Patients' Experiences of Using Smartphone Apps to Support Self-Management and Improve Medication Adherence in Hypertension: Qualitative Study

Patient-reported usability challenges when implementing integrated EHR medication reminders for kidney transplant patients in a home setting: A pilot study

BACKGROUND

With an aging population and the increasing prevalence of chronic diseases such as chronic kidney disease (CKD), kidney transplantation is the preferred treatment for end-stage renal disease due to its superior clinical outcomes and cost-effectiveness compared to dialysis. Although EHR-integrated medication reminders have the potential to enhance adherence in transplant patients, their feasibility require further investigation.

OBJECTIVE

The objective of this pilot study was to assess the feasibility of an integrated medication reminder tool for kidney transplant patients in terms of experienced usability and satisfaction.

METHODS

A single-arm survey design was used to assess the usability and satisfaction in kidney transplant recipients using an EHR-integrated medication reminder tool through the patient portal at a large academic hospital in the Netherlands. Usability and satisfaction were evaluated using the validated Experienced Usability and Satisfaction with self-monitoring in the home Setting (GEMS) questionnaire comprising four subconstructs: Convenience of use, Perceived value, Efficiency of use, and Satisfaction. Quantitative data were analysed and assessed through descriptive statistics. Furthermore, six additional questions assessed logging into the system, ease of follow-up on reminder, satisfaction with reminder timing, perceived support for adherence, occurrence of incorrect reminders, and willingness to continue using the tool, using Likert scales and open-ended responses.

RESULTS

In total, forty-three patients participated in this study. The results showed mixed experienced usability and satisfaction, with a GEMS score of 65.0%. The Efficiency of use subconstruct revealed issues such as difficulties in checking off medication and accessing the patient portal. The Satisfaction subconstruct revealed limitations of the tool, as reminders cannot be customized, creating inconvenience for patients who had developed their own medication routines after transplantation. One third (35.7%) of the patients reported willingness to continue using the tool after the pilot program.

CONCLUSION

The experienced usability and satisfaction of an integrated EHR medication reminder tool were adequate for half of the patients. To facilitate large-scale implementation, improvements of the tool are needed to maximize its effectiveness for kidney transplant patients, particularly by enhancing customization of the notification system to better meet user needs and support medication adherence.

Benefits and Barriers to mHealth in Hypertension Care: Qualitative Study With German Health Care Professionals

BACKGROUND

Digital health technologies, particularly mobile health (mHealth) apps and wearable devices, have emerged as crucial assets in the battle against hypertension. By enabling lifestyle modifications, facilitating home blood pressure monitoring, and promoting treatment adherence, these technologies have significantly enhanced hypertension treatment.

OBJECTIVE

This study aims to explore the perspectives of health care professionals (HCPs) regarding the perceived benefits and barriers associated with the integration of mHealth apps into routine hypertension care. Additionally, strategies for overcoming these barriers will be identified.

METHODS

Through qualitative analysis via semistructured interviews, general practitioners (n=10), cardiologists (n=14), and nurses (n=3) were purposefully selected between October 2022 and March 2023. Verbatim transcripts were analyzed using qualitative content analysis.

RESULTS

The results unveiled 3 overarching themes highlighting the benefits of mHealth apps in hypertension care from the perspective of HCPs. First, these technologies possess the potential to enhance patient safety by facilitating continuous monitoring and early detection of abnormalities. Second, they can empower patients, fostering autonomy in managing their health conditions, thereby promoting active participation in their care. Lastly, mHealth apps may provide valuable support to medical care by offering real-time data that aids in decision-making and treatment adjustments. Despite these benefits, the study identified several barriers hindering the seamless integration of mHealth apps into hypertension care. Challenges predominantly revolved around data management, communication contexts, daily routines, and system handling. HCPs underscored the necessity for structural and procedural modifications in their daily practices to effectively address these challenges.

CONCLUSIONS

In conclusion, the effective usage of digital tools such as mHealth apps necessitates overcoming various obstacles. This entails meeting the information needs of both HCPs and patients, tackling interoperability issues to ensure seamless data exchange between different systems, clarifying uncertainties surrounding reimbursement policies, and establishing the specific clinical benefits of these technologies. Active engagement of users throughout the design and implementation phases is crucial for ensuring the usability and acceptance of mHealth apps. Moreover, enhancing knowledge accessibility through the provision of easily understandable information about mHealth apps is essential for eliminating barriers and fostering their widespread adoption in hypertension care.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00029761; https://drks.de/search/de/trial/DRKS00029761.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.3389/fcvm.2022.1089968.

Trends and Gaps in Digital Precision Hypertension Management: Scoping Review

BACKGROUND

Hypertension (HTN) is the leading cause of cardiovascular disease morbidity and mortality worldwide. Despite effective treatments, most people with HTN do not have their blood pressure under control. Precision health strategies emphasizing predictive, preventive, and personalized care through digital tools offer notable opportunities to optimize the management of HTN.

OBJECTIVE

This scoping review aimed to fill a research gap in understanding the current state of precision health research using digital tools for the management of HTN in adults.

