase awareness of exposures in the workplace. Implementation and dissemination strategies were generated with input from the advisory committee. Conclusions Stakeholders and workshop participants consider the WRASQ(L) to be a useful tool that satisfies many provider needs in their clinical settings. Once validated, dissemination strategies will include developing educational materials that include the WRASQ(L), linking the questionnaire to stakeholder websites or e-toolkits, translation into other languages, leveraging health care and research networks, conference presentations, and peer-reviewed publications. Implementation strategies will include integration into electronic medical records; designing multifaceted interventions; and targeting nontraditional settings such as workplaces, pharmacies, and research settings. The WRASQ(L) addresses many benefits of and barriers to implementation, as identified in the workshop themes. These themes will guide future implementation and dissemination strategies, noting that human limitations identified in providers and patients will need to be overcome for successful implementation.
Collapse
Affiliation(s)
- Madison MacKinnon
- Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON, Canada
- Division of Respirology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Max Moloney
- Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON, Canada
- Division of Respirology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Emma Bullock
- Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON, Canada
- Division of Respirology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Alison Morra
- Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON, Canada
- Division of Respirology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Teresa To
- The Hospital for Sick Children, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Catherine Lemiere
- Department of Chest Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, ON, Canada
- Faculty of Medicine, University of Montreal, Montreal, ON, Canada
| | - M Diane Lougheed
- Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON, Canada
- Division of Respirology, Department of Medicine, Queen's University, Kingston, ON, Canada
| |
Collapse
|
18
|
Huang Y, Upadhyay U, Dhar E, Kuo LJ, Syed-Abdul S. A Scoping Review to Assess Adherence to and Clinical Outcomes of Wearable Devices in the Cancer Population. Cancers (Basel) 2022; 14:cancers14184437. [PMID: 36139602 PMCID: PMC9496886 DOI: 10.3390/cancers14184437] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/06/2022] [Accepted: 09/08/2022] [Indexed: 11/20/2022] Open
Abstract
Simple Summary The use of wearable devices in clinical care is gaining popularity among cancer patients. The COVID-19 pandemic highlighted the value of wearable devices for monitoring health. Wearable devices are used to record and monitor real-time data like physical activity, sleep metrics, and heart rate variables. The use of wearable devices can directly impact clinical decision-making. There are few pieces of evidence that prove that wearable could improve the quality of patient care while reducing the cost of care, such as remote health monitoring. The generated big data by the wearable device is both a challenge and an opportunity. Researchers can apply artificial intelligence and machine learning techniques to improve wearable devices and their usage among cancer patients. In this scoping review, we assessed the adherence to clinical outcomes of wrist-worn wearable devices in the cancer population. Abstract The use of wearable devices (WDs) in healthcare monitoring and management has attracted increasing attention. A major problem is patients’ adherence and acceptance of WDs given that they are already experiencing a disease burden and treatment side effects. This scoping review explored the use of wrist-worn devices in the cancer population, with a special focus on adherence and clinical outcomes. Relevant articles focusing on the use of WDs in cancer care management were retrieved from PubMed, Scopus, and Embase from 1 January 2017 to 3 March 2022. Studies were independently screened and relevant information was extracted. We identified 752 studies, of which 38 met our inclusion criteria. Studies focused on mixed, breast, colorectal, lung, gastric, urothelial, skin, liver, and blood cancers. Adherence to WDs varied from 60% to 100%. The highest adherence was reported in the 12-week studies. Most studies focused on physical activity, sleep analysis, and heart vital signs. Of the 10 studies that described patient-reported outcomes using questionnaires and personal interviews, 8 indicated a positive correlation between the patient-reported and wearable outcomes. The definitions of the outcome measures and adherence varied across the studies. A better understanding of the intervention standards in terms of the clinical outcomes could improve adherence to wearables.
Collapse
Affiliation(s)
- Yaoru Huang
- Department of Radiation Oncology, Taipei Medical University Hospital, Taipei 110, Taiwan
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 110, Taiwan
| | - Umashankar Upadhyay
- Graduate Institute of Biomedical Informatics, College of Medical Sciences and Technology, Taipei Medical University, Taipei 106, Taiwan
- International Center for Health Information Technology, College of Medical Science and Technology, Taipei Medical University, Taipei 106, Taiwan
| | - Eshita Dhar
- Graduate Institute of Biomedical Informatics, College of Medical Sciences and Technology, Taipei Medical University, Taipei 106, Taiwan
- International Center for Health Information Technology, College of Medical Science and Technology, Taipei Medical University, Taipei 106, Taiwan
| | - Li-Jen Kuo
- Division of Colorectal Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei 110, Taiwan
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Shabbir Syed-Abdul
- Graduate Institute of Biomedical Informatics, College of Medical Sciences and Technology, Taipei Medical University, Taipei 106, Taiwan
- International Center for Health Information Technology, College of Medical Science and Technology, Taipei Medical University, Taipei 106, Taiwan
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei 110, Taiwan
- Correspondence: ; Tel.: +886-2-6638-2736 (ext. 1514)
| |
Collapse
|
19
|
Renzi E, Baccolini V, Migliara G, De Vito C, Gasperini G, Cianciulli A, Marzuillo C, Villari P, Massimi A. The Impact of eHealth Interventions on the Improvement of Self-Care in Chronic Patients: An Overview of Systematic Reviews. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081253. [PMID: 36013432 PMCID: PMC9409893 DOI: 10.3390/life12081253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 01/08/2023]
Abstract
Promoting self-care is one of the most promising strategies for managing chronic conditions. This overview aimed to investigate the effectiveness of eHealth interventions at improving self-care in patients with type-2 diabetes mellitus, cardiovascular disease, and chronic obstructive pulmonary disease when compared to standard care. We carried out a review of systematic reviews on PubMed, Scopus, Cochrane, PsychInfo, and CINAHL. AMSTAR-2 was used for quality appraisal. Eight systematic reviews (six with meta-analysis) were included, involving a total of 41,579 participants. eHealth interventions were categorized into three subgroups: (i) reminders via messaging apps, emails, and apps; (ii) telemonitoring and online operator support; (iii) internet and web-based educational programs. Six systematic reviews showed an improvement in self-care measurements through eHealth interventions, which also led to a better quality of life and clinical outcomes (HbA1C, blood pressure, hospitalization, cholesterol, body weight). This overview provided some implications for practice and research: eHealth is effective in increasing self-care in chronic patients; however, it is required to designate the type of eHealth intervention based on the needed outcome (e.g., implementing telemonitoring to increase self-monitoring of blood pressure). In addition, there is a need to standardize self-care measures through increased use of validated assessment tools.
Collapse
Affiliation(s)
- Erika Renzi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
- Correspondence: ; Tel.: +39-06-49914886; Fax: +39-06-49914449
| | - Valentina Baccolini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Giuseppe Migliara
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Giulia Gasperini
- Department of Translational and Precision Medicine, Umberto I Teaching Hospital, 00161 Rome, Italy
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Angelo Cianciulli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Carolina Marzuillo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Paolo Villari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Azzurra Massimi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| |
Collapse
|
20
|
Sippel A, Riemann-Lorenz K, Pöttgen J, Wiedemann R, Drixler K, Bitzer EM, Holmberg C, Lezius S, Heesen C. Validation of the German eHealth impact questionnaire for online health information users affected by multiple sclerosis. BMC Med Inform Decis Mak 2022; 22:219. [PMID: 35974395 PMCID: PMC9380659 DOI: 10.1186/s12911-022-01968-6] [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: 04/11/2022] [Accepted: 08/11/2022] [Indexed: 11/29/2022] Open
Abstract
Background Persons with multiple sclerosis (MS) are confronted by an overwhelming amount of online health information, which can be valuable but also vary in quality and aim. Therefore, it is of great importance for developers and providers of eHealth information to understand its impact on the users. The eHealth Impact Questionnaire (eHIQ) has been developed in the United Kingdom to measure the potential effects of health and experimental information websites. This contains user’s general attitudes towards using the internet to gain health information and attitudes towards a specific health related website. The self-complete questionnaire is divided into two independently administered and scored parts: the 11-item eHIQ part 1 and the 26-item eHIQ part 2. This study aimed to validate the psychometric properties of the German version of the eHealth Impact Questionnaire (eHIQ-G). Methods 162 people with multiple sclerosis browsed one of two possible websites containing information on MS and completed an online survey. Internal consistency was assessed by Cronbach’s alpha and structural validity by Confirmatory Factor Analysis. Construct validity was examined by assessing correlations with the reference instruments eHealth Literacy Questionnaire and the General Self-Efficacy Scale measuring related, but dissimilar constructs. Moreover, we investigated the mean difference of the eHIQ-G score between the two websites. Data were analyzed using SPSS and AMOS software. Results The eHIQ-G subscales showed high internal consistency with Cronbach’s alpha from 0.833 to 0.885. The 2-factor model of eHIQ part 1 achieved acceptable levels of goodness-of-fit indices, whereas the fit for the 3-factor model of eHIQ part 2 was poor and likewise for the alternative modified models. The correlations with the reference instruments were 0.08–0.62 and as expected. Older age was related with lower eHIQ part 1 score, whereas no significant effect was found for education on eHIQ part 1. Although not significant, the website ‘AMSEL’ reached higher mean scores on eHIQ part 2. Conclusions The eHIQ-G has good internal consistency, and sufficient structural and construct validity. This instrument will facilitate the measurement of the potential impact of eHealth tools. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-01968-6.
