1
|
Bocian IY, Chin AR, Rodriguez A, Collins W, Sindher SB, Chinthrajah RS. Asthma management in the digital age. FRONTIERS IN ALLERGY 2024; 5:1451768. [PMID: 39291253 PMCID: PMC11405314 DOI: 10.3389/falgy.2024.1451768] [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: 06/19/2024] [Accepted: 08/05/2024] [Indexed: 09/19/2024] Open
Abstract
Asthma affects 25 million people in the United States, and its prevalence is increasing. Access to care and adherence to prescribed asthma-treatment programs remain the principal formidable challenges for asthma management. Telemedicine offers substantial opportunities for improved asthma care of patients across the full range of socioeconomic strata. Ever-improving digital tools for asthma assessment and treatment are key components of telemedicine platforms for asthma management. These include a variety of remote patient-monitoring devices, digital inhaler systems, and mobile-health applications that facilitate ongoing assessment and adherence to treatment protocols. Digital tools for monitoring treatment focus on tracking medication use, inhalation technique, and physiological markers such as peak-flow rate and pulse-oximetry. Telemedicine visits allow for elements of assessment via video, approximating or duplicating many aspects of in-person visits, such as evaluating a patient's general appearance, breathing effort, and cough. Challenges remain in ensuring equitable access to these technologies, especially in rural and low-income areas, and in maintaining patient privacy and data security in digital platforms.
Collapse
Affiliation(s)
- Ilan Y Bocian
- Department of Medicine, Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Andrew R Chin
- Department of Medicine, Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Alyssa Rodriguez
- Department of Medicine, Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - William Collins
- Department of Medicine, Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - Sayantani B Sindher
- Department of Medicine, Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| | - R Sharon Chinthrajah
- Department of Medicine, Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, CA, United States
| |
Collapse
|
2
|
Oppelaar MC, Emond Y, Bannier MAGE, Reijers MHE, van der Vaart H, van der Meer R, Altenburg J, Conemans L, Rottier BL, Nuijsink M, van den Wijngaart LS, Merkus PJFM, Heinen M, Roukema J. Potential, Pitfalls, and Future Directions for Remote Monitoring of Chronic Respiratory Diseases: Multicenter Mixed Methods Study in Routine Cystic Fibrosis Care. J Med Internet Res 2024; 26:e54942. [PMID: 39106098 PMCID: PMC11336494 DOI: 10.2196/54942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 04/09/2024] [Accepted: 05/27/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND The current literature inadequately addresses the extent to which remote monitoring should be integrated into care models for chronic respiratory diseases (CRDs). OBJECTIVE This study examined a remote monitoring program (RMP) in cystic fibrosis (CF) by exploring experiences, future perspectives, and use behavior over 3 years, with the aim of developing future directions for remote monitoring in CRDs. METHODS This was a mixed methods, multicenter, observational study in 5 Dutch CF centers following a sequential explanatory design. Self-designed questionnaires using the technology acceptance model were sent out to people with CF who had a minimum of 12 months of experience with the RMP and local health care professionals (HCPs). Questionnaire outcomes were used to inform semistructured interviews with HCPs and people with CF. Qualitative findings were reported following the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist. Anonymous data on use frequency of all people with CF were analyzed. RESULTS Between the second quarter of 2020 and the end of 2022, a total of 608 people with CF were enrolled in the program, and a total of 9418 lung function tests and 2631 symptom surveys were conducted. In total, 65% (24/37) of HCPs and 89% (72/81) of people with CF responded to the questionnaire, and 7 HCPs and 12 people with CF participated in semistructured interviews. Both people with CF and HCPs were positive about remote monitoring in CF care and found the RMP a good addition to daily care (people with CF: 44/72, 61%; HCPs: 21/24, 88%). Benefits ranged from supporting individual patients to reducing health care consumption. The most valued monitoring tool was home spirometry by both people with CF (66/72, 92%) and HCPs (22/24, 92%). Downsides included the potential to lose sight of patients and negative psychosocial effects, as 17% (12/72) of people with CF experienced some form of stress due to the RMP. A large majority of people with CF (59/72, 82%) and HCPs (22/24, 92%) wanted to keep using the RMP in future, with 79% (19/24) of HCPs and 75% (54/72) of people with CF looking forward to more replacement of in-person care with digital care during periods of well-being. Future perspectives for the RMP were centered on creating hybrid care models, personalizing remote care, and balancing individual benefits with monitoring burden. CONCLUSIONS Remote monitoring has considerable potential in supporting people with CF and HCPs within the CF care model. We identified 4 practice-based future directions for remote monitoring in CF and CRD care. The strategies, ranging from patient driven to prediction driven, can help clinicians, researchers, and policy makers navigate the rapidly changing digital health field, integrate remote monitoring into local care models, and align remote care with patient and clinician needs.
Collapse
Affiliation(s)
- Martinus C Oppelaar
- Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
| | - Yvette Emond
- IQ Health Science Department, Radboud University Medical Center, Nijmegen, Netherlands
| | - Michiel A G E Bannier
- Department of Paediatric Pulmonology, MosaKids Children's Hospital, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Monique H E Reijers
- Department of Pulmonology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Hester van der Vaart
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | - Josje Altenburg
- Department of Respiratory Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Lennart Conemans
- Department of Respiratory Medicine, Maastricht University Medical Centre+, Maastricht, Netherlands
- Division of Respiratory & Age-related Health, Department of Respiratory Medicine, NUTRIM Institute of Nutrition and Translational Research in Metabolism, Maastricht, Netherlands
| | - Bart L Rottier
- Department of Pediatric Pulmonology and Pediatric Allergology, University Medical Center Groningen, Beatrix Children's Hospital, University of Groningen, Groningen, Netherlands
- Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Marianne Nuijsink
- Haga Teaching Hospital, Juliana Children's Hospital, The Hague, Netherlands
| | - Lara S van den Wijngaart
- Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
| | - Peter J F M Merkus
- Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
| | - Maud Heinen
- IQ Health Science Department, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jolt Roukema
- Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
| |
Collapse
|
3
|
Hakizimana A, Devani P, Gaillard EA. Current technological advancement in asthma care. Expert Rev Respir Med 2024; 18:499-512. [PMID: 38992946 DOI: 10.1080/17476348.2024.2380067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 07/10/2024] [Indexed: 07/13/2024]
Abstract
INTRODUCTION Asthma is a common chronic respiratory disease affecting 262 million people globally, causing half a million deaths each year. Poor asthma outcomes are frequently due to non-adherence to medication, poor engagement with asthma services, and a lack of objective diagnostic tests. In recent years, technologies have been developed to improve diagnosis, monitoring, and care. AREAS COVERED Technology has impacted asthma care with the potential to improve patient outcomes, reduce healthcare costs, and provide personalized management. We focus on current evidence on home diagnostics and monitoring, remote asthma reviews, and digital smart inhalers. PubMed, Ovid/Embase, Cochrane Library, Scopus and Google Scholar were searched in November 2023 with no limit by year of publication. EXPERT OPINION Advanced diagnostic technologies have enabled early asthma detection and personalized treatment plans. Mobile applications and digital therapeutics empower patients to manage their condition and improve adherence to treatments. Telemedicine platforms and remote monitoring devices have the potential to streamline asthma care. AI algorithms can analyze patient data and predict exacerbations in proof-of-concept studies. Technology can potentially provide precision medicine to a wider patient group in the future, but further development is essential for implementation into routine care which in itself will be a major challenge.
Collapse
Affiliation(s)
- Ali Hakizimana
- Department of Paediatric Respiratory Medicine. Leicester Children's Hospital, University Hospitals Leicester, Leicester, UK
| | - Pooja Devani
- Department of Paediatric Respiratory Medicine. Leicester Children's Hospital, University Hospitals Leicester, Leicester, UK
- Department of Respiratory Sciences, Leicester NIHR Biomedical Research Centre (Respiratory Theme), University of Leicester, Leicester, UK
| | - Erol A Gaillard
- Department of Paediatric Respiratory Medicine. Leicester Children's Hospital, University Hospitals Leicester, Leicester, UK
- Department of Respiratory Sciences, Leicester NIHR Biomedical Research Centre (Respiratory Theme), University of Leicester, Leicester, UK
| |
Collapse
|
4
|
Pais-Cunha I, Fontoura Matias J, Almeida AL, Magalhães M, Fonseca JA, Azevedo I, Jácome C. Telemonitoring of pediatric asthma in outpatient settings: A systematic review. Pediatr Pulmonol 2024. [PMID: 38742250 DOI: 10.1002/ppul.27046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/18/2024] [Accepted: 04/24/2024] [Indexed: 05/16/2024]
Abstract
Telemonitoring technologies are rapidly evolving, offering a promising solution for remote monitoring and timely management of asthma acute episodes. We aimed to describe current pediatric asthma telemonitoring technologies. A systematic review was conducted until September 2023 on Medline, Scopus, and Web of Science. We included studies of children (0-18 years) with asthma or recurrent wheezing whose respiratory condition was telemonitored outside the healthcare setting. A narrative synthesis was performed. We identified 40 telemonitoring technologies described in 40 studies. The more frequently used technologies for telemonitoring were mobile applications (n = 21) and web-based systems (n = 14). Telemonitoring duration varied between 2 weeks and 32 months. Data collection included asthma symptoms (n = 30), patient-reported outcome measures (PROMs) (n = 11), spirometry/peak flow readings (n = 20), medication adherence (n = 17), inhaler technique (n = 3), air quality (n = 2), and respiratory sounds (n = 2). Both parents and children were the technology target users in most studies (n = 23). Technology training was reported in 23 studies of which 3 provided ongoing support. Automatic feedback was found in 30 studies, mostly related with asthma control. HCP were involved in data management in 27 studies. Technologies were tested in samples from 4 to 327 children, with most studies including school-aged children and/or adolescents (n = 38) and eight including preschool children. This review provides an overview of existing technologies for the outpatient telemonitoring of pediatric asthma. Specific technologies for preschool children represent a gap in the literature that needs to be specifically addressed in future research.
