Effectiveness of clinical pharmacist-led smartphone application on medication adherence, insulin injection technique and glycemic control for women with gestational diabetes receiving multiple daily insulin injection: A randomized clinical trial

Informatics Interventions for Maternal Morbidity: Scoping Review

BACKGROUND

Women have been entering pregnancy less healthy than previous generations, placing them at increased risk for pregnancy complications. One approach to ensuring effective monitoring and treatment of at-risk women is designing technology-based interventions that prevent maternal morbidities and treat perinatal conditions.

OBJECTIVE

This scoping review evaluates what informatics interventions have been designed and tested to prevent and treat maternal morbidity.

METHODS

MEDLINE, Embase, and Cochrane Library were searched to identify relevant studies. The inclusion criteria were studies that tested a medical or clinical informatics intervention; enrolled adult women; and addressed preeclampsia, gestational diabetes mellitus (GDM), preterm birth, Centers for Disease Control and Prevention-defined severe maternal morbidity, or perinatal mental health conditions. Demographic, population, and intervention data were extracted to characterize the technologies, conditions, and populations addressed.

RESULTS

A total of 80 studies were identified that met the inclusion criteria. Many of the studies tested for multiple conditions. Of these, 73% (60/82) of the technologies were tested for either GDM or perinatal mental health conditions, and 15% (12/82) were tested for preeclampsia. For technologies, 32% (28/87) of the technologies tested were smartphone or tablet applications, 26% (23/87) were telehealth interventions, and 14% (12/87) were remote monitoring technologies. Of the many outcomes measured by the studies, almost half (69/140, 49%) were patient physical or mental health outcomes.

CONCLUSIONS

Per this scoping review, most informatics interventions address three conditions: GDM, preeclampsia, and mental health. There may be opportunities to treat other potentially lethal conditions like postpartum hemorrhage using proven technologies such as mobile apps. Ample gaps in the literature exist concerning the use of informatics technologies aimed at maternal morbidity. There may be opportunities to use informatics for lesser-targeted conditions and populations.

The Effect of Smartphone Application-Based Self-Management Interventions Compared to Face-to-Face Diabetic Interventions for Pregnant Women With Gestational Diabetes Mellitus: A Meta-Analysis

Background: Face-to-face diabetic interventions (FFIs) are the gold standard for diabetic care, and smartphone application (app)-based self-management interventions (SBIs) can be a potential alternative. A few previous reviews compared the effects of both practices. Objectives: This study is aimed at (1) comparing the effectiveness of FFIs and SBIs on maternal and neonatal outcomes in pregnant women with gestational diabetes mellitus (GDM) and (2) exploring potential covariates affecting those outcomes. Methods: Randomized controlled trials (RCTs) were retrieved from PubMed, EMBASE, CINAHL, Cochrane Library, Scopus, and Web of Science from inception to January 15, 2024. Meta-analyses, subgroup analyses, and metaregression analyses were conducted using the R software package meta, Version 4.3.1. Cochrane risk of bias Version 2 (RoB2) and grading of recommendations, assessment, development, and evaluation (GRADE) criteria were employed to appraise the quality of studies and certainty of outcomes. Results: We selected 15 RCTs from 2505 women with GDM across 11 countries for this review. The meta-analyses revealed that women in the SBIs can significantly reduce gestation weight gain (t = -2.45, p = 0.04) and macrosomia (t = -3.35, p = 0.02) when compared to those in the FFIs. We observed a higher likelihood of cesarean delivery when using generic apps (RR = 1.12, 95% confidence interval (CI): 0.59, 2.13) than GDM-specific apps (RR = 0.82, 95% CI: 0.64, 1.06). There was similar fasting plasma glucose, 2-h postprandial plasma glucose, hemoglobin A1c (HbA1c), cesarean section delivery rate, neonatal birthweight, large for gestational age, neonatal hypoglycemia, and neonatal intensive care unit admission between SBIs and FFIs. More than half (52%) were rated low risk based on RoB2. According to the GRADE criteria, very low to moderate evidence was found. Conclusions: SBIs can be considered an alternative management method for women with GDM to reap the benefits of smartphone apps. More high-quality RCTs are required to reaffirm the findings.