Collapse
Affiliation(s)
- Anna Sippel
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Karin Riemann-Lorenz
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Jana Pöttgen
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | - Christine Holmberg
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany.,Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Potsdam, Germany
| | - Susanne Lezius
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
21
|
Vachon E, Robb BW, Haggstrom DA. Impact of a Personal Health Record Intervention Upon Surveillance Among Colorectal Cancer Survivors: Feasibility Study. JMIR Cancer 2022; 8:e34851. [PMID: 35969424 PMCID: PMC9412760 DOI: 10.2196/34851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 07/07/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There are currently an estimated 1.5 million individuals living in the United States with colorectal cancer (CRC), and although the 5-year survival rate has increased, survivors are at risk for recurrence, particularly within the first 2-3 years after treatment. National guidelines recommend continued surveillance after resection to identify recurrence early on. Adherence among survivors ranges from 23% to 94%. Novel interventions are needed to increase CRC survivors' knowledge and confidence in managing their cancer and thus to increase adherence to follow-up surveillance. OBJECTIVE The objective of this study is to develop and test the feasibility and efficacy of a stand-alone, web-based personal health record (PHR) to increase surveillance adherence among CRC survivors, with patient beliefs about surveillance as secondary outcomes. METHODS A pre- and postintervention feasibility trial was conducted testing the efficacy of the colorectal cancer survivor (CRCS)-PHR, which had been previously developed using an iterative, user-centered design approach. RESULTS The average age of the sample was 58 (SD 9.9) years, with 57% (16/28) male and the majority married (20/28, 71%) and employed full-time (15/28, 54%). We observed a significant increase in adherence to colonoscopy (before: 11/21, 52% vs after: 18/21, 86%; P=.005) and CEA (14/21, 67% vs 20/21, 95%; P=.01), as well as a slight increase in CT scans (14/21, 67% vs 18/21, 86%; P=.10). The only significant impact on secondary outcome (patient beliefs) was benefits of CEA test (P=.04), as most of the beliefs were high at baseline. CONCLUSIONS This feasibility study lays the groundwork for continued development of the CRCS-PHR to increase CRC surveillance. Patient-centered technologies, such as the CRCS-PHR, represent an important potential approach to improving the receipt of guideline-concordant care and follow-up surveillance, and not just for CRC survivors. Researchers should continue to develop patient-centered health technologies with clinician implementation in mind to increase patient self-efficacy and surveillance adherence.
Collapse
Affiliation(s)
- Eric Vachon
- School of Nursing, Indiana University, Indianapolis, IN, United States
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, United States
| | - Bruce W Robb
- Department of Surgery, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - David A Haggstrom
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, United States
- Division of General Internal Medicine and Geriatrics, School of Medicine, Indiana University, Indianapolis, IN, United States
| |
Collapse
|
22
|
Cole AC, Adapa K, Khasawneh A, Richardson DR, Mazur L. Codesign approaches involving older adults in the development of electronic healthcare tools: a systematic review. BMJ Open 2022; 12:e058390. [PMID: 35793923 PMCID: PMC9260797 DOI: 10.1136/bmjopen-2021-058390] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE The primary aim was to review and synthesise the current evidence of how older adults are involved in codesign approaches to develop electronic healthcare tools (EHTs). The secondary aim was to identify how the codesign approaches used mutual learning techniques to benefit older adult participants. DESIGN Systematic review following the Preferred Reporting Items for Systematic Reviews 2020 checklist. DATA SOURCES PubMed, Embase and Scopus databases were searched for studies from January 2010 to March 2021. ELIGIBILITY CRITERIA Inclusion criteria were studies employing codesign approaches to develop an EHTs, and the study population was aged 60 years and older. DATA EXTRACTION AND SYNTHESIS Data were extracted for analysis and risk of bias. We evaluated the quality of studies using the Agency for Healthcare Research and Quality Evidence-based Practice Center approach. RESULTS Twenty-five studies met the inclusion criteria for this review. All studies used at least two involvement processes, with interviews and prototypes used most frequently. Through cross-classification, we found an increased utilisation of functional prototypes in studies reaching the 'empower' level of participation and found that studies which benefitted from mutual learning had a higher utilisation of specific involvement processes such as focus groups and functional prototyping. CONCLUSIONS We found gaps to support which involvement processes, participation levels and learning models should be employed when codesigning with older adults. This is important because higher levels of participation may increase the user's knowledge of technology, enhance learning and empower participants. To ensure studies optimise participation and learning of older adults when developing EHTs, there is a need to place more emphasis on the approaches promoting mutual learning. PROSPERO REGISTRATION NUMBER CRD42021240013.
Collapse
Affiliation(s)
- Amy C Cole
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Division of Healthcare Engineering, Department of Radiation Oncology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Karthik Adapa
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Division of Healthcare Engineering, Department of Radiation Oncology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Amro Khasawneh
- Department of Industrial Engineering, School of Engineering, Mercer University, Macon, Georgia, USA
| | - Daniel R Richardson
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Lukasz Mazur
- Carolina Health Informatics Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Division of Healthcare Engineering, Department of Radiation Oncology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| |
Collapse
|
23
|
Barbosa MT, Sousa CS, Morais-Almeida M. Telemedicine in the Management of Chronic Obstructive Respiratory Diseases: An Overview. Digit Health 2022. [DOI: 10.36255/exon-publications-digital-health-respiratory-diseases] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
24
|
Dhippayom T, Boonpattharatthiti K, Thammathuros T, Dilokthornsakul P, Sakunrag I, Devine B. Clinical Outcomes of Different Warfarin Self-Care Strategies: A Systematic Review and Network Meta-Analysis. Thromb Haemost 2022; 122:492-505. [PMID: 34695873 DOI: 10.1055/a-1677-9608] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
AIM To compare the effects of different strategies for warfarin self-care. METHODS PubMed, EMBASE, CENTRAL, CINAHL, ProQuest Dissertations & Theses, and OpenGrey were searched from inception to August 2021. Randomized controlled trials (RCTs) of warfarin self-care, either patient self-testing (PST) or patient self-management (PSM), were included. Self-care approaches were classified based on the TIP framework (theme, intensity, provider): (1) PST ≥1/week via e-Health (PST/High/e-Health); (2) PST ≥1/week by health care practitioner (PST/High/HCP); (3) PST <1/week via e-Health (PST/Low/e-Health); (4) PSM ≥1/week by e-Health (PSM/High/e-Health); (5) PSM ≥1/week by patient (PSM/High/Pt); (6) PSM <1/week by patient (PSM/Low/Pt); and (7) PSM with flexible frequency by patient (PSM/Flex/Pt). Mean differences (MDs) and risk ratios (RRs) with 95% confidence interval (CI) were estimated using frequentist network meta-analyses with a random-effects model. The certainty of evidence was evaluated using CINeMA (Confidence in Network Meta-Analysis). RESULTS Sixteen RCTs involving 5,895 participants were included. When compared with usual care, time in therapeutic range was higher in PSM/High/Pt and PST/High/e-Health with MD [95% CI] of 7.67% [0.26-15.08] and 5.65% [0.04-11.26], respectively. The certainty of evidence was rated as moderate for these findings. The risk of thromboembolic events was lower in the PSM/Flex/Pt group when compared with PST/High/e-Health (RR: 0.39 [0.20-0.77]) and usual care (RR: 0.38 [0.17-0.88]) with low and very low level of evidence, respectively. There was no significant difference in the proportion of international normalized ratio (INR) values in range, major bleeding, and all-cause mortality among different self-care features. CONCLUSION Patient self-care (either PST or PSM) by measuring INR values at least once weekly is more effective in controlling the INR level.
Collapse
Affiliation(s)
- Teerapon Dhippayom
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Kansak Boonpattharatthiti
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.,Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Burapha University, Chon Buri, Thailand
| | - Treeluck Thammathuros
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Piyameth Dilokthornsakul
- Department of Pharmacy Practice, Center of Pharmaceutical Outcomes Research, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Itsarawan Sakunrag
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Beth Devine
- The Comparative Health Outcomes, Policy, and Economics Institute, School of Pharmacy, University of Washington, Seattle, Washington, United States
| |
Collapse
|
25
|
Bates DW, Cheng HY, Cheung NT, Jew R, Mir F, Tamblyn R, Li YC. 'Improving smart medication management': an online expert discussion. BMJ Health Care Inform 2022; 29:e100540. [PMID: 35477691 PMCID: PMC9047882 DOI: 10.1136/bmjhci-2021-100540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/18/2022] [Indexed: 11/04/2022] Open
Abstract
Medication safety continues to be a problem inside and outside the hospital, partly because new smart technologies can cause new drug-related challenges to prescribers and patients. Better integrated digital and information technology (IT) systems, improved education on prescribing for prescribers and greater patient-centred care that empowers patients to take control of their medications are all vital to safer and more effective prescribing. In July 2021, a roundtable discussion was held as a spin-off meeting of the International Forum on Quality and Safety in Health Care Europe 2021 to discuss challenges and future direction in smart medication management. This manuscript summarises the discussion focusing on the aspects of digital and IT systems, safe prescribing, improved communication and education, and drug adherence.
Collapse
Affiliation(s)
- David W Bates
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - N T Cheung
- Hong Kong Hospital Authority, Hong Kong, Hong Kong
| | - Rita Jew
- ISMP, Horsham, Pennsylvania, USA
| | - Fraz Mir
- Addenbrooke's Hospital, Cambridge, UK
| | | | | |
Collapse
|
26
|
Wikström L, Schildmeijer K, Nylander EM, Eriksson K. Patients' and providers' perspectives on e-health applications designed for self-care in association with surgery - a scoping review. BMC Health Serv Res 2022; 22:386. [PMID: 35321707 PMCID: PMC8944084 DOI: 10.1186/s12913-022-07718-8] [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: 10/22/2021] [Accepted: 03/02/2022] [Indexed: 11/11/2022] Open
Abstract
Background Before and after major surgery, access to information in a user-friendly way is a prerequisite for patients to feel confident in taking on the responsibility for their surgical preparation and recovery. Several e-health applications have been developed to support patients perioperatively. The aim of this review was to give an overview of e-health applications designed for self-care associated with surgery by providing a scoping overview of perspectives from providers and patients. Methods We searched the following data sources to identify peer-reviewed quantitative and qualitative studies published between 2015 and 2020: CINAHL, Google Scholar, MEDLINE, PsycInfo, Web of Science, and Scopus. After identifying 960 titles, we screened 638 abstracts, of which 72 were screened in full text. Protocol register: 10.17605/OSF.IO/R3QND. Results We included 15 studies which met our inclusion criteria. Data from several surgical contexts revealed that the most common self-care actions in e-health applications were preoperative preparations and self-assessments of postoperative recovery. Motivational factors for self-care were information, combined with supportive reminders and messages, and chat features. Although there was great variance in research designs and technical solutions, a willingness to engage with and adhere to e-health seemed to increase patients’ self-care activities and thereby accelerate return to work and normal activities. In addition, the need for physical visits seemed to decrease. Even though age groups were not primarily studied, the included studies showed that adult patients of any age engaged in surgical self-care supported by e-health. The providers’ perspectives were not found. Conclusions E-health applications supporting perioperative self-care indicated a positive impact on recovery. However, experiences of healthcare professionals delivering e-health associated with surgery are missing. Additionally, studies based on patients’ perspectives regarding willingness, adherence, and motivation for self-care supported by e-health are sparse. A need for studies examining the supporting role of e-health for self-care in the surgical context is therefore needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07718-8.