Collapse
Affiliation(s)
- Inês Pais-Cunha
- Serviço De Pediatria, Unidade De Gestão Autónoma Da Mulher E Da Criança, Centro Hospitalar Universitário São João, Porto, Portugal
- Departamento De Ginecologia-Obstetrícia e Pediatria, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of University of Porto, Porto, Portugal
| | - José Fontoura Matias
- Serviço De Pediatria, Unidade De Gestão Autónoma Da Mulher E Da Criança, Centro Hospitalar Universitário São João, Porto, Portugal
- Departamento De Ginecologia-Obstetrícia e Pediatria, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Ana Laura Almeida
- Serviço De Pediatria, Unidade De Gestão Autónoma Da Mulher E Da Criança, Centro Hospitalar Universitário São João, Porto, Portugal
- Departamento De Ginecologia-Obstetrícia e Pediatria, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Manuel Magalhães
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of University of Porto, Porto, Portugal
- Serviço De Pediatria, Centro Materno Infantil Do Norte, Centro Hospitalar Universitário Do Porto, Porto, Portugal
| | - João A Fonseca
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of University of Porto, Porto, Portugal
- Allergy Unit, Instituto CUF Porto E Hospital CUF Porto, Porto, Portugal
| | - Inês Azevedo
- Serviço De Pediatria, Unidade De Gestão Autónoma Da Mulher E Da Criança, Centro Hospitalar Universitário São João, Porto, Portugal
- Departamento De Ginecologia-Obstetrícia e Pediatria, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Cristina Jácome
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of University of Porto, Porto, Portugal
| |
Collapse
|
5
|
Abstract
PURPOSE OF REVIEW We highlight the recent advances in home monitoring of patients with asthma, and show that these advances converge towards the implementation of digital twin systems. RECENT FINDINGS Connected devices for asthma are increasingly numerous, reliable and effective: new electronic monitoring devices extend to nebulizers and spacers, are able to assess the quality of the inhalation technique, and to identify asthma attack triggers when they include a geolocation function; environmental data can be acquired from databases and refined by wearable air quality sensors; smartwatches are better validated. Connected devices are increasingly integrated into global monitoring systems. At the same time, machine learning techniques open up the possibility of using the large amount of data collected to obtain a holistic assessment of asthma patients, and social robots and virtual assistants can help patients in the daily management of their asthma. SUMMARY Advances in the internet of things, machine learning techniques and digital patient support tools for asthma are paving the way for a new era of research on digital twins in asthma.
Collapse
Affiliation(s)
- David Drummond
- Department of Pediatric Pulmonology and Allergology, University Hospital Necker-Enfants Malades, AP-HP, Université Paris Cité, Inserm UMR 1138, HeKA team, Centre de Recherche des Cordeliers, Paris, France
| | - Jolt Roukema
- Department of Paediatrics/Paediatric Pulmonology, Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen
| | - Mariëlle Pijnenburg
- Department of Paediatrics/Paediatric Respiratory Medicine and Allergology, Erasmus University Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
| |
Collapse
|
6
|
Faiçal AVB, Mota LR, Correia DDA, Monteiro LP, de Souza EL, Terse-Ramos R. Telehealth for children and adolescents with chronic pulmonary disease: systematic review. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2023; 42:e2024111. [PMID: 37194911 PMCID: PMC10185001 DOI: 10.1590/1984-0462/2024/42/2022111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 12/07/2022] [Indexed: 05/18/2023]
Abstract
OBJECTIVE To revise the impact of telehealth on the quality of life, reduction in pulmonary exacerbations, number of days using antibiotics, adherence to treatment, pulmonary function, emergency visits, hospitalizations, and the nutritional status of individuals with asthma and cystic fibrosis. DATA SOURCE Four databases were used, MEDLINE, LILACS, Web of Science and Cochrane, as well as manual searches in English, Portuguese and Spanish. Randomized clinical trials, published between January 2010 and December 2020, with participants aged 0 to 20 years, were included. DATA SYNTHESIS Seventy-one records were identified after the removal of duplicates; however, twelve trials were eligible for synthesis. Included trials utilized: mobile phone applications (n=5), web platforms (n= 4), mobile telemedicine unit (n=1), software with an electronic record (n=1), remote spirometer (n=1), and active video games platform (n=1). Three trials used two tools, including telephone calls. Among the different types of interventions, improvement in adherence, quality of life, and physiologic variables were observed for mobile application interventions and game platforms compared to usual care. Visits to the emergency department, unscheduled medical appointments, and hospitalizations were not reduced. There was considerable heterogeneity among studies. CONCLUSIONS The findings suggest that better control of symptoms, quality of life, and adherence to treatment can be attributed to the technological interventions used. Nevertheless, further research is needed to compare telehealth with face-to-face care and to indicate the most effective tools in the routine care of children with chronic lung diseases.
Collapse
|
7
|
Wittwer LH, Walters E, Jordan K. Improving Pediatric Asthma Care Through Asthma Apps: A Narrative Review. J Nurse Pract 2023. [DOI: 10.1016/j.nurpra.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
|
8
|
Esposito S, Rosafio C, Antodaro F, Argentiero A, Bassi M, Becherucci P, Bonsanto F, Cagliero A, Cannata G, Capello F, Cardinale F, Chiriaco T, Consolaro A, Dessì A, Di Mauro G, Fainardi V, Fanos V, Guarino A, Li Calzi G, Lodi E, Maghnie M, Manfredini L, Malorgio E, Minuto N, Modena MG, Montori R, Moscatelli A, Patrone E, Pescio E, Poeta M, Ravelli A, Spelta M, Suppiej A, Vai S, Villa L, Zanini R, Botti R, Gaddi AV. Use of Telemedicine Healthcare Systems in Children and Adolescents with Chronic Disease or in Transition Stages of Life: Consensus Document of the Italian Society of Telemedicine (SIT), of the Italian Society of Preventive and Social Pediatrics (SIPPS), of the Italian Society of Pediatric Primary Care (SICuPP), of the Italian Federation of Pediatric Doctors (FIMP) and of the Syndicate of Family Pediatrician Doctors (SIMPeF). J Pers Med 2023; 13:jpm13020235. [PMID: 36836469 PMCID: PMC9965862 DOI: 10.3390/jpm13020235] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/01/2023] Open
Abstract
Telemedicine is considered an excellent tool to support the daily and traditional practice of the health profession, especially when referring to the care and management of chronic patients. In a panorama in which chronic pathologies with childhood onset are constantly increasing and the improvement of treatments has allowed survival for them into adulthood, telemedicine and remote assistance are today considered effective and convenient solutions both for the chronic patient, who thus receives personalized and timely assistance, and for the doctors, who reduce the need for direct intervention, hospitalizations and consequent management costs. This Consensus document, written by the main Italian Scientific Societies involved in the use of telemedicine in pediatrics, has the objectives to propose an organizational model based on the relationships between the actors who participate in the provision of a telemedicine service aimed at minors with chronic pathologies, identifying specific project links between the areas of telemedicine in the developmental age from the first 1000 days of life to the age adult. The future scenario will have to be able to integrate digital innovation in order to offer the best care to patients and citizens. It will have to be able to provide the involvement of patients from the very beginning of the design of any care pathway, increasing where possible the proximity of the health service to citizens.
Collapse
Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
- Correspondence:
| | | | | | - Alberto Argentiero
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Marta Bassi
- Department of Pediatrics, IRCCS Giannina Gaslini, 16147 Genoa, Italy
| | | | | | | | - Giulia Cannata
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Fabio Capello
- UO Territorial Pediatrics, Primary Care Department, AUSL Bologna, 40126 Bologna, Italy
| | - Fabio Cardinale
- UOC of Pediatrics and ED with an Allergy-Pneumological and Immuno-Rheumatological Focus, Giovanni XXIII Pediatric Hospital, University of Bari, 70124 Bari, Italy
| | - Tiziana Chiriaco
- Health Department, ASL Roma 3, 00125 Rome, Italy
- General Management, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Alessandro Consolaro
- Pediatric and Rheumatology Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences (DINOGMI), University of Genoa, 16126 Genoa, Italy
| | - Angelica Dessì
- Department of Surgical Sciences, University of Cagliari, 09127 Cagliari, Italy
| | | | - Valentina Fainardi
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Vassilios Fanos
- Department of Surgical Sciences, University of Cagliari, 09127 Cagliari, Italy
| | - Alfredo Guarino
- Section of Pediatrics, Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Giada Li Calzi
- General Management, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Elisa Lodi
- P.A.S.C.I.A. Center (Heart Failure Care Program, Childhood Heart Diseases and Those at Risk), University of Modena and Reggio Emilia, AOU Polyclinic of Modena, 41124 Modena, Italy
| | - Mohamad Maghnie
- Department of Pediatrics, IRCCS Giannina Gaslini, 16147 Genoa, Italy
| | - Luca Manfredini
- Pediatric Pain and Palliative Care Service, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | | | - Nicola Minuto
- Department of Pediatrics, IRCCS Giannina Gaslini, 16147 Genoa, Italy
| | - Maria Grazia Modena
- P.A.S.C.I.A. Center (Heart Failure Care Program, Childhood Heart Diseases and Those at Risk), University of Modena and Reggio Emilia, AOU Polyclinic of Modena, 41124 Modena, Italy
| | - Rossano Montori
- Community Medicine and Primary Care, AUSL Modena, 41124 Modena, Italy
| | - Andrea Moscatelli
- UOC Anesthesia and Intensive Care, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Elisa Patrone
- UOSID Trial Center, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | - Elena Pescio
- Pediatric and Rheumatology Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Marco Poeta
- Section of Pediatrics, Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Angelo Ravelli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences (DINOGMI), University of Genoa, 16126 Genoa, Italy
- Scientific Directorate, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Maddalena Spelta
- Pediatric and Rheumatology Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Agnese Suppiej
- Pediatric Clinic, University of Ferrara, 44124 Ferrara, Italy
| | | | - Luca Villa
- UOSID Trial Center, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | | | - Renato Botti
- General Management, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Antonio Vittorino Gaddi
- Center for Metabolic Diseases and Atherosclerosis, University of Bologna, 40126 Bologna, Italy
| |
Collapse
|
9
|
Southgate G, Yassaee AA, Harmer MJ, Livesey H, Pryde K, Roland D. Use of Telemedicine in Pediatric Services for 4 Representative Clinical Conditions: Scoping Review. J Med Internet Res 2022; 24:e38267. [DOI: 10.2196/38267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/21/2022] [Accepted: 09/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Telemedicine is becoming routine in health care. Postpandemic, a universal return to face-to-face consultations may risk a loss of some of the advantages of telemedicine. However, rapid implementation and adoption without robust evaluation of usability, efficacy, and effectiveness could potentially lead to suboptimal health outcomes and downstream challenges to providers.
