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Singhal M, Oyston C. Telehealth and Technology for Diabetes in Pregnancy Clinics: Staff Perspectives from South Auckland, New Zealand. Int J Telemed Appl 2024; 2024:6429519. [PMID: 38516417 PMCID: PMC10957257 DOI: 10.1155/2024/6429519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 09/19/2023] [Accepted: 02/08/2024] [Indexed: 03/23/2024] Open
Abstract
Providing care for patients with diabetes in pregnancy (DiP) provides unique challenges beyond those faced in standard antenatal care or diabetes outside of pregnancy. Teleclinics (use of telephone, email, or other technologies) as an alternative to in-person clinic appointments have become more widely used for care since the start of the COVID-19 pandemic. To understand how teleclinics might be improved for ongoing use, it is important to understand the experiences and perceptions of the clinicians involved in DiP care. Aim. To understand staff experiences of DiP teleclinics and gain their perspectives on if and how teleclinics and other technologies might be best used in the future. Methods. A qualitative study using semistructured interviews of healthcare providers in a large DiP service. Twenty staff members (midwifery, obstetrics, physician, dietician, and administration) were approached to participate. Fifteen staff across 5 specialties consented to be interviewed. Template analysis of interview transcripts was performed, with a focus on 3 themes: collaboration and working together are important for providing care for DiP, a need for flexibility in scheduling and the ability to individualise the way care is provided, and challenges to adapting to new technology. Results. Potential benefits of teleclinics were acknowledged, but respondents also viewed teleclinics as not suitable for all DiP patients due to different needs and risks. Challenges to using teleclinics include establishing good rapport and the current limited infrastructure and patient resources. Conclusion. Healthcare providers viewed teleclinics as a way of supporting rather than replacing current care. Maintaining flexibility in clinic scheduling to allow incorporation of teleclinics into patient's current schedule of visits ad hoc and providing extra technical and administrative support are important considerations for developing a teleclinic service.
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Affiliation(s)
- Megan Singhal
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Charlotte Oyston
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Obstetrics and Gynaecology, Middlemore Hospital, Te Whatu Ora Counties Manukau Health, South Auckland, New Zealand
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Montori S, Lugli F, Monesi M, Scutiero G, Forini E, Greco P, Verteramo R. Telemedicine in the treatment of gestational diabetes: An observational cohort study on pregnancy outcomes and maternal satisfaction. Diabet Med 2024; 41:e15201. [PMID: 37643876 DOI: 10.1111/dme.15201] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/31/2023]
Abstract
AIMS Gestational diabetes treatment requires several outpatient consultations from diagnosis until delivery in order to prevent hyperglycaemia, which is associated with maternal and fetal complications. There is limited evidence in the literature about telemedicine superiority in improving pregnancy outcomes for women with gestational diabetes. The primary aim of the study was to evaluate maternal and fetal outcomes, while the secondary aim was to estimate the degree of satisfaction with gestational diabetes treatment, comparing telemedicine versus outpatient care. METHODS This observational cohort study involved 60 consecutive women with gestational diabetes treated at the Diabetology Unit of Ferrara: 27 were followed up through a weekly remote control method (telemedicine group) and 33 in ambulatory clinics every 2 or 3 weeks (conventional group). After giving birth, 56 women responded to the modified Oxford Maternity Diabetes Treatment Satisfaction Questionnaire to assess their satisfaction with diabetes care. RESULTS No statistically significant differences were found in most of the maternal and neonatal parameters evaluated in both groups. The questionnaire scores were positive in all areas investigated. Telemedicine follow-up made women feel more controlled (p = 0.045) and fit better with their lifestyle (p = 0.005). It also emerged that almost all women treated with telemedicine would recommend this method to a relative or a friend. CONCLUSIONS Telemedicine follow-up proved to be safe both in terms of metabolic control and pregnancy outcomes; furthermore, it significantly decreased the need for outpatient consultations and increased women's satisfaction. Studying the impact of telemedicine is also necessary, considering the current difficulties associated with the Sars-COV-2 pandemic.
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Affiliation(s)
- Sara Montori
- Department of Medical Sciences, Section of Obstetrics and Gynecology, S. Anna University Hospital, University of Ferrara, Ferrara, Italy
| | - Francesca Lugli
- Complex Operational Unit Territorial Diabetology, AUSL of Ferrara, Ferrara, Italy
| | - Marcello Monesi
- Complex Operational Unit Territorial Diabetology, AUSL of Ferrara, Ferrara, Italy
| | - Gennaro Scutiero
- Department of Medical Sciences, Section of Obstetrics and Gynecology, S. Anna University Hospital, University of Ferrara, Ferrara, Italy
| | - Elena Forini
- Unit of Statistics, S. Anna University Hospital of Ferrara, University of Ferrara, Ferrara, Italy
| | - Pantaleo Greco
- Department of Medical Sciences, Section of Obstetrics and Gynecology, S. Anna University Hospital, University of Ferrara, Ferrara, Italy
| | - Rosita Verteramo
- Department of Medical Sciences, Section of Obstetrics and Gynecology, S. Anna University Hospital, University of Ferrara, Ferrara, Italy
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Eysenbach G, Chen D, Xu P, Wang X, Zhang W, Mao M, Zheng Q, Jin Y, Feng S. Web-Based Interventions for Pregnant Women With Gestational Diabetes Mellitus: Systematic Review and Meta-analysis. J Med Internet Res 2023; 25:e36922. [PMID: 36656629 PMCID: PMC9896357 DOI: 10.2196/36922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 11/30/2022] [Accepted: 12/18/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Effective management of gestational diabetes mellitus (GDM) is essential because it is one of the most prevalent diseases during pregnancy, and the consequent condition maternal hyperglycemia is closely related to considerable short- and long-term maternal and neonatal complications. Web-based interventions (WBIs), defined as therapeutic interventions offered via the web, have been implemented to assist in managing GDM owing to their advantages of high accessibility and efficiency, but findings across relevant studies are inconsistent. OBJECTIVE This systematic review and meta-analysis aimed to evaluate the effectiveness of WBIs on glycemic control among pregnant women with GDM; examine whether specific types of intervention interactivity, format, and technology have beneficial effects on maternal glycemic control; and comprehensively assess the efficacy of WBIs in maternal behavioral outcomes, cognitive and attitudinal outcomes, mental health, maternal and neonatal clinical outcomes, and medical service use and costs among pregnant women with GDM. METHODS PubMed, Embase, Cochrane Library, Web of Science, CINAHL, and PsycINFO were searched from their respective inception to November 19, 2022, to identify relevant randomized controlled trials and controlled clinical trials. The methodological quality of the included studies was assessed using the Effective Public Health Practice Project tool. Where possible, the data for all outcomes were meta-analyzed using the Stata software (version 12.0; StataCorp). Overall, 3 subgroup analyses and post hoc sensitivity analyses of maternal glycemic control parameters were performed. RESULTS Overall, 25 publications arising from 21 randomized controlled trials and controlled clinical trials were included. The overall meta-analyses on glycemic control parameters demonstrated that WBIs could significantly improve fasting blood glucose (standardized mean difference=-1.764, 95% CI -2.972 to -0.557; P=.004) and 2-hour postprandial blood glucose (standardized mean difference=-1.433, 95% CI -2.561 to -0.304; P=.01) compared with the control group, whereas no significant effect was found on glycated hemoglobin and 1-hour postprandial blood glucose. The results of the subgroup analyses indicated that mobile app-delivered interventions with a personalized format and interactive function showed more beneficial effects on maternal glycemic control. Moreover, WBIs could significantly enhance compliance with the self-monitoring of blood glucose; increase the rate of normal vaginal delivery; and decrease the chance of emergency cesarean, admission to the neonatal intensive care unit, and composite neonatal complications. GDM knowledge, risk perception of the disease, self-efficacy, satisfaction with care, and medical service use of the participants in the WBI group were also improved compared with the control group. However, the effectiveness of WBIs on other secondary outcomes was either nonsignificant or uncertain. CONCLUSIONS WBIs are a promising approach to GDM management. Personalized, interactive, and mobile app-delivered interventions seem more worthy of being recommended for future clinical practice. Further high-quality studies are required to verify these findings before making broad recommendations. TRIAL REGISTRATION PROSPERO CRD42022296625; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=296625.