Collapse
Affiliation(s)
- Lotta Wikström
- School of Health and Welfare, Jönköping University, Jönköping, Sweden. .,Department of Anaesthesia and Intensive Care, Ryhov County Hospital, Jönköping, Sweden. .,Department of Nursing Science, School of Health and Welfare, Lotta Wikström, Jönköping University, Box 1026, 551 11, Jönköping, Sweden.
| | | | | | - Kerstin Eriksson
- School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Department of Anaesthesia and Intensive Care, Ryhov County Hospital, Jönköping, Sweden
| |
Collapse
|
27
|
Deml MJ, Jungo KT, Maessen M, Martani A, Ulyte A. Megatrends in Healthcare: Review for the Swiss National Science Foundation's National Research Programme 74 (NRP74) "Smarter Health Care". Public Health Rev 2022; 43:1604434. [PMID: 35528712 PMCID: PMC9069234 DOI: 10.3389/phrs.2022.1604434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/10/2022] [Indexed: 01/26/2023] Open
Abstract
Objectives: In this paper, we present a review of some relevant megatrends in healthcare conducted as part of the Swiss National Science Foundation's National Research Programme 74 (NRP74) "Smarter Health Care." Our aim is to stimulate discussions about long-term tendencies underlying the current and future development of the healthcare system. Methods: Our team-a multidisciplinary panel of researchers involved in the NRP74-went through an iterative process of internal consultations followed by a rapid literature review with the goal of reaching group consensus concerning the most relevant megatrends in healthcare. Results: Five megatrends were identified, namely: 1) Socio-demographic shifts. 2) Broadening meaning of "health." 3) Empowered patients and service users. 4) Digitalization in healthcare. 5) Emergence of new models of care. The main features of each megatrend are presented, drawing often on the situation in Switzerland as a paradigmatic example and adding reflections on the potential influence of the COVID-19 pandemic on them. Conclusion: Considering the long-term megatrends affecting the evolution of healthcare is important-amongst other things-to understand and contextualise the relevance and implications of innovative health services research results.
Collapse
Affiliation(s)
- Michael J. Deml
- Department of Sociology, Institute of Sociological Research, University of Geneva, Geneva, Switzerland
| | | | - Maud Maessen
- University Centre for Palliative Care, Inselspital University Hospital Bern, Bern, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Andrea Martani
- Institute for Biomedical Ethics (IBMB), University of Basel, Basel, Switzerland
| | - Agne Ulyte
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
- Population Heath Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
| |
Collapse
|
28
|
Brown R, Coventry L, Sillence E, Blythe J, Stumpf S, Bird J, Durrant AC. Collecting and sharing self-generated health and lifestyle data: Understanding barriers for people living with long-term health conditions - a survey study. Digit Health 2022; 8:20552076221084458. [PMID: 35284085 PMCID: PMC8905063 DOI: 10.1177/20552076221084458] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 02/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background The growing popularity of collecting self-generated health and lifestyle data presents a valuable opportunity to develop our understanding of long-term health conditions and improve care. Barriers remain to the effective sharing of health and lifestyle data by those living with long-term health conditions which include beliefs around concepts of Trust, Identity, Privacy and Security, experiences of stigma, perceptions of risk and information sensitivity. Method We surveyed 250 UK adults who reported living with a range of long-term health conditions. We recorded data to assess self-reported behaviours, experiences, attitudes and motivations relevant to sharing self-generated health and lifestyle data. We also asked participants about their beliefs about Trust, Identity, Privacy and Security, stigma, and perceptions of risk and information sensitivity regarding their health and lifestyle data. Results Three-quarters of our sample reported recording information about their health and lifestyle on a daily basis. However, two-thirds reported never or rarely sharing this information with others. Trust, Identity, Privacy and Security concerns were considered to be 'very important' by those with long-term health conditions when deciding whether or not to share self-generated health and lifestyle data with others, with security concerns considered most important. Of those living with a long-term health condition, 58% reported experiencing stigma associated with their condition. The greatest perceived risk from sharing with others was the potential for future harm to their social relationships. Conclusions Our findings suggest that, in order for health professionals and researchers to benefit from the increased prevalence of self-generated health and lifestyle data, more can be done to address security concerns and to understand perceived risks associated with data sharing. Digital platforms aimed at facilitating the sharing of self-generated health and lifestyle data may look to highlight security features, enable users to control the sharing of certain information types, and emphasise the practical benefits to users of sharing health and lifestyle data with others.
Collapse
Affiliation(s)
- Richard Brown
- Psychology Department, Northumbria University, Newcastle, UK
| | - Lynne Coventry
- Psychology Department, Northumbria University, Newcastle, UK
| | | | | | - Simone Stumpf
- Department of Computer Science, City University of London, UK
| | - Jon Bird
- Department of Computer Science, University of Bristol, UK
| | | |
Collapse
|
29
|
Schoultz K, Svensson A, Emilsson M. Nurses' experiences of using AsthmaTuner - an eHealth self-management system for healthcare of patients with asthma. Digit Health 2022; 8:20552076221092542. [PMID: 35433019 PMCID: PMC9008850 DOI: 10.1177/20552076221092542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/21/2022] [Indexed: 11/16/2022] Open
Abstract
Objective This study describes nurses' experiences of using eHealth for assessment in the healthcare of patients with asthma. Methods Five nurses with experience of using AsthmaTuner in the healthcare of patients with asthma participated in the study. Individual semi-structured interviews were conducted with the nurses to understand their experiences of using the eHealth system. The transcribed interviews were analyzed using qualitative content analysis. Results The results show that nurses as well as patients find the tool useful and easy-to-handle. AsthmaTuner gives the nurses access to more and better information about the patients, which facilitates assessments and makes their work more efficient. The patients become more involved in their care, gain increased control and take more responsibility for their illness and treatment. Conclusions The nurses appreciate eHealth in asthma care. Using AsthmaTuner makes the nurses' work more efficient and the patients become more involved in their care.
Collapse
Affiliation(s)
| | - Ann Svensson
- School of Business, Economics and IT, University West, Trollhättan, Sweden
| | - Maria Emilsson
- Department of Health Sciences, University West, Trollhättan, Sweden
| |
Collapse
|
30
|
Yousef CC, Salgado TM, Farooq A, Burnett K, McClelland LE, Abu Esba LC, Alhamdan HS, Khoshhal S, Aldossary I, Alyas OA, DeShazo JP. Predicting Health Care Providers' Acceptance of a Personal Health Record Secure Messaging Feature. Appl Clin Inform 2022; 13:148-160. [PMID: 35139562 PMCID: PMC8828451 DOI: 10.1055/s-0041-1742217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 12/07/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Personal health records (PHRs) can facilitate patient-centered communication through the secure messaging feature. As health care organizations in the Kingdom of Saudi Arabia implement PHRs and begin to implement the secure messaging feature, studies are needed to evaluate health care providers' acceptance. OBJECTIVE The aim of this study was to identify predictors of health care providers' behavioral intention to support the addition of a secure messaging feature in PHRs using an adapted model of the Unified Theory of Acceptance and Use of Technology as the theoretical framework. METHODS Using a cross-sectional survey design, data on acceptance of secure messaging features in PHRs were collected from health care providers working at the Ministry of National Guard Health Affairs between April and May 2021. The proposed model was tested using partial least squares structural equation modeling in SmartPLS. RESULTS There were 224 participants: female (66.5%), 40 to 49 years of age (39.9%), nurses (45.1%), and those working more than 10 years in the organization (68.8%). Behavioral intention to support the addition of a secure messaging feature was significantly influenced by performance expectancy (β = 0.21, p = 0.01) and attitude (β = 0.50, p < 0.01), while other predicting factors, such as effort expectancy, social influence, and facilitating condition, did not significantly affect the intention. Furthermore, age, years of experience, and professional role did not moderate the relationships. CONCLUSION Health care professionals will support introducing a secure messaging feature in the PHRs if they serve the intended purpose. Considering attitude also plays a significant role in acceptance, it is necessary to arrange for training and support, so that caregivers, health care providers, and the patients become familiar with the benefits and expected outcomes of using the feature.
Collapse
Affiliation(s)
- Consuela C. Yousef
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Dammam, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Teresa M. Salgado
- Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Ali Farooq
- Department of Computing, University of Turku, Turku, Finland
| | - Keisha Burnett
- Department of Clinical Laboratory Sciences, Cytopathology Practice Program, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Laura E. McClelland
- Department of Health Administration, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Laila C. Abu Esba
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Hani S. Alhamdan
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Sahal Khoshhal
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Madinah, Saudi Arabia
| | - Ibrahim Aldossary
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Al Ahsa, Saudi Arabia
| | - Omar A. Alyas
- College of Medicine, Royal College of Surgeons in Ireland—Medical University of Bahrain, Kingdom of Bahrain
| | - Jonathan P. DeShazo
- Department of Health Administration, Virginia Commonwealth University, Richmond, Virginia, United States
| |
Collapse
|
31
|
Lee VV, Vijayakumar S, Lau NY, Blasiak A, Siah KTH, Ho D. Understanding the user: Patients’ perception, needs, and concerns of health apps for chronic constipation. Digit Health 2022; 8:20552076221104673. [PMID: 35663236 PMCID: PMC9158402 DOI: 10.1177/20552076221104673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 05/14/2022] [Indexed: 12/04/2022] Open
Abstract
Objective Chronic constipation is a prevalent gastrointestinal disorder that requires long-term management and treatment adherence. With increasing smartphone usage, health app adoption represents an opportunity to incorporate personalized, patient-led care into chronic constipation management. Despite the number of apps available targeting patients with constipation, studies have not yet examined user needs and barriers towards successful app adoption and sustained usage. Accordingly, the current study explored user perception, needs, and concerns of health apps in patients with chronic constipation. Methods Fifteen participants with chronic constipation (age range = 28–79 years, 10 females) in Singapore completed a 60 min semi-structured qualitative interview exploring participant's experiences with and attitudes towards chronic constipation and health apps. Participants also completed two questionnaires regarding their constipation symptoms and general technology usage. Interviews were audio-recorded, transcribed verbatim, and coded using NVivo. Results Four themes and 10 sub-themes were identified using inductive thematic analysis. Themes and sub-themes cover importance of patient identity, disease-based expectations of health apps, barriers towards adoption and sustained usage of health apps, necessary conditions when adopting health apps (including perception of supportive benefits, clear understanding of app intention, personalized technology, and trusted sources), and push factor expectations which includes creative engagement and incentivization embedded within the app. Conclusion The findings captured barriers and key elements necessary for successful health app adoption and continued usage by patients with chronic constipation. Identified elements that matter to patients can provide app developers with user-focused insights and recommendations to develop effective health apps that sustain user engagement.
