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Deng W, M J J van der Kleij R, Shen H, Wei J, Brakema EA, Guldemond N, Song X, Li X, van Tol MJ, Aleman A, Chavannes NH. eHealth-Based Psychosocial Interventions for Adults With Insomnia: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Med Internet Res 2023; 25:e39250. [PMID: 36917145 PMCID: PMC10131777 DOI: 10.2196/39250] [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: 05/11/2022] [Revised: 09/23/2022] [Accepted: 10/07/2022] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Worldwide, insomnia remains a highly prevalent public health problem. eHealth presents a novel opportunity to deliver effective, accessible, and affordable insomnia treatments on a population-wide scale. However, there is no quantitative integration of evidence regarding the effectiveness of eHealth-based psychosocial interventions on insomnia. OBJECTIVE We aimed to evaluate the effectiveness of eHealth-based psychosocial interventions for insomnia and investigate the influence of specific study characteristics and intervention features on these effects. METHODS We searched PubMed, Embase, Web of Science, PsycINFO, and the Cochrane Central Register of Controlled Trials from database inception to February 16, 2021, for publications investigating eHealth-based psychosocial interventions targeting insomnia and updated the search of PubMed to December 6, 2021. We also screened gray literature for unpublished data. Eligible studies were randomized controlled trials of eHealth-based psychosocial interventions targeting adults with insomnia. Random-effects meta-analysis models were used to assess primary and secondary outcomes. Primary outcomes were insomnia severity and sleep quality. Meta-analyses were performed by pooling the effects of eHealth-based psychosocial interventions on insomnia compared with inactive and in-person conditions. We performed subgroup analyses and metaregressions to explore specific factors that affected the effectiveness. Secondary outcomes included sleep diary parameters and mental health-related outcomes. RESULTS Of the 19,980 identified records, 37 randomized controlled trials (13,227 participants) were included. eHealth-based psychosocial interventions significantly reduced insomnia severity (Hedges g=-1.01, 95% CI -1.12 to -0.89; P<.001) and improved sleep quality (Hedges g=-0.58, 95% CI -0.75 to -0.41; P<.001) compared with inactive control conditions, with no evidence of publication bias. We found no significant difference compared with in-person treatment in alleviating insomnia severity (Hedges g=0.41, 95% CI -0.02 to 0.85; P=.06) and a significant advantage for in-person treatment in enhancing sleep quality (Hedges g=0.56, 95% CI 0.24-0.88; P<.001). eHealth-based psychosocial interventions had significantly larger effects (P=.01) on alleviating insomnia severity in clinical samples than in subclinical samples. eHealth-based psychosocial interventions that incorporated guidance from trained therapists had a significantly greater effect on insomnia severity (P=.05) and sleep quality (P=.02) than those with guidance from animated therapists or no guidance. Higher baseline insomnia severity and longer intervention duration were associated with a larger reduction in insomnia severity (P=.004). eHealth-based psychosocial interventions significantly improved each secondary outcome. CONCLUSIONS eHealth interventions for insomnia are effective in improving sleep and mental health and can be considered a promising treatment for insomnia. Our findings support the wider dissemination of eHealth interventions and their further promotion in a stepped-care model. Offering blended care could improve treatment effectiveness. Future research needs to elucidate which specific intervention components are most important to achieve intervention effectiveness. Blended eHealth interventions may be tailored to benefit people with low socioeconomic status, limited access to health care, or lack of eHealth literacy.
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Affiliation(s)
- Wenrui Deng
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands.,Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, China.,Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, Netherlands
| | | | - Hongxia Shen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands.,School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Junjie Wei
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, China
| | - Evelyn A Brakema
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Nick Guldemond
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Xiaoyue Song
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Xiaoming Li
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, China
| | - Marie-José van Tol
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, Netherlands
| | - André Aleman
- Cognitive Neuroscience Center, Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
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Broese JMC, van der Kleij RMJJ, Verschuur EML, Kerstjens HAM, Bronkhorst EM, Chavannes NH, Engels Y. External Validation and User Experiences of the ProPal-COPD Tool to Identify the Palliative Phase in COPD. Int J Chron Obstruct Pulmon Dis 2022; 17:3129-3138. [PMID: 36579356 PMCID: PMC9792220 DOI: 10.2147/copd.s387716] [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: 08/26/2022] [Accepted: 11/24/2022] [Indexed: 12/24/2022] Open
Abstract
Background Difficulty predicting prognosis is a major barrier to timely palliative care provision for patients with COPD. The ProPal-COPD tool, combining six clinical indicators and the Surprise Question (SQ), aims to predict 1-year mortality as a proxy for palliative care needs. It appeared to be a promising tool for healthcare providers to identify patients with COPD who could benefit from palliative care. Objective To externally validate the ProPal-COPD tool and to assess user experiences. Methods Patients admitted with an acute exacerbation COPD were recruited across 10 hospitals. Demographics, clinical characteristics and survival status were collected. Sensitivity, specificity, positive and negative predictive values of the tool using two cut-off values were calculated. Also, predictive properties of the SQ were calculated. In monitoring meetings and interviews, healthcare providers shared their experiences with the tool. Transcripts were deductively coded using six user experience domains: Acceptability, Satisfaction, Credibility, Usability, User-reported adherence and Perceived impact. Results A total of 523 patients with COPD were included between May 2019 and August 2020, of whom 100 (19.1%) died within 12 months. The ProPal-COPD tool had an AUC of 0.68 and a low sensitivity (55%) and moderate specificity (74%) for predicting 1-year all-cause mortality. Using a lower cut-off value, sensitivity was higher (74%), but specificity lower (46%). Sensitivity and specificity of the SQ were 56% and 73%, respectively (AUC 0.65). However, healthcare providers generally appreciated using the tool because it increased awareness of the palliative phase and provided a shared understanding of prognosis, although they considered its outcome not always correct. Conclusion The accuracy of the ProPal-COPD tool to predict 1-year mortality is limited, although screening patients with its indicators increases healthcare providers' awareness of palliative care needs and encourages them to timely initiate appropriate care.
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Affiliation(s)
- Johanna M C Broese
- Public Health & Primary Care, Leiden University Medical Center, Leiden, the Netherlands,Lung Alliance Netherlands, Amersfoort, the Netherlands,Correspondence: Johanna MC Broese, Department of Public Health and Primary Care, Leiden University Medical Centre, Post Zone V0-P, Postbox 9600, Leiden, 2300 RC, the Netherlands, Email
| | | | | | - Huib A M Kerstjens
- Respiratory Medicine & Tuberculosis, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
| | - Ewald M Bronkhorst
- Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Niels H Chavannes
- Public Health & Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Yvonne Engels
- Anesthesiology, Pain & Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
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3
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Broese JMC, van der Kleij RMJJ, Verschuur EML, Kerstjens HAM, Engels Y, Chavannes NH. Implementation of a palliative care intervention for patients with COPD - a mixed methods process evaluation of the COMPASSION study. BMC Palliat Care 2022; 21:219. [PMID: 36476592 PMCID: PMC9727973 DOI: 10.1186/s12904-022-01110-3] [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: 09/01/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Little direction exists on how to effectively implement palliative care for patients with COPD. In the COMPASSION study, we developed, executed, and evaluated a multifaceted implementation strategy to improve the uptake of region-tailored palliative care intervention components into routine COPD care. We evaluated the implementation strategy and assessed the implementation process, barriers, and facilitators. METHODS A mixed methods process evaluation was performed. Primary and secondary healthcare providers in four hospital regions in the Netherlands were trained. Patients identified during hospitalisation for an acute exacerbation received palliative care and were followed for a year. Various sources were used: process data, questionnaires including the End-of-life Professional Caregiver Survey (EPCS), medical records, monitoring meetings, and interviews. The Consolidated Framework of Implementation Research (CFIR) was used to categorize implementation determinants. RESULTS The training sessions with roleplay were positively evaluated and increased professionals' self-efficacy in providing palliative care statistically significantly. Of 98 patients identified, 44 (44.9%) received one or more palliative care conversations at the outpatient clinic. Having those conversations was highly valued by healthcare providers because it led to clarity and peace of mind for the patient and higher job satisfaction. Coordination and continuity remained suboptimal. Most important barriers to implementation were time constraints, the COVID-19 pandemic, and barriers related to transmural and interdisciplinary collaboration. Facilitators were the systematic screening of patients for palliative care needs, adapting to the patient's readiness, conducting palliative care conversations with a pulmonologist and a COPD nurse together, and meeting regularly with a small team led by a dedicated implementation leader. CONCLUSIONS Providing integrated palliative care for patients with COPD is highly valued by healthcare providers but remains challenging. Our findings will guide future implementation efforts. Future research should focus on how to optimize transmural and interdisciplinary collaboration. Trial registration The COMPASSION study is registered in the Netherlands Trial Register (NTR): NL7644. Registration date: 07/04/2019.
