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Bennett MI, Allsop MJ, Allen P, Allmark C, Bewick BM, Black K, Blenkinsopp A, Brown J, Closs SJ, Edwards Z, Flemming K, Fletcher M, Foy R, Godfrey M, Hackett J, Hall G, Hartley S, Howdon D, Hughes N, Hulme C, Jones R, Meads D, Mulvey MR, O’Dwyer J, Pavitt SH, Rainey P, Robinson D, Taylor S, Wray A, Wright-Hughes A, Ziegler L. Pain self-management interventions for community-based patients with advanced cancer: a research programme including the IMPACCT RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2021. [DOI: 10.3310/pgfar09150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background
Each year in England and Wales, 150,000 people die from cancer, of whom 110,000 will suffer from cancer pain. Research highlights that cancer pain remains common, severe and undertreated, and may lead to hospital admissions.
Objective
To develop and evaluate pain self-management interventions for community-based patients with advanced cancer.
Design
A programme of mixed-methods intervention development work leading to a pragmatic multicentre randomised controlled trial of a multicomponent intervention for pain management compared with usual care, including an assessment of cost-effectiveness.
Participants
Patients, including those with metastatic solid cancer (histological, cytological or radiological evidence) and/or those receiving anti-cancer therapy with palliative intent, and health professionals involved in the delivery of community-based palliative care.
Setting
For the randomised controlled trial, patients were recruited from oncology outpatient clinics and were randomly allocated to intervention or control and followed up at home.
Interventions
The Supported Self-Management intervention comprised an educational component called Tackling Cancer Pain, and an eHealth component for routine pain assessment and monitoring called PainCheck.
Main outcome measures
The primary outcome was pain severity (measured using the Brief Pain Inventory). The secondary outcomes included pain interference (measured using the Brief Pain Inventory), participants’ pain knowledge and experience, and cost-effectiveness. We estimated costs and health-related quality-of-life outcomes using decision modelling and a separate within-trial economic analysis. We calculated incremental cost-effectiveness ratios per quality-adjusted life-year for the trial period.
Results
Work package 1 – We found barriers to and variation in the co-ordination of advanced cancer care by oncology and primary care professionals. We identified that the median time between referral to palliative care services and death for 42,758 patients in the UK was 48 days. We identified key components for self-management and developed and tested our Tackling Cancer Pain resource for acceptability. Work package 2 – Patients with advanced cancer and their health professionals recognised the benefits of an electronic system to monitor pain, but had reservations about how such a system might work in practice. We developed and tested a prototype PainCheck system. Work package 3 – We found that strong opioids were prescribed for 48% of patients in the last year of life at a median of 9 weeks before death. We delivered Medicines Use Reviews to patients, in which many medicines-related problems were identified. Work package 4 – A total of 161 oncology outpatients were randomised in our clinical trial, receiving either supported self-management (n = 80) or usual care (n = 81); their median survival from randomisation was 53 weeks. Primary and sensitivity analyses found no significant treatment differences for the primary outcome or for other secondary outcomes of pain severity or health-related quality of life. The literature-based decision modelling indicated that information and feedback interventions similar to the supported self-management intervention could be cost-effective. This model was not used to extrapolate the outcomes of the trial over a longer time horizon because the statistical analysis of the trial data found no difference between the trial arms in terms of the primary outcome measure (pain severity). The within-trial economic evaluation base-case analysis found that supported self-management reduced costs by £587 and yielded marginally higher quality-adjusted life-years (0.0018) than usual care. However, the difference in quality-adjusted life-years between the two trial arms was negligible and this was not in line with the decision model that had been developed. Our process evaluation found low fidelity of the interventions delivered by clinical professionals.
Limitations
In the randomised controlled trial, the low fidelity of the interventions and the challenge of the study design, which forced the usual-care arm to have earlier access to palliative care services, might explain the lack of observed benefit. Overall, 71% of participants returned outcome data at 6 or 12 weeks and so we used administrative data to estimate costs. Our decision model did not include the negative trial results from our randomised controlled trial and, therefore, may overestimate the likelihood of cost-effectiveness.
Conclusions
Our programme of research has revealed new insights into how patients with advanced cancer manage their pain and the challenges faced by health professionals in identifying those who need more help. Our clinical trial failed to show an added benefit of our interventions to enhance existing community palliative care support, although both the decision model and the economic evaluation of the trial indicated that supported self-management could result in lower health-care costs.