Objective
This review assesses telemedicine interventions against international guidance and sufficiency of evidence to support postpandemic utilization in pediatric settings.
Methods
This scoping review was performed following searches on PubMed, Embase, and CINAHL databases on April 15, 2021, and May 31, 2022, and examined studies focused on telemedicine, remote consultation, video call, or remote patient monitoring in children (0-18 years) receiving outpatient care for diabetes, asthma, epilepsy, or renal disease. Exclusion criteria included studies published before 2011 as the technologies used have likely been improved or replaced, studies in adult populations or where it was not possible to disaggregate data for participants younger than 18 years as the focus of the review was on pediatric care, and studies not published in English. Data were extracted by 4 authors, and the data were corroborated by a second reviewer. Studies were examined for feasibility and usability, clinical and process outcomes, and cost-effectiveness.
Results
Of the 3158 studies identified, 56 were suitable for final inclusion and analysis. Data on feasibility or usability of interventions (48 studies) were overwhelmingly positive in support of telemedicine interventions, with common themes including convenience, perceived cost savings, and ease of use. However, use in preference to usual care was rarely explored. Clinical and process outcome data (31 studies) were mostly positive. Across all studies, there was limited measurement of standardized clinical outcomes, although these were more commonly reported in asthma (peak flow) and diabetes (glycated hemoglobin [HbA1c]). Implementation science data generally supported cost-effectiveness of telemedicine with a reduction of health care costs.
Conclusions
There is promising evidence supporting telemedicine in pediatric settings. However, there is a lack of evaluation of telemedicine in comparison with usual outpatient care for noninferiority of clinical outcomes, and this review highlights the need for a more standardized approach to evaluation of digital interventions.
Collapse
|
10
|
Gao E, Radparvar I, Dieu H, Ross MK. User Experience Design for Adoption of Asthma Clinical Decision Support Tools. Appl Clin Inform 2022; 13:971-982. [PMID: 36223869 PMCID: PMC9556170 DOI: 10.1055/s-0042-1757292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Emily Gao
- University of California Los Angeles, Los Angeles, California, United States
| | - Ilana Radparvar
- University of California Los Angeles, Los Angeles, California, United States
| | - Holly Dieu
- Department of Pediatrics, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California, United States
| | - Mindy K Ross
- Department of Pediatrics, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California, United States
| |
Collapse
|
11
|
Barbosa MT, Sousa CS, Morais-Almeida M. Telemedicine in the Management of Chronic Obstructive Respiratory Diseases: An Overview. Digit Health 2022. [DOI: 10.36255/exon-publications-digital-health-respiratory-diseases] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
12
|
Kinley E, Skene I, Steed E, Pinnock H, McClatchey K. Delivery of supported self-management in remote asthma reviews: A systematic rapid realist review. Health Expect 2022; 25:1200-1214. [PMID: 35411670 PMCID: PMC9327809 DOI: 10.1111/hex.13441] [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: 07/16/2021] [Revised: 01/07/2022] [Accepted: 01/09/2022] [Indexed: 11/29/2022] Open
Abstract
Background The COVID‐19 pandemic forced health care systems globally to adapt quickly to remote modes of health care delivery, including for routine asthma reviews. A core component of asthma care is supporting self‐management, a guideline‐recommended intervention that reduces the risk of acute attacks, and improves asthma control and quality of life. Objective We aimed to explore context and mechanisms for the outcomes of clinical effectiveness, acceptability and safety of supported self‐management delivery within remote asthma consultations. Design The review followed standard methodology for rapid realist reviews. An External Reference Group (ERG) provided expert advice and guidance throughout the study. We systematically searched four electronic databases and, with ERG advice, selected 18 papers that explored self‐management delivery during routine asthma reviews. Setting, Participants and Intervention Health care professional delivery of supported self‐management for asthma patients during remote (specifically including telephone and video) consultations. Main Outcome Measures Data were extracted using Context‐Mechanism‐Outcome (C‐M‐O) configurations and synthesised into overarching themes using the PRISMS taxonomy of supported self‐management as a framework to structure the findings. Results The review findings identified how support for self‐management delivered remotely was acceptable (often more acceptable than in‐person consultations), and was a safe and effective alternative to face‐to‐face reviews. In addition, remote delivery of supported self‐management was associated with; increased patient convenience, improved access to and attendance at remote reviews, and offered continuity of care. Discussion Remote delivery of supported self‐management for asthma was generally found to be clinically effective, acceptable, and safe with the added advantage of increasing accessibility. Remote reviews could provide the core content of an asthma review, including remote completion of asthma action plans. Conclusion Our findings support the option of remote delivery of routine asthma care for those who have this preference, and offer healthcare professionals guidance on embedding supported self‐management into remote asthma reviews. Patient and Public Contribution Patient and public contribution was provided by a representative of the Asthma UK Centre for Applied Research (AUKCAR) patient and public involvement (PPI) group. The PPI representative reviewed the findings, and feedback and comments were considered. This lead to further interpretations of the data which were included in the final manuscript.
Collapse
Affiliation(s)
- Emma Kinley
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, Scotland
| | - Imogen Skene
- Asthma UK Centre for Applied Research, Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University London, London, England
| | - Elizabeth Steed
- Asthma UK Centre for Applied Research, Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University London, London, England
| | - Hilary Pinnock
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, Scotland
| | - Kirstie McClatchey
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, Scotland
| |
Collapse
|
13
|
Chen J, Zheng B, Yin L, Zhou Q, Liu W, Li P, Zhao X, Chen X, Li Y, Ding H, Li G. Exploring agreement and feasibility between virtual home visits and in-person home visits for peritoneal dialysis patients-a paired study. Ren Fail 2022; 44:490-502. [PMID: 35285398 PMCID: PMC8928823 DOI: 10.1080/0886022x.2022.2049305] [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] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Virtual home visits may improve chronic disease management. However, whether they are suitable for peritoneal dialysis (PD) patients has not yet been fully investigated. This study aimed to compare the agreement and acceptance of virtual home visits and in-person home visits in PD patients. METHODS This was a paired, single center, noninferiority trial. Participants received a virtual home visit and an in-person home visit simultaneously. A home visit checklist was built for standardization visits. The content was divided into three parts: domestic habits (57 items), bag exchange procedures (56 items), and exit site care (53 items). Satisfaction questionnaires for both patients and nurses were designed to assess attitudes toward home visits and socioeconomic effects. RESULTS A total of 30 PD patients were enrolled in a single center. The information collected from virtual home visits and in-person home visits was found to be highly consistent. The perfect agreement was found in 52/57, 49/56, and 44/53 items (Cohen's kappa 0.81-1.00), substantial agreement in 4/57, 7/56, and 8/53 items (Cohen's kappa 0.61-0.80). Patients reported almost identical satisfaction for virtual home visits and in-person home visits (Z = 0.39, p = 0.70). PD nurses reported similar feasibility and patient cooperation for the two visit types (Z = 0.99, p = 0.33; Z = 1.65, p = 0.10, respectively). In addition, virtual home visits were found to be more cost-effective than in-person home visits. CONCLUSIONS Virtual home visits information collection was similar to in-person home visits in PD. There were no differences in participant satisfaction and feasibility between the two visit types.
Collapse
Affiliation(s)
- Jin Chen
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Bo Zheng
- Department of Sanitary Technology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Lijuan Yin
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Qin Zhou
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Wenshu Liu
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Pengli Li
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiuxiu Zhao
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiuling Chen
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yi Li
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Hanlu Ding
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Guisen Li
- Renal Department and Institute of Nephrology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan Clinic Research Center for Kidney Diseases, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| |
Collapse
|
14
|
Nichols AL, Sonnappa-Naik M, Gardner L, Richardson C, Orr N, Jamalzadeh A, Moore-Crouch R, Makhecha S, Wells C, Hall P, Bush A, Fleming L, Saglani S, Sonnappa S. COVID-19 and delivery of difficult asthma services. Arch Dis Child 2022; 107:e15. [PMID: 34728462 DOI: 10.1136/archdischild-2021-322335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The COVID-19 pandemic necessitated an urgent reconfiguration of our difficult asthma (DA) service. We rapidly switched to virtual clinics and rolled out home spirometry based on clinical need. From March to August 2020, 110 patients with DA (68% virtually) were seen in clinic, compared with March-August 2019 when 88 patients were seen face-to-face. There was DA clinic cancellation/non-attendance (16% vs 43%; p<0.0003). In patients with home spirometers, acute hospital admissions (6 vs 26; p<0.01) from March to August 2020 were significantly lower compared with the same period in 2019. There was no difference in the number of courses of oral corticosteroids or antibiotics prescribed (47 vs 53; p=0.81). From April to August 2020, 50 patients with DA performed 253 home spirometry measurements, of which 39 demonstrated >20% decrease in forced expiratory volume in 1 s, resulting in new action plans in 87% of these episodes. In our DA cohort, we demonstrate better attendance rates at virtual multidisciplinary team consultations and reduced hospital admission rates when augmented with home spirometry monitoring.
Collapse
Affiliation(s)
- Anna-Louise Nichols
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Mayank Sonnappa-Naik
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK.,School of Medicine, Anglia Ruskin University, Chelmsford, UK
| | - Laura Gardner
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Charlotte Richardson
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Natalie Orr
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Angela Jamalzadeh
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Rachel Moore-Crouch
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Sukeshi Makhecha
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Charlotte Wells
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Pippa Hall
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Andrew Bush
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Louise Fleming
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Sejal Saglani
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Samatha Sonnappa
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK .,National Heart and Lung Institute, Imperial College London, London, UK
| |
Collapse
|
15
|
Abstract
Purpose of Review To review the data supporting the use of telemedicine (TM) and to provide practical guidance for practitioners to optimize the care of their asthmatic patients. Recent Findings Previous to the pandemic, TM was little used in various aspects of asthma care. Since the pandemic, TM has been increasingly used in new ways to care for asthma patients at various locations. In addition to direct-to-consumer visits for asthma care, other forms of telehealth visits have been increasing such as facilitated visits, asynchronous, remote patient monitoring, e-consults, and mHealth. Moreover, patient and provider satisfaction with the use of TM has been increasing and is comparable at times with face-to-face visits. In this review, best practices for starting a telemedicine asthma service with patients at home, distant clinic sites, and various other locations, including school-based asthma programs, are reviewed. Summary TM is a valuable adjunct to face-to-face visits for asthma care. Following the recommended best practices can strengthen the implementation of a telemedicine asthma program (TMAP) into clinical practice. Providers must be vigilant in keeping current with the various nuances required for asthma telemedicine care in preparation for the post-pandemic environment.
