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Lenhard J, Margetts M, Meng E. Of not passing: homelessness, addiction, mental health and care during COVID-19. MEDICAL HUMANITIES 2023; 49:55-63. [PMID: 35820777 PMCID: PMC9985758 DOI: 10.1136/medhum-2021-012367] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 06/11/2023]
Abstract
People experiencing homelessness in the UK were unconditionally offered housing (and support) from the beginning of the first lockdown in March 2020. For many, that meant '(re)entering' the support system and having a chance to 'move on' to longer-term housing. This beneficial effect of some of the policy reactions to the pandemic on people experiencing homelessness was unexpected. On the flip side, however, particularly for people struggling with drug use and mental health issues, adequate support was not available for long periods of time; support was either suspended temporarily or people were excluded from institutional support for not adhering to, for instance, lockdown rules. Similarly, digital support alternatives-modelled on increasingly widespread telemedicine-did often not work specifically for people struggling with complex needs or women experiencing homelessness. This research paper reports detailed evidence of what we observed as continued and catalysed exclusions based on interviews and ethnographic observations with both people experiencing homelessness and service providers from the beginning of the COVID-19 pandemic. Referring to our insights and learnings from three locally and temporally overlapping research projects between May 2020 and April 2021, we also propose changes to redesign future (health)care provision to prevent such impasses-which extend beyond lockdown situations to general conditional housing and support.
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Affiliation(s)
| | | | - Eana Meng
- Harvard Medical School, Boston, Massachusetts, USA
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2
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Kershaw K, Martelly L, Stevens C, McInnes DK, Silverman A, Byrne T, Aycinena D, Sabin LL, Garvin LA, Vimalananda VG, Hass R. Text messaging to increase patient engagement in a large health care for the homeless clinic: Results of a randomized pilot study. Digit Health 2022; 8:20552076221129729. [PMID: 36238754 PMCID: PMC9551340 DOI: 10.1177/20552076221129729] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/13/2022] [Indexed: 11/05/2022] Open
Abstract
Objectives To assess the feasibility and effectiveness of text messaging to increase
outpatient care engagement and medication adherence in an urban homeless
population in Boston. Methods Between July 2017 and April 2018, 62 patients from a clinic serving a
homeless population were sent automated text messages for four months.
Messages were either appointment reminders and medication adherence
suggestions (intervention group) or general health promotion messages
(control group). Medical records were reviewed to evaluate appointment
keeping, emergency room (ER) use, and hospitalizations. Pre- and
post-surveys were administered to measure self-reported medication
adherence. Results No significant differences were found in inpatient or outpatient care between
the intervention and control groups, though differences in no-show rates and
medication adherence approached significance. Appointment no-show rates were
21.0% vs. 30.6% (p = 0.08) for intervention and control,
respectively, and rates of completed appointments were 65.8% vs. 56.7%
(p = 0.12). Mean ER visits were 3.86 vs 2.33
(p = 0.16) for intervention and control groups, and
mean inpatient admissions were 0.6 versus 1.24 (p = 0.42).
Self-reported medication adherence increased from 8.27 to 9.84 in
intervention participants, compared to an increase from 8.27 to 8.68 in
control participants (p = 0.07), on a 1–11 scale. Conclusions Text messaging showed the potential to improve patient engagement in care and
medication adherence in an urban homeless population (findings approaching
but not achieving statistical significance). Work is needed to enhance the
effectiveness of text-messaging interventions, which may involve increasing
ease of use for mobile phones and texting apps, and addressing high rates of
phone theft and loss.
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Affiliation(s)
- Karyn Kershaw
- Department of Health Law, Policy, and Management,
Boston
University School of Public Health, Boston,
MA, USA,Department of Health Communication and Promotion,
Boston
University School of Public Health, Boston,
MA, USA
| | - Lisa Martelly
- Department of Epidemiology and Biostatistics,
Boston
University School of Public Health, Boston,
MA, USA
| | - Cassidy Stevens
- Social Services
Department, Massachusetts General Hospital,
Boston, MA, USA
| | - D. Keith McInnes
- Department of Health Law, Policy, and Management,
Boston
University School of Public Health, Boston,
MA, USA,Center for Healthcare Organization and Implementation Research,
VA Bedford
Healthcare System, Bedford, MA, USA,D Keith McInnes, VA Bedford Healthcare
System, Bedford, MA 01730, USA.