Future work
There is a need for further research to (1) understand and facilitate triggers that prompt earlier integration of palliative care and pain management within oncology services; (2) determine the optimal timing of technologies for self-management; and (3) examine prescriber and patient behaviour to achieve the earlier initiation and use of strong opioid treatment.
Trial registration
Current Controlled Trials ISRCTN18281271.
Funding
This project was funded by the National Institute for Health Research Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Matthew J Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | | | - Bridgette M Bewick
- Psychological and Social Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | | | - Julia Brown
- Clinical Trials Research Unit, Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - S José Closs
- School of Healthcare, University of Leeds, Leeds, UK
| | - Zoe Edwards
- School of Pharmacy, University of Bradford, Bradford, UK
| | - Kate Flemming
- Department of Health Sciences, University of York, York, UK
| | - Marie Fletcher
- Clinical Trials Research Unit, Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - Robbie Foy
- Division of Primary Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Mary Godfrey
- Academic Unit of Elderly Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Julia Hackett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Geoff Hall
- Division of Pathology and Data Analytics, Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Suzanne Hartley
- Clinical Trials Research Unit, Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - Daniel Howdon
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Claire Hulme
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Richard Jones
- Yorkshire Centre for Health Informatics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - David Meads
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Matthew R Mulvey
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - John O’Dwyer
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Sue H Pavitt
- School of Dentistry, University of Leeds, Leeds, UK
| | | | | | - Sally Taylor
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Angela Wray
- Psychological and Social Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Lucy Ziegler
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Gholamzadeh M, Abtahi H, Ghazisaeeidi M. Applied techniques for putting pre-visit planning in clinical practice to empower patient-centered care in the pandemic era: a systematic review and framework suggestion. BMC Health Serv Res 2021; 21:458. [PMID: 33985502 PMCID: PMC8116646 DOI: 10.1186/s12913-021-06456-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/27/2021] [Indexed: 11/28/2022] Open
Abstract
Background One of the main elements of patient-centered care is an enhancement of patient preparedness. Thus, pre-visit planning assessment tools was emerged to prepare and involve patients in their treatment process. Objective The main objective of this article was to review the applied tools and techniques for consideration of putting pre-visit planning into practice. Methods Web of Science, Scopus, IEEE, and PubMed databases were searched using keywords from January 2001 to November 2020. The review was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Then, qualitative analysis was done to suggest an appropriate framework by mapping the main concepts. Results Out of 385 citations were retrieved in initial database searches, 49 studies from ten countries were included. Applied pre-visit techniques can be classified into eight categories. Our results showed that almost 81% of studies were related to procedures that were done between each visit, while 42% of articles were related to before visits. Accordingly, the main approach of included articles was patient preparedness. While 38 studies reported this approach is effective, three studies reported the effectiveness of such tools as moderate, only two articles believed it had a low effect on improving patient-centered care. Conclusion This survey summarized the characteristics of published studies on pre-visit planning in the proposed framework. This approach could enhance the quality of patient care alongside enhancement patient-provider communication. However, such an approach can also be helpful to control pandemic diseases by reducing unnecessary referrals. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06456-7.
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Affiliation(s)
- Marsa Gholamzadeh
- Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, 5th Floor, Fardanesh Alley, Qods Ave, Tehran, Iran
| | - Hamidreza Abtahi
- Pulmonary and Critical care Medicine Department, Thoracic Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Ghazisaeeidi
- Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, 5th Floor, Fardanesh Alley, Qods Ave, Tehran, Iran.
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Melchiorre MG, Papa R, Quattrini S, Lamura G, Barbabella F. Integrated Care Programs for People with Multimorbidity in European Countries: eHealth Adoption in Health Systems. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9025326. [PMID: 32337283 PMCID: PMC7168691 DOI: 10.1155/2020/9025326] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 03/07/2020] [Indexed: 01/28/2023]
Abstract
INTRODUCTION eHealth applications have the potential to provide new integrated care services to patients with multimorbidity (MM), also supporting multidisciplinary care. The aim of this paper is to explore how widely eHealth tools have been currently adopted in integrated care programs for (older) people with MM in European countries, including benefits and barriers concerning their adoption, according to some basic health system characteristics. MATERIALS AND METHODS In 2014, in the framework of the ICARE4EU project, expert organizations in 24 European countries identified 101 integrated care programs. Managers of the selected programs completed an online questionnaire on several dimensions, including the use of eHealth. We analyzed data from this questionnaire, in addition to qualitative information from six innovative programs which were studied in depth through case study methodology, according to characteristics of national health systems: a national health model (financing system), overall strength of primary care (PC) (structure/service delivery process), and level of (de)centralization of health system (executive powers in a country). RESULTS 85 programs (out of 101) adopted at least one eHealth tool, and 42 of these targeted explicitly older people. In most cases, Electronic Health Records (EHRs) were used and some benefits emerged like improved care management and integration, although inadequate funding mechanisms represented a major barrier. The analysis by health system characteristics showed a greater adoption of eHealth applications in decentralized countries, in countries with a National Health Service (NHS) model, and in countries with a strong/medium level of PC development. CONCLUSIONS Although in the light of some limitations, findings indicate a relation between implementation of care programs using eHealth tools and basic characteristics of health systems, with decentralization of a health system, NHS model, and strong/medium PC having a key role. However adaptations of European health systems seem necessary, in order to provide a more innovative and integrated care.