METHODS

This study used a scoping review framework to systematically search for articles in 5 databases published between 2013 and 2023. The included articles were thematically analyzed based on their precision health focus: personalized interventions, prediction models, and phenotyping. Data were extracted and summarized for study and sample characteristics, precision health focus, digital health technology, disciplines involved, and characteristics of personalized interventions.

RESULTS

After screening 883 articles, 46 were included; most studies had a precision health focus on personalized digital interventions (34/46, 74%), followed by prediction models (8/46, 17%) and phenotyping (4/46, 9%). Most studies (38/46, 82%) were conducted in or used data from North America or Europe, and 63% (29/46) of the studies came exclusively from the medical and health sciences, with 33% (15/46) of studies involving 2 or more disciplines. The most commonly used digital technologies were mobile phones (33/46, 72%), blood pressure monitors (18/46, 39%), and machine learning algorithms (11/46, 24%). In total, 45% (21/46) of the studies either did not report race or ethnicity data (14/46, 30%) or partially reported this information (7/46, 15%). For personalized intervention studies, nearly half (14/30, 47%) used 2 or less types of data for personalization, with only 7% (2/30) of the studies using social determinants of health data and no studies using physical environment or digital literacy data. Personalization characteristics of studies varied, with 43% (13/30) of studies using fully automated personalization approaches, 33% (10/30) using human-driven personalization, and 23% (7/30) using a hybrid approach.

CONCLUSIONS

This scoping review provides a comprehensive mapping of the literature on the current trends and gaps in digital precision health research for the management of HTN in adults. Personalized digital interventions were the primary focus of most studies; however, the review highlighted the need for more precise definitions of personalization and the integration of more diverse data sources to improve the tailoring of interventions and promotion of health equity. In addition, there were significant gaps in the reporting of race and ethnicity data of participants, underuse of wearable devices for passive data collection, and the need for greater interdisciplinary collaboration to advance precision health research in digital HTN management.

TRIAL REGISTRATION

OSF Registries osf.io/yuzf8; https://osf.io/yuzf8.

Association of Preoperative Walking Speed With 1-Year Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome

BACKGROUND

Previous studies have identified demographic, radiographic, and intraoperative predictors of outcomes after hip arthroscopy for femoroacetabular impingement syndrome, yet few studies have identified whether preoperative gait metrics can predict outcomes.

HYPOTHESIS

Increased preoperative step count, walking speed, step length, and gait symmetry will be associated with better outcomes after surgery.

STUDY DESIGN

Retrospective cohort study.

LEVEL OF EVIDENCE

Level 4.

METHODS

Patients who underwent hip arthroscopy between 2019 and 2022 and downloaded the smartphone app rHip, allowing for retroactive access of gait metric data, were identified. Preoperative gait metrics, age, sex, body mass index (BMI), and exercise participation were analyzed via multivariate stepwise linear regression for a relationship with 1-year postoperative patient-reported outcomes (PROs), including Hip Outcome Scale-Activities of Daily Living (HOS-ADL); HOS-Sports Subscale (HOS-SS), and 12-item international Hip Outcome Tool (iHOT-12). Thresholds for preoperative gait metrics were analyzed via receiver operator characteristic curve. A subgroup analysis was performed to compare those who did and did not reach this threshold.

RESULTS

A total of 43 patients (86% female; age, 33.1 ± 13.7 years; BMI, 23.9 ± 4.4 kg/m2) met inclusion criteria. Multivariate regression found that preoperative walking speed was significantly associated with postoperative HOS-ADL, HOS-SS, and iHOT-12 (P ≤ .01). A preoperative walking speed threshold of 1.065 m/s was predictive of outcome achievement. Those who failed to achieve this threshold were significantly older, of greater BMI, and less active (P ≤ .04). They also showed significantly worse 1-year postoperative scores (P ≤ .02) and lower PASS achievement for HOS-ADL, HOS-SS, and iHOT-12 (P ≤ .04).

CONCLUSION

Preoperative walking speed is significantly associated with 1-year outcomes after hip arthroscopy. Patients who averaged <1.065 m/s show significantly worse outcomes after surgery.

CLINICAL RELEVANCE

Assessment of preoperative walking speed may allow physicians to better counsel patients regarding expected outcomes after hip arthroscopy.

Strategies for Effective Communication in Hypertension Management: Validation of Messages from a Mobile Application to Assist Hypertensive Older Adults in Adherence to Treatment, Nutrition and Physical Activity

BACKGROUND

Poor adherence to antihypertensive treatment is a common problem among elderly hypertensive patients and one of the leading causes of inadequate blood pressure control. In this sense, it is essential to improve strategies for effective communication in managing hypertension treatment for this group.

OBJECTIVE

This study aimed to validate the text messages of a mobile application to aid adherence to antihypertensive treatment, nutrition, and physical activity among older adults with hypertension treated in Brazilian public primary health care.

METHODS

This descriptive, methodological development study with a quantitative approach was carried out between March and August 2024.

RESULTS

A total of 27 messages were constructed and validated by 13 experts, and this stage was divided into two rounds. The Content Validity index and percentage of agreement were used in the validation process. The messages were developed using theory, national guidelines, validation, and expert review.

CONCLUSIONS

Text messages for adherence to antihypertensive treatment involving medication, nutrition, and physical activity have enormous potential with the target audience studied.