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Affiliation(s)
- Johanna M. C. Broese
- grid.10419.3d0000000089452978Public Health & Primary care, Leiden University Medical Centre, Leiden, The Netherlands ,Lung Alliance Netherlands, Amersfoort, The Netherlands
| | - Rianne M. J. J. van der Kleij
- grid.10419.3d0000000089452978Public Health & Primary care, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Huib A. M. Kerstjens
- grid.4494.d0000 0000 9558 4598Respiratory Medicine & Tuberculosis, University Medical Centre Groningen, Groningen, The Netherlands
| | - Yvonne Engels
- grid.10417.330000 0004 0444 9382Anaesthesiology, Pain & Palliative medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Niels H. Chavannes
- grid.10419.3d0000000089452978Public Health & Primary care, Leiden University Medical Centre, Leiden, The Netherlands
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Martens N, Crone MR, Hindori-Mohangoo A, Hindori M, Reis R, Hoxha IS, Abanga J, Matthews S, Berry L, van der Kleij RMJJ, van den Akker-van Marle ME, van Damme A, Talrich F, Beeckman K, Court CM, Rising SS, Billings DL, Rijnders M. Group Care in the first 1000 days: implementation and process evaluation of contextually adapted antenatal and postnatal group care targeting diverse vulnerable populations in high-, middle- and low-resource settings. Implement Sci Commun 2022; 3:125. [DOI: 10.1186/s43058-022-00370-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/06/2022] [Indexed: 11/26/2022] Open
Abstract
Abstract
Background
Group care (GC) improves the quality of maternity care, stimulates women’s participation in their own care and facilitates growth of women’s social support networks. There is an urgent need to identify and disseminate the best mechanisms for implementing GC in ways that are feasible, context appropriate and sustainable. This protocol presents the aims and methods of an innovative implementation research project entitled Group Care in the first 1000 days (GC_1000), which addresses this need.
Aims
The aim of GC_1000 is to co-create and disseminate evidence-based implementation strategies and tools to support successful implementation and scale-up of GC in health systems throughout the world, with particular attention to the needs of ‘vulnerable’ populations.
Methods
By working through five inter-related work packages, each with specific tasks, objectives and deliverables, the global research team will systematically examine and document the implementation and scale-up processes of antenatal and postnatal GC in seven different countries. The GC_1000 project is grounded theoretically in the consolidated framework for implementation research (CFIR), while the process evaluation is guided by ‘Realistic Evaluation’ principles. Data are gathered across all research phases and analysis at each stage is synthesized to develop Context-Intervention-Mechanism-Outcome configurations.
Discussion
GC_1000 will generate evidence-based knowledge about the integration of complex interventions into diverse health care systems. The 4-year project also will pave the way for sustained implementation of GC, significantly benefitting populations with adverse pregnancy and birthing experiences as well as poor outcomes.
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Smith SM, van der Kleij RMJJ, Bais B, Schermer MHN, Ismaili M'hamdi H, Steegers-Theunissen RPM. Preferences of women with a vulnerable health status towards nudging for adequate pregnancy preparation as investment in health of future generations: a qualitative study. BMC Pregnancy Childbirth 2022; 22:559. [PMID: 35831786 PMCID: PMC9281116 DOI: 10.1186/s12884-022-04887-6] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 06/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women with a vulnerable health status, as determined by a low socioeconomic status and poor lifestyle behaviours, are at risk for adverse pregnancy outcomes. Offering tailored preconception lifestyle care can significantly help to improve pregnancy outcomes. We hypothesize that so-called 'nudges' can be a successful way of increasing the uptake of preconception lifestyle care. A nudge is a behavioural intervention that supports healthy choices by making them easier to choose. Nudging, however, raises many moral questions. Effectiveness and respect for autonomy are, among other criteria, required for a nudge to be morally permissible. In general, the target group knows best what they find permissible and what would motivate them to change their lifestyle. Therefore, this study - conducted in women with a vulnerable health status - aimed to identify their preferences towards a nudge, provided via a mobile application that aims to help them adopt healthy lifestyle behaviours by offering rewards. METHODS: We conducted semi-structured interviews with twelve women with a vulnerable health status. A framework approach was used to analyse the data. A thematic content analysis was conducted on five themes: (1) "Usefulness of an app as an integral information source", (2) "Permissibility and effects of offering rewards", (3) "Preferences regarding content", (4) "Preferences regarding type of rewards and system of allocation", and (5) "Barriers". RESULTS Of the 12 participants, 11 deemed an app as integral information source concerning the preconception period useful. None of the participants objected to being nudged i.e., being rewarded for healthy behaviour. All participants stated that they would like the app to contain information on healthy nutrition and 8 participants wanted to know how to get pregnant quickly. Furthermore, participants stated that the freedom to choose the timing and content of the reward would increase the probability of successful behavioural change, and having to pay or contact a healthcare provider to access the app may prevent women using the app. CONCLUSIONS These insights into the preferences of women with a vulnerable health status towards nudging will inform the design of an effective app-based nudge. This may help to improve prepregnancy health as investment in health of current and future generations.
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Affiliation(s)
- Sharissa M Smith
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Rianne M J J van der Kleij
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
| | - Babette Bais
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Maartje H N Schermer
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Hafez Ismaili M'hamdi
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
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Boudewijns EA, Trucchi M, van der Kleij RMJJ, Vermond D, Hoffman CM, Chavannes NH, van Schayck OCP, Kirenga B, Brakema EA. Facilitators and barriers to the implementation of improved solid fuel cookstoves and clean fuels in low-income and middle-income countries: an umbrella review. Lancet Planet Health 2022; 6:e601-e612. [PMID: 35716672 DOI: 10.1016/s2542-5196(22)00094-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 04/01/2022] [Accepted: 04/01/2022] [Indexed: 06/15/2023]
Abstract
2·6 billion people rely on solid fuels for cooking or heating. Accelerating access to cleaner solutions is crucial to reduce the negative effects of solid fuel use. Despite abundant evidence on how to implement these solutions, previous attempts have been disappointing. An overview of the evidence is missing and the translation of the evidence into practice is poor. We conducted an umbrella review using eight databases to: consolidate evidence on the factors that influence the implementation of improved solid fuel cookstoves and clean fuels in low-income and middle-income countries; weigh the level of confidence in existing evidence; and develop two practical implementation strategy tools. We identified 31 relevant reviews (13 systematic reviews and 18 narrative reviews) that covered over 479 primary studies. We found 15 implementation factors supported by the highest level of evidence. Regarding improved solid fuel cookstoves, these factors included: cost; knowledge and beliefs about the innovation; and compatibility. For clean fuels these factors included: cost; knowledge and beliefs about the innovation; and external policy and incentives. The factors were synthesised into the Cleaner Cookstove Implementation Tool and the Clean Fuel Implementation Tool. These tools can be used to optimise the implementation of cleaner cooking solutions, thereby improving health, environmental, climate, and gender equity outcomes.
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Affiliation(s)
- Esther A Boudewijns
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands.