| | - Allie Silverman
- Center for Healthcare Organization and Implementation Research,
VA Bedford
Healthcare System, Bedford, MA, USA,Heller School for Social Policy and Management, Brandeis University,
Waltham, MA, USA
| | - Thomas Byrne
- Center for Healthcare Organization and Implementation Research,
VA Bedford
Healthcare System, Bedford, MA, USA,Boston
University School of Social Work, Boston,
MA, USA
| | - Diana Aycinena
- Boston Health
Care for the Homeless Program, Boston, MA,
USA
| | - Lora L. Sabin
- Department of Global Health, Boston University School of Public
Health, Boston, MA, USA
| | - Lynn A. Garvin
- Department of Health Law, Policy, and Management,
Boston
University School of Public Health, Boston,
MA, USA,Center for Healthcare Organization and Implementation Research, VA
Boston Healthcare System, Boston, MA, USA
| | - Varsha G. Vimalananda
- Center for Healthcare Organization and Implementation Research,
VA Bedford
Healthcare System, Bedford, MA, USA,Section of Endocrinology, Diabetes and Metabolism,
Boston
University School of Medicine, Boston, MA,
USA
| | - Robert Hass
- Boston Health
Care for the Homeless Program, Boston, MA,
USA
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Wray CM, Van Campen J, Hu J, Slightam C, Heyworth L, Zulman DM. Crossing the digital divide: a veteran affairs program to distribute video-enabled devices to patients in a supportive housing program. JAMIA Open 2022; 5:ooac027. [PMID: 35991861 PMCID: PMC9053098 DOI: 10.1093/jamiaopen/ooac027] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/22/2022] [Accepted: 04/13/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Evaluate an initiative to distribute video-enabled tablets and cell phones to individuals enrolled in Veterans Health Affairs supportive housing program during the COVID-19 pandemic. Materials and Methods In September 2020, individuals in the Veteran Health Affairs (VA) Housing and Urban Development-VA Supportive Housing (HUD-VASH) program were offered either a video-enabled tablet or cellphone to support their communication and health care engagement needs. We examined sociodemographic and clinical characteristics of device recipients, and compared engagement in in-person, telephone, and video-based visits (categorized as primary care, specialty care, rehabilitation, HUD-VASH, mental health care, and other) for 6 months prior to (March 1, 2020–August 31, 2020) and following (September 1, 2020–July 30, 2021) device receipt. Results In total, 5127 Veterans received either a tablet (n = 4454) or a cellphone (n = 673). Compared to the 6 months prior to device receipt, in the 6 months following receipt, in-person and video engagement increased by an average of 1.4 visits (8%) and 3.4 visits (125%), respectively, while telephone engagement decreased (−5.2 visits; −27%). Both tablet and cellphone recipients had increased in-person visits (+1.3 visits [8%] and +2.1 visits [13%], respectively); while tablet users had a substantially larger increase in video-based engagement (+3.2 visits [+110%] vs. +0.9 [+64%]). Similar trends were noted across all assessed types of care. Discussion Providing video-enabled devices to Veterans in a supportive housing program may facilitate engagement in health care. Conclusions and Relevance VA’s device distribution program offers a model for expanding access to health-related technology and telemedicine to individuals in supportive housing programs. In September of 2020, the Veteran’s Health Affairs (VA) initiated a program to distribute video-enabled tablets and cellphones to Veterans who were enrolled in the Housing and Urban Development-VA Supportive Housing (HUD-VASH) program. The goal of this program was to maintain communication and health care engagement during the pandemic. After receiving either a tablet or cellphone, we compared in-person, telephone, and video-based engagement among the 4454 tablet recipients and the 673 cellphone recipients. We found in the 6 months following receipt, that overall in-person and video engagement increased by an average of 1.4 visits (8%) and 3.4 visits (125%), while telephone engagement decreased (−5.2 visits; −27%). Both tablet and cellphone recipients had increased in-person visits (+1.3 visits [8%] and +2.1 visits [13%], respectively); while tablet users had a substantially larger increase in video-based engagement (+3.2 visits [+110%] vs. +0.9 [+64%]). This study suggests that providing video-enabled devices to Veterans in a supportive housing program may facilitate engagement in health care.