Application of Alfalfa App in the management of oral anticoagulation in patients with atrial fibrillation: a multicenter randomized controlled trial

BACKGROUND

In recent years, mobile medical technology has made great progress in chronic disease management, but its application in patients with atrial fibrillation (AF) still needs to be clarified.

OBJECTIVE

This study aims to determine whether the newly developed smartphone app for patients with AF (Alfalfa App) can improve anticoagulation knowledge, drug treatment compliance, and satisfaction of AF patients.

METHODS

Alfalfa App integrates the functions of patient education, remote consultation, and medication reminder through a simple user interface. From June 2020 to December 2020, patients with AF were recruited in five large tertiary hospitals in China. Patients were randomly divided into the Alfalfa App or routine nursing groups. Patients' knowledge, medication adherence, and satisfaction with anticoagulation were assessed using validated questionnaires at baseline, 1 month, and 3 months.

RESULTS

In this randomized controlled trial, 113 patients with AF were included, 57 patients were randomly assigned to the Alfalfa App group, and 56 patients were randomly assigned to the routine nursing group. Forty-eight patients in the Alfalfa App group completed a three-month follow-up, and 48 patients in the routine nursing group completed a three-month follow-up. Basic demographic data were comparable between the two groups. The average age of AF patients was 61.65 ± 11.01 years old, and 61.5% of them were male. With time (baseline to 3 months), the knowledge scores of the Alfalfa App group (P<.001) and the routine nursing group (P = .002) were significantly improved, the compliance scores of the routine nursing group(P<.001) and Alfalfa App group(P<.001) significantly improved. Compared with the routine nursing group, patients' knowledge level and medication compliance using the Alfalfa App at 1 month and 3 months were significantly higher (all P < .05). There were significant differences in knowledge and compliance scores between the two groups with time (all P < .05). The satisfaction degree of drug treatment in the Alfalfa App group was significantly better than that in the routine nursing group (all P < .05).

CONCLUSIONS

Alfalfa App significantly improved the anticoagulation knowledge, drug treatment compliance, and satisfaction of AF patients. In oral anticoagulation management for AF patients, mobile medical technology that integrates the functions of patient education, remote consultation, and medication reminder may be helpful.

TRIAL REGISTRATION

Registration number, ChiCTR1900024455. Registered on July 12, 2019.

Effectiveness of a Multifaceted Mobile Health Intervention (Multi-Aid-Package) in Medication Adherence and Treatment Outcomes Among Patients With Hypertension in a Low- to Middle-Income Country: Randomized Controlled Trial

BACKGROUND

The high prevalence of uncontrolled hypertension in Pakistan is predominantly attributed to poor medication adherence. As more than 137 million people in Pakistan use cell phones, a suitable mobile health (mHealth) intervention can be an effective tool to overcome poor medication adherence.

OBJECTIVE

We sought to determine whether a novel mHealth intervention is useful in enhancing antihypertensive therapy adherence and treatment outcomes among patients with hypertension in a low- to middle-income country.

METHODS

A 6-month parallel, single-blinded, superiority randomized controlled trial recruited 439 patients with hypertension with poor adherence to antihypertensive therapy and access to smartphones. An innovative, multifaceted mHealth intervention (Multi-Aid-Package), based on the Health Belief Model and containing reminders (written, audio, visual), infographics, video clips, educational content, and 24/7 individual support, was developed for the intervention group; the control group received standard care. The primary outcome was self-reported medication adherence measured using the Self-Efficacy for Appropriate Medication Adherence Scale (SEAMS) and pill counting; the secondary outcome was systolic blood pressure (SBP) change. Both outcomes were evaluated at baseline and 6 months. Technology acceptance feedback was also assessed at the end of the study. A generalized estimating equation was used to control the covariates associated with the probability of affecting adherence to antihypertensive medication.

RESULTS

Of 439 participants, 423 (96.4%) completed the study. At 6 months post intervention, the median SEAMS score was statistically significantly higher in the intervention group compared to the controls (median 32, IQR 11 vs median 21, IQR 6; U=10,490, P<.001). Within the intervention group, there was an increase in the median SEAMS score by 12.5 points between baseline and 6 months (median 19.5, IQR 5 vs median 32, IQR 11; P<.001). Results of the pill-counting method showed an increase in adherent patients in the intervention group compared to the controls (83/220, 37.2% vs 2/219, 0.9%; P<.001), as well as within the intervention group (difference of n=83, 37.2% of patients, baseline vs 6 months; P<.001). There was a statistically significant difference in the SBP of 7 mmHg between the intervention and control groups (P<.001) at 6 months, a 4 mmHg reduction (P<.001) within the intervention group, and a 3 mmHg increase (P=.314) within the controls. Overall, the number of patients with uncontrolled hypertension decreased by 46 in the intervention group (baseline vs 6 months), but the control group remained unchanged. The variables groups (adjusted odds ratio [AOR] 1.714, 95% CI 2.387-3.825), time (AOR 1.837, 95% CI 1.625-2.754), and age (AOR 1.618, 95% CI 0.225-1.699) significantly contributed (P<.001) to medication adherence. Multi-Aid-Package received a 94.8% acceptability score.

CONCLUSIONS

The novel Multi-Aid-Package is an effective mHealth intervention for enhancing medication adherence and treatment outcomes among patients with hypertension in a low- to middle-income country.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04577157; https://clinicaltrials.gov/study/NCT04577157.