| | - Maria Trucchi
- Leiden University College The Hague, Leiden University, The Hague, Netherlands
| | | | - Debbie Vermond
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Charlotte M Hoffman
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Onno C P van Schayck
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Bruce Kirenga
- Department of Medicine and Makerere Lung Institute, Makerere University, Kampala, Uganda
| | - Evelyn A Brakema
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
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Anastasaki M, van Bree EM, Brakema EA, Tsiligianni I, Sifaki-Pistolla D, Chatzea VE, Crone MC, Karelis A, van der Kleij RMJJ, Poot CC, Reis R, Chavannes NH, Lionis C. Beliefs, Perceptions, and Behaviors Regarding Chronic Respiratory Diseases of Roma in Crete, Greece: A Qualitative FRESH AIR Study. Front Public Health 2022; 10:812700. [PMID: 35493388 PMCID: PMC9051233 DOI: 10.3389/fpubh.2022.812700] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/14/2022] [Indexed: 11/30/2022] Open
Abstract
Background The global burden of chronic respiratory diseases (CRDs) disproportionally affects Roma populations. Health interventions addressing CRD among Roma or other vulnerable groups often fail to be effective, as their implementation strategy misaligns with the local context. To design context-driven strategies, we studied CRD-related beliefs, perceptions, and behaviors among a Greek Roma population, focussing on asthma and COPD. Methods For this qualitative study in Crete, Greece, we used a Rapid Assessment Process. We conducted interviews and focus groups with purposively selected Roma community members (CMs), key informants (KIs) and healthcare professionals (HPs) serving the population. Data were triangulated using observations of households and clinical consultations. Key themes were identified using Thematic Content Analysis. The Health Belief Model, the Explanatory Model of Illness, and the Theory of Planned Behavior that are complementary is some aspects, guided our methodology with the several variables from them to be integrated to better understand CRD risk preventative behavior. Results We conducted six focus groups, seven interviews and 13 observations among 15 CMs, four KIs, and three HPs. Five themes emerged: (1) Poor CRD-awareness (smoking and household air pollution were perceived as harmful, but almost exclusively associated with acute rather than chronic symptoms); (2) Low perceived susceptibility to CRD (and CMs tended to ignore respiratory symptoms); (3) High risk exposure (smoking was common, and air pollution was perceived inevitable due to financial constraints); (4) Healthcare seeking (healthcare was sought only for persistent, severe symptoms, daily needs were a priority); (5) Perceived barriers/facilitators to care (health illiteracy, perceived discrimination and financial constraints were main barriers; established trust the main facilitator). Conclusion These five themes highlight that strategies to tackle CRD in the studied Roma setting require a multilevel approach: bridging awareness gaps at the population level, providing resources to enhance the adoption of healthy behaviors, and fighting discrimination at the societal level, whilst establishing trusted relationships at the local level. Similar methodologies to address local context may strengthen the implementation of effective interventions for similarly vulnerable and/or low-resource populations.
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Affiliation(s)
- Marilena Anastasaki
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
- *Correspondence: Marilena Anastasaki
| | - Egid M. van Bree
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Evelyn A. Brakema
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Ioanna Tsiligianni
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Dimitra Sifaki-Pistolla
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Vasiliki E. Chatzea
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Matty C. Crone
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Andreas Karelis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | | | - Charlotte C. Poot
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Ria Reis
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Niels H. Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
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Tudor Car L, Poon S, Kyaw BM, Cook DA, Ward V, Atun R, Majeed A, Johnston J, van der Kleij RMJJ, Molokhia M, V Wangenheim F, Lupton M, Chavannes N, Ajuebor O, Prober CG, Car J. Digital Education for Health Professionals: An Evidence Map, Conceptual Framework, and Research Agenda. J Med Internet Res 2022; 24:e31977. [PMID: 35297767 PMCID: PMC8972116 DOI: 10.2196/31977] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 07/16/2021] [Revised: 11/07/2021] [Accepted: 11/21/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Health professions education has undergone major changes with the advent and adoption of digital technologies worldwide. OBJECTIVE This study aims to map the existing evidence and identify gaps and research priorities to enable robust and relevant research in digital health professions education. METHODS We searched for systematic reviews on the digital education of practicing and student health care professionals. We searched MEDLINE, Embase, Cochrane Library, Educational Research Information Center, CINAHL, and gray literature sources from January 2014 to July 2020. A total of 2 authors independently screened the studies, extracted the data, and synthesized the findings. We outlined the key characteristics of the included reviews, the quality of the evidence they synthesized, and recommendations for future research. We mapped the empirical findings and research recommendations against the newly developed conceptual framework. RESULTS We identified 77 eligible systematic reviews. All of them included experimental studies and evaluated the effectiveness of digital education interventions in different health care disciplines or different digital education modalities. Most reviews included studies on various digital education modalities (22/77, 29%), virtual reality (19/77, 25%), and online education (10/77, 13%). Most reviews focused on health professions education in general (36/77, 47%), surgery (13/77, 17%), and nursing (11/77, 14%). The reviews mainly assessed participants' skills (51/77, 66%) and knowledge (49/77, 64%) and included data from high-income countries (53/77, 69%). Our novel conceptual framework of digital health professions education comprises 6 key domains (context, infrastructure, education, learners, research, and quality improvement) and 16 subdomains. Finally, we identified 61 unique questions for future research in these reviews; these mapped to framework domains of education (29/61, 47% recommendations), context (17/61, 28% recommendations), infrastructure (9/61, 15% recommendations), learners (3/61, 5% recommendations), and research (3/61, 5% recommendations). CONCLUSIONS We identified a large number of research questions regarding digital education, which collectively reflect a diverse and comprehensive research agenda. Our conceptual framework will help educators and researchers plan, develop, and study digital education. More evidence from low- and middle-income countries is needed.
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Affiliation(s)
- Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Selina Poon
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Bhone Myint Kyaw
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - David A Cook
- Office of Applied Scholarship and Education Science, School of Continuous Professional Development, Mayo Clinic College of Medicine and Science, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Victoria Ward
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford, CA, United States
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard, Boston, MA, United States
| | - Azeem Majeed
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Jamie Johnston
- Stanford Center for Health Education's Digital MedIC Initiative, Stanford School of Medicine, Stanford University, Stanford, CA, United States
| | | | - Mariam Molokhia
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Florian V Wangenheim
- Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Martin Lupton
- Faculty of Medicine, Imperial College London, London, United Kingdom.,The Chelsea and Westminster Hospital, Chelsea, London, United Kingdom
| | - Niels Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Onyema Ajuebor
- Health Workforce Department, World Health Organization, Geneva, Switzerland
| | - Charles G Prober
- Stanford Center for Health Education's Digital MedIC Initiative, Stanford School of Medicine, Stanford University, Stanford, CA, United States
| | - Josip Car
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom.,Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Brakema EA, van der Kleij RMJJ, Poot CC, An PL, Anastasaki M, Crone MR, Hong LHTC, Kirenga B, Lionis C, Mademilov M, Numans ME, Oanh LTT, Tsiligianni I, Sooronbaev T, Walusimbi S, Williams S, Chavannes NH, Reis R. Mapping low-resource contexts to prepare for lung health interventions in four countries (FRESH AIR): a mixed-method study. The Lancet Global Health 2022; 10:e63-e76. [DOI: 10.1016/s2214-109x(21)00456-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/20/2021] [Accepted: 09/13/2021] [Indexed: 01/19/2023] Open
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Versluis A, van Luenen S, Meijer E, Honkoop PJ, Pinnock H, Mohr DC, Neves AL, Chavannes NH, van der Kleij RMJJ. SERIES: eHealth in primary care. Part 4: Addressing the challenges of implementation. Eur J Gen Pract 2021; 26:140-145. [PMID: 33025820 PMCID: PMC7580793 DOI: 10.1080/13814788.2020.1826431] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Indexed: 11/12/2022] Open
Abstract
Background The implementation of eHealth applications in primary care remains challenging. Enhancing knowledge and awareness of implementation determinants is critical to build evidence-based implementation strategies and optimise uptake and sustainability. Objectives We consider how evidence-based implementation strategies can be built to support eHealth implementation. Discussion What implementation strategies to consider depends on (potential) barriers and facilitators to eHealth implementation in a given situation. Therefore, we first discuss key barriers and facilitators following the five domains of the Consolidated Framework for Implementation Research (CFIR). Cost is identified as a critical barrier to eHealth implementation. Privacy, security problems, and a lack of recognised standards for eHealth applications also hinder implementation. Engagement of key stakeholders in the implementation process, planning the implementation of the intervention, and the availability of training and support are important facilitators. To support care professionals and researchers, we provide a stepwise approach to develop and apply evidence-based implementation strategies for eHealth in primary care. It includes the following steps: (1) specify the eHealth application, (2) define problem, (3) specify desired implementation behaviour, and (4) choose and (5) evaluate the implementation strategy. To improve the fit of the implementation strategy with the setting, the stepwise approach considers the phase of the implementation process and the specific context. Conclusion Applying an approach, as provided here, may help to improve the implementation of eHealth applications in primary care.