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Affiliation(s)
- Charlie M Wray
- Department of Medicine, University of California, San Francisco, San Francisco, Virginia, USA
- Section of Hospital Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - James Van Campen
- VA Center for Innovation to Implementation (Ci2i), Menlo Park, California, USA
| | - Jiaqi Hu
- VA Center for Innovation to Implementation (Ci2i), Menlo Park, California, USA
| | - Cindie Slightam
- VA Center for Innovation to Implementation (Ci2i), Menlo Park, California, USA
| | - Leonie Heyworth
- Department of Veterans Affairs Central Office, Office of Connected Care/Telehealth, Washington, District of Columbia, USA
- Department of Medicine, University of California, San Diego, San Diego, California, USA
| | - Donna M Zulman
- VA Center for Innovation to Implementation (Ci2i), Menlo Park, California, USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
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Moczygemba LR, Thurman W, Tormey K, Hudzik A, Welton-Arndt L, Kim E. GPS Mobile Health Intervention Among People Experiencing Homelessness: Pre-Post Study. JMIR Mhealth Uhealth 2021; 9:e25553. [PMID: 34730550 PMCID: PMC8600433 DOI: 10.2196/25553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 05/27/2021] [Accepted: 08/06/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND People experiencing homelessness are at risk for gaps in care after an emergency department (ED) or hospital visit, which leads to increased use, poor health outcomes, and high health care costs. Most people experiencing homelessness have a mobile phone of some type, which makes mobile health (mHealth) interventions a feasible way to connect a person experiencing homelessness with providers. OBJECTIVE This study aims to investigate the accuracy, acceptability, and preliminary outcomes of a GPS-enabled mHealth (GPS-mHealth) intervention designed to alert community health paramedics when people experiencing homelessness are in the ED or hospital. METHODS This study was a pre-post design with baseline and 4-month postenrollment assessments. People experiencing homelessness, taking at least 2 medications for chronic conditions, scoring at least 10 on the Patient Health Questionnaire-9, and having at least 2 ED or hospital visits in the previous 6 months were eligible. Participants were issued a study smartphone with a GPS app programmed to alert a community health paramedic when a participant entered an ED or hospital. For each alert, community health paramedics followed up via telephone to assess care coordination needs. Participants also received a daily email to assess medication adherence. GPS alerts were compared with ED and hospital data from the local health information exchange (HIE) to assess accuracy. Paired t tests compared scores on the Patient Health Questionnaire-9, Medical Outcomes Study Social Support Survey, and Adherence Starts with Knowledge-12 adherence survey at baseline and exit. Semistructured exit interviews examined the perceptions and benefits of the intervention. RESULTS In total, 30 participants were enrolled; the mean age was 44.1 (SD 9.7) years. Most participants were male (20/30, 67%), White (17/30, 57%), and not working (19/30, 63%). Only 19% (3/16) of the ED or hospital visit alerts aligned with HIE data, mainly because of patients not having the smartphone with them during the visit, the smartphone being off, and gaps in GPS technology. There was a significant difference in depressive symptoms between baseline (mean 16.9, SD 5.8) and exit (mean 12.7, SD 8.2; t19=2.9; P=.009) and a significant difference in adherence barriers between baseline (mean 2.4, SD 1.4) and exit (mean 1.5, SD 1.5; t17=2.47; P=.03). Participants agreed that the app was easy to use (mean 4.4/5, SD 1.0, with 5=strongly agree), and the email helped them remember to take their medications (mean 4.6/5, SD 0.6). Qualitative data indicated that unlimited smartphone access allowed participants to meet social needs and maintain contact with case managers, health care providers, family, and friends. CONCLUSIONS mHealth interventions are acceptable to people experiencing homelessness. HIE data provided more accurate ED and hospital visit information; however, unlimited access to reliable communication provided benefits to participants beyond the study purpose of improving care coordination.