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Affiliation(s)
- Maria Gabriella Melchiorre
- Centre for Socio-Economic Research on Ageing, National Institute of Health and Science on Ageing, IRCCS INRCA, Via S. Margherita 5, 60124 Ancona, Italy
| | - Roberta Papa
- Centre for Socio-Economic Research on Ageing, National Institute of Health and Science on Ageing, IRCCS INRCA, Via S. Margherita 5, 60124 Ancona, Italy
| | - Sabrina Quattrini
- Centre for Socio-Economic Research on Ageing, National Institute of Health and Science on Ageing, IRCCS INRCA, Via S. Margherita 5, 60124 Ancona, Italy
| | - Giovanni Lamura
- Centre for Socio-Economic Research on Ageing, National Institute of Health and Science on Ageing, IRCCS INRCA, Via S. Margherita 5, 60124 Ancona, Italy
| | - Francesco Barbabella
- Centre for Socio-Economic Research on Ageing, National Institute of Health and Science on Ageing, IRCCS INRCA, Via S. Margherita 5, 60124 Ancona, Italy
| | - on behalf of ICARE4EU Consortium
- Centre for Socio-Economic Research on Ageing, National Institute of Health and Science on Ageing, IRCCS INRCA, Via S. Margherita 5, 60124 Ancona, Italy
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Perceived value of eHealth among people living with multimorbidity: a qualitative study. JOURNAL OF COMORBIDITY 2017; 7:96-111. [PMID: 29359124 PMCID: PMC5777537 DOI: 10.15256/joc.2017.7.98] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 07/12/2017] [Indexed: 12/02/2022]
Abstract
Background The prevalence of multimorbidity is increasing, creating challenges for patients, healthcare professionals, and healthcare systems. Given that chronic disease management increasingly involves eHealth, it is useful to assess its perceived value among people with multimorbidity. Objective To explore challenges related to multimorbidity and patients’ perspectives on eHealth. Design Ten semi-structured interviews with adults, living with multimorbidity in Copenhagen, Denmark. Interviews focused on patient-experienced challenges, from challenges related to self-management to challenges experienced in the healthcare sector, as well as perceptions of eHealth. During interviews, participants were presented with pictures of different eHealth technologies. Data analysis followed the systematic text condensation approach. Results Participants experienced challenges in their daily lives, e.g. when practicing self-management activities, when navigating the healthcare sector, and when interacting with healthcare professionals. Patient-perceived value of eHealth varied, depending on their burden of illness and treatment: those with a greater burden had more positive perceptions of eHealth, and expressed more intention to use it. Participants with less complex disease patterns and less burdensome treatment regimens were more likely to perceive eHealth as something worthless and undesirable. Participants stressed that eHealth should only be introduced as an optional supplement. Conclusions eHealth can potentially address some patient-experienced challenges related to multimorbidity by promoting self-management, patient-centeredness, and access. However, patients’ needs and preferences vary and eHealth cannot substitute the personal interaction between patient and healthcare professionals. Our findings point to the importance of patient assessment and stratification to ensure appropriate use of eHealth.