Collapse
Affiliation(s)
- Yudy K Persaud
- Division of Allergy, BronxCare Hospital Systems, Bronx, NY, USA.
| |
Collapse
|
16
|
Drummond D. Outils connectés pour la télésurveillance des patients asthmatiques : gadgets ou révolution? Rev Mal Respir 2022; 39:241-257. [DOI: 10.1016/j.rmr.2022.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/07/2022] [Indexed: 11/28/2022]
|
17
|
Beerthuizen T, Rikkers-Mutsaerts ERVM, Snoeck-Stroband JB, Sont JK. The Role of Education, Monitoring, and Symptom Perception in Internet-Based Self-management Among Adolescents With Asthma: Secondary Analysis of a Randomized Controlled Trial. JMIR Pediatr Parent 2021; 4:e17959. [PMID: 34879001 PMCID: PMC8693204 DOI: 10.2196/17959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 12/31/2020] [Accepted: 06/01/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Internet-based self-management programs improve asthma control and the asthma-related quality of life in adults and adolescents. The components of self-management programs include education and the web-based self-monitoring of symptoms; the latter requires adequate perception in order to timely adjust lifestyle or medication or to contact a care provider. OBJECTIVE We aimed to test the hypothesis that adherence to education and web-based monitoring and adequate symptom perception are important determinants for the improvement of asthma control in self-management programs. METHODS We conducted a subgroup analysis of the intervention group of a randomized controlled trial, which included adolescents who participated in the internet-based self-management arm. We assessed the impacts that attendance in education sessions, the frequency of web-based monitoring, and the level of perception had on changes in asthma control (Asthma Control Questionnaire [ACQ]) and asthma-related quality of life (Pediatric Asthma Quality of Life Questionnaire) from baseline to 12 months after intervention. RESULTS Adolescents who attended education sessions had significant and clinically relevant improvements in asthma control (ACQ score difference: -0.6; P=.03) and exhibited a nonsignificant trend of improvement in asthma-related quality of life (Pediatric Asthma Quality of Life Questionnaire score difference: -0.45; P=.15) when compared to those who did not adhere to education. Frequent monitoring alone did not improve asthma control (P=.07) and quality of life (P=.44) significantly, but its combination with education did result in improved ACQ scores (difference: -0.88; P=.02). There were no significant differences in outcomes between normoperceivers and hypoperceivers. CONCLUSIONS Education, especially in combination with frequent web-based monitoring, is an important determinant for the 1-year outcomes of asthma control in internet-based self-management programs for adolescents with partly controlled and uncontrolled asthma; however, we could not establish the effect of symptom perception. This study provides important knowledge on the effects of asthma education and monitoring in daily life.
Collapse
Affiliation(s)
- Thijs Beerthuizen
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, Netherlands
| | | | - Jiska B Snoeck-Stroband
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, Netherlands
| | - Jacob K Sont
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, Netherlands
| |
Collapse
|
18
|
Oppelaar MC, van den Wijngaart LS, Merkus PJFM, Croonen EA, Hugen CAC, Brouwer ML, Boehmer ALM, Roukema J. It Is Not Just the FEV1 That Matters, but the Personal Goals We Reach Along the Way: Qualitative, Multicenter, Prospective, Observational Study. J Med Internet Res 2021; 23:e29218. [PMID: 34668868 PMCID: PMC8567151 DOI: 10.2196/29218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/08/2021] [Accepted: 07/27/2021] [Indexed: 11/17/2022] Open
Abstract
Background The COVID-19 pandemic has boosted the use of forced expiratory volume in 1 second (FEV1) telemonitoring in pediatric asthma, but a consensus on its most efficient and effective implementation is still lacking. To find answers, it is important to study how such an intervention is perceived, experienced, and used by both patients and health care professionals (HCPs). Objective The aim of this study was to provide perspectives on how FEV1 home monitoring should be used in pediatric asthma. Methods This is a qualitative, multicenter, prospective, observational study which included patients with asthma aged 6-16 and HCPs. Primary outcomes were results of 2 surveys that were sent to all participants at study start and after 3-4 months. Secondary outcomes consisted of FEV1 device usage during 4 months after receiving the FEV1 device. Results A total of 39 participants (26 patients and 13 HCPs) were included in this study. Survey response rates were 97% (38/39) at the start and 87% (34/39) at the end of the study. Both patients and HCPs were receptive toward online FEV1 home monitoring and found it contributive to asthma control, self-management, and disease perception. The main concerns were about reliability of the FEV1 device and validity of home-performed lung function maneuvers. FEV1 devices were used with a median frequency of 7.5 (IQR 3.3-25.5) during the 4-month study period. Conclusions Patients and HCPs are receptive toward online FEV1 home monitoring. Frequency of measurements varied largely among individuals, yet perceived benefits remained similar. This emphasizes that online FEV1 home monitoring strategies should be used as a means to reach individual goals, rather than being a goal on their own.
Collapse
Affiliation(s)
- Martinus C Oppelaar
- Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
| | - Lara S van den Wijngaart
- Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
| | - Peter J F M Merkus
- Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
| | - Ellen A Croonen
- Department of Pediatrics, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Cindy A C Hugen
- Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marianne L Brouwer
- Department of Pediatrics, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | | | - Jolt Roukema
- Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
| |
Collapse
|
19
|
Kumari J, Jat KR, Kabra SK. Role of Telemedicine in Follow-up Care of Children with Respiratory Illnesses at a Tertiary Care Hospital - An Ambispective Observational Study. Indian J Pediatr 2021; 88:974-978. [PMID: 33394296 PMCID: PMC7780214 DOI: 10.1007/s12098-020-03590-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 11/25/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess if telemedicine can be used successfully for follow-up care of children with respiratory illnesses. The authors also assessed problems faced by the doctors and satisfaction of caregivers of these patients with telemedicine. METHODS The authors conducted an ambispective observational study. Data related to demographic details and diagnoses of patients who had telemedicine consultation (teleconsultation) appointments between 2nd April 2020 to 15th May 2020 were reviewed retrospectively. They noted proportion of patients having successful prescription. To assess problems faced by doctors and satisfaction of caregiver of patients with teleconsultation, a prospective questionnaire was sent via Google Forms 6-10 wk after the initial appointment date. Those who did not respond to Google Forms were called by phone to assess the same. RESULTS A total of 188 patients received teleconsultation during the study period. Team was able to prescribe treatment in 181 (96.3%) patients via teleconsultation and other seven (3.7%) required physical evaluation. Mean (SD) age of patients was 9.7 (4.9) y, range 3 mo to 18 y. There were 117 (62.2%) boys and 71 (37.8%) girls. Majority (58%) of the patients were asthmatics. The team advised refill prescription in 83% patients as symptoms were controlled. Three out of five residents faced minor problems while providing teleconsultation. In satisfaction assessment, 78% of caregivers rated teleconsultation 8 or more, out of 10 points, suggesting that most of them were satisfied with telemedicine. CONCLUSION In majority of children with respiratory illnesses, successful follow-up care can be provided by telemedicine.
Collapse
Affiliation(s)
- Jyoti Kumari
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Kana Ram Jat
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - S K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| |
Collapse
|
20
|
Rakic M, Jaboyedoff M, Bachmann S, Berger C, Diezi M, do Canto P, Forrest CB, Frey U, Fuchs O, Gervaix A, Gluecksberg AS, Grotzer M, Heininger U, Kahlert CR, Kaiser D, Kopp MV, Lauener R, Neuhaus TJ, Paioni P, Posfay-Barbe K, Ramelli GP, Simeoni U, Simonetti G, Sokollik C, Spycher BD, Kuehni CE. Clinical data for paediatric research: the Swiss approach : Proceedings of the National Symposium in Bern, Switzerland, Dec 5-6, 2019. BMC Proc 2021; 15:19. [PMID: 34538238 PMCID: PMC8450032 DOI: 10.1186/s12919-021-00226-3] [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] [Accepted: 08/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND PURPOSE Continuous improvement of health and healthcare system is hampered by inefficient processes of generating new evidence, particularly in the case of rare diseases and paediatrics. Currently, most evidence is generated through specific research projects, which typically require extra encounters with patients, are costly and entail long delays between the recognition of specific needs in healthcare and the generation of necessary evidence to address those needs. The Swiss Personalised Health Network (SPHN) aims to improve the use of data obtained during routine healthcare encounters by harmonizing data across Switzerland and facilitating accessibility for research. The project "Harmonising the collection of health-related data and biospecimens in paediatric hospitals throughout Switzerland (SwissPedData)" was an infrastructure development project funded by the SPHN, which aimed to identify and describe available data on child health in Switzerland and to agree on a standardised core dataset for electronic health records across all paediatric teaching hospitals. Here, we describe the results of a two-day symposium that aimed to summarise what had been achieved in the SwissPedData project, to put it in an international context, and to discuss the next steps for a sustainable future. The target audience included clinicians and researchers who produce and use health-related data on children in Switzerland. KEY HIGHLIGHTS The symposium consisted of state-of-the-art lectures from national and international keynote speakers, workshops and plenary discussions. This manuscript summarises the talks and discussions in four sections: (I) a description of the Swiss Personalized Health Network and the results of the SwissPedData project; (II) examples of similar initiatives from other countries; (III) an overview of existing health-related datasets and projects in Switzerland; and (IV) a summary of the lessons learned and future prospective from workshops and plenary discussions. IMPLICATIONS Streamlined processes linking initial collection of information during routine healthcare encounters, standardised recording of this information in electronic health records and fast accessibility for research are essential to accelerate research in child health and make it affordable. Ongoing projects prove that this is feasible in Switzerland and elsewhere. International collaboration is vital to success. The next steps include the implementation of the SwissPedData core dataset in the clinical information systems of Swiss hospitals, the use of this data to address priority research questions, and the acquisition of sustainable funding to support a slim central infrastructure and local support in each hospital. This will lay the foundation for a national paediatric learning health system in Switzerland.