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Affiliation(s)
- Leticia R Moczygemba
- Health Outcomes Division, College of Pharmacy, University of Texas at Austin, Austin, TX, United States
| | - Whitney Thurman
- School of Nursing, University of Texas at Austin, Austin, TX, United States
| | - Kyler Tormey
- Health Outcomes Division, College of Pharmacy, University of Texas at Austin, Austin, TX, United States
| | - Anthony Hudzik
- Health Outcomes Division, College of Pharmacy, University of Texas at Austin, Austin, TX, United States
| | - Lauren Welton-Arndt
- Health Outcomes Division, College of Pharmacy, University of Texas at Austin, Austin, TX, United States
| | - Elizabeth Kim
- Health Outcomes Division, College of Pharmacy, University of Texas at Austin, Austin, TX, United States
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5
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Adams CS, Player MS, Berini CR, Perkins S, Fay J, Walker L, Buffalo E, Roach C, Diaz VA. A Telehealth Initiative to Overcome Health Care Barriers for People Experiencing Homelessness. Telemed J E Health 2021; 27:851-858. [PMID: 34297907 DOI: 10.1089/tmj.2021.0127] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
People experiencing homelessness (PEH) encounter barriers to health care, increasing their vulnerability to illness, hospitalization, and death. Telehealth can improve access to health care, but its use in PEH has been insufficiently evaluated. Needs assessment surveys completed by clients at an urban drop-in center for PEH (n = 63) showed mental (58.7%) and physical (52.4%) health challenges were common, as was emergency department (ED) use (75.9%, n = 54). Surveys collected after in-person and telehealth clinical visits showed patient satisfaction was >90% for both visit types (n = 125, 44.0% telehealth and 56.0% in person). Without access to telehealth visits, 29.1% of patients would have gone to the ED and 38.2% would not have gotten care. Providers (n = 93, 69.6% telehealth and 30.4% in person) were more likely to agree/strongly agree they made a positive impact on patients' health through telehealth (92.2%) than in person (71.4%) (p = 0.019). Telehealth is a feasible and potentially cost-effective method to increase access to health care and reduce health outcome disparities in PEH.
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Affiliation(s)
- Cristin S Adams
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Marty S Player
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Carole R Berini
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Suzanne Perkins
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jerome Fay
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Layne Walker
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Echo Buffalo
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Chelsea Roach
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Vanessa A Diaz
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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6
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Heaslip V, Richer S, Simkhada B, Dogan H, Green S. Use of Technology to Promote Health and Wellbeing of People Who Are Homeless: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6845. [PMID: 34202242 PMCID: PMC8296891 DOI: 10.3390/ijerph18136845] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/22/2021] [Accepted: 06/22/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND People who are homeless experience poorer health outcomes and challenges accessing healthcare contribute to the experienced health inequality. There has been an expansion in using technology to promote health and wellbeing and technology has the potential to enable people who are socially excluded, including those who are homeless, to be able to access health services. However, little research has been undertaken to explore how technology is used to promote health and wellbeing for those who are homeless. This review aims to address the questions: 'what mobile health (mHealth) related technology is used by homeless populations' and 'what is the health impact of mobile technology for homeless populations'? METHODS An integrative review methodology was employed. A systematic search of electronic databases was carried out between 4 January 2021 and 30 April 2021, searching for papers published between 2015 and 2021, which yielded 2113 hits, relevant papers were selected using specified inclusion and exclusion criteria reported using the Preferred Reporting Items for Systematic reviews and Meta-Analysis. The quality assessment of each paper included in the review was undertaken using the Mixed Methods Appraisal Tool. RESULTS Seventeen papers were selected for review and thematic analysis identified four themes: technology ownership, barriers to use, connectivity and health benefits. CONCLUSION It is evident that technology has the potential to support the health and wellbeing of individuals who are homeless; however, there are challenges regarding connectivity to the internet, as well as issues of trust in who has access to personal data and how they are used. Further research is needed to explore the use of health technology with people who are homeless to address these challenges.
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Affiliation(s)
- Vanessa Heaslip
- Department of Nursing Science, Faculty of Health and Social Sciences, Bournemouth University, Poole BH12 5BB, UK; (V.H.); (S.G.)
- Department of Social Work, Stavanger University, 4021 Stavanger, Norway
| | - Stephen Richer
- Department of Nursing Science, Faculty of Health and Social Sciences, Bournemouth University, Poole BH12 5BB, UK; (V.H.); (S.G.)
| | - Bibha Simkhada
- Department of Nursing and Midwifery, University of Huddersfield, Huddersfield HD1 3DH, UK;
| | - Huseyin Dogan
- Department of Computing and Informatics, Faculty of Science and Technology, Bournemouth University, Poole BH12 5BB, UK;
| | - Sue Green
- Department of Nursing Science, Faculty of Health and Social Sciences, Bournemouth University, Poole BH12 5BB, UK; (V.H.); (S.G.)
