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Ferreira VR, Brayne C, Ragonese P, Ketzoian C, Piccioli M, Tinti L, Casali C, di Lorenzo C, Ramos C, Azevedo J, Gomes A, Stewart R, Haas H, Hoppenbrouwer S, Metting E, Gallo V. A Delphi consensus to identify the key screening tests/questions for a digital neurological examination for epidemiological research. J Neurol 2024; 271:2694-2703. [PMID: 38378908 PMCID: PMC11055750 DOI: 10.1007/s00415-024-12254-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/06/2024] [Accepted: 02/11/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Most neurological diseases have no curative treatment; therefore, focusing on prevention is key. Continuous research to uncover the protective and risk factors associated with different neurological diseases is crucial to successfully inform prevention strategies. eHealth has been showing promising advantages in healthcare and public health and may therefore be relevant to facilitate epidemiological studies. OBJECTIVE In this study, we performed a Delphi consensus exercise to identify the key screening tests to inform the development of a digital neurological examination tool for epidemiological research. METHODS Twelve panellists (six experts in neurological examination, five experts in data collection-two were also experts in the neurological examination, and three experts in participant experience) of different nationalities joined the Delphi exercise. Experts in the neurological examination provided a selection of items that allow ruling out neurological impairment and can be performed by trained health workers. The items were then rated by them and other experts in terms of their feasibility and acceptability. RESULTS Ten tests and seven anamnestic questions were included in the final set of screening items for the digital neurological examination. Three tests and five anamnestic questions were excluded from the final selection due to their low ratings on feasibility. CONCLUSION This work identifies the key feasible and acceptable screening tests and anamnestic questions to build an electronic tool for performing the neurological examination, in the absence of a neurologist.
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Affiliation(s)
- Vasco Ribeiro Ferreira
- Department of Sustainable Health, University of Groningen, Campus Fryslân, Wirdumerdijk 34, 8911 CE, Leeuwarden, The Netherlands.
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Paolo Ragonese
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University of Palermo, Palermo, Italy
| | - Carlos Ketzoian
- Institute of Neurology, School of Medicine, Neuroepidemiology Section, University of the Republic, Montevideo, Uruguay
| | - Marta Piccioli
- UOC of Neurology, PO San Filippo Neri, ASL Roma 1, Rome, Italy
| | - Lorenzo Tinti
- Laboratory of Neurology, Mario Negri Institute for Pharmacological Research (IRCCS), Milan, Italy
| | - Carlo Casali
- Department of Medico-Surgical Sciences and Biotechnologies (SBMC), University Rome Sapienza, Rome, Italy
| | - Cherubino di Lorenzo
- Department of Medico-Surgical Sciences and Biotechnologies (SBMC), University Rome Sapienza, Rome, Italy
| | - Claudia Ramos
- Grupo de Neurociencias de Antioquia (GNA), Faculty of Medicine, University of Antioquia, Medellín, Colombia
- Grupo de Neuropsicología y Conducta (GRUNECO), Faculty of Medicine, University of Antioquia, Medellín, Colombia
| | - João Azevedo
- Agrupamento de Centros de Saúde de Gaia, Unidade de Saúde Familiar Nova Salus, Vila Nova de Gaia, Portugal
| | | | | | - Hein Haas
- Parkinson Vereniging, Bunnik, The Netherlands
| | | | - Esther Metting
- University Medical Center Groningen, Groningen, The Netherlands
- Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
| | - Valentina Gallo
- Department of Sustainable Health, University of Groningen, Campus Fryslân, Wirdumerdijk 34, 8911 CE, Leeuwarden, The Netherlands
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Leung KY, Metting E, Ebbers W, Veldhuijzen I, Andeweg SP, Luijben G, de Bruin M, Wallinga J, Klinkenberg D. Effectiveness of a COVID-19 contact tracing app in a simulation model with indirect and informal contact tracing. Epidemics 2024; 46:100735. [PMID: 38128242 DOI: 10.1016/j.epidem.2023.100735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 11/17/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023] Open
Abstract
During the COVID-19 pandemic, contact tracing was used to identify individuals who had been in contact with a confirmed case so that these contacted individuals could be tested and quarantined to prevent further spread of the SARS-CoV-2 virus. Many countries developed mobile apps to find these contacted individuals faster. We evaluate the epidemiological effectiveness of the Dutch app CoronaMelder, where we measure effectiveness as the reduction of the reproduction number R. To this end, we use a simulation model of SARS-CoV-2 spread and contact tracing, informed by data collected during the study period (December 2020 - March 2021) in the Netherlands. We show that the tracing app caused a clear but small reduction of the reproduction number, and the magnitude of the effect was found to be robust in sensitivity analyses. The app could have been more effective if more people had used it, and if notification of contacts could have been done directly by the user and thus reducing the time intervals between symptom onset and reporting of contacts. The model has two innovative aspects: i) it accounts for the clustered nature of social networks and ii) cases can alert their contacts informally without involvement of health authorities or the tracing app.