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Affiliation(s)
| | - Dandan Chen
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| | - Ping Xu
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Xiaojuan Wang
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Wei Zhang
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Minna Mao
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Qiong Zheng
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Ying Jin
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Suwen Feng
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
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Guo P, Jin Y, Xiang Z, Chen DD, Xu P, Wang X, Zhang W, Mao M, Zheng Q, Feng S. Web-based interventions for pregnant women with gestational diabetes mellitus: a systematic review and meta-analysis protocol. BMJ Open 2022; 12:e061151. [PMID: 35768118 PMCID: PMC9244690 DOI: 10.1136/bmjopen-2022-061151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) is one of the most prevalent diseases during pregnancy, which is closely associated with many short-term and long-term maternal and neonatal complications and can incur heavy financial burden on both families and society. Web-based interventions have been used to manage GDM because of the advantages of high accessibility and flexibility, but their effectiveness has remained inconclusive. This systematic review and meta-analysis aims to comprehensively investigate the multidimensional effectiveness of web-based interventions for pregnant women with GDM, thereby aiding implementation decisions in clinical settings. METHODS AND ANALYSIS This systematic review protocol strictly adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. Six electronic databases (PubMed, Web of Science, Cochrane Central Register of Controlled Trials, Embase, CINAHL and PsycINFO) will be comprehensively searched from their inception to 26 January 2022 to identify randomised controlled trials and controlled clinical trials regarding the efficacy of web-based interventions for pregnant women with GDM on glycaemic control, behavioural outcomes, cognitive and attitudinal outcomes, mental health, maternal and neonatal clinical outcomes, and medical service utilisation and costs. Two reviewers will independently conduct the study selection, data extraction and quality assessment. The methodological quality of included studies will be assessed using the Effective Public Health Practice Project assessment tool. The overall meta-analyses for each of the interested outcomes will be performed if the outcome data are sufficient and provides similar effect measures, as well as subgroup analyses for glycaemic control indicators based on the different types of intervention format, interactivity and technology. We will conduct a qualitative synthesis for studies that cannot be quantitatively synthesised. ETHICS AND DISSEMINATION Ethics approval is not required for this review as no human participants will be involved. The results will be disseminated via a peer-reviewed journal or an academic conference. PROSPERO REGISTRATION NUMBER CRD42022296625.
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Affiliation(s)
- Pingping Guo
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yin Jin
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhenzhen Xiang
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dan Dan Chen
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| | - Ping Xu
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaojuan Wang
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Zhang
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Minna Mao
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiong Zheng
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Suwen Feng
- Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Safiee L, Rough DJ, Whitford H. Barriers and Facilitators of Using eHealth to Support Gestational Diabetes Mellitus Self-Management (GDM): A Systematic Literature Review of Perceptions of Healthcare Professionals and Women with GDM (Preprint). J Med Internet Res 2022; 24:e39689. [PMID: 36301613 PMCID: PMC9650580 DOI: 10.2196/39689] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/16/2022] [Accepted: 09/28/2022] [Indexed: 11/30/2022] Open
Abstract
Background Gestational diabetes mellitus (GDM) is one of the most common medical complications during pregnancy. eHealth technologies are proving to be successful in supporting the self-management of medical conditions. Digital technologies have the potential to improve GDM self-management. Objective The primary objective of this systematic literature review was to identify the views of health professionals (HPs) and women with GDM regarding the use of eHealth for GDM self-management. The secondary objective was to investigate the usability and user satisfaction levels when using these technologies. Methods Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) approach, the search included primary papers in English on the evaluation of technology to support self-management of GDM from January 2008 to September 2021 using MEDLINE, CINAHL, Embase, ACM, and IEEE databases. The lists of references from previous systematic literature reviews, which were related to technology and GDM, were also examined for primary studies. Papers with qualitative, quantitative, and mixed methodologies were included and evaluated. The selected papers were assessed for quality using the Cochrane Collaboration tool, National Institute for Health and Care Excellence clinical guidelines, Critical Appraisal Skills Programme Qualitative Checklist, and McGill University Mixed Methods Appraisal Tool. NVivo (QSR International) was used to extract qualitative data, which were subjected to thematic analysis. Narrative synthesis was used to analyze the quantitative data. Results A total of 26 papers were included in the review. Of these, 19% (5/26) of studies used quantitative research methodologies, 19% (5/26) used qualitative methods, and 62% (16/26) used mixed methods. In all, 4 themes were identified from the qualitative data: the benefits of using technology, engagement with people via technology, the usability of technology, and discouragement factors for the use of technology. The thematic analysis revealed a vast scope of challenges and facilitators in the use of GDM self-management systems. The challenges included usability aspects of the system, technical problems, data privacy, lack of emotional support, the accuracy of reported data, and adoption of the system by HPs. Convenience, improved GDM self-management, peer support, increased motivation, increased independence, and consistent monitoring were facilitators to use these technologies. Quantitative data showed that there is potential for improving the usability of the GDM self-management systems. It also showed that convenience, usefulness, increasing motivation for GDM self-management, helping with GDM self-management, and being monitored by HPs were facilitators to use the GDM self-management systems. Conclusions This novel systematic literature review shows that HPs and women with GDM encountered some challenges in using GDM self-management systems. The usability of GDM systems was the primary challenge derived from qualitative and quantitative results, with convenience, consistent monitoring, and optimization of GDM self-management emerging as important facilitators.
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Affiliation(s)
- Ladan Safiee
- School of Science and Engineering, University of Dundee, Dundee, United Kingdom
| | - Daniel John Rough
- School of Science and Engineering, University of Dundee, Dundee, United Kingdom
| | - Heather Whitford
- School of Health Sciences, University of Dundee, Dundee, United Kingdom
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6
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Zahmatkeshan M, Zakerabasali S, Farjam M, Gholampour Y, Seraji M, Yazdani A. The use of mobile health interventions for gestational diabetes mellitus: a descriptive literature review. J Med Life 2021; 14:131-141. [PMID: 34104235 PMCID: PMC8169150 DOI: 10.25122/jml-2020-0163] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 04/02/2021] [Indexed: 11/23/2022] Open
Abstract
This study attempted to review the evidence for or against the effectiveness of mobile health (m-health) interventions on health outcomes improvement and/or gestational diabetes mellitus (GDM) management. PubMed, Web of Science, Scopus, and Embase databases were searched from 2000 to 10 July 2018 to find studies investigating the effect of m-health on GDM management. After removing duplications, a total of 27 articles met our defined inclusion criteria. m-health interventions were implemented by smartphone, without referring to its type, in 26% (7/27) of selected studies, short message service (SMS) in 14.9% (4/27), mobile-based applications in 33.3% (9/27), telemedicine-based on smartphones in 18.5% (5/27), and SMS reminder system in 7.1% (2/27). Most of the included studies (n=23) supported the effectiveness of m-health interventions on GDM management and 14.3% (n=4) reported no association between m-health interventions and pregnancy outcomes. Based on our findings, m-health interventions could enhance GDM patients' pregnancy outcomes. A majority of the included studies suggested positive outcomes. M-health can be one of the most prominent technologies for the management of GDM.