The Impact of Mobile Health (mHealth) Apps on Gestational Diabetes: A Systematic Review

Gestational diabetes mellitus (GDM) poses a significant health risk for pregnant women, as it is associated with an increased likelihood of developing type II diabetes and cardiovascular complications. In addition, there is a high risk for pregnancy-related complications, emphasizing the need for effective management of GDM. This study aimed to investigate the potential impact of mHealth applications on gestational diabetes-related outcomes. A systematic review was conducted, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was conducted in Pubmed, Scopus, and Web of Science, using the following search terms: (smartphone* OR mobile OR mHealth OR "mobile health") AND ("gestational diabetes" OR "maternal diabetes" OR "pregnancy diabetes" OR "pregnancy-induced diabetes" OR "perinatal diabetes"). In order to be included in the systematic review, the studies had to be papers published in peer-reviewed journals, published from February 2, 2020 to February 2, 2025, in the English language, being randomized trials, evaluating the impact of mHealth apps on women with GDM, excluding studies that incorporated additional technological interventions (e.g., WeChat supportive groups). The extracted data were the following: authors, country, total and per group number of participants, participants' characteristics, interventional content, assessments, time of the assessments, results, and potential information about participant adherence. The Jadad Scale was used for quality evaluation. Six studies met the predefined criteria and were included in the systematic review. Three studies found no or minimal benefits from the use of such applications. One study demonstrated highly significant benefits, not only in the management of GDM but also in reducing pregnancy-related complications. Another study indicated greater adherence to treatment and fewer admissions to neonatal intensive care units, while a third study reported a shift toward better postpartum health behaviors, which was closely associated with the use of mHealth applications, suggesting that those apps could support women in adopting healthier habits after childbirth. All studies reporting positive outcomes were carried out in Eastern Asian Countries (Singapore and China), whereas studies conducted in Europe found minimal or no benefits. The score on the Jadad Scale ranged from 2 to 3, indicating moderate to low quality. Οverall, while some promising findings were observed, further research is essential to evaluate these apps more thoroughly and enhance their effectiveness. Greater culturally influenced adherence to healthcare instructions leads to more significant benefits for Asian women with GDM. Cultural factors should be carefully considered when designing and implementing mHealth applications for women with GDM.

Insulin therapy adherence and its associated factors among diabetic patients in a Ghanaian primary care hospital

BACKGROUND

Diabetes mellitus (DM) is a global health problem. Adherence to intensive insulin therapy is necessary to achieve better glycemic control in types 1 and 2 DM. This study aimed to evaluate the extent of adherence to insulin therapy, its predictors and to identify barriers to its adherence.

METHOD

This was a cross-sectional survey among adult (≥18 years) diabetic patients who are currently using insulin, either alone or in combination with an oral antidiabetic regimen, and seeking primary care at Kwame Nkrumah University of Science and Technology Hospital in Ghana. A total of one hundred and eight-six patients were conveniently sampled, and interviewed. Insulin adherence was determined using the Medication Adherence Reporting Scale-5. Descriptive statistics, a chi-square test of independence, and a multiple logistic regression analysis were performed using STATA version 14 (StataCorp, TX USA).

RESULTS

The majority of the patients interviewed were over 60 years (40.32%); female (61.83%); married (68.82%); and had completed secondary education (48.39%). 67.20% of the patients were adherent to insulin therapy. Adherence level was associated with age (p = 0.020), marital status (p = 0.001), employment status (p = 0.012), type of DM (p<0.001), regular follow-up (p = 0.007) and comorbidities (p = 0.002) and was only predicted by the type of DM (aOR = 14.82 C.I 1.34-163.50, p-value = 0.028).

CONCLUSION

Adherence to insulin therapy among our study population was suboptimal, which is a concern considering the associated increased risk of complications. Adherence assessment and counselling by healthcare professionals to address barriers to poor adherence must be continually undertaken to achieve optimal glycemic control.

IMPACT OF FINDINGS ON PRACTICE STATEMENTS

Continuous adherence assessment and counselling must be offered to all diabetes mellitus patients on insulin therapy as part of their ambulatory care to help improve outcomes.Using the Medication Adherence Reporting Scale-5 to determine patient adherence levels is an easy-to-use and an inexpensive method; however, it should be used with caution due to the potential for misclassification.Efforts must be made to provide appropriate strategies to deal with barriers to insulin adherence at ambulatory care clinics as part of the individualized comprehensive diabetic care to reduce diabetic complications.