Collapse
Affiliation(s)
- V Vien Lee
- The N.1 Institute for Health, National University of Singapore, Singapore
| | | | - Ni Yin Lau
- The N.1 Institute for Health, National University of Singapore, Singapore
| | - Agata Blasiak
- The N.1 Institute for Health, National University of Singapore, Singapore
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore
- The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Pharmacology; Singapore’s Health District @ Queenstown, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kewin Tien Ho Siah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Dean Ho
- The N.1 Institute for Health, National University of Singapore, Singapore
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore
- The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Pharmacology; Singapore’s Health District @ Queenstown, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
32
|
Edrees H, Song W, Syrowatka A, Simona A, Amato MG, Bates DW. Intelligent Telehealth in Pharmacovigilance: A Future Perspective. Drug Saf 2022; 45:449-458. [PMID: 35579810 PMCID: PMC9112241 DOI: 10.1007/s40264-022-01172-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 01/28/2023]
Abstract
Pharmacovigilance improves patient safety by detecting and preventing adverse drug events. However, challenges exist that limit adverse drug event detection, resulting in many adverse drug events being underreported or inaccurately reported. One challenge includes having access to large data sets from various sources including electronic health records and wearable medical devices. Artificial intelligence, including machine learning methods, such as natural language processing and deep learning, can detect and extract information about adverse drug events, thus automating the pharmacovigilance process and improving the surveillance of known and documented adverse drug events. In addition, with the increased demand for telehealth services, for managing both acute and chronic diseases, artificial intelligence methods can play a role in detecting and preventing adverse drug events. In this review, we discuss two use cases of how artificial intelligence methods may be useful to improve the quality of pharmacovigilance and the role of artificial intelligence in telehealth practices.
Collapse
Affiliation(s)
- Heba Edrees
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA USA ,Department of Pharmacy Practice, MCPHS University, Boston, MA USA ,Harvard Medical School, 1620 Tremont St., 3rd Floor, Boston, MA 02120 USA
| | - Wenyu Song
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA USA ,Harvard Medical School, 1620 Tremont St., 3rd Floor, Boston, MA 02120 USA
| | - Ania Syrowatka
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA USA ,Harvard Medical School, 1620 Tremont St., 3rd Floor, Boston, MA 02120 USA
| | - Aurélien Simona
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA USA ,Harvard Medical School, 1620 Tremont St., 3rd Floor, Boston, MA 02120 USA
| | - Mary G. Amato
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA USA
| | - David W. Bates
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA USA ,Harvard Medical School, 1620 Tremont St., 3rd Floor, Boston, MA 02120 USA ,Department of Health Policy and Management, Harvard School of Public Health, Boston, MA USA
| |
Collapse
|
33
|
Toni E, Pirnejad H, Makhdoomi K, Mivefroshan A, Niazkhani Z. Patient empowerment through a user-centered design of an electronic personal health record: a qualitative study of user requirements in chronic kidney disease. BMC Med Inform Decis Mak 2021; 21:329. [PMID: 34819050 PMCID: PMC8611831 DOI: 10.1186/s12911-021-01689-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 11/11/2021] [Indexed: 11/10/2022] Open
Abstract
Background To improve chronic disease outcomes, self-management is an effective strategy. An electronic personal health record (ePHR) is a promising tool with the potential to support chronic patient’s education, counseling, and self-management. Fitting ePHRs within the daily practices of chronic care providers and chronic patients requires user-centered design approaches. We aimed to understand users’ needs and requirements in chronic kidney disease (CKD) care to consider in the design of an ePHR to facilitate its implementation, adoption, and use. Methods A qualitative study was conducted in a major Iranian nephrology center including inpatient and outpatient settings in 2019. We conducted 28 semi-structured interviews with CKD patients, nurses, and adult nephrologists. To confirm or modify the requirements extracted from the interviews, a focus group was also held. Data were analyzed to extract especially those requirements that can facilitate implementation, adoption, and sustained use based on the PHR adoption model and the unified theory of acceptance and use of technology. Results Participants requested an ePHR that provides access to up to date patient information, facilitates patient-provider communication, and increases awareness about patient individualized conditions. Participants expected a system that is able to cater to low patient e-health literacy and high provider workload. They requested the ePHR to include purposeful documentation of medical history, diagnostic and therapeutic procedures, tailored educational content, and scheduled care reminders. Messaging function, tailored educational content to individual patients’ conditions, and controlled access to information were highly valued in order to facilitate its implementation, adoption, and use. Conclusions We focused on the ePHR’s content and functionalities in the face of facilitators and/or barriers envisioned for its adoption in nephrology care. Designers and implementers should value CKD patients’ needs and requirements for self-management such as providing personalized education and counseling (on the basis of their condition and risk factors), health literacy, and disease progression levels. The socio-technical aspects of care also need further attention to facilitate ePHR’s adoption. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01689-2.
Collapse
Affiliation(s)
- Esmaeel Toni
- Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran.,Department of Health Information Technology, Urmia University of Medical Sciences, Urmia, Iran
| | - Habibollah Pirnejad
- Patient Safety Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran.,Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Khadijeh Makhdoomi
- Department of Adult Nephrology, Urmia University of Medical Sciences, Urmia, Iran.,Nephrology and Kidney Transplant Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran
| | - Azam Mivefroshan
- Department of Adult Nephrology, Urmia University of Medical Sciences, Urmia, Iran
| | - Zahra Niazkhani
- Nephrology and Kidney Transplant Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran.
| |
Collapse
|
34
|
Ramsey RR, Plevinsky JM, Milgrim L, Hommel KA, McDowell KM, Shepard J, Guilbert TW. Feasibility and preliminary validity of mobile spirometry in pediatric asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2021; 9:3821-3823. [PMID: 34153516 PMCID: PMC8511135 DOI: 10.1016/j.jaip.2021.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Rachelle R Ramsey
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Jill M Plevinsky
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa
| | - Lauren Milgrim
- College of Medicine, Florida State University, Tallahassee, Fla
| | - Kevin A Hommel
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Karen M McDowell
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Theresa W Guilbert
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| |
Collapse
|
35
|
Tipparaju VV, Mallires KR, Wang D, Tsow F, Xian X. Mitigation of Data Packet Loss in Bluetooth Low Energy-Based Wearable Healthcare Ecosystem. BIOSENSORS-BASEL 2021; 11:bios11100350. [PMID: 34677306 PMCID: PMC8533907 DOI: 10.3390/bios11100350] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/16/2021] [Accepted: 09/21/2021] [Indexed: 12/26/2022]
Abstract
Bluetooth Low Energy (BLE) plays a critical role in wireless data transmission in wearable technologies. The previous work in this field has mostly focused on optimizing the transmission throughput and power consumption. However, not much work has been reported on a systematic evaluation of the data packet loss of BLE in the wearable healthcare ecosystem, which is essential for reliable and secure data transmission. Considering that diverse wearable devices are used as peripherals and off-the-shelf smartphones (Android, iPhone) or Raspberry Pi with various chipsets and operating systems (OS) as hubs in the wearable ecosystem, there is an urgent need to understand the factors that influence data loss in BLE and develop a mitigation solution to address the data loss issue. In this work, we have systematically evaluated packet losses in Android and iOS based wearable ecosystems and proposed a reduced transmission frequency and data bundling strategy along with queue-based packet transmission protocol to mitigate data packet loss in BLE. The proposed protocol provides flexibility to the peripheral device to work with the host either in real-time mode for timely data transmission or offline mode for accumulated data transmission when there is a request from the host. The test results show that lowered transmission frequency and data bundling reduce the packet losses to less than 1%. The queue-based packet transmission protocol eliminates any remaining packet loss by using re-request routines. The data loss mitigation protocol developed in this research can be widely applied to the BLE-based wearable ecosystem for various applications, such as body sensor networks (BSN), the Internet of Things (IoT), and smart homes.
Collapse
Affiliation(s)
- Vishal Varun Tipparaju
- The Biodesign Institute, Arizona State University, Tempe, AZ 85287, USA; (V.V.T.); (K.R.M.); (D.W.); (F.T.)
| | - Kyle R. Mallires
- The Biodesign Institute, Arizona State University, Tempe, AZ 85287, USA; (V.V.T.); (K.R.M.); (D.W.); (F.T.)
| | - Di Wang
- The Biodesign Institute, Arizona State University, Tempe, AZ 85287, USA; (V.V.T.); (K.R.M.); (D.W.); (F.T.)
| | - Francis Tsow
- The Biodesign Institute, Arizona State University, Tempe, AZ 85287, USA; (V.V.T.); (K.R.M.); (D.W.); (F.T.)
| | - Xiaojun Xian
- The Biodesign Institute, Arizona State University, Tempe, AZ 85287, USA; (V.V.T.); (K.R.M.); (D.W.); (F.T.)