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Affiliation(s)
- Ka Yin Leung
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, the Netherlands.
| | - Esther Metting
- University of Groningen, University Medical Center Groningen, Data Science Center in Health, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Primary Care, the Netherlands; University of Groningen, faculty of Economics and Business, Department of Operations, the Netherlands
| | - Wolfgang Ebbers
- Erasmus School of Social and Behavioural Sciences, Department of Public Administration and Sociology, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Irene Veldhuijzen
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, the Netherlands
| | - Stijn P Andeweg
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, the Netherlands
| | - Guus Luijben
- National Institute for Public Health and the Environment, Centre for Health and Society, Bilthoven, the Netherlands
| | - Marijn de Bruin
- National Institute for Public Health and the Environment, Centre for Health and Society, Bilthoven, the Netherlands; Radboud University Medical Centre, Radboud Institute of Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
| | - Jacco Wallinga
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, the Netherlands; Leiden University Medical Centre, Department of Biomedical Datasciences, Leiden, the Netherlands
| | - Don Klinkenberg
- National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, the Netherlands
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Ferreira VR, Metting E, Schauble J, Seddighi H, Beumeler L, Gallo V. eHealth tools to assess the neurological function for research, in absence of the neurologist - a systematic review, part I (software). J Neurol 2024; 271:211-230. [PMID: 37847293 PMCID: PMC10770248 DOI: 10.1007/s00415-023-12012-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/15/2023] [Accepted: 09/16/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Neurological disorders remain a worldwide concern due to their increasing prevalence and mortality, combined with the lack of available treatment, in most cases. Exploring protective and risk factors associated with the development of neurological disorders will allow for improving prevention strategies. However, ascertaining neurological outcomes in population-based studies can be both complex and costly. The application of eHealth tools in research may contribute to lowering the costs and increase accessibility. The aim of this systematic review is to map existing eHealth tools assessing neurological signs and/or symptoms for epidemiological research. METHODS Four search engines (PubMed, Web of Science, Scopus & EBSCOHost) were used to retrieve articles on the development, validation, or implementation of eHealth tools to assess neurological signs and/or symptoms. The clinical and technical properties of the software tools were summarised. Due to high numbers, only software tools are presented here. FINDINGS A total of 42 tools were retrieved. These captured signs and/or symptoms belonging to four neurological domains: cognitive function, motor function, cranial nerves, and gait and coordination. An additional fifth category of composite tools was added. Most of the tools were available in English and were developed for smartphone device, with the remaining tools being available as web-based platforms. Less than half of the captured tools were fully validated, and only approximately half were still active at the time of data collection. INTERPRETATION The identified tools often presented limitations either due to language barriers or lack of proper validation. Maintenance and durability of most tools were low. The present mapping exercise offers a detailed guide for epidemiologists to identify the most appropriate eHealth tool for their research. FUNDING The current study was funded by a PhD position at the University of Groningen. No additional funding was acquired.
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Affiliation(s)
- Vasco Ribeiro Ferreira
- Department of Sustainable Health, University of Groningen, Campus Fryslân, Wirdumerdijk 34, 8911 CE, Leeuwarden, The Netherlands.