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Affiliation(s)
- Anke Versluis
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands.,National eHealth Living Lab (NeLL), Leiden, the Netherlands
| | - Sanne van Luenen
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands.,National eHealth Living Lab (NeLL), Leiden, the Netherlands.,Section of Clinical Psychology, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, the Netherlands
| | - Eline Meijer
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands.,National eHealth Living Lab (NeLL), Leiden, the Netherlands
| | - Persijn J Honkoop
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands.,National eHealth Living Lab (NeLL), Leiden, the Netherlands
| | | | - David C Mohr
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Ana Luisa Neves
- Institute of Global Health Innovation, Imperial College London, London, UK.,Center for Health Technology and Services Research (CINTESIS)/Department of Community Medicine, Health Information and Decision (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands.,National eHealth Living Lab (NeLL), Leiden, the Netherlands
| | - Rianne M J J van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands.,National eHealth Living Lab (NeLL), Leiden, the Netherlands
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11
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Houwink EJF, Kasteleyn MJ, Alpay L, Pearce C, Butler-Henderson K, Meijer E, van Kampen S, Versluis A, Bonten TN, van Dalfsen JH, van Peet PG, Koster Y, Hierck BP, Jeeninga I, van Luenen S, van der Kleij RMJJ, Chavannes NH, Kramer AWM. SERIES: eHealth in primary care. Part 3: eHealth education in primary care. Eur J Gen Pract 2021; 26:108-118. [PMID: 32757859 PMCID: PMC7470053 DOI: 10.1080/13814788.2020.1797675] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Education is essential to the integration of eHealth into primary care, but eHealth is not yet embedded in medical education. OBJECTIVES In this opinion article, we aim to support organisers of Continuing Professional Development (CPD) and teachers delivering medical vocational training by providing recommendations for eHealth education. First, we describe what is required to help primary care professionals and trainees learn about eHealth. Second, we elaborate on how eHealth education might be provided. DISCUSSION We consider four essential topics. First, an understanding of existing evidence-based eHealth applications and conditions for successful development and implementation. Second, required digital competencies of providers and patients. Third, how eHealth changes patient-provider and provider-provider relationships and finally, understanding the handling of digital data. Educational activities to address these topics include eLearning, blended learning, courses, simulation exercises, real-life practice, supervision and reflection, role modelling and community of practice learning. More specifically, a CanMEDS framework aimed at defining curriculum learning goals can support eHealth education by describing roles and required competencies. Alternatively, Kern's conceptual model can be used to design eHealth training programmes that match the educational needs of the stakeholders using eHealth. CONCLUSION Vocational and CPD training in General Practice needs to build on eHealth capabilities now. We strongly advise the incorporation of eHealth education into vocational training and CPD activities, rather than providing it as a separate single module. How learning goals and activities take shape and how competencies are evaluated clearly requires further practice, evaluation and study.
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Affiliation(s)
- Elisa J F Houwink
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands
| | - Marise J Kasteleyn
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands
| | - Laurence Alpay
- Medical Technology Research Group, Inholland University of Applied Science, Haarlem, The Netherlands
| | - Christopher Pearce
- Centre for Transformation in Digital Health, University of Melbourne, Melbourne, Australia.,Department of General Practice, Monash University, Melbourne, Australia
| | | | - Eline Meijer
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands
| | - Sanne van Kampen
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands
| | - Anke Versluis
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands
| | - Tobias N Bonten
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands
| | - Jens H van Dalfsen
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands
| | - Petra G van Peet
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands
| | - Ybranda Koster
- Medical Technology Research Group, Inholland University of Applied Science, Haarlem, The Netherlands
| | - Beerend P Hierck
- Center for Innovation in Medical Education, Leiden University Medical Center, Leiden, The Netherlands.,Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands.,Leiden Teachers' Academy, Leiden University, Leiden, The Netherlands
| | - Ilke Jeeninga
- Center for Innovation in Medical Education, Leiden University Medical Center, Leiden, The Netherlands
| | - Sanne van Luenen
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands
| | - Rianne M J J van der Kleij
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands.,Department of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands
| | - Anneke W M Kramer
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands
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12
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Broese JMC, van der Kleij RMJJ, Verschuur EML, Kerstjens HAM, Engels Y, Chavannes NH. Provision of Palliative Care in Patients with COPD: A Survey Among Pulmonologists and General Practitioners. Int J Chron Obstruct Pulmon Dis 2021; 16:783-794. [PMID: 33814902 PMCID: PMC8009343 DOI: 10.2147/copd.s293241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/22/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Patients with advanced chronic obstructive pulmonary disease (COPD) experience significant symptom burden, leading to poor quality of life. Although guidelines recommend palliative care for these patients, this is not widely implemented and prevents them from receiving optimal care. Objective A national survey was performed to map the current content and organization of palliative care provision for patients with COPD by pulmonologists and general practitioners (GPs) in the Netherlands. Methods We developed a survey based on previous studies, guidelines and expert opinion. Dutch pulmonologists and GPs were invited to complete the survey between April and August 2019. Results 130 pulmonologists (15.3%; covering 76% of pulmonology departments) and 305 GPs (28.6%) responded. Median numbers of patients with COPD in the palliative phase treated were respectively 20 and 1.5 per year. 43% of pulmonologists and 9% of GPs reported some formalized agreements regarding palliative care provision. Physicians most often determined the start of palliative care based on clinical expertise or the Surprise Question. 31% of pulmonologists stated that they often or always referred palliative patients with COPD to a specialist palliative care team; a quarter rarely referred. 79% of the respondents mentioned to often or always administer opioids to treat dyspnea. The topics least discussed were non-invasive ventilation and the patient's spiritual needs. The most critical barrier to starting a palliative care discussion was difficulty in predicting the disease course. Conclusion Although pulmonologists and GPs indicated to regularly address palliative care aspects, palliative care for patients with COPD remains unstructured and little formalized. However, our data revealed a high willingness to improve this care. Clear guidance and standardization of practice are needed to help providers decide when and how to initiate discussions, when to involve specialist palliative care and how to optimize information exchange between care settings.
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Affiliation(s)
- Johanna M C Broese
- Public Health & Primary Care, Leiden University Medical Center, Leiden, the Netherlands.,Lung Alliance Netherlands, Amersfoort, the Netherlands
| | | | | | - Huib A M Kerstjens
- Respiratory Medicine & Tuberculosis, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
| | - Yvonne Engels
- Anesthesiology, Pain & Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Niels H Chavannes
- Public Health & Primary Care, Leiden University Medical Center, Leiden, the Netherlands
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13
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Shen H, van der Kleij RMJJ, van der Boog PJM, Wang W, Song X, Li Z, Lou X, Chavannes N. Patients' and healthcare professionals' beliefs, perceptions and needs towards chronic kidney disease self-management in China: a qualitative study. BMJ Open 2021; 11:e044059. [PMID: 33664078 PMCID: PMC7934774 DOI: 10.1136/bmjopen-2020-044059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/18/2023] Open
Abstract
OBJECTIVES To support the adaptation and translation of an evidence-based chronic kidney disease (CKD) self-management intervention to the Chinese context, we examined the beliefs, perceptions and needs of Chinese patients with CKD and healthcare professionals (HCPs) towards CKD self-management. DESIGN A basic interpretive, cross-sectional qualitative study comprising semistructured interviews and observations. SETTING One major tertiary referral hospital in Henan province, China. PARTICIPANTS 11 adults with a diagnosis of CKD with CKD stages G1-G5 and 10 HCPs who worked in the Department of Nephrology. RESULTS Four themes emerged: (1) CKD illness perceptions, (2) understanding of and motivation towards CKD self-management, (3) current CKD practice and (4) barriers, (anticipated) facilitators and needs towards CKD self-management. Most patients and HCPs solely mentioned medical management of CKD, and self-management was largely unknown or misinterpreted as adherence to medical treatment. Also, the majority of patients only mentioned performing disease-specific acts of control and not, for instance, behaviour for coping with emotional problems. A paternalistic patient-HCP relationship was often present. Finally, the barriers, facilitators and needs towards CKD self-management were frequently related to knowledge and environmental context and resources. CONCLUSIONS The limited understanding of CKD self-management, as observed, underlines the need for educational efforts on the use and benefits of self-management before intervention implementation. Also, specific characteristics and needs within the Chinese context need to guide the development or tailoring of CKD self-management interventions. Emphasis should be placed on role management and emotional coping skills, while self-management components should be tailored by addressing the existing paternalistic patient-HCP relationship. The use of electronic health innovations can be an essential facilitator for implementation.