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Watson T, Schindel TJ, Simpson SH, Hughes CA. Medication adherence in patients with mental illness and recent homelessness: contributing factors and perceptions on mobile technology use. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2020; 28:362-369. [PMID: 32100398 DOI: 10.1111/ijpp.12608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 01/15/2020] [Accepted: 01/28/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The primary objective was to determine medication-taking behaviours and factors influencing adherence in patients with mental illness and recent homelessness. Secondary objectives were to explore patients' perceptions on mobile technology use to support adherence. METHODS A constructivist approach and qualitative description method was used. The sample population consisted of patients with recent homelessness and mental illness affiliated with a community-based outreach programme in Canada. Participants were purposefully selected; semi-structured interviews were conducted to elicit information on medication-taking strategies and mobile technology to support adherence. A standardized questionnaire collected demographic and medical information; the Medication Adherence Rating Scale (MARS) was used to evaluate self-reported adherence. Questionnaire data were analysed using summary descriptive statistics. Interview data were subject to qualitative content analysis. KEY FINDINGS Fifteen participants with a mean age of 44 years were included. The mean MARS score ± standard deviation was 7.3 ± 1.5. Themes arising from the data included patient factors (i.e. insight, attitudes towards medications, coping strategies) and external factors (i.e. therapeutic alliance, family support that impacted adherence) and technology use and health. Eight participants (53%) had access to a mobile phone. There was a moderate interest in the use of mobile technology to support adherence, with cost and technology literacy identified as barriers. CONCLUSION External supports and individual medication management strategies were important in supporting medication adherence in this patient group. Perceived need for mobile technology, in addition to existing supports for adherence, was not high. Challenges accessing and maintaining consistent mobile technology and individual preferences should be considered when developing mobile technology-based interventions.
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Affiliation(s)
- Tyler Watson
- Alberta College of Pharmacy, Edmonton, AB, Canada.,Faculty of Pharmacy & Pharmaceutical Sciences, 3-171 Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, Canada
| | - Theresa J Schindel
- Faculty of Pharmacy & Pharmaceutical Sciences, 3-171 Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, Canada
| | - Scot H Simpson
- Faculty of Pharmacy & Pharmaceutical Sciences, 3-171 Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, Canada
| | - Christine A Hughes
- Faculty of Pharmacy & Pharmaceutical Sciences, 3-171 Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, Canada
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8
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Mlyuka H, Salehe H, Mikomangwa W, Kilonzi M, Marealle A, Mutagonda R, Bwire GM. Level of medication self-management capacity among patients on ambulatory care exiting hospital pharmacy at Muhimbili National Hospital, Tanzania: a descriptive cross-sectional study. BMC Res Notes 2019; 12:731. [PMID: 31699132 PMCID: PMC6839124 DOI: 10.1186/s13104-019-4772-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 10/30/2019] [Indexed: 01/13/2023] Open
Abstract
Objectives Medication management capacity of a patient on ambulatory care is direct related to adherence. To our knowledge data on medication management capacity for ambulatory care patients exiting outpatient pharmacy outlets in Tanzania are scarce. This study aimed to determine the level of medication management capacity among patients on ambulatory care exiting Muhimbili National Hospital outpatient pharmacy outlet. Results A total of 424 patients on ambulatory care participated in the study. Three hundred eighty-seven (91.3%) out of 424 interview questionnaires had complete data and qualified for data analysis. Majority (62.3%) out of 387 study participants had poor medication management capacity; 65.3% out of 387 patients were unable to correctly read the prescription and match the drugs they are carrying. More than half (57.4%) out of 387 participants were unable to correctly take the dose, 73.9% out of 387 were unable to correctly tell the dosing frequency and duration. Only 10.6% out 155 patients with prescription containing drugs with warning or precaution or contraindication or potential side effects were aware.