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Seil K, Marcum J, Lall R, Stayton C. Utility of a near real-time emergency department syndromic surveillance system to track injuries in New York City. Inj Epidemiol 2015; 2:11. [PMID: 27747743 PMCID: PMC5005715 DOI: 10.1186/s40621-015-0044-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 05/12/2015] [Indexed: 12/17/2022] Open
Abstract
Background The New York City emergency department (ED) syndromic surveillance (SS) system provides near real-time data on the majority of ED visits. The utility of ED SS for injury surveillance has not been thoroughly evaluated. We created injury syndromes based on ED chief complaint information and evaluated their utility compared to administrative billing data. Methods Six injury syndromes were developed: traffic-related injuries to pedal cyclists, pedestrians, and motor vehicle occupants; fall-related injuries; firearm-related injuries; and assault-related stabbings. Daily injury counts were compared for ED SS and the administrative billing data for years 2008–2010. We examined characteristics of injury trends and patterns between the two systems, calculating descriptive statistics for temporal patterns and Pearson correlation coefficients (r) for temporal trends. We also calculated proportions of demographic and geospatial patterns for both systems. Results Although daily volume of the injuries varied between the two systems, the temporal patterns were similar (all r values for daily volume exceeded 0.65). Comparisons of injuries by time of day, day of week, and quarter of year demonstrated high agreement between the two systems—the majority had an absolute percentage point difference of 2.0 or less. Distributions of injury by sex and age group also aligned well. Distribution of injury by neighborhood of residence showed mixed results—some neighborhood comparisons showed a high level of agreement between systems, while others were less successful. Conclusions As evidenced by the strong positive correlation coefficients and the small absolute percentage point differences in our comparisons, we conclude that ED SS captures temporal trends and patterns of injury-related ED visits effectively. The system could be used to identify changes in injury patterns, allowing for situational awareness during emergencies, timely response, and public messaging. Electronic supplementary material The online version of this article (doi:10.1186/s40621-015-0044-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kacie Seil
- Bureau of Environmental Disease and Injury Prevention, NYC Department of Health and Mental Hygiene, New York, NY, USA. .,, 1100 West 49th Street, Room 704.11, Austin, TX, 78714, USA.
| | - Jennifer Marcum
- Bureau of Environmental Disease and Injury Prevention, NYC Department of Health and Mental Hygiene, New York, NY, USA
| | - Ramona Lall
- Bureau of Communicable Diseases, NYC Department of Health and Mental Hygiene, New York, NY, USA
| | - Catherine Stayton
- Bureau of Environmental Disease and Injury Prevention, NYC Department of Health and Mental Hygiene, New York, NY, USA
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Development, implementation and evaluation of an information model for archetype based user responsive medical data visualization. J Biomed Inform 2015; 55:196-205. [PMID: 25934466 DOI: 10.1016/j.jbi.2015.04.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Revised: 04/18/2015] [Accepted: 04/22/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND When medical data have been successfully recorded or exchanged between systems there appear a need to present the data consistently to ensure that it is clearly understood and interpreted. A standard based user interface can provide interoperability on the visual level. OBJECTIVES The goal of this research was to develop, implement and evaluate an information model for building user interfaces for archetype based medical data. METHODS The following types of knowledge were identified as important elements and were included in the information model: medical content related attributes, data type related attributes, user-related attributes, device-related attributes. In order to support flexible and efficient user interfaces an approach that represents different types of knowledge with different models separating the medical concept from a visual concept and interface realization was chosen. We evaluated the developed approach using Guideline for Good Evaluation Practice in Health Informatics (GEP-HI). RESULTS We developed a higher level information model to complement the ISO 13606 archetype model. This enabled the specification of the presentation properties at the moment of the archetypes' definition. The model allows realizing different users' perspectives on the data. The approach was implemented and evaluated within a functioning EHR system. The evaluation involved 30 patients of different age and IT experience and 5 doctors. One month of testing showed that the time required reading electronic health records decreased for both doctors (from average 310 to 220s) and patients (from average 95 to 39s). Users reported a high level of satisfaction and motivation to use the presented data visualization approach especially in comparison with their previous experience. CONCLUSION The introduced information model allows separating medical knowledge and presentation knowledge. The additional presentation layer will enrich the graphical user interface's flexibility and will allow an optimal presentation of medical data considering the different users' perspectives and different media used for data presentation.