| | - Esther Metting
- Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
- University Medical College Groningen, Groningen, The Netherlands
| | - Joshua Schauble
- Department of Knowledge Infrastructure, University of Groningen, Campus Fryslân, Leeuwarden, The Netherlands
| | - Hamed Seddighi
- Department of Sustainable Health, University of Groningen, Campus Fryslân, Wirdumerdijk 34, 8911 CE, Leeuwarden, The Netherlands
- Department of Psychology, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Lise Beumeler
- Department of Sustainable Health, University of Groningen, Campus Fryslân, Wirdumerdijk 34, 8911 CE, Leeuwarden, The Netherlands
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Valentina Gallo
- Department of Sustainable Health, University of Groningen, Campus Fryslân, Wirdumerdijk 34, 8911 CE, Leeuwarden, The Netherlands
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Noort BAC, van der Vaart T, van der Maten J, Metting E, Ahaus K. Intensive out-of-hospital coaching for frequently hospitalized COPD patients: a before-after feasibility study. Front Med (Lausanne) 2023; 10:1195481. [PMID: 37915323 PMCID: PMC10616861 DOI: 10.3389/fmed.2023.1195481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/02/2023] [Indexed: 11/03/2023] Open
Abstract
Background This study assesses whether out-of-hospital coaching of re-hospitalized, severe COPD patients by specialized respiratory nurses is feasible in terms of cost-effectiveness, implementation, and recipient acceptability. The coaching was aimed at improving patients' health management abilities, motivation for healthy behavior, strengthening the professional and informal care network, stimulating physiotherapy treatment and exercise training, improving knowledge on symptom recognition and medication use, and providing safety and support. Methods Cost-effectiveness of 6 months of out-of-hospital coaching was assessed based on a before-after intervention design, with real-life data and one-year follow-up. A total of 170 patients were included. Primary (questionnaires, meeting reports) and secondary data (insurance reimbursement data) were collected in one province in the Netherlands. The implementing and recipient acceptability was assessed based on the number of successfully delivered coaching sessions, questionnaire response rate, Patient Reported Experience Measure, and interviews with coaches. Results Post-intervention, the COPD-related hospitalization rate was reduced by 24%, and patients improved in terms of health status, anxiety, and nutritional status. Patients with a high mental burden and a poor score for health impairment and wellbeing at the start of the intervention showed the greatest reduction in hospitalizations. The coaching service was successfully implemented and considered acceptable by recipients, based on patient and coach satisfaction and clinical use of patient-reported measures. Conclusion The study demonstrates the value of coaching patients out-of-hospital, with a strong link to primary care, but with support of hospital expertise, thereby adding to previous studies on disease- or self-management support in either primary or secondary care settings. Patients benefit from personal attention, practical advice, exercise training, and motivational meetings, thereby improving health status and reducing the likelihood of re-hospitalization and its associated costs.
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Affiliation(s)
- Bart A. C. Noort
- Department of Operations, Faculty of Economics and Business, University of Groningen, Groningen, Netherlands
| | - Taco van der Vaart
- Department of Operations, Faculty of Economics and Business, University of Groningen, Groningen, Netherlands
| | - Jan van der Maten
- Department of Pulmonology, Medical Center Leeuwarden, Leeuwarden, Netherlands
| | - Esther Metting
- Department of Operations, Faculty of Economics and Business, University of Groningen, Groningen, Netherlands
- Data Science Center in Health, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Primary and Elderly Care, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Kees Ahaus
- Health Services Management and Organisation, School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
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Metting E, van Luenen S, Baron AJ, Tran A, van Duinhoven S, Chavannes NH, Hevink M, Lüers J, Kocks J. Overcoming the Digital Divide for Older Patients With Respiratory Disease: Focus Group Study. JMIR Form Res 2023; 7:e44028. [PMID: 37788072 PMCID: PMC10582815 DOI: 10.2196/44028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND The need for and adoption of eHealth programs are growing worldwide. However, access can be limited among patients with low socioeconomic backgrounds, often resulting in a so-called "digital divide" due to a mismatch between eHealth and target populations that can gain benefit. This digital divide can result in unsuccessful eHealth implementations, which is of critical importance to health care. OBJECTIVE This study evaluated the opinions of elderly patients with asthma and chronic obstructive pulmonary disease (COPD) about an existing pharmacy-based personalized patient web portal that provides medication overview and information on associated diagnoses. The aim was to obtain insights on the common barriers of elderly people when using health-related websites, which can help to improve accessibility. METHODS This was a cross-sectional qualitative study of a patient panel of the Groningen Research Institute for Asthma and COPD in primary care. Participants were required to be older than 55 years, be Dutch speaking, have no prior experience with the study website, and be diagnosed with a chronic respiratory illness. Two focus groups were created, and they completed a 45-minute session for testing the website and a 120-minute session for semistructured interviews. The focus group sessions were recorded, transcribed verbatim, and analyzed by content analysis. RESULTS We enrolled 11 patients (9 women) with a mean age of 66 (SD 9) years. Of these, 5 had asthma, 3 had COPD, 2 had asthma-COPD overlap syndrome, and 1 had bronchiectasis. Participants were generally positive about the website, especially the areas providing disease-related information and the medication overview. They appreciated that the website would enable them to share this information with other health care providers. However, some difficulties were reported with navigation, such as opening a new tab, and others reported that the layout of the website was difficult either because of visual impairments or problems with navigation. It was also felt that monitoring would only be relevant if it is also checked by health care professionals as part of a treatment plan. Participants mentioned few privacy or safety concerns. CONCLUSIONS It is feasible to develop websites for elderly patients; however, developers must take the specific needs and limitations of elderly people into account (eg, navigation problems, poor vision, or poor hand-eye coordination). The provision of information appears to be the most important aspect of the website, and as such, we should endeavor to ensure that the layout and navigation remain basic and accessible. Patients are only motivated to use self-management applications if they are an integrated part of their treatment. The usability of the website can be improved by including older people during development and by implementing design features that can improve accessibility in this group.