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Affiliation(s)
- Hamu Mlyuka
- Clinical Pharmacy and Pharmacology Department, School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65013, Dar es Salaam, Tanzania.
| | - Hija Salehe
- Clinical Pharmacy and Pharmacology Department, School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65013, Dar es Salaam, Tanzania
| | - Wigilya Mikomangwa
- Clinical Pharmacy and Pharmacology Department, School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65013, Dar es Salaam, Tanzania
| | - Manase Kilonzi
- Clinical Pharmacy and Pharmacology Department, School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65013, Dar es Salaam, Tanzania
| | - Alphonce Marealle
- Clinical Pharmacy and Pharmacology Department, School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65013, Dar es Salaam, Tanzania
| | - Ritah Mutagonda
- Clinical Pharmacy and Pharmacology Department, School of Pharmacy, Muhimbili University of Health and Allied Sciences, P.O. Box 65013, Dar es Salaam, Tanzania
| | - George M Bwire
- Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, P.O. Box 65013, Dar es Salaam, Tanzania
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9
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Tsang VWL, Papamihali K, Crabtree A, Buxton JA. Acceptability of technological solutions for overdose monitoring: Perspectives of people who use drugs. Subst Abus 2019; 42:284-293. [PMID: 31657675 DOI: 10.1080/08897077.2019.1680479] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Rising overdose deaths are a devastating problem across the United States and Canada. Despite the availability of observed consumption sites in British Columbia (BC), data suggest people who use drugs (PWUD) alone in private residences are most at risk of overdose death. These individuals may not use consumption sites due to fear of stigmatization, lack of privacy, or personal preference. It is this population that would benefit from overdose monitoring alternatives. METHODS This 2018 study employed two sources of data. (1) A provincial harm reduction distribution site client survey administered at 27 sites across BC asked about cell phone possession and functionality. (2) Structured interviews with PWUD in Vancouver gathered perspectives regarding monitoring devices and alerting systems. Results: The client survey was administered to 486 individuals. Among 443 respondents, 48% (n = 212) owned a cellphone and 68% (n = 115) of individuals with a cellphone with access to internet (n = 168) would use an application to mitigate opioid-related overdose deaths. Thirty qualitative interviews were performed; thematic analysis of the responses identified three major themes - safety, public versus private drug use, and technological monitoring and function. The relevance of technological devices was affected by the inconsistent availability of cellphones, concerns about anonymity, as well as personal comfort while using drugs. Conclusions: Technological applications may not be suitable for clients with transient lifestyles, no permanent home, and lack of consistent access to a mobile device. Thorough needs assessments, considerations of lifestyle limitations, and understanding perceptions around cellphone and overdose monitoring can increase the potential that devices will be used.Highlights45% (n = 219) of client survey respondents owned a cellphoneOut of cellphone owners, 59% (n = 102) of client survey respondents had access to internetOf 168 with internet access, 68% willing to use any applications for overdose responseApplications not suitable for transient lifestyles, no permanent home, and lack of consistent access to cellphone.
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Affiliation(s)
- V W L Tsang
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - K Papamihali
- BC Centre for Disease Control, Vancouver, Canada
| | - A Crabtree
- BC Centre for Disease Control, Vancouver, Canada
| | - J A Buxton
- Faculty of Medicine, University of British Columbia, Vancouver, Canada.,BC Centre for Disease Control, Vancouver, Canada
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10
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Baggett TP, Liauw SS, Hwang SW. Cardiovascular Disease and Homelessness. J Am Coll Cardiol 2019; 71:2585-2597. [PMID: 29852981 DOI: 10.1016/j.jacc.2018.02.077] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 02/09/2018] [Accepted: 02/11/2018] [Indexed: 01/14/2023]
Abstract
Cardiovascular disease (CVD) is a major cause of death among homeless adults, at rates that exceed those in nonhomeless individuals. A complex set of factors contributes to this disparity. In addition to a high prevalence of cigarette smoking and suboptimal control of traditional CVD risk factors such as hypertension and diabetes, a heavy burden of nontraditional psychosocial risk factors like chronic stress, depression, heavy alcohol use, and cocaine use may confer additional risk for adverse CVD outcomes beyond that predicted by conventional risk estimation methods. Poor health care access and logistical challenges to cardiac testing may lead to delays in presentation and diagnosis. The management of established CVD may be further challenged by barriers to medication adherence, communication, and timely follow-up. The authors present practical, patient-centered strategies for addressing these challenges, emphasizing the importance of multidisciplinary collaboration and partnership with homeless-tailored clinical programs to improve CVD outcomes in this population.
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Affiliation(s)
- Travis P Baggett
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts
| | - Samantha S Liauw
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stephen W Hwang
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.
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11
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Integration of Mobile Health Applications in Health Information Technology Initiatives: Expanding Opportunities for Nurse Participation in Population Health. Comput Inform Nurs 2018; 36:209-213. [PMID: 29734236 DOI: 10.1097/cin.0000000000000445] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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