Dropout rate in clinical trials of smartphone apps for diabetes management: A meta-analysis

Applicability of smartphone-based digital health in diabetes management still face challenges due tolow user retention or engagement. Thus, this systematic and meta-analysis aimed to estimate the dropout rate from the clinical trials. Search of literature was performedon 4 September 2023 through various databases (PubMed, Scilit, Scopus, Embase, and Web of Science). Those reporting clinical trials of smartphone apps for diabetic controls (either type 1 or type 2 diabetes mellitus) were screened and selected in accordance with PRISMA guideline. Of 5,429 identified records, as many as 36 studies were found eligible with a total of 3,327 patients in the intervention group. The overall dropout rate was 29.6 % (95 %CI: 25 %-34.3 %) with high heterogeneity (p-Het < 0.001;I2 = 84.84 %). Sample size, intervention duration, patients' age and gender, and cultural adaptation on the app appeared to be non-significant moderators (p > 0.05). In sub-group levels, notably high dropout rates were observed in studies performing cultural adaptation (34.6 %) and conducted in high-income countries (31.9 %). Given the high dropout rate, the engagement level toward diabetic management apps in real-world setting is expected to be low. High heterogeneity in this study, however, requires careful interpretation of the foregoing results. PROSPERO: CRD42023460365 (14 September 2023).

Impact of mHealth interventions on maternal, newborn, and child health from conception to 24 months postpartum in low- and middle-income countries: a systematic review

BACKGROUND

Mobile health (mHealth) technologies have been harnessed in low- and middle-income countries (LMICs) to address the intricate challenges confronting maternal, newborn, and child health (MNCH). This review aspires to scrutinize the effectiveness of mHealth interventions on MNCH outcomes during the pivotal first 1000 days of life, encompassing the period from conception through pregnancy, childbirth, and post-delivery, up to the age of 2 years.

METHODS

A comprehensive search was systematically conducted in May 2022 across databases, including PubMed, Cochrane Library, Embase, Cumulative Index to Nursing & Allied Health (CINAHL), Web of Science, Scopus, PsycINFO, and Trip Pro, to unearth peer-reviewed articles published between 2000 and 2022. The inclusion criteria consisted of (i) mHealth interventions directed at MNCH; (ii) study designs, including randomized controlled trials (RCTs), RCT variations, quasi-experimental designs, controlled before-and-after studies, or interrupted time series studies); (iii) reports of outcomes pertinent to the first 1000 days concept; and (iv) inclusion of participants from LMICs. Each study was screened for quality in alignment with the Cochrane Handbook for Systematic Reviews of Interventions and the Joanne Briggs Institute Critical Appraisal tools. The included articles were then analyzed and categorized into 12 mHealth functions and outcome domain categories (antenatal, delivery, and postnatal care), followed by forest plot comparisons of effect measures.

RESULTS

From the initial pool of 7119 articles, we included 131 in this review, comprising 56 RCTs, 38 cluster-RCTs, and 37 quasi-experimental studies. Notably, 62% of these articles exhibited a moderate or high risk of bias. Promisingly, mHealth strategies, such as dispatching text message reminders to women and equipping healthcare providers with digital planning and scheduling tools, exhibited the capacity to augment antenatal clinic attendance and enhance the punctuality of child immunization. However, findings regarding facility-based delivery, child immunization attendance, and infant feeding practices were inconclusive.

CONCLUSIONS

This review suggests that mHealth interventions can improve antenatal care attendance and child immunization timeliness in LMICs. However, their impact on facility-based delivery and infant feeding practices varies. Nevertheless, the potential of mHealth to enhance MNCH services in resource-limited settings is promising. More context-specific implementation studies with rigorous evaluations are essential.

Surgical Pharmacy for Optimizing Medication Therapy Management Services within Enhanced Recovery after Surgery (ERAS®) Programs

Drug-related problems (DRPs) are common among surgical patients, especially older patients with polypharmacy and underlying diseases. DRPs can potentially lead to morbidity, mortality, and increased treatment costs. The enhanced recovery after surgery (ERAS) system has shown great advantages in managing surgical patients. Medication therapy management for surgical patients (established as "surgical pharmacy" by Guangdong Province Pharmaceutical Association (GDPA)) is an important part of the ERAS system. Improper medication therapy management can lead to serious consequences and even death. In order to reduce DRPs further, and promote the rapid recovery of surgical patients, the need for pharmacists in the ERAS program is even more pressing. However, the medication therapy management services of surgical pharmacy and how surgical pharmacists should participate in ERAS programs are still unclear worldwide. Therefore, this article reviews the main perioperative medical management strategies and precautions from several aspects, including antimicrobial agents, antithrombotic agents, pain medication, nutritional therapy, blood glucose monitoring, blood pressure treatment, fluid management, treatment of nausea and vomiting, and management of postoperative delirium. Additionally, the way surgical pharmacists participate in perioperative medication management, and the relevant medication pathways are explored for optimizing medication therapy management services within the ERAS programs. This study will greatly assist surgical pharmacists' work, contributing to surgeons accepting that pharmacists have an important role in the multidisciplinary team, benefitting medical workers in treating, counseling, and advocating for their patients, and further improving the effectiveness, safety and economy of medication therapy for patients and promoting patient recovery.