Collapse
Affiliation(s)
- Milenko Rakic
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Manon Jaboyedoff
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Sara Bachmann
- University of Basel Children’s Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Christoph Berger
- University Children’s Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Manuel Diezi
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | | | - Urs Frey
- University of Basel Children’s Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Oliver Fuchs
- Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alain Gervaix
- Department of Woman, Child and Adolescent, Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Amalia Stefani Gluecksberg
- Paediatric Department of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland and Università della Svizzera Italiana, Lugano, Switzerland
| | - Michael Grotzer
- University Children’s Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ulrich Heininger
- University of Basel Children’s Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | | | - Daniela Kaiser
- Children’s Hospital of Lucerne, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Matthias V. Kopp
- Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roger Lauener
- Children’s Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Thomas J. Neuhaus
- Children’s Hospital of Lucerne, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Paolo Paioni
- University Children’s Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Klara Posfay-Barbe
- Department of Woman, Child and Adolescent, Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Gian Paolo Ramelli
- Paediatric Department of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland and Università della Svizzera Italiana, Lugano, Switzerland
| | - Umberto Simeoni
- Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Giacomo Simonetti
- Paediatric Department of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland and Università della Svizzera Italiana, Lugano, Switzerland
| | - Christiane Sokollik
- Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ben D. Spycher
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Claudia E. Kuehni
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| |
Collapse
|
21
|
Milne-Ives M, Lam C, Meinert E. Digital Technologies for Monitoring and Improving Treatment Adherence in Children and Adolescents With Asthma: Scoping Review of Randomized Controlled Trials. JMIR Pediatr Parent 2021; 4:e27999. [PMID: 34533463 PMCID: PMC8486994 DOI: 10.2196/27999] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/28/2021] [Accepted: 06/03/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Inadequate pediatric asthma care has resulted in potentially avoidable unplanned hospital admissions and morbidity. A wide variety of digital technologies have been developed to monitor and support treatment adherence in children and adolescents with asthma. However, existing reviews need to be updated and expanded to provide an overview of the current state of research on these technologies and how they are being integrated into existing health care services and care pathways. OBJECTIVE This study aims to provide an overview of the current research landscape and knowledge gaps regarding the use of digital technologies to support the care of children and adolescents with asthma. METHODS This study was structured according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) and Population, Intervention, Comparator, Outcome, and Study frameworks. Five databases (PubMed, the Cochrane Central Register of Controlled Trials, Web of Science, Embase, and PsycINFO) were systematically searched for studies published in English from 2014 onward. Two reviewers independently screened the references and selected studies for inclusion based on the eligibility criteria. Data were systematically extracted per research question, which were synthesized in a descriptive analysis. RESULTS A wide variety of study characteristics, including the number and age of participants, study duration, and type of digital intervention, were identified. There was mixed evidence for the effectiveness of the interventions. Of the 10 studies that evaluated treatment adherence, 7 (70%) found improvements, but the evidence was inconsistent for asthma control (6/9, 67% of studies reported improvement or maintenance, but only 1 was significantly different between groups) and health outcome variables (5/9, 56% of studies found no evidence of effectiveness). The 6 studies that examined patient perceptions and assessments of acceptability and usability generally had positive findings. CONCLUSIONS A wide range of digital interventions are being developed and evaluated to support the monitoring and treatment adherence of children and adolescents with asthma. Meta-analyses are inhibited by the use of samples with a variety of overlapping age ranges; a theoretical framework for evaluating specific age groups would aid comparison between studies. Most studies found significant evidence for improved adherence to treatment or medications, but there was mixed evidence of the impact of the digital interventions on asthma control and other health outcomes. There are gaps in the literature relating to cost-effectiveness and integration with existing clinical care pathways. This study will be necessary to determine which digital interventions for children and young people with asthma are worth supporting and adopting in the clinical care pathways.
Collapse
Affiliation(s)
- Madison Milne-Ives
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | - Ching Lam
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Edward Meinert
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom.,Department of Primary Care and Public Health, Imperial College London, London, United Kingdom.,Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
| |
Collapse
|
22
|
van der Kamp M, Reimering Hartgerink P, Driessen J, Thio B, Hermens H, Tabak M. Feasibility, Efficacy, and Efficiency of eHealth-Supported Pediatric Asthma Care: Six-Month Quasi-Experimental Single-Arm Pretest-Posttest Study. JMIR Form Res 2021; 5:e24634. [PMID: 34309568 PMCID: PMC8367169 DOI: 10.2196/24634] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/28/2020] [Accepted: 05/16/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Early detection of loss of asthma control can effectively reduce the burden of the disease. However, broad implementation in clinical practice has not been accomplished so far. We are in need of research investigating the operationalization of eHealth pediatric asthma care in practice, which can provide the most potential benefits in terms of adoption, efficiency, and effectiveness. OBJECTIVE The aim of this study was to investigate the technical and clinical feasibility, including an exploration of the efficacy and cost-efficiency, of an eHealth program implemented in daily clinical pediatric asthma practice. METHODS We designed an eHealth-supported pediatric asthma program facilitating early detection of loss of asthma control while increasing symptom awareness and self-management. In the 6-month program, asthma control was monitored by 4 health care professionals (HCPs) by using objective home measurements and the web-based Puffer app to allow timely medical anticipation and prevent treatment delay. Technical feasibility was assessed by technology use, system usability, and technology acceptance. Clinical feasibility was assessed by participation and patient-reported health and care outcomes and via a focus group with HCPs regarding their experiences of implementing eHealth in daily practice. The efficacy and cost-efficiency were explored by comparing pretest-posttest program differences in asthma outcomes (asthma control, lung function, and therapy adherence) and medical consumption. RESULTS Of 41 children, 35 children with moderate-to-severe asthma volunteered for participation. With regard to technical feasibility, the Puffer app scored a good usability score of 78 on the System Usability Scale and a score of 70 for technology acceptance on a scale of 1 to 100. Approximately 75% (18/24) of the children indicated that eHealth helped them to control their asthma during the program. HCPs indicated that home measurements and real time communication enabled them to make safe and substantiated medical decisions during symptom manifestations. With an average time commitment of 15 minutes by patients, eHealth care led to a 80% gross reduction (from €71,784 to €14,018, US $1=€0.85) in health care utilization, 8.6% increase (from 18.6 to 20.2, P=.40) in asthma control, 25.0% increase (from 2.8 to 3.5, P=.04) in the self-management level, and 20.4% improved (from 71.2 to 76.8, P=.02) therapy adherence. CONCLUSIONS eHealth asthma care seems to be technically and clinically feasible, enables safe remote care, and seems to be beneficial for pediatric asthma care in terms of health outcomes and health care utilization. Follow-up research should focus on targeted effectiveness studies with the lessons learned, while also enabling individualization of eHealth for personalized health care.
Collapse
Affiliation(s)
- Mattienne van der Kamp
- Department of Pediatrics, Medisch Spectrum Twente, Enschede, Netherlands.,Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
| | | | - Jean Driessen
- Department of Pediatrics, Medisch Spectrum Twente, Enschede, Netherlands.,Department of Sports Medicine, Orthopedisch Centrum Oost Nederland, Hengelo, Netherlands
| | - Bernard Thio
- Department of Pediatrics, Medisch Spectrum Twente, Enschede, Netherlands
| | - Hermie Hermens
- Biomedical Signals and Systems, University of Twente, Enschede, Netherlands.,Department of eHealth, Roessingh Research and Development, Enschede, Netherlands
| | - Monique Tabak
- Biomedical Signals and Systems, University of Twente, Enschede, Netherlands.,Department of eHealth, Roessingh Research and Development, Enschede, Netherlands
| |
Collapse
|
23
|
Mosnaim G, Safioti G, Brown R, DePietro M, Szefler SJ, Lang DM, Portnoy JM, Bukstein DA, Bacharier LB, Merchant RK. Digital Health Technology in Asthma: A Comprehensive Scoping Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2377-2398. [PMID: 33652136 DOI: 10.1016/j.jaip.2021.02.028] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND A variety of digital intervention approaches have been investigated for asthma therapy during the past decade, with different levels of interactivity and personalization and a range of impacts on different outcome measurements. OBJECTIVE To assess the effectiveness of digital interventions in asthma with regard to acceptability and outcomes and evaluate the potential of digital initiatives for monitoring or treating patients with asthma. METHODS We evaluated digital interventions using a scoping review methodology through a literature search and review. Of 871 articles identified, 121 were evaluated to explore intervention characteristics, the perception and acceptability of digital interventions to patients and physicians, and effects on asthma outcomes. Interventions were categorized by their level of interactivity with the patient. RESULTS Interventions featuring non-individualized content sent to patients appeared capable of promoting improved adherence to inhaled corticosteroids, but with no identified improvement in asthma burden; and data-gathering interventions appeared to have little effect on adherence or asthma burden. Evidence of improvement in both adherence and patients' impairment due to asthma were seen only with interactive interventions involving two-way responsive patient communication. Digital interventions were generally positively perceived by patients and physicians. Implementation was considered feasible, with certain preferences for design and features important to drive use. CONCLUSIONS Digital health interventions show substantial promise for asthma disease monitoring and personalization of treatment. To be successful, future interventions will need to include both inhaler device and software elements, combining accurate measurement of clinical parameters with careful consideration of ease of use, personalization, and patient engagement aspects.
