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Slaats BM, Blok S, Somsen GA, Tulevski II, Knops RE, van den Born BJH, Winter MM. Can eHealth programs for cardiac arrhythmias be scaled-up by using the KardiaMobile algorithm? CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2024; 5:78-84. [PMID: 38765619 PMCID: PMC11096654 DOI: 10.1016/j.cvdhj.2023.11.004] [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] [Indexed: 05/22/2024] Open
Abstract
Background Remote monitoring devices for atrial fibrillation are known to positively contribute to the diagnostic process and therapy compliance. However, automatic algorithms within devices show varying sensitivity and specificity, so manual double-checking of electrocardiographic (ECG) recordings remains necessary. Objective The purpose of this study was to investigate the validity of the KardiaMobile algorithm within the Dutch telemonitoring program (HartWacht). Methods This retrospective study determined the diagnostic accuracy of the algorithm using assessments by a telemonitoring team as reference. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and F1 scores were determined. Results A total of 2298 patients (59.5% female; median age 57 ± 15 years) recorded 86,816 ECGs between April 2019 and January 2021. The algorithm showed sensitivity of 0.956, specificity 0.985, PPV 0.996, NPV 0.847, and F1 score 0.976 for the detection of sinus rhythm. A total of 29 false-positive outcomes remained uncorrected within the same patients. The algorithm showed sensitivity of 0.989, specificity 0.953, PPV 0.835, NPV 0.997, and F1 score 0.906 for detection of atrial fibrillation. A total of 2 false-negative outcomes remained uncorrected. Conclusion Our research showed high validity of the algorithm for the detection of both sinus rhythm and, to a lesser extent, atrial fibrillation. This finding suggests that the algorithm could function as a standalone instrument particularly for detection of sinus rhythm.
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Affiliation(s)
- Bridget M.I. Slaats
- Cardiology Centers of the Netherlands, Utrecht, The Netherlands
- Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, The Netherlands
| | - Sebastiaan Blok
- Cardiology Centers of the Netherlands, Utrecht, The Netherlands
- Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, The Netherlands
| | | | | | - Reinoud E. Knops
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Bert-Jan H. van den Born
- Cardiology Centers of the Netherlands, Utrecht, The Netherlands
- Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, The Netherlands
| | - Michiel M. Winter
- Cardiology Centers of the Netherlands, Utrecht, The Netherlands
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
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Lee JS, Bhatt A, Pollack LM, Jackson SL, Chang JE, Tong X, Luo F. Telehealth use during the early COVID-19 public health emergency and subsequent health care costs and utilization. HEALTH AFFAIRS SCHOLAR 2024; 2. [PMID: 38410743 PMCID: PMC10895996 DOI: 10.1093/haschl/qxae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Telehealth utilization increased during the COVID-19 pandemic, yet few studies have documented associations of telehealth use with subsequent medical costs and health care utilization. We examined associations of telehealth use during the early COVID-19 public health emergency (March-June 2020) with subsequent total medical costs and health care utilization among people with heart disease (HD). We created a longitudinal cohort of individuals with HD using MarketScan Commercial Claims data (2018-2022). We used difference-in-differences methodology adjusting for patients' characteristics, comorbidities, COVID-19 infection status, and number of in-person visits. We found that using telehealth during the stay-at-home order period was associated with a reduction in total medical costs (by -$1814 per person), number of emergency department visits (by -88.6 per 1000 persons), and number of inpatient admissions (by -32.4 per 1000 persons). Telehealth use increased per-person per-year pharmacy prescription claims (by 0.514) and average number of days' drug supply (by 0.773 days). These associated benefits of telehealth use can inform decision makers, insurance companies, and health care professionals, especially in the context of disrupted health care access.