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Affiliation(s)
- Esther Metting
- Data Science Center in Health, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Primary and Elderly Care, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Operations, Faculty of Economics and Business, University of Groningen, Groningen, Netherlands
| | - Sanne van Luenen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Anna-Jetske Baron
- Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Anthony Tran
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | | | | | - Maud Hevink
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, Netherlands
| | - Jos Lüers
- Farmacologica, Nictiz, Groningen, Netherlands
| | - Janwillem Kocks
- Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- General Practitioners Research Institute, University of Groningen, Groningen, Netherlands
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Department of Pulmonology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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van Boxtel J, Wessels N, Ruiter E, Loohuis A, Metting E, van der Worp H, Blanker M. Perspective of Dutch healthcare professionals on care for female urinary incontinence: a mixed-methods study. Br J Gen Pract 2023; 73:bjgp23X734277. [PMID: 37479314 DOI: 10.3399/bjgp23x734277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Urinary incontinence (UI) impacts patients and society in many ways. There are good treatment options, but healthcare delivery and processes are often suboptimal. AIM Healthcare professionals (HCPs) can reveal practical recommendations to improve processes and address challenges in the care of women with UI in the Netherlands. METHOD We conducted an exploratory, sequential, mixed-methods study among HCPs, using outcomes of five focus group sessions (30 HCPs) to inform a subsequent survey. HCPs included GPs, practice assistants (PAs), pelvic physiotherapists (PPTs), and urologists and gynecologists (UGs). RESULTS Main themes arising from the five focus group sessions (with six GPs, seven PAs, six (resident) UGs, eight PPTs, and seven PPTs) were 'identification of UI', 'current state of care', and 'guiding patients through the healthcare system'. Survey responders (n = 741) included 351 PAs, 124 GPs, 75 PPTs, and 183 UGs. Overall, 72.8% (strongly) agreed that the identification of UI required improvement and 60% confirmed the need for further education. Most HCPs (83.1%) found it useful to offer a patient information leaflet when buying incontinence products but less useful to ask about UI routinely, and most (75%) agreed that a multidisciplinary guideline could improve health care. Interestingly, 86% of PPTs and 21% of UGs advocated referral to a PPT before referral to a specialist, while 87% of PPTs wanted primary care services to offer a UI consultation hour and 36% of the GPs (strongly) disagreed. CONCLUSION Poor UI identification in primary care and a lack of patient guidance through the healthcare system hamper continence care provision.
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Affiliation(s)
- Jorke van Boxtel
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen
| | - Nienke Wessels
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen
| | - Eline Ruiter
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen
| | - Anne Loohuis
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen
| | - Esther Metting
- University medical center Groningen, university of Groningen, the Netherlands
| | - Henk van der Worp
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen
| | - Marco Blanker
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen
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Wessels N, Ruiter E, Hulshof L, Loohuis A, van Gemert-Pijnen J, Metting E, van der Worp H, Blanker M. Care provider views on app-based treatment for female urinary incontinence: a mixed-methods study. Br J Gen Pract 2023; 73:bjgp23X734265. [PMID: 37479256 DOI: 10.3399/bjgp23x734265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND App-based treatment for female urinary incontinence (UI) is a cost-effective alternative to care as usual. For successful implementation it is of major importance to involve stakeholders like care providers. AIM To explore the views and preferences of care providers on app use for the treatment of UI and to identify the anticipated barriers to, and facilitators of, implementation. METHOD We performed an exploratory, two-phase, sequential mixed-methods study. In phase 1, the views of care providers were explored through five focus group sessions with care providers involved in UI: GPs, practice assistants (PAs), pelvic physical therapists (PPTs), and (uro)gynecologists (UGs). In phase 2, the identified themes and subthemes were quantified in an online survey distributed among different care providers matching these groups. RESULTS In the focus group sessions, 30 female and two male care providers participated. Survey participants included 351 PAs and 76 PPTs (all female) next to 124 GPs and 183 UGs (70% female). Caregivers generally considered UI treatment apps as having a supportive role, being less convinced about their advantages in the absence of a care provider. Additionally, they required that the effectiveness of an app should be proven first, and that privacy and safety should be ensured. Contrasting with other research, lack of time and financial compensation were not considered important barriers to implementation. CONCLUSION Our results add to the existing knowledge about eHealth-related barriers and facilitators. These findings can be used to optimise implementation strategies for other apps and to enhance the uptake of app-based treatment for UI in the Netherlands.