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Affiliation(s)
- Maryam Zahmatkeshan
- Noncommunicable Diseases Research Center, School of Medicine, Fasa University of Medical Sciences, Fasa, Iran
| | - Somayyeh Zakerabasali
- Department of Health Information Management, Health Human Resources Research Center, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojtaba Farjam
- Noncommunicable Diseases Research Center, School of Medicine, Fasa University of Medical Sciences, Fasa, Iran
- Clinical Research Development Unit, Valie-Asr Hospital, Fasa University of Medical Sciences, Fasa, Iran
| | | | - Maryam Seraji
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Azita Yazdani
- Department of Health Information Management, Health Human Resources Research Center, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Hussain T, Smith P, Yee LM. Mobile Phone-Based Behavioral Interventions in Pregnancy to Promote Maternal and Fetal Health in High-Income Countries: Systematic Review. JMIR Mhealth Uhealth 2020; 8:e15111. [PMID: 32463373 PMCID: PMC7290451 DOI: 10.2196/15111] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 11/22/2019] [Accepted: 01/26/2020] [Indexed: 12/13/2022] Open
Abstract
Background Chronic diseases have recently had an increasing effect on maternal-fetal health, especially in high-income countries. However, there remains a lack of discussion regarding health management with technological approaches, including mobile health (mHealth) interventions. Objective This study aimed to systematically evaluate mHealth interventions used in pregnancy in high-income countries and their effects on maternal health behaviors and maternal-fetal health outcomes. Methods This systematic review identified studies published between January 1, 2000, and November 30, 2018, in MEDLINE via PubMed, Cochrane Library, EMBASE, CINAHL, PsycINFO, Web of Science, and gray literature. Studies were eligible for inclusion if they included only pregnant women in high-income countries and evaluated stand-alone mobile phone interventions intended to promote healthy maternal beliefs, behaviors, and/or maternal-fetal health outcomes. Two researchers independently reviewed and categorized aspects of full-text articles, including source, study design, intervention and control, duration, participant age, attrition rate, main outcomes, and risk of bias. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and the study was registered in PROSPERO before initiation. Results Of the 2225 records examined, 28 studies were included and categorized into 4 themes: (1) gestational weight gain, obesity and physical activity (n=9); (2) smoking cessation (n=9); (3) influenza vaccination (n=2); and (4) general prenatal health, preventive strategies, and miscellaneous topics (n=8). Reported sample sizes ranged from 16 to 5243 with a median of 91. Most studies were performed in the United States (18/28, 64%) and were randomized controlled trials (21/28, 75%). All participants in the included studies were pregnant at the time of study initiation. Overall, 14% (4/28) of studies showed association between intervention use and improved health outcomes; all 4 studies focused on healthy gestational weight. Among those, 3 studies showed intervention use was associated with less overall gestational weight gain. These 3 studies involved interventions with text messaging or an app in combination with another communication strategy (Facebook or email). Regarding smoking cessation, influenza vaccination, and miscellaneous topics, there was some evidence of positive effects on health behaviors and beliefs, but very limited correlation with improved health outcomes. Data and interventions were heterogeneous, precluding a meta-analysis. Conclusions In high-income countries, utilization of mobile phone–based health behavior interventions in pregnancy demonstrates some correlation with positive beliefs, behaviors, and health outcomes. More effective interventions are multimodal in terms of features and tend to focus on healthy gestational weight gain.
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Affiliation(s)
- Tasmeen Hussain
- Department of Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Patricia Smith
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Lynn M Yee
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Ayatollahi H, Ghalandar Abadi M, Hemmat M. Web and mobile-based technologies for monitoring high-risk pregnancies. BMJ Health Care Inform 2019; 26:bmjhci-2019-000025. [PMID: 31201201 PMCID: PMC7062320 DOI: 10.1136/bmjhci-2019-000025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 03/18/2019] [Accepted: 12/08/2018] [Indexed: 11/24/2022] Open
Abstract
Introduction High-risk pregnancy is an illness in which there are severe complications and problems that may cause fetal loss and requires continuous care. It seems that using telemedicine technology is helpful to provide wider access to prenatal care. The aim of this study was to compare the feasibility of using web-based and mobile-based technologies in caring for high-risk pregnancy. Materials and methods This was a cross-sectional study and the participants included midwives and gynaecologists who worked at teaching hospitals. The data were collected by using two five-point Likert scale questionnaires which were designed based on the literature review. The questionnaires included two main sections: demographic questions and questions related to five aspects of a feasibility study. Face and content validity of the questionnaires were confirmed by the experts and the reliability was checked by using the test-retest method. The data were analysed using descriptive and inferential statistics. Results In this study, 79 questionnaires were completed by 50 midwives (63.29%) and 29 gynaecologists (36.71%). Overall, midwives (p=0.001) and gynaecologists (p=0.003) believed that using mobile-based technologies was more feasible than using web-based technologies in caring for high-risk pregnancies. Conclusion It seems that planning for the future technological direction and providing mobile-based applications should be taken into account and prioritised to improve the quality of prenatal care and to increase access to healthcare services for high-risk pregnancies.
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Affiliation(s)
- Haleh Ayatollahi
- Health Management and Economics Research center, Iran University of Medical Sciences, Tehran, Iran
| | - Malihe Ghalandar Abadi
- Health Information Technology, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Morteza Hemmat
- Health Information Management, Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
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Alqudah A, McMullan P, Todd A, O’Doherty C, McVey A, McConnell M, O’Donoghue J, Gallagher J, Watson CJ, McClements L. Service evaluation of diabetes management during pregnancy in a regional maternity hospital: potential scope for increased self-management and remote patient monitoring through mHealth solutions. BMC Health Serv Res 2019; 19:662. [PMID: 31514743 PMCID: PMC6743173 DOI: 10.1186/s12913-019-4471-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 08/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pre-gestational and gestational diabetes mellitus are common complications in pregnancy affecting one in six pregnancies. The maternity services are under significant strain managing the increasing number of complex pregnancies. This has an impact on patients' experience of antenatal care. Therefore, there is a clear need to address pregnancy care. One possible solution is to use home-based digital technology to reduce clinic visits and improve clinical monitoring. METHODS The aim of this study was to evaluate the antenatal services provided to pregnant women with diabetes who were monitored at the joint metabolic and obstetric clinic at the Southern Health and Social Care Trust in Northern Ireland. RESULTS The questionnaires were completed by sixty-three women, most of whom had gestational diabetes mellitus. Most of the participants were between 25 and 35 years of age (69.8%), had one or more children (65.1%) and spent over 2 h attending the clinics (63.9%); 78% of women indicated that their travel time to and from the clinic appointment was over 15 min. Over 70% of women used smartphones for health-related purposes. However, only 8.8% used smartphones to manage their health or diabetes. Less than 25% of the women surveyed expressed concerns about using digital technology from home to monitor various aspects of their health in pregnancy. CONCLUSIONS Overall, pregnant women who had or developed diabetes in pregnancy experience frequent hospital visits and long waiting times in the maternity clinics. Most of these pregnant women are willing to self-manage their condition from home and to be monitored remotely by the healthcare staff.