- Department of Electrical Engineering and Computer Science, South Dakota State University, Brookings, SD 57007, USA
- Correspondence:
| |
Collapse
|
36
|
Chalfont G, Mateus C, Varey S, Milligan C. Self-Efficacy of Older People Using Technology to Self-Manage COPD, Hypertension, Heart Failure, or Dementia at Home: An Overview of Systematic Reviews. THE GERONTOLOGIST 2021; 61:e318-e334. [PMID: 32530031 DOI: 10.1093/geront/gnaa045] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Although telehealth research among the general population is voluminous, the quality of studies is low and results are mixed. Little is known specifically concerning older people and their self-efficacy to engage with and benefit from such technologies. This article reviews the evidence for which self-care telehealth technology supports the self-efficacy of older people with long-term conditions (LTCs) living at home. RESEARCH DESIGN AND METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA) guidelines, this overview of systematic reviews focused on four LTCs and the concept of "self-efficacy." Quality was appraised using R-AMSTAR and study evaluation was guided by the PRISMS taxonomy for reporting of self-management support. Heterogeneous data evidencing technology-enhanced self-efficacy were narratively synthesized. RESULTS Five included articles contained 74 primary studies involving 9,004 participants with chronic obstructive pulmonary disease, hypertension, heart failure, or dementia. Evidence for self-care telehealth technology supporting the self-efficacy of older people with LTCs living at home was limited. Self-efficacy was rarely an outcome, also attrition and dropout rates and mediators of support or education. The pathway from telehealth to self-efficacy depended on telehealth modes and techniques promoting healthy lifestyles. Increased self-care and self-monitoring empowered self-efficacy, patient activation, or mastery. DISCUSSION AND IMPLICATIONS Future research needs to focus on the process by which the intervention works and the effects of mediating variables and mechanisms through which self-management is achieved. Self-efficacy, patient activation, and motivation are critical components to telehealth's adoption by the patient and hence to the success of self-care in self-management of LTCs. Their invisibility as outcomes is a limitation.
Collapse
Affiliation(s)
- Garuth Chalfont
- Centre for Ageing Research, Division of Health Research, Faculty of Health and Medicine, Health Innovation 1, Lancaster University, UK
| | - Céu Mateus
- Health Economics, Division of Health Research, Faculty of Health and Medicine, Health Innovation One, Lancaster University, UK
| | - Sandra Varey
- Centre for Ageing Research, Division of Health Research, Faculty of Health and Medicine, Health Innovation 1, Lancaster University, UK
| | - Christine Milligan
- Centre for Ageing Research, Division of Health Research, Faculty of Health and Medicine, Health Innovation 1, Lancaster University, UK
| |
Collapse
|
37
|
Antela A, Rivero A, Llibre JM, Moreno S. Redefining therapeutic success in HIV patients: an expert view. J Antimicrob Chemother 2021; 76:2501-2518. [PMID: 34077524 PMCID: PMC8446931 DOI: 10.1093/jac/dkab168] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Thanks to advances in the field over the years, HIV/AIDS has now become a manageable chronic condition. Nevertheless, a new set of HIV-associated complications has emerged, related in part to the accelerated ageing observed in people living with HIV/AIDS, the cumulative toxicities from exposure to antiretroviral drugs over decades and emerging comorbidities. As a result, HIV/AIDS can still have a negative impact on patients' quality of life (QoL). In this scenario, it is reasonable to believe that the concept of therapeutic success, traditionally associated with CD4 cell count restoration and HIV RNA plasma viral load suppression and the absence of drug resistances, needs to be redefined to include other factors that reach beyond antiretroviral efficacy. With this in mind, a group of experts initiated and coordinated the RET Project, and this group, using the available evidence and their clinical experience in the field, has proposed new criteria to redefine treatment success in HIV, arranged into five main concepts: rapid initiation, efficacy, simplicity, safety, and QoL. An extensive review of the literature was performed for each category, and results were discussed by a total of 32 clinicians with experience in HIV/AIDS (4 coordinators + 28 additional experts). This article summarizes the conclusions of these experts and presents the most updated overview on the five topics, along with a discussion of the experts' main concerns, conclusions and/or recommendations on the most controversial issues.
Collapse
Affiliation(s)
- Antonio Antela
- Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Antonio Rivero
- Hospital Universitario Reina Sofía, Cordoba, Spain
- Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain
| | - Josep M Llibre
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Santiago Moreno
- Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| |
Collapse
|
38
|
Knapp A, Harst L, Hager S, Schmitt J, Scheibe M. Use of Patient-reported Outcome Measures and Patient-reported Experience Measures within Evaluation Studies of Telemedicine Applications: Systematic Review. J Med Internet Res 2021; 23:e30042. [PMID: 34523604 PMCID: PMC8663685 DOI: 10.2196/30042] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/06/2021] [Accepted: 09/12/2021] [Indexed: 01/08/2023] Open
Abstract
Background With the rise of digital health technologies and telemedicine, the need for evidence-based evaluation is growing. Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are recommended as an essential part of the evaluation of telemedicine. For the first time, a systematic review has been conducted to investigate the use of PROMs and PREMs in the evaluation studies of telemedicine covering all application types and medical purposes. Objective This study investigates the following research questions: in which scenarios are PROMs and PREMs collected for evaluation purposes, which PROM and PREM outcome domains have been covered and how often, which outcome measurement instruments have been used and how often, does the selection and quantity of PROMs and PREMs differ between study types and application types, and has the use of PROMs and PREMs changed over time. Methods We conducted a systematic literature search of the MEDLINE and Embase databases and included studies published from inception until April 2, 2020. We included studies evaluating telemedicine with patients as the main users; these studies reported PROMs and PREMs within randomized controlled trials, controlled trials, noncontrolled trials, and feasibility trials in English and German. Results Of the identified 2671 studies, 303 (11.34%) were included; of the 303 studies, 67 (22.1%) were feasibility studies, 70 (23.1%) were noncontrolled trials, 20 (6.6%) were controlled trials, and 146 (48.2%) were randomized controlled trials. Health-related quality of life (n=310; mean 1.02, SD 1.05), emotional function (n=244; mean 0.81, SD 1.18), and adherence (n=103; mean 0.34, SD 0.53) were the most frequently assessed outcome domains. Self-developed PROMs were used in 21.4% (65/303) of the studies, and self-developed PREMs were used in 22.3% (68/303). PROMs (n=884) were assessed more frequently than PREMs (n=234). As the evidence level of the studies increased, the number of PROMs also increased (τ=−0.45), and the number of PREMs decreased (τ=0.35). Since 2000, not only has the number of studies using PROMs and PREMs increased, but the level of evidence and the number of outcome measurement instruments used have also increased, with the number of PREMs permanently remaining at a lower level. Conclusions There have been increasingly more studies, particularly high-evidence studies, which use PROMs and PREMs to evaluate telemedicine. PROMs have been used more frequently than PREMs. With the increasing maturity stage of telemedicine applications and higher evidence level, the use of PROMs increased in line with the recommendations of evaluation guidelines. Health-related quality of life and emotional function were measured in almost all the studies. Simultaneously, health literacy as a precondition for using the application adequately, alongside proper training and guidance, has rarely been reported. Further efforts should be pursued to standardize PROM and PREM collection in evaluation studies of telemedicine.
Collapse
Affiliation(s)
- Andreas Knapp
- Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstrasse 74, Dresden, DE
| | - Lorenz Harst
- Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstrasse 74, Dresden, DE
| | - Stefan Hager
- Comprehensive Pain Center, University Hospital Carl Gustav Carus Dresden, Dresden, Germany, Dresden, DE
| | - Jochen Schmitt
- Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstrasse 74, Dresden, DE
| | - Madlen Scheibe
- Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus and Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstrasse 74, Dresden, DE
| |
Collapse
|
39
|
Smith BM, Sharma R, Das A, Aboumatar H, Pitts SI, Day J, Holzhauer K, Bass E, Bennett WL. Patient and family engagement strategies for children and adolescents with chronic diseases: A review of systematic reviews. PATIENT EDUCATION AND COUNSELING 2021; 104:2213-2223. [PMID: 33678498 DOI: 10.1016/j.pec.2021.02.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 01/14/2021] [Accepted: 02/10/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Patient and family engagement is important for family-centered care, particularly for children and adolescents with chronic disease. We aimed to 1) identify available evidence from systematic reviews on engagement strategies used to help children, adolescents, and their caregivers manage chronic conditions, and 2) identify gaps in the literature. METHODS We searched PubMed and CINAHL from January 2015 to January 2020 for systematic reviews on patient and family engagement strategies in the pediatrics population (<18 years). Strategies were categorized by direct patient care, health system, and community policy levels. We excluded reviews if interventions were unidirectional or without comparison. RESULTS We identified 25 systematic reviews. Twenty-two evaluated direct patient care, with 14 (279 unique studies) exclusively in pediatrics and 8 (24 unique studies) that included pediatric results with adults. Three reviews (9 unique studies) evaluated health system strategies. Direct patient care reviews focused on self-management support (n = 16) and shared decisionmaking (n = 6). Asthma was the most frequently evaluated condition (n = 14). CONCLUSIONS AND PRACTICE IMPLICATIONS Engagement strategies for children and adolescents with chronic disease are focused on direct patient care, particularly for asthma. More research is needed to address engagement for broader populations, expanded outcomes, and at health system and community levels.
Collapse
Affiliation(s)
- Brandon M Smith
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA.
| | - Ritu Sharma
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Asar Das
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Hanan Aboumatar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Samantha I Pitts
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Jeff Day
- Department of Art as Applied to Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Katherine Holzhauer
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Eric Bass
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Wendy L Bennett
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| |
Collapse
|
40
|
van der Kamp M, Reimering Hartgerink P, Driessen J, Thio B, Hermens H, Tabak M. Feasibility, Efficacy, and Efficiency of eHealth-Supported Pediatric Asthma Care: Six-Month Quasi-Experimental Single-Arm Pretest-Posttest Study. JMIR Form Res 2021; 5:e24634. [PMID: 34309568 PMCID: PMC8367169 DOI: 10.2196/24634] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/28/2020] [Accepted: 05/16/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Early detection of loss of asthma control can effectively reduce the burden of the disease. However, broad implementation in clinical practice has not been accomplished so far. We are in need of research investigating the operationalization of eHealth pediatric asthma care in practice, which can provide the most potential benefits in terms of adoption, efficiency, and effectiveness. OBJECTIVE The aim of this study was to investigate the technical and clinical feasibility, including an exploration of the efficacy and cost-efficiency, of an eHealth program implemented in daily clinical pediatric asthma practice. METHODS We designed an eHealth-supported pediatric asthma program facilitating early detection of loss of asthma control while increasing symptom awareness and self-management. In the 6-month program, asthma control was monitored by 4 health care professionals (HCPs) by using objective home measurements and the web-based Puffer app to allow timely medical anticipation and prevent treatment delay. Technical feasibility was assessed by technology use, system usability, and technology acceptance. Clinical feasibility was assessed by participation and patient-reported health and care outcomes and via a focus group with HCPs regarding their experiences of implementing eHealth in daily practice. The efficacy and cost-efficiency were explored by comparing pretest-posttest program differences in asthma outcomes (asthma control, lung function, and therapy adherence) and medical consumption. RESULTS Of 41 children, 35 children with moderate-to-severe asthma volunteered for participation. With regard to technical feasibility, the Puffer app scored a good usability score of 78 on the System Usability Scale and a score of 70 for technology acceptance on a scale of 1 to 100. Approximately 75% (18/24) of the children indicated that eHealth helped them to control their asthma during the program. HCPs indicated that home measurements and real time communication enabled them to make safe and substantiated medical decisions during symptom manifestations. With an average time commitment of 15 minutes by patients, eHealth care led to a 80% gross reduction (from €71,784 to €14,018, US $1=€0.85) in health care utilization, 8.6% increase (from 18.6 to 20.2, P=.40) in asthma control, 25.0% increase (from 2.8 to 3.5, P=.04) in the self-management level, and 20.4% improved (from 71.2 to 76.8, P=.02) therapy adherence. CONCLUSIONS eHealth asthma care seems to be technically and clinically feasible, enables safe remote care, and seems to be beneficial for pediatric asthma care in terms of health outcomes and health care utilization. Follow-up research should focus on targeted effectiveness studies with the lessons learned, while also enabling individualization of eHealth for personalized health care.