Modelling the significance of value-belief-norm framework to predict mass adoption potentials of internet of things-enabled wearable fitness devices

Self-health monitoring technologies have become increasingly popular in averting unanticipated health complications. However, the adoption rate of such technologies in developing countries is surprisingly low. Furthermore, empirical studies on the application of the value-belief-norm (VBN) model to elucidate intention to use IoT-enabled wearable fitness devices (IoT-enabled WFDs) are scarce. This study aimed to expand the VBN model by integrating health values, health consciousness, health knowledge-seeking, and social norms as influencing constructs. The proposed holistic framework was empirically tested to examine these constructs on users' decision-making process of adopting IoT-enabled WFDs. A web-based survey involving 866 adults in China aged 18-30 years was conducted. The gathered data were analysed using partial least squares-structural equation modeling. The results revealed the significant influence of health consciousness and health knowledge-seeking on personal health beliefs, as well as the favourable impact of personal health beliefs on personal norms and awareness of consequences. The results further demonstrated the substantial influence of awareness of consequences and ascription of responsibilities on personal norms. Besides that, personal norms and societal norms were found to have strong influence on the intention to adopt IoT-enabled WFDs, which was revealed to have significant influence on the actual usage. This study's findings offer novel theoretical insights on the behavioural characteristics of adopting IoT-enabled WFDs and serve as a practical guideline for industry experts and marketers to establish appropriate marketing strategies to support the IoT-enabled wearable sector. The findings also benefit policymakers in their efforts of developing strategies that emphasise the unique benefits of self-healthcare monitoring to encourage active lifestyle and decrease obesity and overweight-related health risks.

Contribution of Flexig mobile application to assess adherence of patients treated with immunoglobulins in chronic diseases

Background

Long-term therapeutic adherence remains an essential challenge for better management of chronic diseases. It is estimated at 50% in developed countries.

Objective

The study aimed to evaluate, under real conditions, the influence of satisfaction with Flexig use on adherence to subcutaneous immunoglobulin home-treatment therapy in a sample of French patients with chronic dysimmune diseases.

Methods

This is a 2-year prospective cohort involving 241 patients from several hospitals in France whose data were extracted from the Flexig 2.0 mHealth application. Satisfaction was assessed by System Usability Scale (SUS) and user experience by User Experience Questionnaire (UEQ). Adherence to Ig therapy was assessed by medication possession rate. We analyzed the relationship between Flexig user satisfaction and adherence to treatment, as well as determinants of adherence.

Results

Most patients (82.7%) were being treated for an immunodeficiency, versus 17.3% for a chronic autoimmune and inflammatory disease. Almost all patients (97.9%) received subcutaneous immunoglobulin therapy. The patients' ages (means ± SDs) were 36.5 ± 18.3 years, disease duration was about 6 years, and 58.5% were men. Flexig user satisfaction was 76.2 ± 8 (System Usability Scale), associated with good user experience reported on UEQ. Adherence rate was 99.7%. Time on app, disease duration, and Flexig user satisfaction were statistically predictive of adherence to IgG therapy. High adherence to Ig therapy was associated with good satisfaction with using Flexig (P < .0001).

Conclusion

Adherence to Ig therapy in chronic dysimmune disease was strong and was associated with good satisfaction among Flexig users, suggesting that electronic support may be a valuable compliance aid.

Strengthening health monitoring: Intention and adoption of Internet of Things-enabled wearable healthcare devices

Objective

Health self-monitoring technologies are gaining popularity worldwide, but they face low adoption rates in emerging countries. There is a deficiency in studies that have applied the value-belief-norm (VBN) model to understand the adoption of IoT-enabled wearable healthcare devices (WHDs). This study investigates the adoption of IoT-enabled WHDs among older adults in China, using the VBN model as a theoretical framework.

Methods

Using a convenience sampling method and a web-based cross-sectional survey method, we collected data from 476 respondents, which we analyzed using partial least squares structural equation modeling using Smart PLS version 3.3.5.

Results

The findings highlight the significance of health values and motivation in shaping personal health beliefs, which, in turn, influence personal norms and awareness of consequences. Particularly, awareness of consequences and attributions of responsibility significantly impact personal norms. Personal and social norms, in turn, strongly affect the intention to adopt IoT-enabled WHDs, ultimately driving their actual adoption.

Conclusion

This research contributes novel insights into the behavioral dynamics surrounding the adoption of IoT-enabled WHDs, providing valuable guidance for marketers and policymakers. Marketers can leverage these insights to develop tailored marketing strategies within the IoT-enabled WHD industry. Additionally, policymakers are urged to prioritize campaigns aimed at enhancing awareness and understanding of self-healthcare monitoring, with a focus on promoting the unique health benefits of IoT-enabled WHDs.