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Affiliation(s)
- Abdelrahim Alqudah
- The Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
- School of Pharmacy, The Hashemite University, Zarqa, Jordan
| | - Paul McMullan
- Craigavon Area Hospital, Southern Health and Social Care Trust, Craigavon, United Kingdom
| | - Anna Todd
- Craigavon Area Hospital, Southern Health and Social Care Trust, Craigavon, United Kingdom
| | - Conor O’Doherty
- Craigavon Area Hospital, Southern Health and Social Care Trust, Craigavon, United Kingdom
| | - Anne McVey
- Craigavon Area Hospital, Southern Health and Social Care Trust, Craigavon, United Kingdom
| | - Mae McConnell
- Craigavon Area Hospital, Southern Health and Social Care Trust, Craigavon, United Kingdom
| | | | - Joe Gallagher
- gHealth Research group, School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Chris J. Watson
- The Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - Lana McClements
- The Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, Australia
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10
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Fantinelli S, Marchetti D, Verrocchio MC, Franzago M, Fulcheri M, Vitacolonna E. Assessment of Psychological Dimensions in Telemedicine Care for Gestational Diabetes Mellitus: A Systematic Review of Qualitative and Quantitative Studies. Front Psychol 2019; 10:153. [PMID: 30804842 PMCID: PMC6370698 DOI: 10.3389/fpsyg.2019.00153] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 01/16/2019] [Indexed: 12/04/2022] Open
Abstract
Background and Objective: Gestational Diabetes Mellitus (GDM) is a complex and wide spread problem and is considered one of the most frequent chronic metabolic conditions during pregnancy. According to a recent consensus conference held in Italy, new technologies can play a role in the so-called process of fertilization of the individual's ecosystem engagement, representing support for systemic collaboration among the main actors. The current systematic review aimed at providing an update of the literature about telemedicine for GDM, considering the role of psychological dimensions such as empowerment/self-efficacy, engagement and satisfaction. Methods: The review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. The data sources were PubMed, ScienceDirect, Cochrane, and Scopus databases. Results: Thirteen articles were identified as eligible and relevant for the final qualitative synthesis, but none was specific for the topic of engagement. The quality or research bias of the studies presents methodological limits. Most studies had clinical outcomes as a primary object. Concerning empowerment and self-efficacy, there were only preliminary findings reporting any improvements derived from using telemedicine approaches. Conversely, there were more consistent and positive results concerning the satisfaction of patients and clinicians. Conclusions: These results are not sufficient to state a conclusive evaluation of positive effects of telemedicine use for GDM care. A more in-depth investigation of engagement and empowerment dimensions is necessary, as some benefits for the management of chronic conditions were already detected. Further investigations will also be necessary concerning the acceptability and feasibility of telemedicine systems by clinicians.
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Affiliation(s)
- Stefania Fantinelli
- Department of Psychological, Health, and Territorial Sciences, School of Medicine and Health Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Daniela Marchetti
- Department of Psychological, Health, and Territorial Sciences, School of Medicine and Health Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Maria Cristina Verrocchio
- Department of Psychological, Health, and Territorial Sciences, School of Medicine and Health Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Marica Franzago
- Department of Medicine and Aging, "G. d'Annunzio" University, Chieti, Italy
| | - Mario Fulcheri
- Department of Psychological, Health, and Territorial Sciences, School of Medicine and Health Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Ester Vitacolonna
- Department of Medicine and Aging, "G. d'Annunzio" University, Chieti, Italy
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Feig DS, Berger H, Donovan L, Godbout A, Kader T, Keely E, Sanghera R. Diabetes and Pregnancy. Can J Diabetes 2018; 42 Suppl 1:S255-S282. [DOI: 10.1016/j.jcjd.2017.10.038] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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13
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Ming WK, Mackillop LH, Farmer AJ, Loerup L, Bartlett K, Levy JC, Tarassenko L, Velardo C, Kenworthy Y, Hirst JE. Telemedicine Technologies for Diabetes in Pregnancy: A Systematic Review and Meta-Analysis. J Med Internet Res 2016; 18:e290. [PMID: 27829574 PMCID: PMC5121530 DOI: 10.2196/jmir.6556] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 10/05/2016] [Accepted: 10/07/2016] [Indexed: 11/24/2022] Open
Abstract
Background Diabetes in pregnancy is a global problem. Technological innovations present exciting opportunities for novel approaches to improve clinical care delivery for gestational and other forms of diabetes in pregnancy. Objective To perform an updated and comprehensive systematic review and meta-analysis of the literature to determine whether telemedicine solutions offer any advantages compared with the standard care for women with diabetes in pregnancy. Methods The review was developed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. Randomized controlled trials (RCT) in women with diabetes in pregnancy that compared telemedicine blood glucose monitoring with the standard care were identified. Searches were performed in SCOPUS and PubMed, limited to English language publications between January 2000 and January 2016. Trials that met the eligibility criteria were scored for risk of bias using the Cochrane Collaborations Risk of Bias Tool. A meta-analysis was performed using Review Manager software version 5.3 (Nordic Cochrane Centre, Cochrane Collaboration). Results A total of 7 trials were identified. Meta-analysis demonstrated a modest but statistically significant improvement in HbA1c associated with the use of a telemedicine technology. The mean HbA1c of women using telemedicine was 5.33% (SD 0.70) compared with 5.45% (SD 0.58) in the standard care group, representing a mean difference of −0.12% (95% CI −0.23% to −0.02%). When this comparison was limited to women with gestational diabetes mellitus (GDM) only, the mean HbA1c of women using telemedicine was 5.22% (SD 0.70) compared with 5.37% (SD 0.61) in the standard care group, mean difference −0.14% (95% CI −0.25% to −0.04%). There were no differences in other maternal and neonatal outcomes reported. Conclusions There is currently insufficient evidence that telemedicine technology is superior to standard care for women with diabetes in pregnancy; however, there was no evidence of harm. No trials were identified that assessed patient satisfaction or cost of care delivery, and it may be in these areas where these technologies may be found most valuable.
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Affiliation(s)
- Wai-Kit Ming
- Nuffield Department of Obstetrics & Gynaecology, John Radcliffe Hospital, Oxford, United Kingdom.,Department of Obstetrics & Gynaecology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lucy H Mackillop
- Women's Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Andrew J Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Lise Loerup
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Katy Bartlett
- Women's Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Jonathan C Levy
- The Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Lionel Tarassenko
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Carmelo Velardo
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Yvonne Kenworthy
- Nuffield Department of Obstetrics & Gynaecology, John Radcliffe Hospital, Oxford, United Kingdom
| | - Jane E Hirst
- Nuffield Department of Obstetrics & Gynaecology, John Radcliffe Hospital, Oxford, United Kingdom
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Hirst JE, Loerup L, Mackillop L, Farmer A, Kenworthy Y, Bartlett K, Velardo C, Kevat DA, Tarassenko L, Levy JC. Digital blood glucose monitoring could provide new objective assessments of blood glucose control in women with gestational diabetes. Diabet Med 2016; 33:1598-1599. [PMID: 26606543 DOI: 10.1111/dme.13035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- J E Hirst
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, UK
| | - L Loerup
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - L Mackillop
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, UK
- Oxford University Hospitals, NHS Trust, Oxford, UK
| | - A Farmer
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Y Kenworthy
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, UK
| | - K Bartlett
- Oxford University Hospitals, NHS Trust, Oxford, UK
| | - C Velardo
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - D A Kevat
- Oxford University Hospitals, NHS Trust, Oxford, UK
| | - L Tarassenko
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - J C Levy
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals, NHS Trust, Oxford, UK
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Athavale P, Thomas M, Delgadillo-Duenas AT, Leong K, Najmabadi A, Harleman E, Rios C, Quan J, Soria C, Handley MA. Linking High Risk Postpartum Women with a Technology Enabled Health Coaching Program to Reduce Diabetes Risk and Improve Wellbeing: Program Description, Case Studies, and Recommendations for Community Health Coaching Programs. J Diabetes Res 2016; 2016:4353956. [PMID: 27830157 PMCID: PMC5088315 DOI: 10.1155/2016/4353956] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 08/01/2016] [Accepted: 08/14/2016] [Indexed: 12/20/2022] Open
Abstract
Background. Low-income minority women with prior gestational diabetes mellitus (pGDM) or high BMIs have increased risk for chronic illnesses postpartum. Although the Diabetes Prevention Program (DPP) provides an evidence-based model for reducing diabetes risk, few community-based interventions have adapted this program for pGDM women. Methods. STAR MAMA is an ongoing randomized control trial (RCT) evaluating a hybrid HIT/Health Coaching DPP-based 20-week postpartum program for diabetes prevention compared with education from written materials at baseline. Eligibility includes women 18-39 years old, ≥32 weeks pregnant, and GDM or BMI > 25. Clinic- and community-based recruitment in San Francisco and Sonoma Counties targets 180 women. Sociodemographic and health coaching data from a preliminary sample are presented. Results. Most of the 86 women included to date (88%) have GDM, 80% were identified as Hispanic/Latina, 78% have migrant status, and most are Spanish-speaking. Women receiving the intervention indicate high engagement, with 86% answering 1+ calls. Health coaching callbacks last an average of 9 minutes with range of topics discussed. Case studies presented convey a range of emotional, instrumental, and health literacy-related supports offered by health coaches. Discussion. The DPP-adapted HIT/health coaching model highlights the possibility and challenge of delivering DPP content to postpartum women in community settings. This trial is registered with ClinicalTrials.gov NCT02240420.