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Affiliation(s)
- Nienke Wessels
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen
| | - Eline Ruiter
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen
| | - Lisa Hulshof
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen
| | - Anne Loohuis
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen
| | | | - Esther Metting
- University medical center Groningen, university of Groningen, the Netherlands
| | - Henk van der Worp
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen
| | - Marco Blanker
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen
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Ferreira VR, Seddighi H, Beumeler L, Metting E, Gallo V. eHealth tools to assess neurological function: a systematic review protocol for a mapping exercise. BMJ Open 2022; 12:e062691. [PMID: 36167388 PMCID: PMC9516209 DOI: 10.1136/bmjopen-2022-062691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Population-based epidemiological studies investigating risk/protective factors are outlining prevention strategies for neurological conditions that often do not have effective treatment. However, ascertaining neurological outcomes can be a time consuming and expensive process, often requiring specialised personnel and/or equipment. Thus, collecting neurological data on a large scale has been an ongoing challenge for clinicians and researchers alike. The development of new technology and the emergence of several opportunities to adapt it to the health research and practice (eHealth) can be a promising solution to this problem. Several neurological eHealth tools have been developed, with many others being currently planned. METHODS AND ANALYSIS We propose a systematic review mapping the available eHealth tools for assessing the different aspects of neurological function. The search aims at identifying studies published in peer-reviewed journals, which focused on the development or implementation of eHealth for assessing neurological signs or symptoms. Four engine databases are being considered (PubMed, EBSCOhost, Web of Science and Scopus), and data extraction will follow a process aimed at classifying them by their characteristics and purposes. ETHICS AND DISSEMINATION This mapping exercise will be made available to researchers in order to aid them in successfully ascertaining neurological outcomes in large population-based epidemiological studies. Given the nature of this study, no ethical clearance was needed to conduct the review.
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Affiliation(s)
- Vasco Ribeiro Ferreira
- Sustainable Health Department, Campus Fryslân, University of Groningen, Leeuwarden, The Netherlands
| | - Hamed Seddighi
- Sustainable Health Department, Campus Fryslân, University of Groningen, Leeuwarden, The Netherlands
- Social Welfare Management Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Lise Beumeler
- Sustainable Health Department, Campus Fryslân, University of Groningen, Leeuwarden, The Netherlands
| | - Esther Metting
- Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
- Faculty of Medical Sciences, University Medical Center Groningen, Groningen, The Netherlands
| | - Valentina Gallo
- Sustainable Health Department, Campus Fryslân, University of Groningen, Leeuwarden, The Netherlands
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van de Vijver S, Hummel D, van Dijk AH, Cox J, van Dijk O, Van den Broek N, Metting E. Evaluation of a Digital Self-management Platform for Patients With Chronic Illness in Primary Care: Qualitative Study of Stakeholders' Perspectives. JMIR Form Res 2022; 6:e38424. [PMID: 35921145 PMCID: PMC9386583 DOI: 10.2196/38424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/27/2022] [Accepted: 05/29/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Population aging and multimorbidity has led to increasing chronic care needs associated with new challenges in managing growing costs, rising health care professional workloads, and the adoption of rigorous guidelines. These issues could all benefit from greater digitalization and a more patient-centered approach to chronic care, a situation brought to the fore by the COVID-19 pandemic. Little is known about real-life use in primary care. OBJECTIVE This study aimed to explore the views, thoughts, usability, and experiences concerning a recently introduced digital self-care platform for chronic conditions in 3 Dutch primary care practices. METHODS We conducted an explorative study combining questionnaires and interviews among patients and general practitioners from 3 general practices that used the digital platform. Questionnaires were sent to patients in each practice to seek the views and experiences of both patient nonusers (n=20) and patient users (n=58) of the platform, together with standardized questionnaires about illness perception and quality of life. In addition, patients (n=15) and general practitioners (n=4) who used the platform took part in semistructured interviews. We transcribed interviews verbatim and performed qualitative content analysis using a deductive approach. The results of the questionnaires were analyzed with descriptive analysis. RESULTS Among patients who had not actively used the platform but had received an explanation, only 35% (7/20) would recommend its use due to concerns over communication and handling. However, this percentage increased to 76.3% (45/59) among the people who actively used the platform. Interviews with patients and general practitioners who used the platform uncovered several key benefits, including reduced time requirements, reduced workload, improved care quality, and improved accessibility due to the greater patient-centeredness and use of different communication tools. In addition, the self-management tool led to greater patient autonomy and empowerment. Although users considered the platform feasible, usable, and easy to use, some technical issues remained and some patients expressed concerns about the reduction in human contact and feedback. CONCLUSIONS The overall experience and usability of the platform was good. Support for the online self-management platform for chronic care increased when patients actively used the tool and could experience or identify important advantages. However, patients still noted several areas for improvement that need to be tackled in future iterations. To ensure benefit in the wider population, we must also evaluate this platform in cohorts with lower digital and health literacy.