Collapse
Affiliation(s)
- Mattienne van der Kamp
- Department of Pediatrics, Medisch Spectrum Twente, Enschede, Netherlands.,Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
| | | | - Jean Driessen
- Department of Pediatrics, Medisch Spectrum Twente, Enschede, Netherlands.,Department of Sports Medicine, Orthopedisch Centrum Oost Nederland, Hengelo, Netherlands
| | - Bernard Thio
- Department of Pediatrics, Medisch Spectrum Twente, Enschede, Netherlands
| | - Hermie Hermens
- Biomedical Signals and Systems, University of Twente, Enschede, Netherlands.,Department of eHealth, Roessingh Research and Development, Enschede, Netherlands
| | - Monique Tabak
- Biomedical Signals and Systems, University of Twente, Enschede, Netherlands.,Department of eHealth, Roessingh Research and Development, Enschede, Netherlands
| |
Collapse
|
41
|
Márquez Fosser S, Mahmoud N, Habib B, Weir DL, Chan F, El Halabieh R, Vachon J, Thakur M, Tran T, Bustillo M, Beauchamp C, Bonnici A, Buckeridge DL, Tamblyn R. Smart about medications (SAM): a digital solution to enhance medication management following hospital discharge. JAMIA Open 2021; 4:ooab037. [PMID: 34159299 PMCID: PMC8211568 DOI: 10.1093/jamiaopen/ooab037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/16/2021] [Accepted: 04/15/2021] [Indexed: 11/21/2022] Open
Abstract
Objective To outline the development of a software solution to improve medication management after hospital discharge, including its design, data sources, intrinsic features, and to evaluate the usability and the perception of use by end-users. Materials and Methods Patients were directly involved in the development using a User Center Design (UCD) approach. We conducted usability interviews prior to hospital discharge, before a user started using the application. A technology acceptance questionnaire was administered to evaluate user self-perception after 2 weeks of use. Results The following features were developed; pill identification, patient-friendly drug information leaflet, side effect checker, and interaction checker, adherence monitoring and alerts, weekly medication schedule, daily pill reminders, messaging service, and patient medication reviews. The usability interviews show a 98.3% total success rate for all features, severity (on a scale of 1–4) 1.4 (SD 0.79). Regarding the self-perception of use (1–7 agreement scale) the 3 highest-rated domains were: (1) perceived ease of use 5.65 (SD 2.02), (2) output quality 5.44 (SD 1.65), and (3) perceived usefulness 5.29 (SD 2.11). Discussion Many medication management apps solutions have been created and most of them have not been properly evaluated. SAM (Smart About Medications) includes the user perspective, integration between a province drug database and the pharmacist workflow in real time. Its features are not limited to maintaining a medication list through manual entry. Conclusion We can conclude after evaluation that the application is usable and has been self-perceived as easy to use by end-users. Future studies are required to assess the health benefits associated with its use.
Collapse
Affiliation(s)
- Santiago Márquez Fosser
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada.,Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Nadar Mahmoud
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada
| | - Bettina Habib
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada
| | - Daniala L Weir
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada
| | - Fiona Chan
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada
| | - Rola El Halabieh
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada
| | - Jeanne Vachon
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada
| | - Manish Thakur
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada
| | - Thai Tran
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada
| | - Melissa Bustillo
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada
| | | | - André Bonnici
- Pharmacy Department, McGill University Health Centre, Montreal, Canada
| | - David L Buckeridge
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada.,Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Robyn Tamblyn
- Clinical and Health Informatics Research Group, Department of Medicine, McGill University, Montreal, Canada.,Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada.,Department of Medicine, McGill University, Montréal, Canada
| |
Collapse
|
42
|
Bailey R, English J, Knee C, Keller A. Treatment Adherence in Integrative Medicine-Part Two: Practitioner Insights. Integr Med (Encinitas) 2021; 20:61-65. [PMID: 34373680 PMCID: PMC8325502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Treatment adherence is a topic that is well studied but not well understood. Low treatment adherence is a significant issue that limits the effective management and treatment of chronic conditions, creating significant health care burden, costs, and poor patient outcomes. This report provides a review of the factors that facilitate or create barriers to treatment adherence, as well as strategies recommended to overcome adherence barriers. A total of 25 interviews were conducted with practitioners demonstrating both high (n = 16) and low (n = 9) treatment adherence rates. A total of 185 survey responses were received from high-treatment adherence rate practitioners (n = 21), low-treatment adherence rate practitioners (n = 83), and practitioners that were neither in the high- or low-treatment adherence rate range (n = 81). Practitioner prescribing behaviors and adherence statistics were determined and stratified by high-treatment adherence rate and low-treatment adherence rate practitioners. From the interviews, 78% of low-rate practitioners mentioned that establishing trust is a primary best practice for optimizing adherence, and for high-rate practitioners, 69% thought that facilitating trust was important to optimizing adherence. Both low-and high-adherence rate practitioners prioritized using a staged approach as a strategy to overcome barriers to adherence. From the total survey sample it was found that key strategies to improving adherence included the practice of booking follow-up appointments, using lab results to explain treatment plans, and using a staged approach for treatment plans. Our research sought to elicit strategies and skills that can help improve treatment adherence in integrative medicine and our findings have identified several common practices that can help to improve adherence. Research taking advantage of mobile devices and the internet for adherence has started to expand within the last 10 to 15 years. Technology has the potential to lead the development and establishment of a centralized database that acquires adherence information and provides solutions to its practitioners and patients. Further work to advance the field of integrative medicine through additional research and interventions that support treatment adherence would be valuable to the effective treatment and management of integrative medicine patients.
Collapse
|
43
|
Gomis-Pastor M, Mirabet Perez S, Roig Minguell E, Brossa Loidi V, Lopez Lopez L, Ros Abarca S, Galvez Tugas E, Mas-Malagarriga N, Mangues Bafalluy MA. Mobile Health to Improve Adherence and Patient Experience in Heart Transplantation Recipients: The mHeart Trial. Healthcare (Basel) 2021; 9:healthcare9040463. [PMID: 33919899 PMCID: PMC8070926 DOI: 10.3390/healthcare9040463] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 11/24/2022] Open
Abstract
Non-adherence after heart transplantation (HTx) is a significant problem. The main objective of this study was to evaluate if a mHealth strategy is more effective than standard care in improving adherence and patients’ experience in heart transplant recipients. Methods: This was a single-center, randomized controlled trial (RCT) in adult recipients >1.5 years post-HTx. Participants were randomized to standard care (control group) or to the mHeart Strategy (intervention group). For patients randomized to the mHeart strategy, multifaceted theory-based interventions were provided during the study period to optimize therapy management using the mHeart mobile application. Patient experience regarding their medication regimens were evaluated in a face-to-face interview. Medication adherence was assessed by performing self-reported questionnaires. A composite adherence score that included the SMAQ questionnaire, the coefficient of variation of drug levels and missing visits was also reported. Results: A total of 134 HTx recipients were randomized (intervention N = 71; control N = 63). Mean follow-up was 1.6 (SD 0.6) years. Improvement in adherence from baseline was significantly higher in the intervention group versus the control group according to the SMAQ questionnaire (85% vs. 46%, OR = 6.7 (2.9; 15.8), p-value < 0.001) and the composite score (51% vs. 23%, OR = 0.3 (0.1; 0.6), p-value = 0.001). Patients’ experiences with their drug therapy including knowledge of their medication timing intakes (p-value = 0.019) and the drug indications or uses that they remembered (p-value = 0.003) significantly improved in the intervention versus the control group. Conclusions: In our study, the mHealth-based strategy significantly improved adherence and patient beliefs regarding their medication regimens among the HTx population. The mHeart mobile application was used as a feasible tool for providing long-term, tailor-made interventions to HTx recipients to improve the goals assessed.