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Affiliation(s)
- Hongxia Shen
- Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Rianne M J J van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Wenjiao Wang
- Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Xiaoyue Song
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Zhengyan Li
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoping Lou
- Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Niels Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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14
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Boudewijns EA, Vermond D, van der Kleij RMJJ, Chavannes NH, van Schayck OCP, Kirenga B, Brakema EA. Factors critical to implementation success of cleaner cooking interventions in low-income and middle-income countries: protocol for an umbrella review. BMJ Open 2020; 10:e041821. [PMID: 33293323 PMCID: PMC7722821 DOI: 10.1136/bmjopen-2020-041821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Over a third of the world's population relies on solid fuels as their primary energy source. These fuels have damaging effects on health, air quality and forest resources. Interventions to promote access to cleaner solid fuel cookstoves and clean fuels have existed for decades. However, the adoption by local communities has largely failed, which led to a waste of resources and suboptimal outcomes. Therefore, the objective of this umbrella review is to identify factors that determine implementation success for cleaner cooking interventions in low-resource settings and weigh their level of confidence in the evidence. METHODS AND ANALYSIS We identified systematic and narrative reviews examining factors that influence the acquisition, initial adoption or sustained use of cleaner solid fuel cookstoves and clean fuels at any scale by a literature search in PubMed, Embase, Global Health Database, Cochrane, PsycINFO, Emcare, Web of Science and CINAHL, without date or language restrictions. The search was conducted on 23 October 2017 and updated on 10 July 2019. Reviews based on qualitative, quantitative or mixed-methods studies were included and will be appraised using the Meta Quality Appraisal Tool combined with the Assessment of Multiple Systematic Reviews. Data will be extracted and factors affecting implementation will be coded using the Consolidated Framework for Implementation Research. The Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative Research tool will be used to determine the level of confidence in the coded factors. Two researchers will independently conduct these steps. ETHICS AND DISSEMINATION This umbrella review does not require the approval of an ethical review board. Study results will be published in an international peer-reviewed journal. The outcomes will be converted into two practical tools: one for cleaner solid fuel cookstoves and one for clean fuels. These tools can guide the development of evidence-based implementation strategies for cleaner cooking interventions in low-income and middle-income countries to improve implementation success. These tools should be pilot-tested and promoted among regional and global initiatives. PROSPERO REGISTRATION NUMBER CRD42018088687.
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Affiliation(s)
- Esther A Boudewijns
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Debbie Vermond
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Onno C P van Schayck
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Bruce Kirenga
- Department of Medicine and Makerere Lung Institute, Makerere University, Kampala, Uganda
| | - Evelyn A Brakema
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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15
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Broese JMC, van der Kleij RMJJ, Kerstjens HAM, Verschuur EML, Engels Y, Chavannes NH. A cluster randomized controlled trial on a multifaceted implementation strategy to promote integrated palliative care in COPD: study protocol of the COMPASSION study. BMC Palliat Care 2020; 19:155. [PMID: 33038932 PMCID: PMC7548043 DOI: 10.1186/s12904-020-00657-3] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the urgent need for palliative care for patients with advanced chronic obstructive pulmonary disease (COPD), it is not yet daily practice. Important factors influencing the provision of palliative care are adequate communication skills, knowing when to start palliative care and continuity of care. In the COMPASSION study, we address these factors by implementing an integrated palliative care approach for patients with COPD and their informal caregivers. METHODS An integrated palliative care intervention was developed based on existing guidelines, a literature review, and input from patient and professional organizations. To facilitate uptake of the intervention, a multifaceted implementation strategy was developed, comprising a toolbox, (communication) training, collaboration support, action planning and monitoring. Using a hybrid effectiveness-implementation type 2 design, this study aims to simultaneously evaluate the implementation process and effects on patient, informal caregiver and professional outcomes. In a cluster randomized controlled trial, eight hospital regions will be randomized to receive the integrated palliative care approach or to provide care as usual. Eligible patients are identified during hospitalization for an exacerbation using the Propal-COPD tool. The primary outcome is quality of life (FACIT-Pal) at 6 months. Secondary outcome measures include spiritual well-being, anxiety and depression, unplanned healthcare use, informal caregiver burden and healthcare professional's self-efficacy to provide palliative care. The implementation process will be investigated by a comprehensive mixed-methods evaluation assessing the following implementation constructs: context, reach, dose delivered, dose received, fidelity, implementation level, recruitment, maintenance and acceptability. Furthermore, determinants to implementation will be investigated using the Consolidated Framework for Implementation Research. DISCUSSION The COMPASSION study will broaden knowledge on the effectiveness and process of palliative care integration into COPD-care. Furthermore, it will improve our understanding of which strategies may optimize the implementation of integrated palliative care. TRIAL REGISTRATION Netherlands Trial Register (NTR): NL7644 . Registration date: April 7, 2019.
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Affiliation(s)
- Johanna M C Broese
- Public Health and Primary care, Leiden University Medical Centre, Post zone V0-P, Postbox 9600, 2300 RC, Leiden, The Netherlands.
- Lung Alliance Netherlands, Amersfoort, The Netherlands.
| | - Rianne M J J van der Kleij
- Public Health and Primary care, Leiden University Medical Centre, Post zone V0-P, Postbox 9600, 2300 RC, Leiden, The Netherlands
| | - Huib A M Kerstjens
- Department of Respiratory Medicine and Tuberculosis, and Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen and University Medical Centre Groningen, Groningen, The Netherlands
| | | | - Yvonne Engels
- Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Niels H Chavannes
- Public Health and Primary care, Leiden University Medical Centre, Post zone V0-P, Postbox 9600, 2300 RC, Leiden, The Netherlands
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16
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Jimenez G, Spinazze P, Matchar D, Koh Choon Huat G, van der Kleij RMJJ, Chavannes NH, Car J. Digital health competencies for primary healthcare professionals: A scoping review. Int J Med Inform 2020; 143:104260. [PMID: 32919345 DOI: 10.1016/j.ijmedinf.2020.104260] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 07/20/2020] [Revised: 08/15/2020] [Accepted: 08/20/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite digital health providing opportunities to enhance the quality, efficiency and safety of primary healthcare, the adoption of digital tools and technologies has been slow, partly because of poor digital health literacy. For primary healthcare systems to take full advantage of these technologies, a capable, digitally literate workforce is necessary. Still, the essential digital health competencies (DHCs) for primary healthcare have not been explored. This review aims to examine the broad literature on DHCs as it applies to Primary Care (PC) settings. METHODS We performed a scoping review on all types of research linking DHCs to PC. We searched all major databases including Medline, Embase, CINAHL, and Cochrane Library in November 2019. Concurrently, a thorough grey literature search was performed through OpenGrey, ResearchGate, Google Scholar, and key government and relevant professional associations' websites. Screening and selection of studies was performed in pairs, and data was analysed and presented using a narrative, descriptive approach. Thematic analysis was performed to identify key DHC domains. RESULTS A total of 28 articles were included, most of them (54 %) published before 2005. These articles were primarily aimed at PC physicians or general practitioners, and focused on improving knowledge about information technologies and medical informatics, basic computer and information literacy, and optimal use of electronic medical records. We identified 17 DHC domains, and important knowledge gaps related to digital health education and curriculum integration, the need for evidence of the impact of services, and the importance of wider support for digital health. CONCLUSIONS Literature explicitly linking DHCs to PC was mostly published over a decade ago. There is a need for an updated and current set of DHCs for PC professionals to more consistently reap the benefits of digital technologies. This review identified key DHC domains and statements that may be used to guide on the development of a set of DHC for PC, and critical knowledge gaps and needs to be considered. Such a DHC set may be used for curricula development and for ensuring that the essential DHC for PC are met at a clinical or organizational level, and eventually improve health outcomes.
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Affiliation(s)
- Geronimo Jimenez
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Department of Public Health and Primary Care, Leiden University Medical Center, the Netherlands.
| | - Pier Spinazze
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
| | - David Matchar
- Health Services and Systems Research (HSSR), Duke-NUS Medical School, Singapore.
| | | | | | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, the Netherlands.