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Affiliation(s)
- Steven van de Vijver
- Amsterdam Health & Technology Institute, Amsterdam University Medical Center, Amsterdam, Netherlands
- Family Medicine Department, OLVG, Amsterdam, Netherlands
| | - Deirdre Hummel
- Faculty of Economics and Business, University of Groningen, Groningen, Netherlands
| | | | - Jan Cox
- Medicine Men, Utrecht, Netherlands
| | | | - Nicoline Van den Broek
- Department of General Practice and Elderly Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Esther Metting
- Faculty of Economics and Business, University of Groningen, Groningen, Netherlands
- Department of General Practice and Elderly Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Data Science Center in Health, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Metting E, Dassen L, Aardoom J, Versluis A, Chavannes N. Effectiveness of Telemonitoring for Respiratory and Systemic Symptoms of Asthma and COPD: A Narrative Review. Life (Basel) 2021; 11:1215. [PMID: 34833091 PMCID: PMC8624095 DOI: 10.3390/life11111215] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/20/2021] [Accepted: 10/28/2021] [Indexed: 12/25/2022] Open
Abstract
Asthma and chronic obstructive pulmonary diseases (COPD) are highly prevalent chronic lung diseases that require ongoing self-management, which itself is often suboptimal. Therefore, telemonitoring has been used to help patients measure their symptoms, share data with healthcare providers and receive education and feedback to improve disease management. In this study, we conducted a narrative review of recent evidence on the effectiveness of telemonitoring for asthma and COPD in adults. Of the thirteen identified studies, eleven focused on COPD and two focused on asthma. All studies were reviewed, and effects were compared between intervention and care as usual groups. Of the study interventions, seven showed a positive outcome on at least one outcome measure, and six had no significant results on any of the outcome measures. All of the interventions with a positive outcome included an educational component, while only one of the six interventions without positive outcomes included an educational component. We conclude that telemonitoring interventions for asthma and COPD seem more effective if they included an educational component regarding different aspects of self-management.
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Affiliation(s)
- Esther Metting
- Data Science Center in Health, University of Groningen, University Medical Center Groningen, 9713 BZ Groningen, The Netherlands
- Department of Operations, Faculty of Economics and Business, University of Groningen, 9724 AV Groningen, The Netherlands;
- National eHealth Living Lab, Medical Center, Leiden University, 2233 ZD Leiden, The Netherlands; (J.A.); (A.V.); (N.C.)
| | - Lizayra Dassen
- Department of Operations, Faculty of Economics and Business, University of Groningen, 9724 AV Groningen, The Netherlands;
| | - Jiska Aardoom
- National eHealth Living Lab, Medical Center, Leiden University, 2233 ZD Leiden, The Netherlands; (J.A.); (A.V.); (N.C.)
- Public Health and Primary Care, Medical Center, Leiden University, 2233 ZD Leiden, The Netherlands
| | - Anke Versluis
- National eHealth Living Lab, Medical Center, Leiden University, 2233 ZD Leiden, The Netherlands; (J.A.); (A.V.); (N.C.)