Effect of a Medication Adherence Mobile Phone App on Medically Underserved Patients with Chronic Illness: Preliminary Efficacy Study

BACKGROUND

Medication adherence is vital in the treatment of patients with chronic illness who require long-term medication therapies to maintain optimal health. Medication adherence, a complex and widespread problem, has been difficult to solve. Additionally, lower-income, medically underserved communities have been found to have higher rates of inadequate adherence to oral medications. Even so, this population has been underrepresented in studies using mobile medication adherence app interventions. Federally qualified health centers provide care for medically underserved populations, defined as communities and populations where there is a demonstrable unmet need for health services. These centers have been reporting an increase in a more complex chronic disease population. Including medically underserved individuals in mobile health studies provides opportunities to support this disproportionately affected group, work toward reducing health disparities in access to health care, and understand barriers to mobile health uptake.

OBJECTIVE

The aim of this preliminary efficacy study was to evaluate the effects and feasibility of a commercially available medication adherence app, Medisafe, in a medically underserved adult population with various chronic illnesses seeking care in a federally qualified health center.

METHODS

Participants in this single-arm pre-post intervention preliminary efficacy study (N=10) completed a baseline survey, used the app for 2 weeks, and completed an end-of-study survey. The primary outcome measures were medication adherence and medication self-efficacy. Feedback on the use of the app was also gathered.

RESULTS

A statistically significant median increase of 8 points on the self-efficacy for adherence to medications scale was observed (P=.03, Cohen d=0.69). Though not significant, the adherence to refills and medications scale demonstrated a median change of 2.5 points in the direction of increased medication adherence (P=.21, Cohen d=0.41). Feedback about the app was positive.

CONCLUSIONS

Use of the Medisafe app is a viable option to improve medication self-efficacy and medication adherence in medically underserved patients in an outpatient setting with a variety of chronic illnesses.

Delineating and clarifying the concept of self-care monitoring: a concept analysis

AIM

To delineate and clarify the meaning of the concept of self-care monitoring from a patient perspective.

METHODS

A systematic search was performed in the databases ASSIA, CINAHL, PsycInfo, and PubMed (January 2016-September 2021). A selection of 46 peer-reviewed articles was included in the study and analysed using Rodgers' Evolutionary Method for Concept Analysis.

RESULTS

The following four attributes were identified: Tracking symptoms, signs, and actions, Paying attention, Being confident, and Needing routines, creating a descriptive definition: "Self-care monitoring is an activity that means a person has to pay attention and be confident and needs routines for tracking symptoms, signs, and action." The antecedents of the concept were shown to be Increased knowledge, Wish for independence, and Commitment. The concepts' consequences were identified as Increased interaction, Perceived burden, and Enhanced well-being.

CONCLUSIONS

This concept analysis provides extensive understanding of self-care monitoring from a patient perspective. It was shown that the concept occurs when a person practices self-care monitoring at home either with or without devices. A descriptive definition was constructed and presented with exemplars to encourage practice of the concept in various healthcare settings and could be of relevance to people with chronic illnesses or other long-term conditions.

Toward the Design of Sensing-Based Medication Adherence Aids That Support Individualized Activities of Daily Living: Survey and Interviews With Patients and Providers

BACKGROUND

Nearly half of Americans taking prescription medications do not take them properly. The resulting implications have a broad impact. Nonadhering patients develop worsened medical conditions and increased comorbidity of disease or die.

OBJECTIVE

Clinical studies have shown that the most effective strategies for addressing adherence are those that are individualized to the context that each patient and situation require. However, existing aids for adherence are relatively ridged and poorly support adaptation to individual behaviors and lifestyles. The aim of our study was to better understand this design tension.

METHODS

A series of 3 qualitative studies was conducted: a web-based survey of 200 Americans that investigated existing adherence strategies and behaviors and perception of how hypothetical in-home tracking technologies would assist adherence; in-person semistructured interviews with 20 medication takers from Pittsburgh, PA, that investigated personal adherence behaviors, which included demonstration of medication locations and routines as well as an assessment of hypothetical technologies; and semistructured interviews with 6 pharmacists and 3 family physicians to gain a provider perspective on patient adherence strategies, which included feedback on hypothetical technologies in the context of their patient populations. Inductive thematic coding of all interview data was performed. Studies were conducted consecutively, with the results informing the subsequent studies.

RESULTS

Synthesized, the studies identified key medication adherence behaviors amenable to technological interventions, distilled important home-sensing literacy considerations, and detailed critical privacy considerations. Specifically, 4 key insights were obtained: medication routines are heavily influenced and adapted by and through the physical location and placement of medications relative to activities of daily living, routines are chosen to be inconspicuous to maintain privacy, the value of provider-involved routines is motivated by a desire to build trust in shared decision-making, and the introduction of new technologies can create further burden on patients and providers.

CONCLUSIONS

There is considerable potential to improve individual medication adherence by creating behavior-focused interventions that leverage emerging artificial intelligence (AI), machine learning (ML), and in-home Internet of Things (IoT) sensing technologies. However, success will be dependent on the technology's ability to learn effectively and accurately from individual behaviors, needs, and routines and tailor interventions accordingly. Patient routines and attitudes toward adherence will likely affect the use of proactive (eg, AI-assistant routine modification) versus reactive (eg, notification of associated behaviors with missed dosages) intervention strategies. Successful technological interventions must support the detection and tracking of patient routines that can adjust to variations in patient location, schedule, independence, and habituation.

Finnish emergency medical services managers' and medical directors' perceptions of collaborating with patients concerning patient safety issues: a qualitative study

OBJECTIVES

This study aimed to describe emergency medical services (EMS) managers' and medical directors' perceptions of collaborating with patients concerning patient safety issues in the EMS.