| | - Josip Car
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
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17
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Lee Y, Brietzke E, Cao B, Chen Y, Linnaranta O, Mansur RB, Cortes P, Kösters M, Majeed A, Tamura JK, Lui LMW, Vinberg M, Keinänen J, Kisely S, Naveed S, Barbui C, Parker G, Owolabi M, Nishi D, Lee J, Srisurapanont M, Gill H, Guo L, Balanzá-Martínez V, Partonen T, Nolen WA, Lee JH, Kim JH, Chavannes NH, Ewais T, Atienza-Carbonell B, Silven AV, Yasuma N, Gil A, Novikov A, Lacey C, Versluis A, von Malortie S, Chan LF, Waqas A, Purgato M, Aardoom JJ, Ly-Uson JT, Sim K, Tuineag M, van der Kleij RMJJ, van Luenen S, Suttajit S, Hajek T, Lee YW, Porter RJ, Alsuwaidan M, Rosenblat JD, Ravindran AV, Lam RW, McIntyre RS. Development and implementation of guidelines for the management of depression: a systematic review. Bull World Health Organ 2020; 98:683-697H. [PMID: 33177758 PMCID: PMC7652558 DOI: 10.2471/blt.20.251405] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 12/12/2022] Open
Abstract
Objective To evaluate the development and implementation of clinical practice guidelines for the management of depression globally. Methods We conducted a systematic review of existing guidelines for the management of depression in adults with major depressive or bipolar disorder. For each identified guideline, we assessed compliance with measures of guideline development quality (such as transparency in guideline development processes and funding, multidisciplinary author group composition, systematic review of comparative efficacy research) and implementation (such as quality indicators). We compared guidelines from low- and middle-income countries with those from high-income countries. Findings We identified 82 national and 13 international clinical practice guidelines from 83 countries in 27 languages. Guideline development processes and funding sources were explicitly specified in a smaller proportion of guidelines from low- and middle-income countries (8/29; 28%) relative to high-income countries (35/58; 60%). Fewer guidelines (2/29; 7%) from low- and middle-income countries, relative to high-income countries (22/58; 38%), were authored by a multidisciplinary development group. A systematic review of comparative effectiveness was conducted in 31% (9/29) of low- and middle-income country guidelines versus 71% (41/58) of high-income country guidelines. Only 10% (3/29) of low- and middle-income country and 19% (11/58) of high-income country guidelines described plans to assess quality indicators or recommendation adherence. Conclusion Globally, guideline implementation is inadequately planned, reported and measured. Narrowing disparities in the development and implementation of guidelines in low- and middle-income countries is a priority. Future guidelines should present strategies to implement recommendations and measure feasibility, cost–effectiveness and impact on health outcomes.
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Affiliation(s)
- Yena Lee
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada
| | - Elisa Brietzke
- Department of Psychiatry, Queen's University School of Medicine, Kingston, Canada
| | - Bing Cao
- School of Psychology and Key Laboratory of Cognition and Personality, Southwest University, Chongqing, China
| | - Yan Chen
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Outi Linnaranta
- Bipolar Disorders Clinic, Douglas Mental Health University Institute, Montréal, Canada
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada
| | - Paulina Cortes
- Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile
| | - Markus Kösters
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Amna Majeed
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada
| | - Jocelyn K Tamura
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada
| | - Leanna M W Lui
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada
| | - Maj Vinberg
- Psychiatric Research Unit, Psychiatric Centre North Zealand, Hilleroed, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Jaakko Keinänen
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Steve Kisely
- School of Clinical Medicine, The University of Queensland, Brisbane, Australia
| | - Sadiq Naveed
- Department of Psychiatry and Behavioral Sciences, University of Kansas Medical Center, Kansas, USA
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Biomedicine and Movement Sciences, Verona, Italy
| | - Gary Parker
- Global Alliance for Chronic Diseases, Wellcome Trust, London, England
| | - Mayowa Owolabi
- Center for Genomics and Precision Medicine, University of Ibadan, Ibadan, Nigeria
| | - Daisuke Nishi
- Department of Mental Health, The University of Tokyo, Tokyo, Japan
| | - JungGoo Lee
- Paik Institute for Clinical Research, Inje University, Busan, Republic of Korea
| | | | - Hartej Gill
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada
| | - Lan Guo
- School of Public Health, Sun Yat-sen University, Guangdong, China
| | - Vicent Balanzá-Martínez
- Teaching Unit of Psychiatry and Psychological Medicine, University of Valencia, Valencia, CIBERSAM, Spain
| | - Timo Partonen
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Willem A Nolen
- Department of Psychiatry, University of Groningen, Groningen, Netherlands
| | - Jae-Hon Lee
- Department of Psychiatry, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Ji Hwan Kim
- Paik Institute for Clinical Research, Inje University, Busan, Republic of Korea
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Tatjana Ewais
- School of Clinical Medicine, The University of Queensland, Brisbane, Australia
| | | | - Anna V Silven
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Naonori Yasuma
- Department of Mental Health, The University of Tokyo, Tokyo, Japan
| | - Artyom Gil
- WHO European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programme, Moscow, Russian Federation
| | - Andrey Novikov
- Psychiatric and Neurological Hospital, Surgut, Russian Federation
| | - Cameron Lacey
- Maori Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Anke Versluis
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | | | - Lai Fong Chan
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada.,Department of Psychiatry, Queen's University School of Medicine, Kingston, Canada
| | - Ahmed Waqas
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada.,School of Psychology and Key Laboratory of Cognition and Personality, Southwest University, Chongqing, China
| | - Marianna Purgato
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Biomedicine and Movement Sciences, Verona, Italy
| | - Jiska Joëlle Aardoom
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Josefina T Ly-Uson
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Kang Sim
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada.,Bipolar Disorders Clinic, Douglas Mental Health University Institute, Montréal, Canada
| | - Maria Tuineag
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada.,Pontificia Universidad Católica de Chile, Santiago, Región Metropolitana, Chile
| | | | - Sanne van Luenen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Sirijit Suttajit
- Department of Psychiatry, Chiang Mai University, Chiang Mai, Thailand
| | - Tomas Hajek
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada.,Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Yu Wei Lee
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada.,Bipolar Disorders Clinic, Douglas Mental Health University Institute, Montréal, Canada
| | - Richard J Porter
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada.,Psychiatric Research Unit, Psychiatric Centre North Zealand, Hilleroed, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Mohammad Alsuwaidan
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada.,Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada.,School of Clinical Medicine, The University of Queensland, Brisbane, Australia
| | - Arun V Ravindran
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada.,School of Clinical Medicine, The University of Queensland, Brisbane, Australia
| | - Raymond W Lam
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada.,Department of Psychiatry and Behavioral Sciences, University of Kansas Medical Center, Kansas, USA
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, Toronto Western Hospital, University Health Network, 399 Bathurst St 9MP-325, Toronto, Ontario, Canada
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18
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Brakema EA, Tabyshova A, van der Kleij RMJJ, Sooronbaev T, Lionis C, Anastasaki M, An PL, Nguyen LT, Kirenga B, Walusimbi S, Postma MJ, Chavannes NH, van Boven JFM. The socioeconomic burden of chronic lung disease in low-resource settings across the globe - an observational FRESH AIR study. Respir Res 2019; 20:291. [PMID: 31864411 PMCID: PMC6925865 DOI: 10.1186/s12931-019-1255-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 12/05/2019] [Indexed: 01/01/2023] Open
Abstract
Background Low-resource settings are disproportionally burdened by chronic lung disease due to early childhood disadvantages and indoor/outdoor air pollution. However, data on the socioeconomic impact of respiratory diseases in these settings are largely lacking. Therefore, we aimed to estimate the chronic lung disease-related socioeconomic burden in diverse low-resource settings across the globe. To inform governmental and health policy, we focused on work productivity and activity impairment and its modifiable clinical and environmental risk factors. Methods We performed a cross-sectional, observational FRESH AIR study in Uganda, Vietnam, Kyrgyzstan, and Greece. We assessed the chronic lung disease-related socioeconomic burden using validated questionnaires among spirometry-diagnosed COPD and/or asthma patients (total N = 1040). Predictors for a higher burden were studied using multivariable linear regression models including demographics (e.g. age, gender), health parameters (breathlessness, comorbidities), and risk factors for chronic lung disease (smoking, solid fuel use). We applied identical models per country, which we subsequently meta-analyzed. Results Employed patients reported a median [IQR] overall work impairment due to chronic lung disease of 30% [1.8–51.7] and decreased productivity (presenteeism) of 20.0% [0.0–40.0]. Remarkably, work time missed (absenteeism) was 0.0% [0.0–16.7]. The total population reported 40.0% [20.0–60.0] impairment in daily activities. Breathlessness severity (MRC-scale) (B = 8.92, 95%CI = 7.47–10.36), smoking (B = 5.97, 95%CI = 1.73–10.22), and solid fuel use (B = 3.94, 95%CI = 0.56–7.31) were potentially modifiable risk factors for impairment. Conclusions In low-resource settings, chronic lung disease-related absenteeism is relatively low compared to the substantial presenteeism and activity impairment. Possibly, given the lack of social security systems, relatively few people take days off work at the expense of decreased productivity. Breathlessness (MRC-score), smoking, and solid fuel use are potentially modifiable predictors for higher impairment. Results warrant increased awareness, preventive actions and clinical management of lung diseases in low-resource settings from health policymakers and healthcare workers.