- Public Health and Primary Care, Medical Center, Leiden University, 2233 ZD Leiden, The Netherlands
| | - Niels Chavannes
- National eHealth Living Lab, Medical Center, Leiden University, 2233 ZD Leiden, The Netherlands; (J.A.); (A.V.); (N.C.)
- Public Health and Primary Care, Medical Center, Leiden University, 2233 ZD Leiden, The Netherlands
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Mariani S, Metting E, Lahr MMH, Vargiu E, Zambonelli F. Developing an ML pipeline for asthma and COPD: The case of a Dutch primary care service. INT J INTELL SYST 2021. [DOI: 10.1002/int.22568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Stefano Mariani
- Department of Sciences and Methods for Engineering University of Modena and Reggio Emilia Reggio Emilia Italy
| | - Esther Metting
- Health Technology Assessment, Department of Epidemiology, University of Groningen University Medical Center Groningen The Netherlands
| | - Maarten M. H. Lahr
- Health Technology Assessment, Department of Epidemiology, University of Groningen University Medical Center Groningen The Netherlands
| | - Eloisa Vargiu
- EURECAT Technology Centre Digital Health Unit Barcelona Spain
| | - Franco Zambonelli
- Department of Sciences and Methods for Engineering University of Modena and Reggio Emilia Reggio Emilia Italy
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Janknegt R, Kooistra J, Metting E, Dekhuijzen R. Rational selection of inhalation devices in the treatment of chronic obstructive pulmonary disease by means of the System of Objectified Judgement Analysis (SOJA). Eur J Hosp Pharm 2020; 28:e4. [PMID: 32920532 DOI: 10.1136/ejhpharm-2020-002229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/17/2020] [Accepted: 06/30/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The large number of available medicines and devices makes it almost impossible to have sufficient knowledge of each individual medicine and device, especially for general practitioners. This may lead to suboptimal treatment, more exacerbations, hospitalisations and higher treatment costs. Reducing the number of medicines and devices, based on rational criteria, allows physicians and pharmacists to build experience with a more limited set of medicines and to standardise the inhalation instructions. METHODS In this study inhalers are compared by means of the System of Objectified Judgement Analysis (SOJA) method. The following selection criteria were applied: uniformity in device, number of steps per inhalation, risk of errors, hygienic aspects, feedback mechanism, and risk of inhalation with an empty inhaler. RESULTS Substantial differences were seen in the overall scores, with the Ellipta device showing the highest score, followed by Diskus/Accuhaler, Genuair and Nexthaler. Several devices require more or less identical techniques, such Ellipta and Diskus/Accuhaler as well as Genuair and Novolizer. When patients use these devices in combination this increases their uniformity, because additional medicines become available for the devices: starting therapy with Diskus or Novolizer and follow-up with Ellipta or Genuair. The resistance of Respimat and Breezhaler is lower than that of other devices, which makes these devices suitable for patients who cannot generate sufficient inhalation flow. CONCLUSIONS A substantial reduction of inhalers, combined with optimal and standardised instructions, should improve the care of patients with chronic obstructive pulmonary disease.
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Affiliation(s)
- Robert Janknegt
- Zuyderland Medical Centre Sittard-Geleen, Sittard-Geleen, Netherlands
| | | | - Esther Metting
- Groningen University Department of Health Sciences, Groningen, Groningen, Netherlands
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Metting E, Schrage AJ, Kocks JW, Sanderman R, van der Molen T. Assessing the Needs and Perspectives of Patients With Asthma and Chronic Obstructive Pulmonary Disease on Patient Web Portals: Focus Group Study. JMIR Form Res 2018; 2:e22. [PMID: 30684436 PMCID: PMC6334706 DOI: 10.2196/formative.8822] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 04/27/2018] [Accepted: 06/18/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND As accessibility to the internet has increased in society, many health care organizations have developed patient Web portals (PWPs), which can provide a range of self-management options to improve patient access. However, the available evidence suggests that they are used inefficiently and do not benefit patients with low health literacy. Asthma and chronic obstructive pulmonary disease (COPD) are common chronic diseases that require ongoing self-management. Moreover, patients with COPD are typically older and have lower health literacy. OBJECTIVE This study aimed to obtain and present an overview of patients' perspectives of PWPs to facilitate the development of a portal that better meets the needs of patients with asthma and COPD. METHODS We performed a focus group study using semistructured interviews in 3 patient groups from the north of the Netherlands who were recruited through the Dutch Lung Foundation. Each group met 3 times for 2 hours each at a 1-week interval. Data were analyzed with coding software, and patient descriptors were analyzed with nonparametric tests. The consolidated criteria for reporting qualitative research were followed when conducting the study. RESULTS We included 29 patients (16/29, 55% male; mean age 65 [SD 10] years) with COPD (n=14), asthma-COPD overlap (n=4), asthma (n=10), or other respiratory disease (n=1). There was a large variation in the internet experience; some patients hardly used the internet (4/29, 14%), whereas others used internet >3 times a week (23/29, 79%). In general, patients were positive about having access to a PWP, considering access to personal medical records as the most important option, though only after discussion with their physician. A medication overview was considered a useful option. We found that communication between health care professionals could be improved if patients could use the PWP to share information with their health care professionals. However, as participants were worried about the language and usability of portals, it was recommended that language should be adapted to the patient level. Another concern was that disease monitoring through Web-based questionnaire use would only be useful if the results were discussed with health care professionals. CONCLUSIONS Participants were positive about PWPs and considered them a logical step. Today, most patients tend to be better educated and have internet access, while also being more assertive and better informed about their disease. A PWP could support these patients. Our participants also provided practical suggestions for implementation in current and future PWP developments. The next step will be to develop a portal based on these recommendations and assess whether it meets the needs of patients and health care providers.