DESIGN

The study used a descriptive qualitative approach. Five focus groups and two individuals were interviewed using a semi-structured guide with open-ended questions. The data were analysed using reflexive thematic analysis. Consolidated criteria for Reporting Qualitative research was used to guide the reporting of this study.

SETTING

EMS organisations from Finland's five healthcare districts.

PARTICIPANTS

EMS medical directors (n=5) and EMS managers (n=14). Purposive sampling was used.

RESULTS

Two main themes, 'Patient safety considered an organisational responsibility' and 'EMS patients' opportunities and obstacles to speaking up', were generated from the data. Under the main theme, 'Patient safety considered an organisational responsibility', were three subthemes: patient safety considered part of the quality in EMS, system-level models for handling and observing patient safety in EMS, and management's ability to find a balance when using patients' feedback for patient safety development. Under the other main theme were four subthemes: 'social and feedback skills of EMS personnel and management', 'managements' assumptions of patients' reasons for not speaking up', 'EMS organisations' different but unsystematic ways of collecting feedback' and 'management's openness to develop patient participation'.

CONCLUSIONS

The nature of the EMS organisations and EMS assignments could affect a patient's participation in developing patient safety in EMS. However, EMS managers and medical directors are receptive to collaborating with patients concerning patient safety issues if they have sufficient resources and a coherent way to collect patient safety concerns. The management is open to collaborating with patients, but there is a need to develop a systematic method with enough resources to facilitate the management's collaborating with patients.

Prospective Study Comparing Quantitative Self-Monitoring Metamorphopsia Measurement Tools in Myopic Choroidal Neovascularization (mCNV)

Purpose

To assess the ability of two self-monitoring digital devices to detect metamorphopsia in myopic choroidal neovascularization (mCNV) and compare their usability.

Patients and Methods

This was a 12-month prospective observational study at a tertiary care eye hospital, Switzerland. Twenty-three Caucasian patients with mCNV were recruited, 21 eyes were analyzed. Primary and secondary outcome measures: Primary outcome measures were the metamorphopsia index scores as assessed by the two self-monitoring digital devices (Alleye App and AMD - A-Metamorphopsia-Detector software) at baseline, at 6 and 12 months and individual optional visits in between. Secondary outcome measures included best corrected visual acuity and morphological parameters (including disease activity) as evaluated by spectral-domain optical coherence tomography and fundus autofluorescence imaging. Location of mCNV was graded using the Early Treatment of Diabetic Retinopathy Study grid overlay. A usability questionnaire was administered at 12 months. Bland-Altman plots evaluated the limits of agreement of both devices. Linear regression analysis assessed the correlation between the difference and the average of the two scores.

Results

A total of 202 tests were performed. Disease activity of mCNV was observed at least once in 14 eyes. Both scores concordantly detected metamorphopsia exhibiting a displaced scale of measurement yielding a coefficient of determination of 0.99. Concordance rate for pathological scores was 73.3%. Both scores were not significantly different in active and inactive mCNV. Overall, the usability scores were higher for the Alleye App than the AMD - A-Metamorphopsia-Detector software (4.61±0.56 vs 3.31±1.20; p<0.001). In subjects aged >75 years, scores were slightly lower (4.08±0.86 vs 2.97±1.16; p= 0.032).

Conclusion

Whilst both self-monitoring devices concordantly identified metamorphopsia, they might act as an adjunct to hospital visits, but due to slight reactivations in mCNV and presence of metamorphopsia also in inactive disease the ability of detecting early mCNV activity might be limited.

Attitude and Needs Toward MTM Applications of Chronic Disease in China: A Questionnaire Survey

Objective

Chronic diseases are characterized by high incidence, long-term medication, and complex types of medication. There are also many corresponding medication therapy management (MTM) applications on the market, such as iCarea, and Medisafe. However, the existing research mainly focuses on how to choose high-quality MTM applications, and few researchers consider the expectations of MTM applications from potential users. The aims of this study were to investigate the demand, attitude, and expectations of the Chinese patients for the MTM applications to support.

Methods

From August 2019 to December 2019, we created a questionnaire to have knowledge of user needs, preferences, and expectations for MTM applications among 302 chronic patients in Hunan, Guangdong, and other provinces in China. Logistic regression analysis was performed to analyze the risk factors of affecting patients' attitudes toward MTM applications. Then, respondents' expectations and preferences for MTM applications were statistically analyzed. The survey data were merged to provide information for the design of targeted chronic disease MTM applications.

Results

A total of 260 (86.09%) out of 302 patients the respondents were willing to use the MTM applications of chronic disease. The independent influencing factors for using the MTM applications were long-term medication history (OR = 4.45, P &lt; 0.001), willing to learn about medicine knowledge (OR = 3.01, P = 0.04), and wanting to get more professional medication knowledge via Internet (OR = 2.86, P = 0.005). It was worth noting that among those willing to use MTM applications, 55.00% of respondents were willing to use the WeChat applet for MTM, while only 23.46% of respondents preferred other applications. As to the more prevalent WeChat applet for MTM, the majority of participants expected the inclusion of useful modules, such as medication log (62.81%), medication reminder (62.81%), and medication recommendations (57.79%).