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Affiliation(s)
- Priyanka Athavale
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA
| | - Melanie Thomas
- Department of Psychiatry, UCSF/Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | | | - Karen Leong
- Division of General Internal Medicine, UCSF/Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Adriana Najmabadi
- Division of General Internal Medicine, UCSF/Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Elizabeth Harleman
- Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, CA, USA
- San Francisco General Hospital, San Francisco, CA, USA
| | - Christina Rios
- UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA
- Division of General Internal Medicine, UCSF/Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Judy Quan
- UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA
- Division of General Internal Medicine, UCSF/Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Catalina Soria
- UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA
- Division of General Internal Medicine, UCSF/Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Margaret A. Handley
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA
- Division of General Internal Medicine, UCSF/Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
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16
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Handley MA, Harleman E, Gonzalez-Mendez E, Stotland NE, Althavale P, Fisher L, Martinez D, Ko J, Sausjord I, Rios C. Applying the COM-B model to creation of an IT-enabled health coaching and resource linkage program for low-income Latina moms with recent gestational diabetes: the STAR MAMA program. Implement Sci 2016; 11:73. [PMID: 27193580 PMCID: PMC4870786 DOI: 10.1186/s13012-016-0426-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/24/2016] [Indexed: 11/10/2022] Open
Abstract
Background One of the fastest growing risk groups for early onset of diabetes is women with a recent pregnancy complicated by gestational diabetes, and for this group, Latinas are the largest at-risk group in the USA. Although evidence-based interventions, such as the Diabetes Prevention Program (DPP), which focuses on low-cost changes in eating, physical activity and weight management can lower diabetes risk and delay onset, these programs have yet to be tailored to postpartum Latina women. This study aims to tailor a IT-enabled health communication program to promote DPP-concordant behavior change among postpartum Latina women with recent gestational diabetes. The COM-B model (incorporating Capability, Opportunity, and Motivational behavioral barriers and enablers) and the Behavior Change Wheel (BCW) framework, convey a theoretically based approach for intervention development. We combined a health literacy-tailored health IT tool for reaching ethnic minority patients with diabetes with a BCW-based approach to develop a health coaching intervention targeted to postpartum Latina women with recent gestational diabetes. Current evidence, four focus groups (n = 22 participants), and input from a Regional Consortium of health care providers, diabetes experts, and health literacy practitioners informed the intervention development. Thematic analysis of focus group data used the COM-B model to determine content. Relevant cultural, theoretical, and technological components that underpin the design and development of the intervention were selected using the BCW framework. Results STAR MAMA delivers DPP content in Spanish and English using health communication strategies to: (1) validate the emotions and experiences postpartum women struggle with; (2) encourage integration of prevention strategies into family life through mothers becoming intergenerational custodians of health; and (3) increase social and material supports through referral to social networks, health coaches, and community resources. Feasibility, acceptability, and health-related outcomes (weight loss, physical activity, consumption of healthy foods, breastfeeding, and glucose screening) will be evaluated at 9 months postpartum using a randomized controlled trial design. Conclusions STAR MAMA provides a DPP-based intervention that integrates theory-based design steps. Through systematic use of behavioral theory to inform intervention development, STAR MAMA may represent a strategy to develop health IT intervention tools to meet the needs of diverse populations. Trial registration ClinicalTrials.gov NCT02240420 Electronic supplementary material The online version of this article (doi:10.1186/s13012-016-0426-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Margaret A Handley
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA. .,Division of General Internal Medicine, UCSF/Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, USA. .,UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA, 94110, USA.
| | - Elizabeth Harleman
- Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, USA.,Zuckerberg San Francisco General Hospital, San Francisco, USA
| | - Enrique Gonzalez-Mendez
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, USA.,Vista Family Health Center, Santa Rosa, USA
| | - Naomi E Stotland
- Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, USA.,Zuckerberg San Francisco General Hospital, San Francisco, USA
| | - Priyanka Althavale
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA.,UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA, 94110, USA
| | - Lawrence Fisher
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, USA
| | - Diana Martinez
- Division of General Internal Medicine, UCSF/Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, USA.,UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA, 94110, USA
| | - Jocelyn Ko
- University of California San Francisco, San Francisco, USA
| | - Isabel Sausjord
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, USA.,UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA, 94110, USA
| | - Christina Rios
- Division of General Internal Medicine, UCSF/Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, USA.,UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA, 94110, USA
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Han MK, Martinez CH, Au DH, Bourbeau J, Boyd CM, Branson R, Criner GJ, Kalhan R, Kallstrom TJ, King A, Krishnan JA, Lareau SC, Lee TA, Lindell K, Mannino DM, Martinez FJ, Meldrum C, Press VG, Thomashow B, Tycon L, Sullivan JL, Walsh J, Wilson KC, Wright J, Yawn B, Zueger PM, Bhatt SP, Dransfield MT. Meeting the challenge of COPD care delivery in the USA: a multiprovider perspective. THE LANCET RESPIRATORY MEDICINE 2016; 4:473-526. [PMID: 27185520 DOI: 10.1016/s2213-2600(16)00094-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/01/2016] [Accepted: 03/01/2016] [Indexed: 12/21/2022]
Abstract
The burden of chronic obstructive pulmonary disease (COPD) in the USA continues to grow. Although progress has been made in the the development of diagnostics, therapeutics, and care guidelines, whether patients' quality of life is improved will ultimately depend on the actual implementation of care and an individual patient's access to that care. In this Commission, we summarise expert opinion from key stakeholders-patients, caregivers, and medical professionals, as well as representatives from health systems, insurance companies, and industry-to understand barriers to care delivery and propose potential solutions. Health care in the USA is delivered through a patchwork of provider networks, with a wide variation in access to care depending on a patient's insurance, geographical location, and socioeconomic status. Furthermore, Medicare's complicated coverage and reimbursement structure pose unique challenges for patients with chronic respiratory disease who might need access to several types of services. Throughout this Commission, recurring themes include poor guideline implementation among health-care providers and poor patient access to key treatments such as affordable maintenance drugs and pulmonary rehabilitation. Although much attention has recently been focused on the reduction of hospital readmissions for COPD exacerbations, health systems in the USA struggle to meet these goals, and methods to reduce readmissions have not been proven. There are no easy solutions, but engaging patients and innovative thinkers in the development of solutions is crucial. Financial incentives might be important in raising engagement of providers and health systems. Lowering co-pays for maintenance drugs could result in improved adherence and, ultimately, decreased overall health-care spending. Given the substantial geographical diversity, health systems will need to find their own solutions to improve care coordination and integration, until better data for interventions that are universally effective become available.