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Affiliation(s)
- Evelyn A Brakema
- Department of Public Health and Primary Care, Leiden University Medical Center, Postzone V0-P, Postbus 9600, 2300 RC, Leiden, The Netherlands.
| | - Aizhamal Tabyshova
- Pulmonary Department, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan.,Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rianne M J J van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Center, Postzone V0-P, Postbus 9600, 2300 RC, Leiden, The Netherlands
| | - Talant Sooronbaev
- Pulmonary Department, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Marilena Anastasaki
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Pham Le An
- University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | | | - Bruce Kirenga
- Department of Medicine and Makerere Lung Institute, Makerere University, Kampala, Uganda
| | - Simon Walusimbi
- Department of Medicine and Makerere Lung Institute, Makerere University, Kampala, Uganda
| | - Maarten J Postma
- Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Postzone V0-P, Postbus 9600, 2300 RC, Leiden, The Netherlands
| | - Job F M van Boven
- Department of General Practice & Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
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19
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Shen H, van der Kleij RMJJ, van der Boog PJM, Chang X, Chavannes NH. Electronic Health Self-Management Interventions for Patients With Chronic Kidney Disease: Systematic Review of Quantitative and Qualitative Evidence. J Med Internet Res 2019; 21:e12384. [PMID: 31687937 PMCID: PMC6864489 DOI: 10.2196/12384] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [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: 10/02/2018] [Revised: 06/28/2019] [Accepted: 08/19/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) poses a major challenge to public health. In CKD patients, adequate disease self-management has been shown to improve both proximal and distal outcomes. Currently, electronic health (eHealth) interventions are increasingly used to optimize patients' self-management skills. OBJECTIVE This study aimed to systematically review the existing evidence regarding the implementation and effectiveness of eHealth self-management interventions for patients with CKD. METHODS Following a search in 8 databases (up to November 2017), quantitative and qualitative data on process and effect outcomes were extracted from relevant studies. Quality was appraised using the Crowe Critical Appraisal Tool; narrative synthesis was performed to analyze the data extracted. RESULTS Of the 3307 articles retrieved, 24 (comprising 23 studies) were included in this review; of these, almost half were appraised to be of low to moderate quality. There was considerable heterogeneity in the types of interventions used and the outcomes measured. A total of 10 effect and 9 process outcome indicators were identified. The most frequently reported effect outcome indicators were specific laboratory tests and blood pressure (BP), whereas satisfaction was the most frequently reported process outcome indicator. Positive effects were found for proximal outcomes (eg, BP control and medication adherence), and mixed effects were found for more distal outcomes (eg, quality of life). High feasibility, usability, and acceptability of and satisfaction with eHealth self-management interventions were reported. The determinant ability of health care professionals to monitor and, if necessary, anticipate on patient measurements online was mostly cited to influence patients' adherence to interventions. CONCLUSIONS eHealth self-management interventions have the potential to improve disease management and health outcomes. To broaden the evidence base and facilitate intervention upscaling, more detailed descriptions and thorough analysis of the intervention components used are required. In addition, our review reveals that outcomes closely related to the scope and duration of the intervention implemented are most likely to be impacted. For instance, if a 4-week Web-based training to optimize disease management skills is implemented, the outcome perceived control would more likely be affected than kidney function. Although this seems obvious, most studies evaluate only distal outcomes and thereby fail to capture intervention effects that might contribute to long-term health improvement. We advise future researchers to carefully consider their choice of outcomes based on their sensitivity for change. In this way, we ensure that relevant effects are captured and legitimate conclusions are drawn.
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Affiliation(s)
- Hongxia Shen
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Rianne M J J van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands.,Department of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Xinwei Chang
- Department of Surgery, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
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20
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Boers SN, Jongsma KR, Lucivero F, Aardoom J, Büchner FL, de Vries M, Honkoop P, Houwink EJF, Kasteleyn MJ, Meijer E, Pinnock H, Teichert M, van der Boog P, van Luenen S, van der Kleij RMJJ, Chavannes NH. SERIES: eHealth in primary care. Part 2: Exploring the ethical implications of its application in primary care practice. Eur J Gen Pract 2019; 26:26-32. [PMID: 31663394 PMCID: PMC7034078 DOI: 10.1080/13814788.2019.1678958] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background: eHealth promises to increase self-management and personalised medicine and improve cost-effectiveness in primary care. Paired with these promises are ethical implications, as eHealth will affect patients’ and primary care professionals’ (PCPs) experiences, values, norms, and relationships. Objectives: We argue what ethical implications related to the impact of eHealth on four vital aspects of primary care could (and should) be anticipated. Discussion: (1) EHealth influences dealing with predictive and diagnostic uncertainty. Machine-learning based clinical decision support systems offer (seemingly) objective, quantified, and personalised outcomes. However, they also introduce new loci of uncertainty and subjectivity. The decision-making process becomes opaque, and algorithms can be invalid, biased, or even discriminatory. This has implications for professional responsibilities and judgments, justice, autonomy, and trust. (2) EHealth affects the roles and responsibilities of patients because it can stimulate self-management and autonomy. However, autonomy can also be compromised, e.g. in cases of persuasive technologies and eHealth can increase existing health disparities. (3) The delegation of tasks to a network of technologies and stakeholders requires attention for responsibility gaps and new responsibilities. (4) The triangulate relationship: patient–eHealth–PCP requires a reconsideration of the role of human interaction and ‘humanness’ in primary care as well as of shaping Shared Decision Making. Conclusion: Our analysis is an essential first step towards setting up a dedicated ethics research agenda that should be examined in parallel to the development and implementation of eHealth. The ultimate goal is to inspire the development of practice-specific ethical recommendations.
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Affiliation(s)
- Sarah N Boers
- Julius Centre for Health Sciences and Primary Care, Department of Medical Humanities, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Karin R Jongsma
- Julius Centre for Health Sciences and Primary Care, Department of Medical Humanities, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Federica Lucivero
- Ethox and Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jiska Aardoom
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands.,National eHealth Living Lab (NELL), Leiden, the Netherlands
| | - Frederike L Büchner
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
| | - Martine de Vries
- Department of Medical Ethics and Health Law, Leiden University Medical Centre, Leiden, the Netherlands
| | - Persijn Honkoop
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands.,Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands
| | - Elisa J F Houwink
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
| | - Marise J Kasteleyn
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands.,National eHealth Living Lab (NELL), Leiden, the Netherlands
| | - Eline Meijer
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands.,National eHealth Living Lab (NELL), Leiden, the Netherlands
| | - Hilary Pinnock
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Martina Teichert
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Paul van der Boog
- Department of Nephrology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Sanne van Luenen
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands.,National eHealth Living Lab (NELL), Leiden, the Netherlands
| | - Rianne M J J van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands.,National eHealth Living Lab (NELL), Leiden, the Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands.,National eHealth Living Lab (NELL), Leiden, the Netherlands
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21
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van der Kleij RMJJ, Kasteleyn MJ, Meijer E, Bonten TN, Houwink EJF, Teichert M, van Luenen S, Vedanthan R, Evers A, Car J, Pinnock H, Chavannes NH. SERIES: eHealth in primary care. Part 1: Concepts, conditions and challenges. Eur J Gen Pract 2019; 25:179-189. [PMID: 31597502 PMCID: PMC6853224 DOI: 10.1080/13814788.2019.1658190] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [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] [Indexed: 01/12/2023] Open
Abstract
Primary care is challenged to provide high quality, accessible and affordable care for an increasingly ageing, complex, and multimorbid population. To counter these challenges, primary care professionals need to take up new and innovative practices, including eHealth. eHealth applications hold the promise to overcome some difficulties encountered in the care of people with complex medical and social needs in primary care. However, many unanswered questions regarding (cost) effectiveness, integration with healthcare, and acceptability to patients, caregivers, and professionals remain to be elucidated. What conditions need to be met? What challenges need to be overcome? What downsides must be dealt with? This first paper in a series on eHealth in primary care introduces basic concepts and examines opportunities for the uptake of eHealth in primary care. We illustrate that although the potential of eHealth in primary care is high, several conditions need to be met to ensure that safe and high-quality eHealth is developed for and implemented in primary care. eHealth research needs to be optimized; ensuring evidence-based eHealth is available. Blended care, i.e. combining face-to-face care with remote options, personalized to the individual patient should be considered. Stakeholders need to be involved in the development and implementation of eHealth via co-creation processes, and design should be mindful of vulnerable groups and eHealth illiteracy. Furthermore, a global perspective on eHealth should be adopted, and eHealth ethics, patients’ safety and privacy considered.