Collapse
Affiliation(s)
- Mar Gomis-Pastor
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, 08025 Barcelona, Catalonia, Spain
- Correspondence: ; Tel.: +34-667411996
| | - Sonia Mirabet Perez
- Cardiology Department, Hospital de la Santa Creu i Santa Pau and CIBER de Enfermedades Cardiovasculares (CIBER-CV), 08041 Barcelona, Catalonia, Spain;
| | - Eulalia Roig Minguell
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Santa Pau, 08041 Barcelona, Catalonia, Spain; (E.R.M.); (V.B.L.); (L.L.L.); (S.R.A.); (E.G.T.)
| | - Vicenç Brossa Loidi
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Santa Pau, 08041 Barcelona, Catalonia, Spain; (E.R.M.); (V.B.L.); (L.L.L.); (S.R.A.); (E.G.T.)
| | - Laura Lopez Lopez
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Santa Pau, 08041 Barcelona, Catalonia, Spain; (E.R.M.); (V.B.L.); (L.L.L.); (S.R.A.); (E.G.T.)
| | - Sandra Ros Abarca
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Santa Pau, 08041 Barcelona, Catalonia, Spain; (E.R.M.); (V.B.L.); (L.L.L.); (S.R.A.); (E.G.T.)
| | - Elisabeth Galvez Tugas
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Santa Pau, 08041 Barcelona, Catalonia, Spain; (E.R.M.); (V.B.L.); (L.L.L.); (S.R.A.); (E.G.T.)
| | - Núria Mas-Malagarriga
- Pharmacy Department, Hospital de la Santa Creu i Santa Pau, 08025 Barcelona, Catalonia, Spain;
| | - Mª Antonia Mangues Bafalluy
- Pharmacy Department, Hospital de la Santa Creu i Santa Pau and CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 08025 Barcelona, Catalonia, Spain;
| |
Collapse
|
44
|
Domhardt M, Schröder A, Geirhos A, Steubl L, Baumeister H. Efficacy of digital health interventions in youth with chronic medical conditions: A meta-analysis. Internet Interv 2021; 24:100373. [PMID: 33732626 PMCID: PMC7941178 DOI: 10.1016/j.invent.2021.100373] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/18/2021] [Accepted: 02/17/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Digital health interventions might extend service provisions for youth with chronic medical conditions (CC) and comorbid mental health symptoms. We aimed to comprehensively evaluate the efficacy of Internet- and mobile-based interventions (IMIs) for different psychological and disease-related outcomes in children and adolescents with CC. METHOD Studies were identified by systematic searches in CENTRAL, Embase, MEDLINE/PubMed and PsycINFO, complemented by searches in reference lists of eligible studies and other reviews. We included studies, when they were randomized controlled trials (RCTs) comparing the efficacy of an IMI to control conditions in improving psychological and disease-related outcomes in youth (mean age ≤ 18 years) with CC. Study selection, data extraction and risk of bias assessment were conducted independently by two reviewers. Meta-analyses were performed within a random-effects model, and Hedges' g (with 95% confidence intervals) was calculated as effect size measure. Primary outcomes were comorbid mental health symptoms (i.e., depression, anxiety and stress), as well as quality of life and self-efficacy. RESULTS A total of 19 randomized controlled trials (2410 patients) were included in this meta-analysis. IMIs were associated with improvements in self-efficacy (g = 0.38; 95% CI, 0.15 to 0.61; I 2 = 0) and combined disease-related outcomes (g = -0.13; 95% CI, -0.25 to -0.01; I 2 = 21). Meta-analyses on other outcomes were non-significant, and some pre-planned analyses were not feasible because of a shortage of studies. CONCLUSION The available evidence on IMIs for improving mental and health-related outcomes in youth with CC is limited. Our findings point to a rather small benefit and limited efficacy. Future research is needed, to comprehensively assess the potential of IMIs to extend collaborative care, and to identify factors contributing to improved user-centered interventions with better treatment outcomes.
Collapse
Affiliation(s)
- Matthias Domhardt
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Germany
| | - Annalena Schröder
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Germany
| | - Agnes Geirhos
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Germany
| | - Lena Steubl
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Germany
| |
Collapse
|
45
|
Bhatia A, Kara J, Janmohamed T, Prabhu A, Lebovic G, Katz J, Clarke H. User Engagement and Clinical Impact of the Manage My Pain App in Patients With Chronic Pain: A Real-World, Multi-site Trial. JMIR Mhealth Uhealth 2021; 9:e26528. [PMID: 33661130 PMCID: PMC7974758 DOI: 10.2196/26528] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/27/2021] [Accepted: 02/14/2021] [Indexed: 12/21/2022] Open
Abstract
Background Chronic pain imposes a large burden on individuals and society. A patient-centric digital chronic pain management app called Manage My Pain (MMP) can be used to enhance communication between providers and patients and promote self-management. Objective The purpose of this study was to evaluate the real-world engagement of patients in urban and rural settings in Ontario, Canada with the MMP app alongside their standard of care and assess the impact of its usage on clinical outcomes of pain and related mental health. Methods A total of 246 participants with chronic pain at a rural and 2 urban pain clinics were recruited into this prospective, open-label, exploratory study that compared the use of MMP, a digital health app for pain that incorporates validated questionnaires and provides patients with summarized reports of their progress in combination with standard care (app group), against data entered on paper-based questionnaires (nonapp group). Participants completed validated questionnaires on anxiety, depression, pain catastrophizing, satisfaction, and daily opioid consumption up to 4.5 months after the initial visit (short-term follow-up) and between 4.5 and 7 months after the initial visit (long-term follow-up). Engagement and clinical outcomes were compared between participants in the two groups. Results A total of 73.6% (181/246) of the participants agreed to use the app, with 63.4% (111/175) of them using it for at least one month. Individuals who used the app rated lower anxiety (reduction in Generalized Anxiety Disorder 7-item questionnaire score by 2.10 points, 95% CI –3.96 to –0.24) at short-term follow-up and had a greater reduction in pain catastrophizing (reduction in Pain Catastrophizing Scale score by 5.23 points, 95% CI –9.55 to –0.91) at long-term follow-up relative to patients with pain who did not engage with the MMP app. Conclusions The use of MMP by patients with chronic pain is associated with engagement and improvements in self-reported anxiety and pain catastrophizing. Further research is required to understand factors that impact continued engagement and clinical outcomes in patients with chronic pain. Trial Registration ClinicalTrials.gov NCT04762329; https://clinicaltrials.gov/ct2/show/NCT04762329
Collapse
Affiliation(s)
- Anuj Bhatia
- Department of Anesthesia and Pain Medicine, University Health Network, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Jamal Kara
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.,Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | | | - Atul Prabhu
- Department of Anesthesia and Pain Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Gerald Lebovic
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Applied Health Research Centre, Unity Health Toronto, Toronto, ON, Canada
| | - Joel Katz
- Department of Anesthesia and Pain Medicine, University Health Network, University of Toronto, Toronto, ON, Canada.,Department of Psychology, York University, Toronto, ON, Canada
| | - Hance Clarke
- Department of Anesthesia and Pain Medicine, University Health Network, University of Toronto, Toronto, ON, Canada.,Transitional Pain Service, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| |
Collapse
|
46
|
Velloza J, Kapogiannis B, Bekker LG, Celum C, Hosek S, Delany-Moretlwe S, Baggaley R, Dalal S. Interventions to improve daily medication use among adolescents and young adults: what can we learn for youth pre-exposure prophylaxis services? AIDS 2021; 35:463-475. [PMID: 33252486 PMCID: PMC7855564 DOI: 10.1097/qad.0000000000002777] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 10/30/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Oral pre-exposure prophylaxis (PrEP) is an important HIV prevention method and studies have shown that young people ages 15-24 have difficulty adhering to daily PrEP. The field of PrEP delivery for young people is relatively nascent and lessons about potential PrEP adherence interventions could be learned from the larger evidence base of adherence interventions for other daily medications among youth. DESIGN Systematic review of adherence support interventions for adolescents. METHODS We searched PubMed, CINAHL, EMBASE, and PsycINFO through January 2020 for oral contraceptive pill (OCP), antiretroviral therapy (ART), asthma, and diabetes medication adherence interventions. We reviewed primary articles about OCP adherence interventions and reviewed systematic reviews for ART, asthma, and diabetes medication adherence interventions. Studies were retained if they included participants' ages 10-24 years; measured OCP, ART, asthma, or diabetes medication adherence; and were systematic reviews, randomized trials, or quasi-experimental studies. RESULTS Fifteen OCP articles and 26 ART, diabetes, and asthma systematic reviews were included. Interventions that improved medication adherence for OCPs, ART, asthma, and diabetes treatment included reminder text messages, computer-based and phone-based support, and enhanced counseling. Multi-month prescriptions and same-day pill starts also were found to improve OCP adherence and continuation. Adolescent-friendly clinics and peer-based counseling significantly improved ART adherence, and telemedicine interventions improved diabetes medication adherence. CONCLUSION Interventions that improve medication adherence among youth include enhanced counseling, extended pill supply, adolescent-friendly services, and text message reminders. PrEP programs could incorporate and evaluate such interventions for their impact on PrEP adherence and continuation among at-risk adolescents.
Collapse
Affiliation(s)
- Jennifer Velloza
- Department of Global Health, University of Washington, Seattle, Washington
| | - Bill Kapogiannis
- Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Connie Celum
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Medicine, University of Washington, Seattle, Washington
| | - Sybil Hosek
- Department of Psychiatry, Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Sinead Delany-Moretlwe
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rachel Baggaley
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Shona Dalal
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| |
Collapse
|
47
|
Kastner M, Makarski J, Hayden L, Hamid JS, Holroyd-Leduc J, Twohig M, Macfarlane C, Hynes MT, Prasaud L, Sklar B, Honsberger J, Wang M, Kramer G, Hobden G, Armson H, Ivers N, Leung FH, Liu B, Marr S, Greiver M, Desroches S, Sibley K, Saunders H, Isaranuwatchai W, McArthur E, Harvey S, Manawadu K, Petricca K, Straus SE. Effectiveness of an eHealth self-management tool for older adults with multimorbidity (KeepWell): protocol for a hybrid effectiveness-implementation randomised controlled trial. BMJ Open 2021; 11:e048350. [PMID: 33597147 PMCID: PMC7893667 DOI: 10.1136/bmjopen-2020-048350] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION In response to the burden of chronic disease among older adults, different chronic disease self-management tools have been created to optimise disease management. However, these seldom consider all aspects of disease management are not usually developed specifically for seniors or created for sustained use and are primarily focused on a single disease. We created an eHealth self-management application called 'KeepWell' that supports seniors with complex care needs in their homes. It incorporates the care for two or more chronic conditions from among the most prevalent high-burden chronic diseases. METHODS AND ANALYSIS We will evaluate the effectiveness, cost and uptake of KeepWell in a 6-month, pragmatic, hybrid effectiveness-implementation randomised controlled trial. Older adults age ≥65 years with one or more chronic conditions who are English speaking are able to consent and have access to a computer or tablet device, internet and an email address will be eligible. All consenting participants will be randomly assigned to KeepWell or control. The allocation sequence will be determined using a random number generator.Primary outcome is perceived self-efficacy at 6 months. Secondary outcomes include quality of life, health background/status, lifestyle (nutrition, physical activity, caffeine, alcohol, smoking and bladder health), social engagement and connections, eHealth literacy; all collected via a Health Risk Questionnaire embedded within KeepWell (intervention) or a survey platform (control). Implementation outcomes will include reach, effectiveness, adoption, fidelity, implementation cost and sustainability. ETHICS AND DISSEMINATION Ethics approval has been received from the North York General Hospital Research and Ethics Board. The study is funded by the Canadian Institutes of Health Research and the Ontario Ministry of Health. We will work with our team to develop a dissemination strategy which will include publications, presentations, plain language summaries and an end-of-grant meeting. TRIAL REGISTRATION NUMBER NCT04437238.