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Affiliation(s)
- Jun Soo Lee
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30341, United States
| | - Ami Bhatt
- ASRT, Inc, Atlanta, GA 30346, United States
| | - Lisa M Pollack
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30341, United States
| | - Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30341, United States
| | - Ji Eun Chang
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY 10003, United States
| | - Xin Tong
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30341, United States
| | - Feijun Luo
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30341, United States
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Rivera BD, Nurse C, Shah V, Roldan C, Jumbo AE, Faysel M, Levine SR, Kaufman D, Afable A. Do digital health interventions hold promise for stroke prevention and care in Black and Latinx populations in the United States? A scoping review. BMC Public Health 2023; 23:2549. [PMID: 38129850 PMCID: PMC10734160 DOI: 10.1186/s12889-023-17255-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 11/17/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Black and Latinx populations are disproportionately affected by stroke and are likely to experience gaps in health care. Within fragmented care systems, remote digital solutions hold promise in reversing this pattern. However, there is a digital divide that follows historical disparities in health. Without deliberate attempts to address this digital divide, rapid advances in digital health will only perpetuate systemic biases. This study aimed to characterize the range of digital health interventions for stroke care, summarize their efficacy, and examine the inclusion of Black and Latinx populations in the evidence base. METHODS We searched PubMed, the Web of Science, and EMBASE for publications between 2015 and 2021. Inclusion criteria include peer-reviewed systematic reviews or meta-analyses of experimental studies focusing on the impact of digital health interventions on stroke risk factors and outcomes in adults. Detailed information was extracted on intervention modality and functionality, clinical/behavioral outcome, study location, sample demographics, and intervention results. RESULTS Thirty-eight systematic reviews met inclusion criteria and yielded 519 individual studies. We identified six functional categories and eight digital health modalities. Case management (63%) and health monitoring (50%) were the most common intervention functionalities. Mobile apps and web-based interventions were the two most commonly studied modalities. Evidence of efficacy was strongest for web-based, text-messaging, and phone-based approaches. Although mobile applications have been widely studied, the evidence on efficacy is mixed. Blood pressure and medication adherence were the most commonly studied outcomes. However, evidence on the efficacy of the various intervention modalities on these outcomes was variable. Among all individual studies, only 38.0% were conducted in the United States (n = 197). Of these U.S. studies, 54.8% adequately reported racial or ethnic group distribution. On average, samples were 27.0% Black, 17.1% Latinx, and 63.4% White. CONCLUSION While evidence of the efficacy of selected digital health interventions, particularly those designed to improve blood pressure management and medication adherence, show promise, evidence of how these interventions can be generalized to historically underrepresented groups is insufficient. Including these underrepresented populations in both digital health experimental and feasibility studies is critical to advancing digital health science and achieving health equity.
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Affiliation(s)
- Bianca D Rivera
- School of Public Health, Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA.
| | - Claire Nurse
- School of Public Health, Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
| | - Vivek Shah
- College of Medicine, Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
| | - Chastidy Roldan
- College of Medicine, Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
| | - Adiebonye E Jumbo
- School of Health Professions, Health Informatics Program, Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
| | - Mohammad Faysel
- School of Health Professions, Health Informatics Program, Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
| | - Steven R Levine
- Department of Neurology/Stroke Center, Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
| | - David Kaufman
- School of Health Professions, Health Informatics Program, Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
| | - Aimee Afable
- School of Public Health, Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA
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de Bell S, Zhelev Z, Shaw N, Bethel A, Anderson R, Thompson Coon J. Remote monitoring for long-term physical health conditions: an evidence and gap map. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-74. [PMID: 38014553 DOI: 10.3310/bvcf6192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Background Remote monitoring involves the measurement of an aspect of a patient's health without that person being seen face to face. It could benefit the individual and aid the efficient provision of health services. However, remote monitoring can be used to monitor different aspects of health in different ways. This evidence map allows users to find evidence on different forms of remote monitoring for different conditions easily to support the commissioning and implementation of interventions. Objectives The aim of this map was to provide an overview of the volume, diversity and nature of recent systematic reviews on the effectiveness, acceptability and implementation of remote monitoring for adults with long-term physical health conditions. Data sources We searched MEDLINE, nine