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Affiliation(s)
- Esther Metting
- Groningen Research Institute for Asthma and COPD, Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Aaltje Jantine Schrage
- Groningen Research Institute for Asthma and COPD, Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Janwillem Wh Kocks
- Groningen Research Institute for Asthma and COPD, Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Robbert Sanderman
- GZW-Health Psychology-GZW-General, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Department of Psychology, Health & Technology, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
| | - Thys van der Molen
- Groningen Research Institute for Asthma and COPD, Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Tsiligianni I, Metting E, van der Molen T, Chavannes N, Kocks J. Morning and night symptoms in primary care COPD patients: a cross-sectional and longitudinal study. An UNLOCK study from the IPCRG. NPJ Prim Care Respir Med 2016; 26:16040. [PMID: 27442618 PMCID: PMC4956029 DOI: 10.1038/npjpcrm.2016.40] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 03/25/2016] [Accepted: 04/27/2016] [Indexed: 11/09/2022] Open
Abstract
COPD symptoms show a diurnal variability. However, morning and night variability has generally not been taken into consideration in disease management plans. The aims of this study were to cross-sectionally assess morning and night symptom prevalence and correlation with health status and disease severity in COPD, and to determine to what extent they could predict longitudinal outcomes, exacerbations and health status. A further aim is to explore whether the CCQ is able to depict this morning/night symptomatology. We included 2,269 primary care COPD patients (58% male, 49% current smokers, with a mean age of 65±11 years) from a Dutch Asthma/COPD service. Spirometry, patient history, the Clinical COPD Questionnaire(CCQ) and the Asthma Control Questionnaire(ACQ) were assessed; we used the latter to evaluate morning (question 2) and night symptoms (question 1). A total of 1159 (51.9%) patients reported morning symptoms (ACQ question 2>0) and 879 (39.4%) had night complaints (ACQ question 1>0). Patients with morning/night symptoms were mostly smokers and had on average poorer lung function, higher CCQ scores and used more rescue inhalers (P<0.0001). Patients using long-acting muscarinic antagonists (LAMAs) had less night symptoms, showing a possible favourable effect. Only a small proportion of stable or slightly unstable patients (CCQ total scores <2) had severe morning symptoms (ACQ 2⩾4: n=19, 1.1%) or severe night symptoms (ACQ 1⩾4: n=11, 0.7%). Night symptoms seemed to predict future exacerbations; however, baseline exacerbations were the strongest predictors (n=346, OR:4.13, CI: 2.45-6.95, P<0.000). Morning symptoms increased the odds of poor health status at follow-up (n=346, OR:12.22, CI:4.76-31.39, P<0.000). Morning and night symptoms in COPD patients are common, and they are associated with poor health status and predicted future exacerbations. Our study showed that patients with morning/night symptoms have higher scores in CCQ, and therefore we do not really miss patients with high morning/night symptomatology when we only measure CCQ. Severe morning symptoms predicted worsening of COPD health status.
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Affiliation(s)
- Ioanna Tsiligianni
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Esther Metting
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Thys van der Molen
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Niels Chavannes
- Department of Public Health and Primary Care LUMC, Leiden, The Netherlands
| | - Janwillem Kocks
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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