Collapse
Affiliation(s)
- Giselle Mosnaim
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, North Shore University Health System, Evanston, Ill
| | | | - Randall Brown
- Teva Branded Pharmaceutical Products R&D, Inc, West Chester, Pa
| | - Michael DePietro
- Teva Branded Pharmaceutical Products R&D, Inc, West Chester, Pa.
| | - Stanley J Szefler
- The Breathing Institute and Pulmonary Medicine Section, Children's Hospital Colorado and University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
| | - David M Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jay M Portnoy
- Pediatric Allergy and Immunology, Children's Mercy Hospital, Kansas City School of Medicine, Kansas City, Mo
| | - Don A Bukstein
- Allergy, Asthma and Sinus Center, Milwaukee, Greenfield, Wis
| | - Leonard B Bacharier
- Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt University Medical Center, Nashville, Tenn
| | - Rajan K Merchant
- Woodland Clinic Medical Group, Allergy Department, Dignity Health, Woodland, Calif
| |
Collapse
|
24
|
Davies B, Kenia P, Nagakumar P, Gupta A. Paediatric and adolescent asthma: A narrative review of telemedicine and emerging technologies for the post-COVID-19 era. Clin Exp Allergy 2021; 51:393-401. [PMID: 33527625 PMCID: PMC8013619 DOI: 10.1111/cea.13836] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/22/2020] [Accepted: 01/16/2021] [Indexed: 01/25/2023]
Abstract
Children and young people with asthma need regular monitoring to maintain good asthma control, prevent asthma attacks and manage comorbidities. The COVID‐19 pandemic has resulted in healthcare professionals making fundamental changes to the way healthcare is delivered and for patients and families adapting to these changes. Comprehensive remotely delivered, technology‐based healthcare, closer to the patients home (reducing hospital footfall and possibly reducing carbon footprint) is likely to be one of the important collateral effects of the pandemic. Telemedicine is anticipated to impact everyone involved in healthcare ‐ providers and patients alike. It is going to bring changes to organization, work areas and work culture in healthcare. Healthcare providers, policymakers and those accessing healthcare services will experience the impact of technology‐based healthcare delivery. Telemedicine can play an exciting role in the management of childhood asthma by delivering high‐quality care closer to the child's home. However, unlike adults, children still need to be accompanied by their carers for virtual care. Policymakers will need to take into account potential additional costs as well as the legal, ethical and cultural implications of large scale use of telemedicine. In this narrative review, we review evidence regarding the role of telemedicine and related emerging technologies in paediatric and adolescent asthma. Although there are gaps in the current knowledge, there is evidence demonstrating the important role of telemedicine in management of childhood and adolescent asthma. However, there is an urgent need for healthcare researchers and policymakers to focus on improving the technologies and address the disparities in accessing novel technology‐based management strategies to improve asthma care.
Collapse
Affiliation(s)
- Benjamin Davies
- Department of Paediatric Respiratory Medicine, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK.,Birmingham Acute Care Research, University of Birmingham, Birmingham, UK
| | - Priti Kenia
- Department of Paediatric Respiratory Medicine, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Prasad Nagakumar
- Department of Paediatric Respiratory Medicine, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK.,Birmingham Acute Care Research, University of Birmingham, Birmingham, UK
| | - Atul Gupta
- Department of Paediatric Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
25
|
Poowuttikul P, Seth D. New Concepts and Technological Resources in Patient Education and Asthma Self-Management. Clin Rev Allergy Immunol 2021; 59:19-37. [PMID: 32215784 DOI: 10.1007/s12016-020-08782-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Asthma is a chronic disease that is associated with significant morbidity and mortality. In general, the use of technology resources or electronic health (e-health) has been shown to have beneficial effects on patients with asthma. E-health can impact a broad section of patients and can be cost-effective and associated with high patient satisfaction. E-health may enable remote delivery of care, as well as timely access to health care, which are some of the common challenges faced by patients with asthma. Web-based asthma self-management systems have been found to improve quality of life, self-reported asthma symptoms, lung function, reduction in asthma symptoms/exacerbations, and self-reported adherence for adults. Social media is commonly being used as a platform to disseminate information on asthma to increase public awareness. It can facilitate asthma self-management in a patient friendly manner and has shown to improve asthma control test scores as well as self-esteem. Text massages reminders can increase awareness regarding asthma treatment and control, thus potentially can improve adherence to medications and asthma outcome. Mobile health applications can support asthma self-management, improve a patient's quality of life, promote medication adherence, and potentially reduce the overall costs for asthma care. Inhaler trackers have shown to be beneficial to asthma outcome in various populations by improving adherence to asthma medications. Barriers such as physician financial reimbursement as well as licensing for rendering tele-healthcare services are important concerns. Other limitations of using technology resources in health care are related to liability, professionalism, and ethical issues such as breach of patient confidentiality and privacy. Additionally, there may be less face-to-face interaction and care of the patient when e-health is used.
Collapse
Affiliation(s)
- Pavadee Poowuttikul
- Department of Pediatrics, Division of Allergy/Immunology, Children's Hospital of Michigan, Wayne State University School of Medicine, 3950 Beaubien, 4th Floor, Pediatric Specialty Building, Detroit, MI, 48201, USA.
| | - Divya Seth
- Department of Pediatrics, Division of Allergy/Immunology, Children's Hospital of Michigan, Wayne State University School of Medicine, 3950 Beaubien, 4th Floor, Pediatric Specialty Building, Detroit, MI, 48201, USA
| |
Collapse
|
26
|
Kruizinga MD, van der Heide N, Moll A, Zhuparris A, Yavuz Y, de Kam ML, Stuurman FE, Cohen AF, Driessen GJA. Towards remote monitoring in pediatric care and clinical trials-Tolerability, repeatability and reference values of candidate digital endpoints derived from physical activity, heart rate and sleep in healthy children. PLoS One 2021; 16:e0244877. [PMID: 33411722 PMCID: PMC7790377 DOI: 10.1371/journal.pone.0244877] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/17/2020] [Indexed: 12/26/2022] Open
Abstract
Background Digital devices and wearables allow for the measurement of a wide range of health-related parameters in a non-invasive manner, which may be particularly valuable in pediatrics. Incorporation of such parameters in clinical trials or care as digital endpoint could reduce the burden for children and their parents but requires clinical validation in the target population. This study aims to determine the tolerability, repeatability, and reference values of novel digital endpoints in healthy children. Methods Apparently healthy children (n = 175, 46% male) aged 2–16 were included. Subjects were monitored for 21 days using a home-monitoring platform with several devices (smartwatch, spirometer, thermometer, blood pressure monitor, scales). Endpoints were analyzed with a mixed effects model, assessing variables that explained within- and between-subject variability. Endpoints based on physical activity, heart rate, and sleep-related parameters were included in the analysis. For physical-activity-related endpoints, a sample size needed to detect a 15% increase was calculated. Findings Median compliance was 94%. Variability in each physical activity-related candidate endpoint was explained by age, sex, watch wear time, rain duration per day, average ambient temperature, and population density of the city of residence. Estimated sample sizes for candidate endpoints ranged from 33–110 per group. Daytime heart rate, nocturnal heart rate and sleep duration decreased as a function of age and were comparable to reference values published in the literature. Conclusions Wearable- and portable devices are tolerable for pediatric subjects. The raw data, models and reference values presented here can be used to guide further validation and, in the future, clinical trial designs involving the included measures.
Collapse
Affiliation(s)
- M. D. Kruizinga
- Centre for Human Drug Research, Leiden, The Netherlands
- Juliana Children’s Hospital, HAGA Teaching Hospital, The Hague, The Netherlands
- Leiden University Medical Centre, Leiden, The Netherlands
- * E-mail:
| | - N. van der Heide
- Centre for Human Drug Research, Leiden, The Netherlands
- Juliana Children’s Hospital, HAGA Teaching Hospital, The Hague, The Netherlands
| | - A. Moll
- Centre for Human Drug Research, Leiden, The Netherlands
- Juliana Children’s Hospital, HAGA Teaching Hospital, The Hague, The Netherlands
| | - A. Zhuparris
- Centre for Human Drug Research, Leiden, The Netherlands
| | - Y. Yavuz
- Centre for Human Drug Research, Leiden, The Netherlands
| | - M. L. de Kam
- Centre for Human Drug Research, Leiden, The Netherlands
| | - F. E. Stuurman
- Centre for Human Drug Research, Leiden, The Netherlands
- Leiden University Medical Centre, Leiden, The Netherlands
| | - A. F. Cohen
- Centre for Human Drug Research, Leiden, The Netherlands
- Leiden University Medical Centre, Leiden, The Netherlands
| | - G. J. A. Driessen
- Juliana Children’s Hospital, HAGA Teaching Hospital, The Hague, The Netherlands
- Maastricht University Medical Centre, Maastricht, The Netherlands
| |
Collapse
|
27
|
van der Kamp MR, Tabak M, de Rooij SEJA, van Lierop PPE, Thio BJ. COVID-19: Technology-Supported Remote Assessment of Pediatric Asthma at Home. Front Pediatr 2020; 8:529. [PMID: 33014930 PMCID: PMC7506114 DOI: 10.3389/fped.2020.00529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/24/2020] [Indexed: 12/24/2022] Open
Abstract
The COVID-19 crisis has pressured hospital-based care for children with high-risk asthma as they have become deprived of regular clinical evaluations. However, COVID-19 also provided important lessons about implementing novel directions for care. Personalized eHealth technology, tailored to the individual and the healthcare system, could substitute elements of hospital care and facilitate early and appropriate medical anticipation in response to imminent loss of control. This perspective article discusses new approaches to the clinical, organizational, and scientific aspects of the use of eHealth technology in pediatric asthma care in times of COVID-19, as illustrated by a case report of an acute asthma exacerbation possibly caused by COVID-19 infection.
Collapse
Affiliation(s)
- Mattienne R. van der Kamp
- Department of Pediatrics, Medisch Spectrum Twente, Enschede, Netherlands
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
| | - Monique Tabak
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
- Roessingh Research and Development, Enschede, Netherlands
| | - Sophia E. J. A. de Rooij
- Board of Directors, Medisch Spectrum Twente, Enschede, Netherlands
- Department of Internal Medicine and Geriatrics, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Pieter P. E. van Lierop
- Department of Pediatrics, Medisch Spectrum Twente, Enschede, Netherlands
- Medical Director Pediatric Department, Medisch Spectrum Twente, Enschede, Netherlands
| | - Boony J. Thio
- Department of Pediatrics, Medisch Spectrum Twente, Enschede, Netherlands
| |
Collapse
|
28
|
Kruizinga MD, Essers E, Stuurman FE, Zhuparris A, van Eik N, Janssens HM, Groothuis I, Sprij AJ, Nuijsink M, Cohen AF, Driessen GJA. Technical validity and usability of a novel smartphone-connected spirometry device for pediatric patients with asthma and cystic fibrosis. Pediatr Pulmonol 2020; 55:2463-2470. [PMID: 32592537 PMCID: PMC7496177 DOI: 10.1002/ppul.24932] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/25/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Diagnosis and follow-up of respiratory diseases traditionally rely on pulmonary function tests (PFTs), which are currently performed in hospitals and require trained personnel. Smartphone-connected spirometers, like the Air Next spirometer, have been developed to aid in the home monitoring of patients with pulmonary disease. The aim of this study was to investigate the technical validity and usability of the Air Next spirometer in pediatric patients. METHODS Device variability was tested with a calibrated syringe. About 90 subjects, aged 6 to 16, were included in a prospective cohort study. Fifty-eight subjects performed conventional spirometry and subsequent Air Next spirometry. The bias and the limits of agreement between the measurements were calculated. Furthermore, subjects used the device for 28 days at home and completed a subject-satisfaction questionnaire at the end of the study period. RESULTS Interdevice variability was 2.8% and intradevice variability was 0.9%. The average difference between the Air Next and conventional spirometry was 40 mL for forced expiratory volume in 1 second (FEV1) and 3 mL for forced vital capacity (FVC). The limits of agreement were -270 mL and +352 mL for FEV1 and -403 mL and +397 mL for FVC. About 45% of FEV1 measurements and 41% of FVC measurements at home were acceptable and reproducible according to American Thoracic Society/European Respiratory Society criteria. Parents scored difficulty, usefulness, and reliability of the device 1.9, 3.5, and 3.8 out of 5, respectively. CONCLUSION The Air Next device shows validity for the measurement of FEV1 and FVC in a pediatric patient population.