further databases and Epistemonikos for systematic reviews published between 2018 and March 2022, PROSPERO for continuing reviews, and completed citation chasing on included studies. Review methods (Study selection and Study appraisal): Included systematic reviews focused on adult populations with a long-term physical health condition and reported on the effectiveness, acceptability or implementation of remote monitoring. All forms of remote monitoring where data were passed to a healthcare professional as part of the intervention were included. Data were extracted on the characteristics of the remote monitoring intervention and outcomes assessed in the review. AMSTAR 2 was used to assess quality. Results were presented in an interactive evidence and gap map and summarised narratively. Stakeholder and public and patient involvement groups provided feedback throughout the project. Results We included 72 systematic reviews. Of these, 61 focus on the effectiveness of remote monitoring and 24 on its acceptability and/or implementation, with some reviews reporting on both. The majority contained studies from North America and Europe (38 included studies from the United Kingdom). Patients with cardiovascular disease, diabetes and respiratory conditions were the most studied populations. Data were collected predominantly using common devices such as blood pressure monitors and transmitted via applications, websites, e-mail or patient portals, feedback provided via telephone call and by nurses. In terms of outcomes, most reviews focused on physical health, mental health and well-being, health service use, acceptability or implementation. Few reviews reported on less common conditions or on the views of carers or healthcare professionals. Most reviews were of low or critically low quality. Limitations Many terms are used to describe remote monitoring; we searched as widely as possible but may have missed some relevant reviews. Poor reporting of remote monitoring interventions may mean some included reviews contain interventions that do not meet our definition, while relevant reviews might have been excluded. This also made the interpretation of results difficult. Conclusions and future work The map provides an interactive, visual representation of evidence on the effectiveness of remote monitoring and its acceptability and successful implementation. This evidence could support the commissioning and delivery of remote monitoring interventions, while the limitations and gaps could inform further research and technological development. Future reviews should follow the guidelines for conducting and reporting systematic reviews and investigate the application of remote monitoring in less common conditions. Review registration A protocol was registered on the OSF registry (https://doi.org/10.17605/OSF.IO/6Q7P4). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Services and Delivery Research programme (NIHR award ref: NIHR135450) as part of a series of evidence syntheses under award NIHR130538. For more information, visit https://fundingawards.nihr.ac.uk/award/NIHR135450 and https://fundingawards.nihr.ac.uk/award/NIHR130538. The report is published in full in Health and Social Care Delivery Research; Vol. 11, No. 22. See the NIHR Funding and Awards website for further project information.
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Affiliation(s)
- Siân de Bell
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Zhivko Zhelev
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Naomi Shaw
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Alison Bethel
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Rob Anderson
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
| | - Jo Thompson Coon
- Exeter HS&DR Evidence Synthesis Centre, Department of Health and Community Sciences, Medical School, University of Exeter, Exeter, UK
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Minuz P, Albini FL, Imbalzano E, Izzo R, Masi S, Pengo MF, Pucci G, Scalise F, Salvetti M, Tocci G, Cicero A, Iaccarino G, Savoia C, Sechi L, Parati G, Borghi C, Volpe M, Ferri C, Grassi G, Muiesan ML. Telemedicine and Digital Medicine in the Clinical Management of Hypertension and Hypertension-Related Cardiovascular Diseases: A Position Paper of the Italian Society of Arterial Hypertension (SIIA). High Blood Press Cardiovasc Prev 2023; 30:387-399. [PMID: 37594686 PMCID: PMC10600275 DOI: 10.1007/s40292-023-00595-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/25/2023] [Indexed: 08/19/2023] Open
Abstract
High blood pressure is the leading cause of death and disability globally and an important treatable risk factor for cardiovascular, cerebrovascular and chronic kidney diseases. Digital technology, including mobile health solutions and digital therapy, is expanding rapidly in clinical medicine and has the potential to improve the quality of care and effectiveness of drug treatment by making medical interventions timely, tailored to hypertensive patients' needs and by improving treatment adherence. Thus, the systematic application of digital technologies could support diagnosis and awareness of hypertension and its complications, ultimately leading to improved BP control at the population level. The progressive implementation of digital medicine in the national health systems must be accompanied by the supervision and guidance of health authorities and scientific societies to ensure the correct use of these new technologies with consequent maximization of the potential benefits. The role of scientific societies in relation to the rapid adoption of digital technologies, therefore, should encompass the entire spectrum of activities pertaining to their institutional role: information, training, promotion of research, scientific collaboration and advice, evaluation and validation of technological tools, and collaboration with regulatory and health authorities.