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Affiliation(s)
- MeiLan K Han
- Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, MI, USA.
| | - Carlos H Martinez
- Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, MI, USA
| | - David H Au
- Center of Innovation for Veteran-Centered and Value-Driven Care, and VA Puget Sound Health Care System, US Department of Veteran Affairs, Seattle, WA, USA; Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USA
| | - Jean Bourbeau
- McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard Branson
- Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Ravi Kalhan
- Asthma and COPD Program, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Jerry A Krishnan
- University of Illinois Hospital & Health Sciences System, University of Illinois, Chicago, IL, USA
| | - Suzanne C Lareau
- University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Todd A Lee
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois, Chicago, IL, USA
| | | | - David M Mannino
- Department of Preventive Medicine and Environmental Health, University of Kentucky, Lexington, KY, USA
| | - Fernando J Martinez
- Department of Internal Medicine, Weill Cornell School of Medicine, New York, NY, USA
| | - Catherine Meldrum
- Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, MI, USA
| | - Valerie G Press
- Section of Hospital Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Byron Thomashow
- Division of Pulmonary, Critical Care and Sleep Medicine, Columbia University Medical Center, New York, NY, USA
| | - Laura Tycon
- Palliative and Supportive Institute, Pittsburgh, PA, USA
| | | | | | - Kevin C Wilson
- Boston University School of Medicine, Boston, MA, USA; American Thoracic Society, New York, NY, USA
| | - Jean Wright
- Carolinas HealthCare System, Charlotte, NC, USA
| | - Barbara Yawn
- Family and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Patrick M Zueger
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois, Chicago, IL, USA
| | - Surya P Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, and UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mark T Dransfield
- Division of Pulmonary, Allergy and Critical Care Medicine, and UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA; Birmingham VA Medical Center, Birmingham, AL, USA
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Rubio JA, Ontañón M, Perea V, Megia A. Health care of pregnant women with diabetes in Spain: Approach using a questionnaire. ENDOCRINOLOGIA Y NUTRICION : ORGANO DE LA SOCIEDAD ESPANOLA DE ENDOCRINOLOGIA Y NUTRICION 2016; 63:113-120. [PMID: 26775016 DOI: 10.1016/j.endonu.2015.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 11/12/2015] [Accepted: 11/13/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To ascertain how health care for pregnant women with gestational diabetes (GD) and pregestational diabetes (PGD) is organized, and to estimate the number of Pregnancy and Diabetes Units (PDUs) in Spain in 2013. MATERIAL AND METHODS The Spanish Group of Diabetes and Pregnancy (GEDE) developed and agreed on a questionnaire based on the recommendations of the group. The questionnaire was sent to members of the Spanish Society of Diabetes and the Spanish Society of Endocrinology and Nutrition. RESULTS Eighty-seven questionnaires were received from 81 hospitals, 4 outpatient specialty centers, and 2 primary healthcare centers, which accounted for 51% of the Spanish population and for 39% of births in 2013. GD was mainly diagnosed based on GEDE recommendations (98%), and less than 50% of women were reevaluated after delivery in primary care. Fourteen (26%) of the 53 centers identified as PDUs corresponded to a minimal model. Continuous subcutaneous insulin infusion (CSII) therapy was not available in 30% of centers, and 13% of hospitals had no preconceptional clinics. No nurse support was available in 20% of centers. CONCLUSIONS Care of women with PGD has a fair coverage with PDU, but significant deficits still exist, for instance, in preconception clinic and CSII. However, organization of care for women with GD appears to be adequate. There are aspects in need of improvement such as integration of diabetes educators and coordination with primary care for postpartum reclassification.
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Affiliation(s)
- José Antonio Rubio
- Servicio de Endocrinología y Nutrición, Hospital Universitario Príncipe de Asturias , Alcalá de Henares, Madrid, España; Departamento de Ciencias Biomédicas, Universidad de Alcalá, Alcalá de Henares, España.
| | - Marta Ontañón
- Servicio de Obstetricia y Ginecología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - Verónica Perea
- Servicio de Endocrinología y Nutrición, Hospital Mutua de Terrassa, Barcelona, España
| | - Ana Megia
- Servicio de Endocrinología y Nutrición, Hospital Universitario Joan XXIII, Tarragona, España
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Given JE, Bunting BP, O'Kane MJ, Dunne F, Coates VE. Tele-Mum: A Feasibility Study for a Randomized Controlled Trial Exploring the Potential for Telemedicine in the Diabetes Care of Those with Gestational Diabetes. Diabetes Technol Ther 2015; 17:880-8. [PMID: 26394017 DOI: 10.1089/dia.2015.0147] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The incidence of gestational diabetes mellitus (GDM)--hyperglycemia with onset or first recognition during pregnancy--is increasing and will have a significant impact on diabetes services. This study aimed to determine the feasibility and acceptability of using telemedicine in the diabetes care of women with GDM and the possibility of replacing alternate (one in every two) diabetes review appointments with telemedicine. SUBJECTS AND METHODS A feasibility study for a randomized controlled trial was conducted across two sites. Fifty women with GDM were randomized to usual care (n = 26) or usual care plus telemedicine (n = 24). Telemedicine entailed weekly blood pressure and weight measurements and transmission of these data, along with blood glucose readings, for review by the healthcare team. Patients were contacted about these results as necessary. Patients completed questionnaires to measure their satisfaction with telemedicine or blood glucose monitoring. The intervention group and healthcare providers also took part in qualitative interviews. Analysis involved descriptive statistics for the satisfaction questionnaires and framework analysis for the qualitative interviews. RESULTS Eighty-nine percent of patients were satisfied with telemedicine and would use it again. Both HCPs and patients found the equipment easy to use and were positive about using it to replace alternate diabetes review appointments in the future. If used in this way, healthcare providers felt that protected time in which to perform the telemedicine review would be necessary. CONCLUSIONS Telemedicine may help meet the growing demand on diabetes services due to increasing numbers of women being diagnosed with GDM.
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Affiliation(s)
- Joanne E Given
- 1 Institute of Nursing and Health Research, Ulster University , Coleraine, United Kingdom
| | - Brendan P Bunting
- 2 School of Psychology, Ulster University , Magee Campus, Londonderry, United Kingdom
| | - Maurice J O'Kane
- 3 Department of Clinical Chemistry, Altnagelvin Hospital , Londonderry, United Kingdom
| | - Fidelma Dunne
- 4 Clinical Sciences Institute, National University of Ireland , Galway, Ireland
| | - Vivien E Coates
- 1 Institute of Nursing and Health Research, Ulster University , Coleraine, United Kingdom
- 5 Directorate of Nursing, Western Health and Social Care Trust, Altnagelvin Hospital , Londonderry, United Kingdom
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20
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Cordova FC, Ciccolella D, Grabianowski C, Gaughan J, Brennan K, Goldstein F, Jacobs MR, Criner GJ. A Telemedicine-Based Intervention Reduces the Frequency and Severity of COPD Exacerbation Symptoms: A Randomized, Controlled Trial. Telemed J E Health 2015; 22:114-122. [PMID: 26259074 DOI: 10.1089/tmj.2015.0035] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) may not recognize worsening symptoms that require intensification of therapy. They may also be reluctant to contact a healthcare provider for minor worsening of symptoms. A telemedicine application for daily symptom reporting may reduce these barriers and improve patient outcomes. MATERIALS AND METHODS Patients hospitalized for a COPD exacerbation within the past year or using supplemental O2 were approached for participation. Patients received optimal COPD care and were given a telecommunication device for symptom reporting. Initial symptom scores were obtained while patients were in their usual state of health. Patients were randomly assigned to an intervention group or a control group (usual medical care). The control group patients were instructed to seek medical care if their condition worsened. The intervention group symptom scores were assessed by a computer algorithm and compared with initial values. Scores 1 or more points above the initial score generated an "alert," and patients were reviewed by a nurse and referred to a physician who prescribed treatment. RESULTS Eighty-six patients were screened; 79 met entry criteria and were randomized (intervention group, n=39; control group, n=40). Twelve patients submitted five or fewer symptom reports (5 intervention; 7 control) and were excluded from the analysis. Daily peak flow and dyspnea scores improved only in the intervention group. There were no differences in hospitalization and mortality rates between groups. No serious adverse events were reported. CONCLUSIONS A telemedicine-based symptom reporting program facilitated early treatment of symptoms and improved lung function and functional status.