Collapse
Affiliation(s)
- Matthijs D Kruizinga
- Centre for Human Drug Research, Leiden, The Netherlands.,Juliana Children's Hospital, HAGA Teaching Hospital, The Hague, The Netherlands.,Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus Medical Centre/Sophia Children's Hospital, University Hospital Rotterdam, Rotterdam, The Netherlands.,Department of Pediatrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Esmée Essers
- Centre for Human Drug Research, Leiden, The Netherlands.,Juliana Children's Hospital, HAGA Teaching Hospital, The Hague, The Netherlands
| | - F E Stuurman
- Centre for Human Drug Research, Leiden, The Netherlands.,Department of Clinical Pharmacology and Toxicology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Nellie van Eik
- Juliana Children's Hospital, HAGA Teaching Hospital, The Hague, The Netherlands
| | - Hettie M Janssens
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus Medical Centre/Sophia Children's Hospital, University Hospital Rotterdam, Rotterdam, The Netherlands
| | - Iris Groothuis
- Juliana Children's Hospital, HAGA Teaching Hospital, The Hague, The Netherlands
| | - Arwen J Sprij
- Juliana Children's Hospital, HAGA Teaching Hospital, The Hague, The Netherlands
| | - Marianne Nuijsink
- Juliana Children's Hospital, HAGA Teaching Hospital, The Hague, The Netherlands
| | - Adam F Cohen
- Centre for Human Drug Research, Leiden, The Netherlands.,Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | | |
Collapse
|
29
|
Wijesooriya NR, Mishra V, Brand PL, Rubin BK. COVID-19 and telehealth, education, and research adaptations. Paediatr Respir Rev 2020; 35:38-42. [PMID: 32653468 PMCID: PMC7301824 DOI: 10.1016/j.prrv.2020.06.009] [Citation(s) in RCA: 123] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/11/2020] [Indexed: 11/20/2022]
Abstract
For decades, there have been government funded services to provide healthcare telephonically to remote sites both on the earth and in the air. This capability has evolved into what we now know as telehealth. The use of telehealth dramatically accelerated as a result of concerns for patient and healthcare provider safety during the SARS-CoV2 pandemic. Similarly, concerns regarding transmission of infection have required medical schools to provide robust, easily accessible virtual education options. At short notice, faculties have had to develop new telehealth focused curriculum components. However, telehealth, online education, and internet enabled research should not be simply a new way to do traditional jobs but rather, an opportunity to take advantage of how technology can best be used to develop new and better ways to provide care, educate health care providers, and support research.
Collapse
Affiliation(s)
- N. Romesh Wijesooriya
- Department of Pediatrics and the Children’s Hospital of Richmond, Virginia Commonwealth University, USA
| | - Vimal Mishra
- Department of Internal Medicine, Virginia Commonwealth University, USA
| | - Paul L.P. Brand
- Department of Medical Education and Faculty Development, Isala Hospital, Zwolle, The Netherlands
| | - Bruce K Rubin
- Department of Pediatrics and the Children's Hospital of Richmond, Virginia Commonwealth University, USA.
| |
Collapse
|
30
|
Wong ZS, Siy B, Da Silva Lopes K, Georgiou A. Improving Patients' Medication Adherence and Outcomes in Nonhospital Settings Through eHealth: Systematic Review of Randomized Controlled Trials. J Med Internet Res 2020; 22:e17015. [PMID: 32663145 PMCID: PMC7471892 DOI: 10.2196/17015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/24/2020] [Accepted: 04/10/2020] [Indexed: 01/15/2023] Open
Abstract
Background Electronic health (eHealth) refers to the use of information and communication technologies for health. It plays an increasingly important role in patients’ medication management. Objective To assess evidence on (1) whether eHealth for patients’ medication management can improve drug adherence and health outcomes in nonhospital settings and (2) which eHealth functions are commonly used and are effective in improving drug adherence. Methods We searched for randomized controlled trials (RCTs) on PubMed, MEDLINE, CINAHL, EMBASE, EmCare, ProQuest, Scopus, Web of Science, ScienceDirect, and IEEE Xplore, in addition to other published sources between 2000 and 2018. We evaluated the studies against the primary outcome measure of medication adherence and multiple secondary health care outcome measures relating to adverse events, quality of life, patient satisfaction, and health expenditure. The quality of the studies included was assessed using the Cochrane Collaboration’s Risk of Bias (RoB) tool. Results Our initial search yielded 9909 records, and 24 studies met the selection criteria. Of these, 13 indicated improvement in medication adherence at the significance level of P<.1 and 2 indicated an improved quality of life at the significance level of P<.01. The top 3 functions that were employed included mechanisms to communicate with caregivers, monitoring health features, and reminders and alerts. eHealth functions of providing information and education, and dispensing treatment and administration support tended to favor improved medication adherence outcomes (Fisher exact test, P=.02). There were differences in the characteristics of the study population, intervention design, functionality provided, reporting adherence, and outcome measures among the included studies. RoB assessment items, including blinding of outcome assessment and method for allocation concealment, were not explicitly reported in a large number of studies. Conclusions All the studies included were designed for patient home-based care application and provided a mechanism to communicate with caregivers. A targeted study population such as older patients should be considered to maximize the public health impact on the self-management of diseases. Trial Registration International Prospective Register of Systematic Reviews (PROSPERO) CRD42018096627; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=96627
Collapse
Affiliation(s)
- Zoie Sy Wong
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Braylien Siy
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | | | - Andrew Georgiou
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| |
Collapse
|
31
|
Badawy SM, Radovic A. Digital Approaches to Remote Pediatric Health Care Delivery During the COVID-19 Pandemic: Existing Evidence and a Call for Further Research. JMIR Pediatr Parent 2020; 3:e20049. [PMID: 32540841 PMCID: PMC7318926 DOI: 10.2196/20049] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/11/2020] [Accepted: 06/14/2020] [Indexed: 12/15/2022] Open
Abstract
The global spread of the coronavirus disease (COVID-19) outbreak poses a public health threat and has affected people worldwide in various unprecedented ways, both personally and professionally. There is no question that the current global COVID-19 crisis, now more than ever, is underscoring the importance of leveraging digital approaches to optimize pediatric health care delivery in the era of this pandemic. In this perspective piece, we highlight some of the available digital approaches that have been and can continue to be used to streamline remote pediatric patient care in the era of the COVID-19 pandemic, including but not limited to telemedicine. JMIR Pediatrics and Parenting is currently publishing a COVID-19 special theme issue in which investigators can share their interim and final research data related to digital approaches to remote pediatric health care delivery in different settings. The COVID-19 pandemic has rapidly transformed health care systems worldwide, with significant variations and innovations in adaptation. There has been rapid expansion of the leveraging and optimization of digital approaches to health care delivery, particularly integrated telemedicine and virtual health. Digital approaches have played and will play major roles as invaluable and reliable resources to overcome restrictions and challenges imposed during the COVID-19 pandemic and to increase access to effective, accessible, and consumer-friendly care for more patients and families. However, a number of challenges remain to be addressed, and further research is needed. Optimizing digital approaches to health care delivery and integrating them into the public health response will be an ongoing process during the current COVID-19 outbreak and during other possible future pandemics. Regulatory changes are essential to support the safe and wide adoption of these approaches. Involving all relevant stakeholders in addressing current and future challenges as well as logistical, technological, and financial barriers will be key for success. Future studies should consider evaluating the following research areas related to telemedicine and other digital approaches: cost-effectiveness and return on investment; impact on quality of care; balance in use and number of visits needed for the management of both acute illness and chronic health conditions; system readiness for further adoption in other settings, such as inpatient services, subspecialist consultations, and rural areas; ongoing user-centered evaluations, with feedback from patients, families, and health care providers; strategies to optimize health equity and address disparities in access to care related to race and ethnicity, socioeconomic status, immigration status, and rural communities; privacy and security concerns for protected health information with Health Insurance Portability and Accountability Act (HIPAA)-secured programs; confidentiality issues for some specific populations, especially adolescents and those in need of mental health services; early detection of exposure to violence and child neglect; and integration of training into undergraduate and graduate medical education and subspecialty fellowships. Addressing these research areas is essential to understanding the benefits, sustainability, safety, and optimization strategies of telemedicine and other digital approaches as key parts of modern health care delivery. These efforts will inform long-term adoption of these approaches with expanded dissemination and implementation efforts.
Collapse
Affiliation(s)
- Sherif M Badawy
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Ana Radovic
- Department of Pediatrics, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| |
Collapse
|
32
|
Connected Subspecialty Care: Applying Telehealth Strategies to Specific Referral Barriers. Acad Pediatr 2020; 20:16-22. [PMID: 31404707 PMCID: PMC6944761 DOI: 10.1016/j.acap.2019.08.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 07/21/2019] [Accepted: 08/02/2019] [Indexed: 10/26/2022]
Abstract
Nearly a quarter of families of children with need of subspecialty care report difficulty accessing that care. Telehealth is a method to overcome barriers to subspecialty care. However, improving access to subspecialty care through telehealth requires granular identification of specific subspecialty barriers and recognition of the strengths and limitations of each telehealth strategy for addressing identified barriers. Focusing on each sequential step in subspecialty referrals and potential associated barriers, we summarize specific telehealth and technology-enabled strategies to improve access to subspecialty care, including electronic consultations, live interactive telemedicine, store-and-forward telemedicine, tele-mentoring, patient portals, and remote patient monitoring. Intentionally selecting telehealth strategies to target specific subspecialty referral barriers may avoid risks from misapplication of telehealth, may more clearly elevate equitable access as an essential goal within telehealth initiatives, and may also lead to synergistic use of strategies that overcome sequential barriers.