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Affiliation(s)
| | - Marise J Kasteleyn
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Eline Meijer
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Tobias N Bonten
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Elisa J F Houwink
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Martine Teichert
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Sanne van Luenen
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Clinical Psychology, Faculty of Social Sciences, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Rajesh Vedanthan
- Department of Population Health, Section for Global Health, NYU School of Medicine, New York, NY, USA
| | - Andrea Evers
- Department of Health, Medical and Neuropsychology, Faculty of Social Sciences, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Hilary Pinnock
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
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22
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Brakema EA, Tabyshova A, Kasteleyn MJ, Molendijk E, van der Kleij RMJJ, van Boven JFM, Emilov B, Akmatalieva M, Mademilov M, Numans ME, Williams S, Sooronbaev T, Chavannes NH. High COPD prevalence at high altitude: does household air pollution play a role? Eur Respir J 2019; 53:13993003.01193-2018. [PMID: 30464013 PMCID: PMC6428658 DOI: 10.1183/13993003.01193-2018] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/02/2018] [Indexed: 01/09/2023]
Abstract
Studies comparing chronic obstructive pulmonary disease (COPD) prevalence across altitudes report conflicting results. However, household air pollution (HAP), a major COPD risk factor, was mostly not accounted for in previous analyses and never objectively measured. We aimed to compare the prevalence of COPD and its risk factors between low-resource highlands and lowlands, with a particular focus on objectively measured HAP. We conducted a population-based, observational study in a highland (∼2050 m above sea level) and a lowland (∼750 m above sea level) setting in rural Kyrgyzstan. We performed spirometry in randomly selected households, measured indoor particulate matter with an aerodynamic diameter <2.5 µm (PM2.5) and administered a questionnaire on other COPD risk factors. Descriptive statistics and multivariable logistic regressions were used for analyses. We included 392 participants: 199 highlanders and 193 lowlanders. COPD was more prevalent among highlanders (36.7% versus 10.4%; p<0.001). Their average PM2.5 exposure was also higher (290.0 versus 72.0 µg·m−3; p<0.001). In addition to high PM2.5 exposure (OR 3.174, 95% CI 1.061–9.493), the altitude setting (OR 3.406, 95% CI 1.483–7.825), pack-years of smoking (OR 1.037, 95% CI 1.005–1.070) and age (OR 1.058, 95% CI 1.037–1.079) also contributed to a higher COPD prevalence among highlanders. COPD prevalence and HAP were highest in the highlands, and were independently associated. Preventive interventions seem warranted in these low-resource, highland settings. With this study being one of the first spirometry-based prevalence studies in Central Asia, generalisability needs to be assessed. High indoor PM2.5levels could explain elevated COPD prevalence in rural, high-altitude settings: prevention is key!http://ow.ly/hvC930mFEKJ
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Affiliation(s)
- Evelyn A Brakema
- Dept of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Aizhamal Tabyshova
- Pulmonary Dept, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan.,Dept of General Practice and Elderly Care Medicine, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marise J Kasteleyn
- Dept of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Eveline Molendijk
- Dept of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Job F M van Boven
- Dept of General Practice and Elderly Care Medicine, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Berik Emilov
- Pulmonary Dept, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Meerim Akmatalieva
- Pulmonary Dept, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Maamed Mademilov
- Pulmonary Dept, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Mattijs E Numans
- Dept of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Sian Williams
- International Primary Care Respiratory Group (IPCRG), London, UK
| | - Talant Sooronbaev
- Pulmonary Dept, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Niels H Chavannes
- Dept of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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23
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Luymes CH, van der Kleij RMJJ, Poortvliet RKE, de Ruijter W, Reis R, Numans ME. Deprescribing Potentially Inappropriate Preventive Cardiovascular Medication: Barriers and Enablers for Patients and General Practitioners. Ann Pharmacother 2016; 50:446-54. [PMID: 26939589 DOI: 10.1177/1060028016637181] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The use of preventive cardiovascular medication by patients with low cardiovascular disease (CVD) risk is potentially inappropriate. OBJECTIVE The aim of this study was to identify barriers to and enablers of deprescribing potentially inappropriate preventive cardiovascular medication experienced by patients and general practitioners (GPs). METHODS A total of 10 GPs participating in the ECSTATIC trial (Evaluating Cessation of STatins and Antihypertensive Treatment In primary Care) audiotaped deprescribing consultations with low-CVD-risk patients. After initial conventional content analysis, 2 researchers separately coded all barriers to and enablers of deprescribing medication using framework analysis. We performed a within-case and cross-case analysis to explore barriers and enablers among both patients and GPs. RESULTS Patients (n = 49) and GPs (n = 10) expressed barriers and enablers with regard to the appropriateness of the medication and the deprescribing process. A family history for CVD was identified as a barrier to deprescribing medication for both patients and GPs. Patients feared possible consequences of deprescribing and were influenced by the opinion of their GP. Additionally, a presumed disapproving opinion from specialists influenced the GPs' willingness to deprescribe medication. CONCLUSIONS Patients appreciated discussing their doubts regarding deprescribing potentially inappropriate preventive cardiovascular medication. Furthermore, they acknowledged their GP's expertise and took their opinion toward deprescribing into consideration. The GPs' decisions to deprescribe were influenced by the low CVD risk of the patients, additional risk factors, and the alleged specialist's opinion toward deprescribing. We recommend deprescribing consultations to be patient centered, with GPs addressing relevant themes and probable consequences of deprescribing preventive cardiovascular medication.
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Affiliation(s)
- Clare H Luymes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Rosalinde K E Poortvliet
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Wouter de Ruijter
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Ria Reis
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, the Netherlands The Children's Institute, University of Cape Town, Cape Town, South Africa
| | - Mattijs E Numans
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
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24
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van der Kleij RMJJ, Crone MR, Paulussen TGWM, van de Gaar VM, Reis R. A stitch in time saves nine? A repeated cross-sectional case study on the implementation of the intersectoral community approach Youth At a Healthy Weight. BMC Public Health 2015; 15:1032. [PMID: 26449368 PMCID: PMC4597380 DOI: 10.1186/s12889-015-2306-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 09/21/2015] [Indexed: 11/22/2022] Open
Abstract
Background The implementation of programs complex in design, such as the intersectoral community approach Youth At a Healthy Weight (JOGG), often deviates from their application as intended. There is limited knowledge of their implementation processes, making it difficult to formulate sound implementation strategies. Methods For two years, we performed a repeated cross-sectional case study on the implementation of a JOGG fruit and water campaign targeting children age 0–12. Semi-structured observations, interviews, field notes and professionals’ logs entries were used to evaluate implementation process. Data was analyzed via a framework approach; within-case and cross-case displays were formulated and key determinants identified. Principles from Qualitative Comparative Analysis (QCA) were used to identify causal configurations of determinants per sector and implementation phase. Results Implementation completeness differed, but was highest in the educational and health care sector, and higher for key than additional activities. Determinants and causal configurations of determinants were mostly sector- and implementation phase specific. High campaign ownership and possibilities for campaign adaptation were most frequently mentioned as facilitators. A lack of reinforcement strategies, low priority for campaign use and incompatibility of own goals with campaign goals were most often indicated as barriers. Discussion We advise multiple ‘stitches in time’; tailoring implementation strategies to specific implementation phases and sectors using both the results from this study and a mutual adaptation strategy in which professionals are involved in the development of implementation strategies. Conclusion The results of this study show that the implementation process of IACOs is complex and sustainable implementation is difficult to achieve. Moreover, this study reveals that the implementation process is influenced by predominantly sector and implementation phase specific (causal configurations of) determinants.
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Affiliation(s)
- Rianne M J J van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Center, Postbus 9600 zone V-0-P 2300 RC, Leiden, The Netherlands. .,Academic Workplace (AWP) Public Health Zuid-Holland Noord, Leiden, The Netherlands.
| | - Mathilde R Crone
- Department of Public Health and Primary Care, Leiden University Medical Center, Postbus 9600 zone V-0-P 2300 RC, Leiden, The Netherlands. .,Academic Workplace (AWP) Public Health Zuid-Holland Noord, Leiden, The Netherlands.
| | - Theo G W M Paulussen
- Academic Workplace (AWP) Public Health Zuid-Holland Noord, Leiden, The Netherlands. .,TNO Research Group Lifestyle, Leiden, The Netherlands.
| | - Vivan M van de Gaar
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands.
| | - Ria Reis
- Department of Public Health and Primary Care, Leiden University Medical Center, Postbus 9600 zone V-0-P 2300 RC, Leiden, The Netherlands. .,Academic Workplace (AWP) Public Health Zuid-Holland Noord, Leiden, The Netherlands. .,Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands. .,The Children's Institute, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
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