Conclusion

The participants are willing to use MTM applications of chronic disease, with a preference for the WeChat applet. Patients tended to use MTM applications if they had a long-term medication history or a desire for medical knowledge, especially if they want to get more professional medication knowledge via the Internet. Participants are expected to include in the WeChat applet as medication logs, medication reminders, and medication recommendations which should be taken into serious account for the further development of MTM applications.

Electronic health strategies to improve medication adherence in patients with cardiometabolic disease: current status and future directions

PURPOSE OF REVIEW

Enabled by widespread technological advancements, electronic health (eHealth) strategies have expanded rapidly over the last decade, presenting opportunities to support self-management including medication adherence for cardiometabolic disease control. eHealth can minimize access barriers to medications, enable timely assessment and shared decision-making, and provide medication reminders and health data feedback. This review summarizes current evidence for effectiveness of eHealth strategies for improving medication adherence in patients with hypertension, type 2 diabetes, and/or hyperlipidemia, and identifies priorities for future research.

RECENT FINDINGS

Current research supports the effectiveness of eHealth strategies to improve medication adherence and clinical outcomes for cardiometabolic disease. Although patient acceptability of eHealth strategies is generally high, engagement may decline over time. In addition, differences in effectiveness across intervention characteristics and sociodemographic groups are understudied, limiting generalizability and tailoring of interventions to local health system resources, culture, and patient needs or preferences.

SUMMARY

eHealth is a promising tool for addressing low medication adherence. Further work incorporating rigorous evaluation, assessment of patient engagement over time and effectiveness of intervention characteristics and components, and a health equity lens addressing eHealth use in vulnerable groups will increase understanding of the full potential of eHealth for improving medication adherence in diverse patients with cardiometabolic disease.

Prevalence and correlates of medication reminder app ‘use and use intention’ among older adults

Background

Medication adherence is relatively poor among older adults. Although there exist medication reminder apps, data on the prevalence and correlates of their ‘use and use intention’ by older adults are limited.

Objective

To examine the prevalence, and socio-demographic and health correlates of medication reminder app use and use intention among older adults in Singapore.

Methods

Data from a nationally representative survey of 2228 adults aged 62 years and above, who were taking at least one prescription medication, were analysed. Medication reminder app use (in the past one month) and use intention (in the next one month) were self-reported. Bivariate and multivariable logistic regression models were used to identify the correlates of medication reminder app use and use intention.

Results

The prevalence of medication reminder app use and use intention was low at 2.6% (comprising 0.5% for use and 2.1% for use intention). Age, ethnicity, education level, previous participation in information technology/computer-related courses, comorbidity, health literacy, medication adherence and polypharmacy were correlated with app use and use intention in multivariable analyses.

Conclusion

The very low prevalence of medication reminder app use and use intention among older adults in Singapore and identified correlates point to opportunities to increase the use of such apps.

Comparing the Acceptance of Mobile Hypertension Apps for Disease Management Among Patients Versus Clinical Use Among Physicians: Cross-sectional Survey

Background

High blood pressure or hypertension is a vastly prevalent chronic condition among adults that can, if not appropriately treated, contribute to several life-threatening secondary diseases and events, such as stroke. In addition to first-line medication, self-management in daily life is crucial for tertiary prevention and can be supported by mobile health apps, including medication reminders. However, the prescription of medical apps is a relatively novel approach. There is limited information regarding the determinants of acceptance of such mobile health (mHealth) apps among patients as potential users and physicians as impending prescribers in direct comparison.

Objective

The present study aims to investigate the determinants of the acceptance of health apps (in terms of intention to use) among patients for personal use and physicians for clinical use in German-speaking countries. Moreover, we assessed patients’ preferences regarding different delivery modes for self-care service (face-to-face services, apps, etc).

Methods

Based on an extended model of the unified theory of acceptance and use of technology (UTAUT2), we performed a web-based cross-sectional survey to explore the acceptance of mHealth apps for self-management of hypertension among patients and physicians in Germany. In addition to UTAUT2 variables, we measured self-reported self-efficacy, eHealth literacy, previous experiences with health apps, perceived threat to privacy, and protection motivation as additional determinants of mHealth acceptance. Data from 163 patients and 46 physicians were analyzed using hierarchical regression and mediation analyses.

Results

As expected, a significant influence of the unified theory of acceptance and use of technology (UTAUT) predictors on intentions to use hypertension apps was confirmed, especially for performance expectancy. Intention to use was moderate in patients (mean 3.5; SD 1.1; range 1-5) and physicians (mean 3.4, SD 0.9), and did not differ between both groups. Among patients, a higher degree of self-reported self-efficacy and protection motivation contributed to an increased explained variance in acceptance with R²=0.09, whereas eHealth literacy was identified as exerting a positive influence on physicians (increased R²=0.10). Furthermore, our findings indicated mediating effects of performance expectancy on the acceptance among patients but not among physicians.

Conclusions

In summary, this study has identified performance expectancy as the most important determinant of the acceptance of mHealth apps for self-management of hypertension among patients and physicians. Concerning patients, we also identified mediating effects of performance expectancy on the relationships between effort expectancy and social influence and the acceptance of apps. Self-efficacy and protection motivation also contributed to an increase in the explained variance in app acceptance among patients, whereas eHealth literacy was a predictor in physicians. Our findings on additional determinants of the acceptance of health apps may help tailor educational material and self-management interventions to the needs and preferences of prospective users of hypertension apps in future research.