Collapse
|
33
|
Mousa AY, Broce M, Duvall N, AbuRahma AF. A proposed protocol for the comparison of virtual to physical health assessments and treatment plans for patients presenting for initial vascular clinic visits. Vascular 2019; 28:205-211. [PMID: 31711374 DOI: 10.1177/1708538119888342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The current manuscript contains a protocol proposal for a prospective research trial comparing virtual vascular clinic visits to actual physical clinic visits. Patient dissatisfaction can increase because of the complexities associated with navigating modern health care systems. It is easy to speculate that some of this dissatisfaction is associated with travel, wait times and other issues that arise during routine clinic visits. The authors of recent studies have demonstrated that it is possible and feasible to conduct many routine visits remotely. It is our belief that virtual health assessments and treatment plans (VHAT) conducted remotely can be as effective, perhaps be more efficient and increase patient satisfaction when compared to regular physical health assessments and treatment plans (PHAT). Physicians want to provide optimal health care; however, in geographically isolated areas such as some locations in West Virginia that can be a challenge. It seems reasonable to believe that monitoring patients with telehealth technology, collecting on-going real time data and conducting VHAT can provide high-quality health care for patients. It can also help to classify health risk, increase patient and medical staff satisfaction, decrease staff time for visits, while at the same time increase the efficiency of the follow-up process. We plan to compare the physician assessments and future treatment plans made using VHAT to those made after PHAT. It is believed that VHAT will be in agreement with those made with PHAT. Aims/objectives: The primary objective of the current project is to compare assessment and future treatment plans for low-risk patients made via VHAT and PHAT visits. A secondary objective is to measure patient and physician satisfaction. Methods Study hypotheses: 1. There will be good agreement (kappa coefficient ≥ 0.80) between VHAT and PHAT assessments and treatment plans. More specifically, VHAT and PHAT assessments will be used to classify patients into low, moderate and high risk for intervention and there will be good agreement between the two methods. 2. Patient satisfaction will be greater for VHAT as compared to PHAT visits.
Collapse
Affiliation(s)
- Albeir Y Mousa
- Department of Surgery, Robert C. Byrd Health Sciences Center/West Virginia University, Charleston Area Medical Center, Vascular Center of Excellence, Charleston, WV, USA
| | - Mike Broce
- Center for Health Services and Outcomes Research, Charleston Area Medical Center Health Education and Research Institute, Charleston, WV, USA
| | - Nancy Duvall
- Center for Clinical Sciences Research, Charleston Area Medical Center Health Education and Research Institute, Charleston, WV, USA
| | - Ali F AbuRahma
- Department of Surgery, Robert C. Byrd Health Sciences Center/West Virginia University, Charleston Area Medical Center, Vascular Center of Excellence, Charleston, WV, USA
| |
Collapse
|
34
|
Sheridan GA, Nagle M, Howells C, Gallagher O, Kiely PJ, O’Toole P, Kelly PM, Moore DP. A radiographic clinic for developmental dysplasia of the hip (DDH). Ir J Med Sci 2019; 189:27-31. [DOI: 10.1007/s11845-019-02039-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 05/13/2019] [Indexed: 11/29/2022]
|
35
|
van den Wijngaart LS, Geense WW, Boehmer AL, Brouwer ML, Hugen CA, van Ewijk BE, Koenen-Jacobs MJ, Landstra AM, Niers LE, van Onzenoort-Bokken L, Ottink MD, Rikkers-Mutsaerts ER, Groothuis I, Vaessen-Verberne AA, Roukema J, Merkus PJ. Barriers and Facilitators When Implementing Web-Based Disease Monitoring and Management as a Substitution for Regular Outpatient Care in Pediatric Asthma: Qualitative Survey Study. J Med Internet Res 2018; 20:e284. [PMID: 30377147 PMCID: PMC6239865 DOI: 10.2196/jmir.9245] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 05/17/2018] [Accepted: 06/21/2018] [Indexed: 01/17/2023] Open
Abstract
Background Despite their potential benefits, many electronic health (eHealth) innovations evaluated in major studies fail to integrate into organizational routines, and the implementation of these innovations remains problematic. Objective The purpose of this study was to describe health care professionals’ self-identified perceived barriers and facilitators for the implementation of a Web-based portal to monitor asthmatic children as a substitution for routine outpatient care. Also, we assessed patients’ (or their parents) satisfaction with this eHealth innovation. Methods Between April and November 2015, we recruited 76 health care professionals (from 14 hospitals). During a period of 6 months, participants received 3 questionnaires to identify factors that facilitated or impeded the use of this eHealth innovation. Questionnaires for patients (or parents) were completed after the 6-month virtual asthma clinic (VAC) implementation period. Results Major perceived barriers included concerns about the lack of structural financial reimbursement for Web-based monitoring, lack of integration of this eHealth innovation with electronic medical records, the burden of Web-based portal use on clinician workload, and altered patient-professional relationship (due to fewer face-to-face contacts). Major perceived facilitators included enthusiastic and active initiators, a positive attitude of professionals toward eHealth, the possibility to tailor care to individual patients (“personalized eHealth”), easily deliverable care according to current guidelines using the VAC, and long-term profit and efficiency. Conclusions The implementation of Web-based disease monitoring and management in children is complex and dynamic and is influenced by multiple factors at the levels of the innovation itself, individual professionals, patients, social context, organizational context, and economic and political context. Understanding and defining the barriers and facilitators that influence the context is crucial for the successful implementation and sustainability of eHealth innovations.
Collapse
Affiliation(s)
- Lara S van den Wijngaart
- Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Wytske W Geense
- IQ Healthcare, Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
| | | | - Marianne L Brouwer
- Department of Pediatrics, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Cindy Ac Hugen
- Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bart E van Ewijk
- Department of Pediatrics, Tergooi Hospital, Blaricum, Netherlands.,Department of Pediatrics, Tergooi Hospital, Hilversum, Netherlands
| | | | | | - Laetitia Em Niers
- Department of Pediatrics, Maxima Medical Center, Veldhoven, Netherlands
| | | | - Mark D Ottink
- Department of Pediatrics, Medical Spectrum Twente Hospital, Enschede, Netherlands
| | | | - Iris Groothuis
- Department of Pediatric Pulmonology, Juliana Children's Hospital, Haga Hospital, The Hague, Netherlands
| | | | - Jolt Roukema
- Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Peter Jfm Merkus
- Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| |
Collapse
|
36
|
Waibel KH, Bickel RA, Brown T. Outcomes From a Regional Synchronous Tele-Allergy Service. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 7:1017-1021. [PMID: 30385405 DOI: 10.1016/j.jaip.2018.10.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 10/01/2018] [Accepted: 10/11/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although the framework and potential benefits for using telemedicine have been described, allergy-specific outcomes are often limited or have a narrow focus. OBJECTIVE To determine the percentage of new and follow-up visits conducted via synchronous telemedicine requiring an in-person visit. METHODS A retrospective review evaluating synchronous tele-allergy appointments in a hospital-based allergy clinic was performed. RESULTS A total of 360 unique patients participated in 423 synchronous tele-allergy visits from January 2016 to December 2017; 275 (65.0%) were new consultations, 54% were males, and 118 (28%) visits were for children. Allergic rhinitis (35%), asthma (24%), and food allergy (10%) represented the top 3 diagnoses. New and follow-up tele-allergy visits accounted for 13.1% (275 of 2097) and 10.4% (148 of 1426) of all outpatient visits during the study period, respectively. Sixty-five (23.4%) new patients and 14 (9.5%) follow-up patients were recommended for an in-person appointment (P < .001). Compared with follow-up tele-allergy visits, new visits were more likely to have medication prescribed (64.4% vs 49.0%; P < .002) and laboratory tests ordered (46.2% vs 7.4%; P < .001); there were no differences between new and follow-up tele-allergy visits for mean study observation period (P = .680), subsequent in-person visits conducted on the basis of provider recommendation (P = .120), or telephone consultations (P = .190). One hundred forty (33.1%) patients completed an anonymous satisfaction survey, with 98.8% of patients recommending telehealth and reporting high satisfaction. On the basis of 423 visits from 13 originating sites, patients saved an average of $485 in travel expenses, 438 driving miles, and 2.3 days of work or school per visit. CONCLUSIONS Coupled with high patient satisfaction and significant time and cost savings, tele-allergy supported most of the new and follow-up visits without an in-person recommendation. Although not all tele-allergy efforts incorporate a synchronous modality with a dedicated patient presenter, allergists should continue to seek opportunities to incorporate synchronous tele-allergy with a trained patient presenter into their clinical practice.
Collapse
Affiliation(s)
- Kirk H Waibel
- Allergy Service, Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, San Antonio, Texas.
| | - Richard A Bickel
- Allergy Service, Division of Medicine, Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Tyson Brown
- Allergy Service, Division of Medicine, Landstuhl Regional Medical Center, Landstuhl, Germany
| |
Collapse
|
37
|
van den Wijngaart LS, Kievit W, Roukema J, Boehmer ALM, Brouwer ML, Hugen CAC, Niers LEM, Sprij AJ, Rikkers-Mutsaerts ERVM, Rottier BL, Verhaak CM, Pijnenburg MW, Merkus PJFM. Online asthma management for children is cost-effective. Eur Respir J 2017; 50:50/4/1701413. [PMID: 28982768 DOI: 10.1183/13993003.01413-2017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 07/23/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Lara S van den Wijngaart
- Dept of Paediatric Pulmonology, Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Wietske Kievit
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jolt Roukema
- Dept of Paediatric Pulmonology, Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen, The Netherlands
| | | | - Marianne L Brouwer
- Dept of Paediatrics, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Cindy A C Hugen
- Dept of Paediatric Pulmonology, Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen, The Netherlands
| | | | - Arwen J Sprij
- Dept of Paediatric Pulmonology, Haga Hospital, Juliana Children's hospital, Den Hague, The Netherlands
| | | | - Bart L Rottier
- Dept of Paediatric Pulmonology and Allergology, Groningen Research Institute for Asthma and COPD, University of Groningen, University Medical Centre Groningen, Beatrix Children's Hospital, Groningen, The Netherlands
| | - Chris M Verhaak
- Dept of Psychology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Mariëlle W Pijnenburg
- Dept of Paediatric Pulmonology, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Peter J F M Merkus
- Dept of Paediatric Pulmonology, Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen, The Netherlands
| |
Collapse
|