Collapse
Affiliation(s)
- Monika Kastner
- Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
- Research and Innovation, University of Toronto, Toronto, Ontario, Canada
| | - Julie Makarski
- Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Leigh Hayden
- Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Jemila S Hamid
- Department of Mathematics and Statistics, University of Ottawa, Ottawa, Ontario, Canada
| | - Jayna Holroyd-Leduc
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Margo Twohig
- Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Charlie Macfarlane
- Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Mary Trapani Hynes
- Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Leela Prasaud
- Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Barb Sklar
- Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Joan Honsberger
- Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Marilyn Wang
- Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Gloria Kramer
- Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Gerry Hobden
- Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Heather Armson
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Noah Ivers
- Department of Family Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Fok-Han Leung
- Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| | - Barbara Liu
- Geriatric Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sharon Marr
- Division of Geriatric Medicine, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Michelle Greiver
- Department of Family and Community Medicine, North York General Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sophie Desroches
- School of Nutrition, Université Laval, Quebec City, Quebec, Canada
| | - Kathryn Sibley
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Hailey Saunders
- Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| | | | | | - Sarah Harvey
- Healthcare technologies, QoC Health, Toronto, Ontario, Canada
| | - Kithara Manawadu
- Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Kadia Petricca
- Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Sharon E Straus
- Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
48
|
Gomis-Pastor M, Mirabet S, Roig E, Lopez L, Brossa V, Galvez-Tugas E, Rodriguez-Murphy E, Feliu A, Ontiveros G, Garcia-Cuyàs F, Salazar A, Mangues MA. Interdisciplinary Mobile Health Model to Improve Clinical Care After Heart Transplantation: Implementation Strategy Study. JMIR Cardio 2020; 4:e19065. [PMID: 33231557 PMCID: PMC7723747 DOI: 10.2196/19065] [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: 04/02/2020] [Revised: 07/05/2020] [Accepted: 09/16/2020] [Indexed: 12/12/2022] Open
Abstract
Background Solid organ transplantation could be the only life-saving treatment for end-stage heart failure. Nevertheless, multimorbidity and polypharmacy remain major problems after heart transplant. A technology-based behavioral intervention model was established to improve clinical practice in a heart transplant outpatient setting. To support the new strategy, the mHeart app, a mobile health (mHealth) tool, was developed for use by patients and providers. Objective The primary objective of this study was to describe the implementation of the mHeart model and to outline the main facilitators identified when conceiving an mHealth approach. The secondary objectives were to evaluate the barriers, benefits, and willingness to use mHealth services reported by heart transplant recipients and cardiology providers. Methods This was an implementation strategy study directed by a multidisciplinary cardiology team conducted in four stages: design of the model and the software, development of the mHeart tool, interoperability among systems, and quality and security requirements. A mixed methods study design was applied combining a literature review, several surveys, interviews, and focus groups. The approach involved merging engineering and behavioral theory science. Participants were chronic-stage heart transplant recipients, patient associations, health providers, stakeholders, and diverse experts from the legal, data protection, and interoperability fields. Results An interdisciplinary and patient-centered process was applied to obtain a comprehensive care model. The heart transplant recipients (N=135) included in the study confirmed they had access to smartphones (132/135, 97.7%) and were willing to use the mHeart system (132/135, 97.7%). Based on stakeholder agreement (>75%, N=26), the major priorities identified of the mHealth approach were to improve therapy management, patient empowerment, and patient-provider interactions. Stakeholder agreement on the barriers to implementing the system was weak (<75%). Establishing the new model posed several challenges to the multidisciplinary team in charge. The main factors that needed to be overcome were ensuring data confidentiality, reducing workload, minimizing the digital divide, and increasing interoperability. Experts from various fields, scientific societies, and patient associations were essential to meet the quality requirements and the model scalability. Conclusions The mHeart model will be applicable in distinct clinical and research contexts, and may inspire other cardiology health providers to create innovative ways to deal with therapeutic complexity and multimorbidity through health care systems. Professionals and patients are willing to use such innovative mHealth programs. The facilitators and key strategies described were needed for success in the implementation of the new holistic theory–based mHealth strategy.
Collapse
Affiliation(s)
- Mar Gomis-Pastor
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Sonia Mirabet
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Eulalia Roig
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Laura Lopez
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Vicens Brossa
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Elisabeth Galvez-Tugas
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Anna Feliu
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Gerardo Ontiveros
- Information System Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Albert Salazar
- Director Manager, Hospital Universitari Vall Hebron, Barcelona, Spain
| | - M Antonia Mangues
- Pharmacy Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| |
Collapse
|
49
|
Alhodaib HI, Antza C, Chandan JS, Hanif W, Sankaranarayanan S, Paul S, Sutcliffe P, Nirantharakumar K. Mobile Clinical Decision Support System for the Management of Diabetic Patients With Kidney Complications in UK Primary Care Settings: Mixed Methods Feasibility Study. JMIR Diabetes 2020; 5:e19650. [PMID: 33206055 PMCID: PMC7710444 DOI: 10.2196/19650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/03/2020] [Accepted: 10/27/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Attempts to utilize eHealth in diabetes mellitus (DM) management have shown promising outcomes, mostly targeted at patients; however, few solutions have been designed for health care providers. OBJECTIVE The purpose of this study was to conduct a feasibility project developing and evaluating a mobile clinical decision support system (CDSS) tool exclusively for health care providers to manage chronic kidney disease (CKD) in patients with DM. METHODS The design process was based on the 3 key stages of the user-centered design framework. First, an exploratory qualitative study collected the experiences and views of DM specialist nurses regarding the use of mobile apps in clinical practice. Second, a CDSS tool was developed for the management of patients with DM and CKD. Finally, a randomized controlled trial examined the acceptability and impact of the tool. RESULTS We interviewed 15 DM specialist nurses. DM specialist nurses were not currently using eHealth solutions in their clinical practice, while most nurses were not even aware of existing medical apps. However, they appreciated the potential benefits that apps may bring to their clinical practice. Taking into consideration the needs and preferences of end users, a new mobile CDSS app, "Diabetes & CKD," was developed based on guidelines. We recruited 39 junior foundation year 1 doctors (44% male) to evaluate the app. Of them, 44% (17/39) were allocated to the intervention group, and 56% (22/39) were allocated to the control group. There was no significant difference in scores (maximum score=13) assessing the management decisions between the app and paper-based version of the app's algorithm (intervention group: mean 7.24 points, SD 2.46 points; control group: mean 7.39, SD 2.56; t37=-0.19, P=.85). However, 82% (14/17) of the participants were satisfied with using the app. CONCLUSIONS The findings will guide the design of future CDSS apps for the management of DM, aiming to help health care providers with a personalized approach depending on patients' comorbidities, specifically CKD, in accordance with guidelines.
Collapse
Affiliation(s)
- Hala Ibrahim Alhodaib
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.,Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Christina Antza
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
| | - Joht Singh Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Wasim Hanif
- Diabetes Centre, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Sailesh Sankaranarayanan
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism Centre, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Sunjay Paul
- The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - Paul Sutcliffe
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom.,Health Data Research UK, Birmingham, United Kingdom
| |
Collapse
|
50
|
Beauchamp UL, Pappot H, Holländer-Mieritz C. The Use of Wearables in Clinical Trials During Cancer Treatment: Systematic Review. JMIR Mhealth Uhealth 2020; 8:e22006. [PMID: 33174852 PMCID: PMC7688381 DOI: 10.2196/22006] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 12/17/2022] Open
Abstract
Background Interest in the use of wearables in medical care is increasing. Wearables can be used to monitor different variables, such as vital signs and physical activity. A crucial point for using wearables in oncology is if patients already under the burden of severe disease and oncological treatment can accept and adhere to the device. At present, there are no specific recommendations for the use of wearables in oncology, and little research has examined the purpose of using wearables in oncology. Objective The purpose of this review is to explore the use of wearables in clinical trials during cancer treatment, with a special focus on adherence. Methods PubMed and EMBASE databases were searched prior and up to October 3, 2019, with no limitation in the date of publication. The search strategy was aimed at studies using wearables for monitoring adult patients with cancer during active antineoplastic treatment. Studies were screened independently by 2 reviewers by title and abstract, selected for inclusion and exclusion, and the full-text was assessed for eligibility. Data on study design, type of wearable used, primary outcome, adherence, and device outcome were extracted. Results were presented descriptively. Results Our systematic search identified 1269 studies, of which 25 studies met our inclusion criteria. The types of cancer represented in the studies were breast (7/25), gastrointestinal (4/25), lung (4/25), and gynecologic (1/25); 9 studies had multiple types of cancer. Oncologic treatment was primarily chemotherapy (17/25). The study-type distribution was pilot/feasibility study (12/25), observational study (10/25), and randomized controlled trial (3/25). The median sample size was 40 patients (range 7-180). All studies used a wearable with an accelerometer. Adherence varied across studies, from 60%-100% for patients wearing the wearable/evaluable sensor data and 45%-94% for evaluable days, but was differently measured and reported. Of the 25 studies, the most frequent duration for planned monitoring with a wearable was 8-30 days (13/25). Topics for wearable outcomes were physical activity (19/25), circadian rhythm (8/25), sleep (6/25), and skin temperature (1/25). Patient-reported outcomes (PRO) were used in 17 studies; of the 17 PRO studies, only 9 studies reported correlations between the wearable outcome and the PRO. Conclusions We found that definitions of outcome measures and adherence varied across studies, and limited consensus among studies existed on which variables to monitor during treatment.
Less heterogeneity, better consensus in terms of the use of wearables, and established standards for the definitions of wearable outcomes and adherence would improve comparisons of outcomes from studies using wearables. Adherence, and the definition of such, seems crucial to conclude on data from wearable studies in oncology. Additionally, research using advanced wearable devices and active use of the data are encouraged to further explore the potential of wearables in oncology during treatment. Particularly, randomized clinical studies are warranted to create consensus on when and how to implement in oncological practice.
Collapse
Affiliation(s)
| | - Helle Pappot
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Faculty of Health, University of Copenhagen, Copenhagen, Denmark
| | | |
Collapse
|