A qualitative exploration of adolescents’ experiences of digital Dialectical Behaviour Therapy during the COVID-19 pandemic

The UK government implemented national social-distancing measures in response to the global COVID19 pandemic. As a result, many appointments in the National Health Service (NHS) took place virtually, including psychological interventions in out-patient settings. This study explored the experiences of adolescents participating in a dialectical behaviour therapy (DBT-A) programme via teletherapy (i.e. via video or telephone call) in a Children and Adolescent Mental Health Service (CAMHS). Thirteen adolescents with emotion dysregulation and related problems completed an online qualitative survey about their experience and acceptance of DBT-A delivered virtually. Thematic analysis was conducted on the survey data and generated three over-arching themes: (1) sense of loss; (2) feeling uncontained; and (3) benefits of virtual DBT. These over-arching themes were composed of eight subthemes (‘loss of connection with group and therapist’; ‘loss of skills-building opportunities’; ‘limited privacy’; ‘lack of safe therapy space’; ‘difficult endings’; ‘home comforts’; ‘convenience and accessibility’; and ‘easier to participate with others’). This study suggests that adolescents doing virtual DBT-A need approaches that acknowledge and address the additional relational, emotional and practical challenges of online therapy while maintaining fidelity to the evidence-based treatment model. Suggestions for further research and preliminary practice guidelines are discussed.

Key learning aims

(1)

Collection of the International Hip Outcome Tool-12 Using a Smartphone Application Format Is Faster and Preferred When Compared With the Paper Version: A Pilot Study of rHip

Purpose

To evaluate the agreeability between the mobile application-based International Hip Outcome Tool-12 (iHOT-12) survey with the paper version, as well as compare the time it takes patients each of the versions, and patient preferences between the two.

Methods

Patients seen with symptomatic femoroacetabular impingement syndrome were prospectively enrolled in February 2019 and completed both the paper and application-based iHOT-12, in randomized order. Outcomes scores and time to completion were recorded for each version, and patients were also asked which they preferred. Intraclass correlation coefficient was calculated to assess for absolute agreement between the 2 versions. Bland–Altman plots were constructed to evaluate the agreeability between paper and application-based iHOT-12 scores. Bland–Altman plots were evaluated to identify systematic bias and data stratification was performed to identify sequence bias between the application and paper-based collection modalities.

Results

Twenty-nine patients (aged15-56 years) completed both the paper and application-based versions of the iHOT-12. Between the application-based and paper versions, the intraclass correlation coefficient was 0.98, and Bland–Altman analysis showed agreement without bias between versions. There was no sequence bias. Accounting for completion order, the application-based iHOT-12 was faster for patients when compared to the paper version (61.4 ± 20.3 vs 71.9 ± 23.6 seconds, P = .02). Twenty-two patients reported a version preference where 19 of 22 (86%) chose application-based (P < .001).

Conclusions

The application-based iHOT-12 demonstrated absolute agreement with the paper iHOT-12, and is faster for patients to complete. Patients preferred using the application-based iHOT-12 over the paper-based version. Application-based PROs allow for collection of patient data at more frequent time points, which may be helpful in tracking the recovery progress of patients and predicting outcomes.

Clinical Relevance

As electronic-based outcome surveys become more common, it is important to know how the results may differ from traditional paper-based surveys.

Patient and caregiver perspectives on blood pressure in children with chronic kidney disease

BACKGROUND

Over 50% of children with chronic kidney disease (CKD) have uncontrolled hypertension, increasing their long-term risk of cardiovascular disease and progression to kidney failure. Children receiving medications or dialysis may also experience acute blood pressure fluctuations accompanied by debilitating symptoms. We aimed to describe the perspectives of children with CKD and their parental caregivers on blood pressure, to inform patient-centered care.

METHODS

Secondary thematic analysis was conducted on qualitative data from the Standardized Outcomes in Nephrology-Children and Adolescents initiative, encompassing 16 focus groups, an international Delphi survey, and two consensus workshops. We analyzed responses from children with CKD (aged 8-21 years) and caregivers (of children aged 0-21 years) pertaining to blood pressure.

RESULTS

Overall, 120 patients and 250 caregivers from 22 countries participated. We identified five themes: invisibility and normalization (reassured by apparent normotension, absence of symptoms, expected links with CKD); confused by ambiguity (hypertension indistinguishable from cardiovascular disease, questioning need for prophylactic intervention, frustrated by inconsistent messages, struggling with technical skills in measurement); enabling monitoring and maintaining health (gauging wellbeing, preventing vascular complications); debilitating and constraining daily living (provoking anxiety and agitation, helpless and powerless, limiting life activities); and burden of medications (overwhelmed by quantity of tablets, distress from unexpected side effects).

CONCLUSIONS

For children with CKD and their caregivers, blood pressure was an important heath indicator, but uncertainty around its implications and treatment hampered management. Providing educational resources to track blood pressure, and minimizing symptoms and treatment burden, may improve outcomes in children with CKD.