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Affiliation(s)
- Francis C Cordova
- 1 Department of Thoracic Medicine and Surgery, Temple University School of Medicine , Philadelphia, Pennsylvania
| | - David Ciccolella
- 1 Department of Thoracic Medicine and Surgery, Temple University School of Medicine , Philadelphia, Pennsylvania
| | - Carla Grabianowski
- 1 Department of Thoracic Medicine and Surgery, Temple University School of Medicine , Philadelphia, Pennsylvania
| | - John Gaughan
- 2 Biostatistics Consulting Center, Temple University School of Medicine , Philadelphia, Pennsylvania
| | - Kathleen Brennan
- 1 Department of Thoracic Medicine and Surgery, Temple University School of Medicine , Philadelphia, Pennsylvania
| | - Frederick Goldstein
- 3 Department of Neuroscience, Physiology, and Pharmacology, Philadelphia College of Osteopathic Medicine , Philadelphia, Pennsylvania
| | - Michael R Jacobs
- 1 Department of Thoracic Medicine and Surgery, Temple University School of Medicine , Philadelphia, Pennsylvania.,4 Temple University School of Pharmacy , Philadelphia, Pennsylvania
| | - Gerard J Criner
- 1 Department of Thoracic Medicine and Surgery, Temple University School of Medicine , Philadelphia, Pennsylvania
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Carral F, Ayala MDC, Fernández JJ, González C, Piñero A, García G, Cañavate C, Jiménez AI, García C. Web-based telemedicine system is useful for monitoring glucose control in pregnant women with diabetes. Diabetes Technol Ther 2015; 17:349-54. [PMID: 25629547 DOI: 10.1089/dia.2014.0223] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to examine the impact of a Web-based telemedicine system for monitoring glucose control in pregnant women with diabetes on healthcare visits, metabolic control, and pregnancy outcomes. SUBJECTS AND METHODS A prospective, single-center, interventional study with two parallel groups was performed in Puerto Real University Hospital (Cadiz, Spain). Women were assigned to two different glucose monitoring groups: the control group (CG), which was managed only by follow-ups with the Gestational Diabetes Unit (GDU), and the telemedicine group (TMG), which was monitored by both more spaced GDU visits and a Web-based telemedicine system. The number of healthcare visits, degree of metabolic control, and maternal and neonatal outcomes were evaluated. RESULTS One hundred four pregnant women with diabetes (77 with gestational diabetes, 16 with type 1 diabetes, and 11 with type 2 diabetes) were included in the TMG (n=40) or in the CG (n=64). There were no significant differences in mean glycated hemoglobin level during pregnancy or after delivery, despite a significantly lower number of visits to the GDU (3.2±2.3 vs. 5.9±2.3 visits; P<0.001), nurse educator (1.7±1.3 vs. 3.0±1.7 visits; P<0.001), and general practitioner (3.7±2.0 vs. 4.9±2.8 visits; P<0.034) in the TMG. There were no significant differences between groups in maternal or neonatal outcomes. CONCLUSIONS A Web-based telemedicine system can be a useful tool facilitating the management of pregnant diabetes patients, as a complement to conventional outpatient clinic visits.
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Hirst JE, Mackillop L, Loerup L, Kevat DA, Bartlett K, Gibson O, Kenworthy Y, Levy JC, Tarassenko L, Farmer A. Acceptability and user satisfaction of a smartphone-based, interactive blood glucose management system in women with gestational diabetes mellitus. J Diabetes Sci Technol 2015; 9:111-5. [PMID: 25361643 PMCID: PMC4495541 DOI: 10.1177/1932296814556506] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The increase in gestational diabetes mellitus (GDM) is challenging maternity services. We have developed an interactive, smartphone-based, remote blood glucose (BG) monitoring system, GDm-health. The objective was to determine women's satisfaction with using the GDm-health system and their attitudes toward their diabetes care. In a service development program involving 52 pregnant women (September 2012 to June 2013), BG was monitored using GDm-health from diagnosis until delivery. Following birth, women completed a structured questionnaire assessing (1) general satisfaction, (2) equipment issues, and (3) relationship with the diabetes care team. Responses were scored on a 7-point Likert-type scale. Reliability and validity of the questionnaire were assessed using statistical methods. Of 52 women, 49 completed the questionnaire; 32 had glucose tolerance test confirmed GDM (gestation at recruitment 29 ± 4 weeks (mean ± SD), and 17 women previous GDM recommended for BG monitoring (18 ± 6 weeks). In all, 45 of 49 women agreed their care was satisfactory and the best for them, 47 of 49 and 43 of 49 agreed the equipment was convenient and reliable respectively, 42 of 49 agreed GDm-health fitted into their lifestyle, and 46 of 49 agreed they had a good relationship with their care team. Written comments supported these findings, with very positive reactions from the majority of women. Cronbach's alpha was .89 with factor analysis corresponding with question thematic trends. This pilot demonstrates that GDm-health is acceptable and convenient for a large proportion of women. Effects on clinical and economic outcomes are currently under investigation in a randomized trial (clinicaltrials.gov NCT01916694).
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Affiliation(s)
| | | | | | - Dev A Kevat
- Royal Brisbane and Women's Hospital, Brisbane, Australia
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23
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Abstract
ABSTRACT Research in pregnancy is challenging as it involves a special ‘vulnerable’ group due to the involvement of the mother and the fetus. These challenges, which are inherent in studying pregnancy in physiologic and pathologic states, have contributed to the scant research in pregnancy. Until recently, most studies in pregnancy were nonrandomized and retrospective in nature, representing prevailing clinical standards of practice and clinicians’ biases. Prospective studies were generally limited to single centers, comprising of small sample sizes and were observational in nature, rather than randomized studies involving therapy. Ethical and legal factors, research mandates, patient factors, the protracted nature of pregnancy, institutional commitment to research, interdisciplinary clinical and research collaboration, funding support, administrative issues and the level of involvement of national cardiac and obstetric and gynecological societies have been barriers to research in pregnancy in developed countries. Even prospective observational studies are difficult to perform due the difficulties involved with obtaining consent, study recruitment and follow-up. Misconceptions regarding research have led to a lack of participation by women. The longitudinal nature of prospective studies in pregnancy, the problems associated with enrolling women before pregnancy and in the first trimester and the failure to understand the commitment required by the patient, as well as many social factors, have led to increased drop-out rates during pregnancy, as well as difficulty with follow-up in the post-partum state. These factors, along with the failure to supplement funding support due to longer study periods than anticipated, have led to studies of small sample sizes. Understanding patient factors that lead to a lack of participation in research or dropping out following initial consent could help make research participation more conducive for pregnant women. The involvement of national societies in the planning and funding of multicenter studies, interdepartmental and interinstitutional collaboration, institutional and extramural funding support and patient incentives are crucial for shortening study duration and ensuring adequacy of sample sizes for successful research in pregnancy. National health service structures, such as those found in Europe and Canada, makes multicenter collaboration for prospective studies more feasible than for countries such as the USA, in which the fees-for-service system is used. Utilization of telemedicine and handheld ultrasound systems and participation in prospective multicenter registries could not only improve the clinical care of pregnant women in underdeveloped countries, but also provide a platform for research during pregnancy. Multicenter and even global registries supported by European cardiac societies have been formed recently that are beginning to bring forth much-needed data regarding pathological states, such as peripartum cardiomyopathy and pregnancy in congenital heart disease. Such studies are largely confined to non-US countries and have started seeing participation from underdeveloped countries. Studies on pregnancy in connective tissue disorders, older women, post-chemoradiation therapy or organ transplantation and in the HIV state remain limited.