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Affiliation(s)
- Pietro Minuz
- Department of Medicine, University of Verona, Medicina Generale C, Policlinico GB Rossi, Piazzale LA Scuro 10, 37134, Verona, Italy.
| | | | - Egidio Imbalzano
- Hypertension Unit, Division of Internal Medicine, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Institute of Cardiovascular Science, University College London, London, UK
| | - Martino F Pengo
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Giacomo Pucci
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Unit of Internal Medicine, "Santa Maria" Terni Hospital, Terni, Italy
| | - Filippo Scalise
- Center for the Study of Hypertension and Vascular Diseases-Clinical Institute Verano Brianza, Policlinico di Monza, Monza, Italy
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia and Emergency Medicine ASST Spedali Civili di Brescia, Brescia, Italy
| | - Giuliano Tocci
- Division of Cardiology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Azienda Ospedaliero-Universitaria Sant'Andrea, Rome, Italy
| | - Arrigo Cicero
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Guido Iaccarino
- Center for Research on Hypertension and Related Conditions, Federico II University of Naples, Naples, Italy
| | - Carmine Savoia
- Clinical and Molecular Medicine, University of Rome Sapienza and IRCCS San Raffaele Roma, Rome, Italy
| | - Leonardo Sechi
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- IRCCS, Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Massimo Volpe
- Clinical and Molecular Medicine, University of Rome Sapienza and IRCCS San Raffaele Roma, Rome, Italy
| | - Claudio Ferri
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Guido Grassi
- Clinica Medica, University of Milano-Bicocca, Milan, Italy
| | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia and Emergency Medicine ASST Spedali Civili di Brescia, Brescia, Italy
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Su JJ, Bayuo J, Abu-Odah H, Lin RSY, He Q, Molassiotis A. Perception of eHealth Programs for Cardiovascular Health: Qualitative Systematic Review and Meta-synthesis. J Cardiovasc Nurs 2023:00005082-990000000-00105. [PMID: 37436250 DOI: 10.1097/jcn.0000000000001012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
BACKGROUND Despite emerging evidence on the effectiveness of eHealth interventions in improving cardiovascular health, little is known about the perception of use and efficacy of these interventions and real-world application. OBJECTIVE We sought to develop an in-depth understanding of the perceptions of eHealth interventions in improving cardiovascular health. METHODS This is a systematic review and meta-synthesis of qualitative studies. A comprehensive search of multiple databases and a manual search of the references list were conducted. Meta-synthesis of qualitative data was performed to review and interpret the findings. The study report followed the ENTREQ checklist. RESULTS Four themes emerged regarding perceptions of eHealth interventions: preferred eHealth intervention design features, enabling healthcare professionals' support, eHealth engagement for health benefits, and barriers to eHealth engagement. Intervention design features should integrate motivational elements, use an eHealth literacy lens, and enhance cultural relevance. Healthcare professionals appreciated these new working methods but voiced concern about competency building. Real-world usage initiation was driven by perceived needs and usefulness, whereas persistent engagement was inspired by intrinsic motivation in participants. CONCLUSIONS eHealth interventions were appreciated as a valuable opportunity for providing alternative/supplementary cardiac care for health optimization. Participants commented on the need for more explicit and accurate health information presentation, and they appreciated the motivational elements in empowering them with self-determination over daily self-care behaviors. Professionals raised the need for specific guidance to enhance competency and intervention fidelity when delivering eHealth care.