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Mackillop L, Loerup L, Bartlett K, Farmer A, Gibson OJ, Hirst JE, Kenworthy Y, Kevat DA, Levy JC, Tarassenko L. Development of a real-time smartphone solution for the management of women with or at high risk of gestational diabetes. J Diabetes Sci Technol 2014; 8:1105-14. [PMID: 25004915 PMCID: PMC4455469 DOI: 10.1177/1932296814542271] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Gestational diabetes mellitus (GDM) is defined as new onset or recognition of glucose intolerance in pregnancy. Evidence supports tight blood glucose regulation to prevent adverse maternal and fetal outcomes. Finger-prick blood glucose (BG) testing with frequent clinic review remains the most common method of managing diabetes in pregnancy. The prevalence of GDM is rising globally, pressuring resource-limited services. We have developed an intuitive, interactive, reliable, and accurate management system to record BG measurements and deliver management of GDM remotely. Following an initial scoping phase, a prototype software application was developed using an Android smartphone with BG meter linkage via Bluetooth. A custom website was built for clinician review of the data transmitted by the smartphone. After system refinement, further evaluation was undertaken for usability and reliability in a 48-patient service development project. Women used the system for an average of 13.1 weeks. In all, 19 686 BG measures were transmitted, 98.6% of which had a meal tag. A total of 466 text messages were transmitted. A mean of 30 BG readings per woman per week were transmitted, and 85% of women submitted the minimum requirement of 18 readings per week. We have developed a novel, real-time, smartphone-based BG monitoring management system that allows clinician review of real-time patient-annotated BG results. Results indicate high usage and excellent compliance by women. Robust clinical, economic, and satisfaction evaluations are required. To address these requirements, we are currently conducting a randomized controlled pilot trial.
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Affiliation(s)
| | - Lise Loerup
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | | | - Andrew Farmer
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Oliver J Gibson
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Jane E Hirst
- Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - Dev A Kevat
- Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - Lionel Tarassenko
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
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Chilelli NC, Dalfrà MG, Lapolla A. The emerging role of telemedicine in managing glycemic control and psychobehavioral aspects of pregnancy complicated by diabetes. Int J Telemed Appl 2014; 2014:621384. [PMID: 25295059 PMCID: PMC4177083 DOI: 10.1155/2014/621384] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 08/04/2014] [Indexed: 12/24/2022] Open
Abstract
There is a gradual decline in concern of specialists who follow up the care of pregnant women with diabetes. In addition, due to the dwindling economic resources allocated to health services, access to specialized healthcare facilities is becoming more difficult. Telemedicine, or medicine practiced at a distance, is inserted in this context with applications differing for type of interaction (real-time or deferred, i.e., videoconferencing versus store-and-forward data transmission), type of monitoring (automatic versus requesting cooperation from the patient), and type of devices used (web connections and use of mobile phones or smartphones). Telemedicine can cope with the current lack of ability to ensure these patients frequent direct contact with their caregivers. This approach may have an impact not only on the classical maternal-fetal outcome, but also on some underestimated aspects of patients with diabetes in pregnancy, in this case their quality of life, the perception of "diabetes self-efficacy," and the glycemic variability. In this paper, we will analyze the current evidence regarding the use of telemedicine in pregnancies complicated by diabetes, trying to highlight the main limitations of these studies and possible strategies to overcome them in order to improve the effectiveness of future clinical interventions with these medical applications.
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Affiliation(s)
- Nino Cristiano Chilelli
- Department of Medicine (DIMED), University of Padova, Via Giustiniani n 2, 35100 Padova, Italy
| | - Maria Grazia Dalfrà
- Department of Medicine (DIMED), University of Padova, Via Giustiniani n 2, 35100 Padova, Italy
| | - Annunziata Lapolla
- Department of Medicine (DIMED), University of Padova, Via Giustiniani n 2, 35100 Padova, Italy
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Vinagre I, Giménez M, Pericot A, Bellart J, Conget I. Sensor augmented pump therapy in the management of type 1 diabetes complicated with Addison's disease prior to and during pregnancy. ACTA ACUST UNITED AC 2014; 61:341-3. [PMID: 24680974 DOI: 10.1016/j.endonu.2014.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 01/31/2014] [Accepted: 02/03/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Irene Vinagre
- Diabetes Unit, Department of Endocrinology and Nutrition, Institut Clínic de Malalties Digestives i Metabòliques, Hospital Clínic i Universitari, Barcelona, Spain.
| | - Marga Giménez
- Diabetes Unit, Department of Endocrinology and Nutrition, Institut Clínic de Malalties Digestives i Metabòliques, Hospital Clínic i Universitari, Barcelona, Spain
| | - Anna Pericot
- Department of Maternal-Fetal Medicine, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic i Universitari, Barcelona, Spain
| | - Jordi Bellart
- Department of Maternal-Fetal Medicine, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic i Universitari, Barcelona, Spain
| | - Ignacio Conget
- Diabetes Unit, Department of Endocrinology and Nutrition, Institut Clínic de Malalties Digestives i Metabòliques, Hospital Clínic i Universitari, Barcelona, Spain
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Perry HB, Zulliger R, Rogers MM. Community health workers in low-, middle-, and high-income countries: an overview of their history, recent evolution, and current effectiveness. Annu Rev Public Health 2014; 35:399-421. [PMID: 24387091 DOI: 10.1146/annurev-publhealth-032013-182354] [Citation(s) in RCA: 469] [Impact Index Per Article: 46.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Over the past half-century, community health workers (CHWs) have been a growing force for extending health care and improving the health of populations. Following their introduction in the 1970s, many large-scale CHW programs declined during the 1980s, but CHW programs throughout the world more recently have seen marked growth. Research and evaluations conducted predominantly during the past two decades offer compelling evidence that CHWs are critical for helping health systems achieve their potential, regardless of a country's level of development. In low-income countries, CHWs can make major improvements in health priority areas, including reducing childhood undernutrition, improving maternal and child health, expanding access to family-planning services, and contributing to the control of HIV, malaria, and tuberculosis infections. In many middle-income countries, most notably Brazil, CHWs are key members of the health team and essential for the provision of primary health care and health promotion. In the United States, evidence indicates that CHWs can contribute to reducing the disease burden by participating in the management of hypertension, in the reduction of cardiovascular risk factors, in diabetes control, in the management of HIV infection, and in cancer screening, particularly with hard-to-reach subpopulations. This review highlights the history of CHW programs around the world and their growing importance in achieving health for all.
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Preconception care for people living with HIV: recommendations for advancing implementation. AIDS 2013; 27 Suppl 1:S113-9. [PMID: 24088677 DOI: 10.1097/qad.0000000000000059] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Globally, research has documented high fertility desires and intentions among HIV-positive women. Improving implementation of preconception care (PCC) for people living with HIV is critical, given estimates that the majority of HIV-positive women who want future biological children have not received reproductive counseling, largely due to a lack of provider-initiated conversations. This article offers initial recommendations and outlines key considerations for a research agenda to advance PCC implementation efforts in both high-resource and low-resource settings. We consider who should provide PCC; where it can be effectively delivered; when it should be offered; and two potential implementation models depending on available resources. We conclude with a call for PCC-specific implementation science and research translation to help people living with HIV achieve their reproductive goals.
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