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van de Vijver S, Hummel D, van Dijk AH, Cox J, van Dijk O, Van den Broek N, Metting E. Evaluation of a Digital Self-management Platform for Patients With Chronic Illness in Primary Care: Qualitative Study of Stakeholders' Perspectives. JMIR Form Res 2022; 6:e38424. [PMID: 35921145 PMCID: PMC9386583 DOI: 10.2196/38424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/27/2022] [Accepted: 05/29/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Population aging and multimorbidity has led to increasing chronic care needs associated with new challenges in managing growing costs, rising health care professional workloads, and the adoption of rigorous guidelines. These issues could all benefit from greater digitalization and a more patient-centered approach to chronic care, a situation brought to the fore by the COVID-19 pandemic. Little is known about real-life use in primary care. OBJECTIVE This study aimed to explore the views, thoughts, usability, and experiences concerning a recently introduced digital self-care platform for chronic conditions in 3 Dutch primary care practices. METHODS We conducted an explorative study combining questionnaires and interviews among patients and general practitioners from 3 general practices that used the digital platform. Questionnaires were sent to patients in each practice to seek the views and experiences of both patient nonusers (n=20) and patient users (n=58) of the platform, together with standardized questionnaires about illness perception and quality of life. In addition, patients (n=15) and general practitioners (n=4) who used the platform took part in semistructured interviews. We transcribed interviews verbatim and performed qualitative content analysis using a deductive approach. The results of the questionnaires were analyzed with descriptive analysis. RESULTS Among patients who had not actively used the platform but had received an explanation, only 35% (7/20) would recommend its use due to concerns over communication and handling. However, this percentage increased to 76.3% (45/59) among the people who actively used the platform. Interviews with patients and general practitioners who used the platform uncovered several key benefits, including reduced time requirements, reduced workload, improved care quality, and improved accessibility due to the greater patient-centeredness and use of different communication tools. In addition, the self-management tool led to greater patient autonomy and empowerment. Although users considered the platform feasible, usable, and easy to use, some technical issues remained and some patients expressed concerns about the reduction in human contact and feedback. CONCLUSIONS The overall experience and usability of the platform was good. Support for the online self-management platform for chronic care increased when patients actively used the tool and could experience or identify important advantages. However, patients still noted several areas for improvement that need to be tackled in future iterations. To ensure benefit in the wider population, we must also evaluate this platform in cohorts with lower digital and health literacy.
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Affiliation(s)
- Steven van de Vijver
- Amsterdam Health & Technology Institute, Amsterdam University Medical Center, Amsterdam, Netherlands
- Family Medicine Department, OLVG, Amsterdam, Netherlands
| | - Deirdre Hummel
- Faculty of Economics and Business, University of Groningen, Groningen, Netherlands
| | | | - Jan Cox
- Medicine Men, Utrecht, Netherlands
| | | | - Nicoline Van den Broek
- Department of General Practice and Elderly Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Esther Metting
- Faculty of Economics and Business, University of Groningen, Groningen, Netherlands
- Department of General Practice and Elderly Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Data Science Center in Health, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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8
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Shen H, van der Kleij R, van der Boog PJM, Wang W, Song X, Li Z, Brakema E, Lou X, Chavannes N. Digital tools/eHealth to support CKD self-management: A qualitative study of perceptions, attitudes and needs of patients and health care professionals in China. Int J Med Inform 2022; 165:104811. [PMID: 35753175 DOI: 10.1016/j.ijmedinf.2022.104811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 05/05/2022] [Accepted: 06/05/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND A growing body of evidence supports the potential effectiveness of electronic health (eHealth) self-management interventions in improving disease self-management skills and health outcomes of patients suffering from chronic kidney disease (CKD). However, current research on CKD eHealth self-management interventions has almost exclusively focused on high-income, western countries. OBJECTIVE To inform the adaptation of a tailored eHealth self-management intervention for patients with CKD in China based on the Dutch Medical Dashboard (MD) intervention, we examined the perceptions, attitudes and needs of Chinese patients with CKD and health care professionals (HCPs) towards eHealth based (self-management) interventions in general and the Dutch MD intervention in specific. METHODS We conducted a basic interpretive, cross-sectional qualitative study comprising semi-structured interviews with 11 patients with CKD and 10 HCPs, and 2 focus group discussions with 9 patients with CKD. This study was conducted in the First Affiliated Hospital of Zhengzhou University in China. Data collection continued until data saturation was reached. All data were transcribed verbatim and analyzed using a framework approach. RESULTS Three themes emerged: (1) experience with eHealth in CKD (self-management), (2) needs for supporting CKD self-management with the use of eHealth, and (3) adaptation and implementation of the Dutch MD intervention in China. Both patients and HCPs had experience with and solely mentioned eHealth to 'inform, monitor and track' as potentially relevant interventions to support CKD self-management, not those to support 'interaction' and 'data utilization'. Factors reported to influence the implementation of CKD eHealth self-management interventions included information barriers (i.e. quality and consistency of the disease-related information obtained via eHealth), perceived trustworthiness and safety of eHealth sources, clinical compatibility and complexity of eHealth, time constraints and eHealth literacy. Moreover, patients and HCPs expressed that eHealth interventions should support CKD self-management by improving the access to reliable and relevant disease related knowledge and optimizing the timeliness and quality of patient and HCPs interactions. Finally, suggestions to adaptation and implementation of the Dutch MD intervention in China were mainly related to improving the intervention functionalities and content of MD such as addressing the complexity of the platform and compatibility with HCPs' workflows. CONCLUSIONS The identified perceptions, attitudes and needs towards eHealth self-management interventions in Chinese settings should be considered by researchers and intervention developers to adapt a tailored eHealth self-management intervention for patients with CKD in China. In more detail, future research needs to engage in co-creation processes with vulnerable groups during eHealth development and implementation, increase eHealth literacy and credibility of eHealth (information resource), ensure eHealth to be easy to use and well-integrated into HCPs' workflows.
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Affiliation(s)
- Hongxia Shen
- School of Nursing, Guangzhou Medical University, Guangzhou, China; Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China.
| | - Rianne van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands; Department of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Wenjiao Wang
- Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Xiaoyue Song
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Zhengyan Li
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Evelyn Brakema
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Xiaoping Lou
- Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Niels Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
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Halasz G, Parati G, Piepoli MF. Editor comment: Focus on cardiovascular prevention. Eur J Prev Cardiol 2021; 28:1523-1525. [PMID: 34929043 DOI: 10.1093/eurjpc/zwab194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Geza Halasz
- Cardiac Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
| | - Gianfranco Parati
- University of Milano-Bicocca and IRCCS, Istituto Auxologico Italiano, Milan, Italy
| | - Massimo F Piepoli
- Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy
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Kocher A, Simon M, Dwyer AA, Blatter C, Bogdanovic J, Künzler-Heule P, Villiger PM, Dan D, Distler O, Walker UA, Nicca D. Patient and healthcare professional eHealth literacy and needs for systemic sclerosis support: a mixed methods study. RMD Open 2021; 7:rmdopen-2021-001783. [PMID: 34475248 PMCID: PMC8413951 DOI: 10.1136/rmdopen-2021-001783] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/28/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES We engaged patients with systemic sclerosis (SSc) and healthcare professionals to assess electronic health (eHealth) literacy and needs relating to web-based support using internet-based information and communication technologies (ICT). METHODS We employed an explanatory sequential mixed methods design. First, we conducted a cross-sectional survey in patients (n=101) and professionals (n=47). Next, we conducted three focus groups with patients, family members and professionals (n=17). RESULTS Of patients, 89.1% used ICT at least weekly for private communication. Patients reported relatively high comprehension of eHealth information ([Formula: see text] =6.7, 95% CI: 6.2 to 7.3, range 1-10), yet were less confident evaluating information reliability ([Formula: see text] =5.8, 95% CI: 5.1 to 6.4) and finding eHealth apps ([Formula: see text] =4.8, 95% CI: 4.2 to 5.4). Patients and professionals reported little experience with web-based self-management support. Focus groups revealed 'considering non-ICT-accessible groups' and 'fitting patients' and professionals' technology' as crucial for acceptability. In relation to understanding/appraising eHealth, participants highlighted that general SSc information is not tailored to individual's disease course. Recommendations included 'providing timely, understandable and safe information' and 'empowering end-users in ICT and health decision-making skills'. Professionals expressed concerns about lacking resources. Patients were concerned about data security and person-centredness. Key eHealth drivers included 'addressing end-user perceptions' and 'putting people at the centre of technology'. CONCLUSIONS Patients and professionals need education/training to support uptake of eHealth resources. Key elements include guiding patients to timely/reliable information and using eHealth to optimise patient-provider communication. Design that is responsive to end-users' needs and considers individuals with limited eHealth literacy and/or ICT access appears to be critical for acceptability.
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Affiliation(s)
- Agnes Kocher
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland.,Head Office of Nursing, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Simon
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland.,Nursing & Midwifery Research Unit, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrew A Dwyer
- Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA.,Munn Center for Nursing Research, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Catherine Blatter
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Jasmina Bogdanovic
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Patrizia Künzler-Heule
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland.,Department of Gastroenterology/Hepatology and Department of Nursing, Cantonal Hospital St. Gallen, St Gallen, Switzerland
| | | | - Diana Dan
- Service of Rheumatology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ulrich A Walker
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Dunja Nicca
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland .,Department of Global and Public Health, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland
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11
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Kolk MZH, Blok S, De Wildt MCC, Tjong FVY, Winter MM, Tulevski II, van den Born BJH, Somsen GA. Patient-reported outcomes in symptom-driven remote arrhythmia monitoring: evaluation of the Dutch HartWacht-telemonitoring programme. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 2:224-230. [PMID: 36712387 PMCID: PMC9707978 DOI: 10.1093/ehjdh/ztab030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/19/2021] [Accepted: 03/05/2021] [Indexed: 02/01/2023]
Abstract
Aims There is limited quantitative evidence on the effect of symptom-driven telemonitoring for cardiac arrhythmias on patient-reported outcomes. We evaluated the effect of a symptom-driven remote arrhythmia monitoring programme on the patient-reported health-related quality of life (HRQoL), sense of safety, physical limitations, and self-management. Methods and results This was an observational retrospective longitudinal study of the symptom-driven HartWacht-telemonitoring programme using a remote single-lead electrocardiogram monitoring system. Real-world patient data from participants who were enrolled in the telemonitoring programme for (suspected) symptomatic atrial fibrillation (AF) between July 2017 and September 2019 were evaluated. Primary outcomes were the patient-reported generic HRQoL, disease-specific HRQoL, sense of safety, physical limitations, and self-management at date of enrolment, 3 months and 6 months of follow-up. Outcomes were compared to a historical control group consisting of AF patients receiving standard care. A total of 109 participants in the HartWacht programme [59 men (54%); mean age 61 ± 11 years; 72% diagnosed AF] were included in complete case analysis. There was no significant change in HRQoL and sense of safety during follow-up. A significant improvement in the perceived physical limitations was observed. The level of self-management declined significantly during follow-up. Comparisons to the historic control group (n = 83) showed no difference between the patient-reported disease-specific HRQoL, sense of safety and physical limitations at 6 months of follow-up. Conclusion Symptom-driven remote arrhythmia monitoring for AF does not seem to affect HRQoL and sense of safety, whereas the perceived physical limitations tend to improve. Patient-reported self-management declined during the first 6 months of participation.
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Affiliation(s)
- Maarten Z H Kolk
- Cardiology Centers of the Netherlands, Amsterdam, The Netherlands,Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands,Corresponding author. Tel: 020 56 65550,
| | - Sebastiaan Blok
- Cardiology Centers of the Netherlands, Amsterdam, The Netherlands,Department of Internal and Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Fleur V Y Tjong
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands
| | - Michiel M Winter
- Cardiology Centers of the Netherlands, Amsterdam, The Netherlands,Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands
| | - Igor I Tulevski
- Cardiology Centers of the Netherlands, Amsterdam, The Netherlands
| | - Bert-Jan H van den Born
- Department of Internal and Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands,Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - G Aernout Somsen
- Cardiology Centers of the Netherlands, Amsterdam, The Netherlands
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12
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Hofstra L, Somsen GA. Telemedicine in post-CABG patients: promises and pitfalls. Neth Heart J 2021; 29:78-79. [PMID: 33475931 PMCID: PMC7818690 DOI: 10.1007/s12471-021-01537-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- L Hofstra
- Cardiology Centres of the Netherlands, Amsterdam, The Netherlands.
| | - G A Somsen
- Cardiology Centres of the Netherlands, Amsterdam, The Netherlands
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