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Johansen MA, Berntsen GKR, Schuster T, Henriksen E, Horsch A. Electronic symptom reporting between patient and provider for improved health care service quality: a systematic review of randomized controlled trials. part 2: methodological quality and effects. J Med Internet Res 2012; 14:e126. [PMID: 23032363 PMCID: PMC3510713 DOI: 10.2196/jmir.2216] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Revised: 07/11/2012] [Accepted: 07/12/2012] [Indexed: 02/03/2023] Open
Abstract
Background We conducted in two parts a systematic review of randomized controlled trials (RCTs) on electronic symptom reporting between patients and providers to improve health care service quality. Part 1 reviewed the typology of patient groups, health service innovations, and research targets. Four innovation categories were identified: consultation support, monitoring with clinician support, self-management with clinician support, and therapy. Objective To assess the methodological quality of the RCTs, and summarize effects and benefits from the methodologically best studies. Methods We searched Medline, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, and IEEE Xplore for original studies presented in English-language articles between 1990 and November 2011. Risk of bias and feasibility were judged according to the Cochrane recommendation, and theoretical evidence and preclinical testing were evaluated according to the Framework for Design and Evaluation of Complex Interventions to Improve Health. Three authors assessed the risk of bias and two authors extracted the effect data independently. Disagreement regarding bias assessment, extraction, and interpretation of results were resolved by consensus discussions. Results Of 642 records identified, we included 32 articles representing 29 studies. No articles fulfilled all quality requirements. All interventions were feasible to implement in a real-life setting, and theoretical evidence was provided for almost all studies. However, preclinical testing was reported in only a third of the articles. We judged three-quarters of the articles to have low risk for random sequence allocation and approximately half of the articles to have low risk for the following biases: allocation concealment, incomplete outcome data, and selective reporting. Slightly more than one fifth of the articles were judged as low risk for blinding of outcome assessment. Only 1 article had low risk of bias for blinding of participants and personnel. We excluded 12 articles showing high risk or unclear risk for both selective reporting and blinding of outcome assessment from the effect assessment. The authors’ hypothesis was confirmed for 13 (65%) of the 20 remaining articles. Articles on self-management support were of higher quality, allowing us to assess effects in a larger proportion of studies. All except one self-management interventions were equally effective to or better than the control option. The self-management articles document substantial benefits for patients, and partly also for health professionals and the health care system. Conclusion Electronic symptom reporting between patients and providers is an exciting area of development for health services. However, the research generally is of low quality. The field would benefit from increased focus on methods for conducting and reporting RCTs. It appears particularly important to improve blinding of outcome assessment and to precisely define primary outcomes to avoid selective reporting. Supporting self-management seems to be especially promising, but consultation support also shows encouraging results.
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Affiliation(s)
- Monika Alise Johansen
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway.
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Johansen MA, Henriksen E, Horsch A, Schuster T, Berntsen GKR. Electronic symptom reporting between patient and provider for improved health care service quality: a systematic review of randomized controlled trials. part 1: state of the art. J Med Internet Res 2012; 14:e118. [PMID: 23032300 PMCID: PMC3510721 DOI: 10.2196/jmir.2214] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Revised: 07/11/2012] [Accepted: 07/12/2012] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Over the last two decades, the number of studies on electronic symptom reporting has increased greatly. However, the field is very heterogeneous: the choices of patient groups, health service innovations, and research targets seem to involve a broad range of foci. To move the field forward, it is necessary to build on work that has been done and direct further research to the areas holding most promise. Therefore, we conducted a comprehensive review of randomized controlled trials (RCTs) focusing on electronic communication between patient and provider to improve health care service quality, presented in two parts. Part 2 investigates the methodological quality and effects of the RCTs, and demonstrates some promising benefits of electronic symptom reporting. OBJECTIVE To give a comprehensive overview of the most mature part of this emerging field regarding (1) patient groups, (2) health service innovations, and (3) research targets relevant to electronic symptom reporting. METHODS We searched Medline, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, and IEEE Xplore for original studies presented in English-language articles published from 1990 to November 2011. Inclusion criteria were RCTs of interventions where patients or parents reported health information electronically to the health care system for health care purposes and were given feedback. RESULTS Of 642 records identified, we included 32 articles representing 29 studies. The included articles were published from 2002, with 24 published during the last 5 years. The following five patient groups were represented: respiratory and lung diseases (12 studies), cancer (6), psychiatry (6), cardiovascular (3), and diabetes (1). In addition to these, 1 study had a mix of three groups. All included studies, except 1, focused on long-term conditions. We identified four categories of health service innovations: consultation support (7 studies), monitoring with clinician support (12), self-management with clinician support (9), and therapy (1). Most of the research (21/29, 72%) was conducted within four combinations: consultation support innovation in the cancer group (5/29, 17%), monitoring innovation in the respiratory and lung diseases group (8/29, 28%), and self-management innovations in psychiatry (4/29, 14%) and in the respiratory and lung diseases group (4/29, 14%). Research targets in the consultation support studies focused on increased patient centeredness, while monitoring and self-management mainly aimed at documenting health benefits. All except 1 study aiming for reduced health care costs were in the monitoring group. CONCLUSION RCT-based research on electronic symptom reporting has developed enormously since 2002. Research including additional patient groups or new combinations of patient groups with the four identified health service innovations can be expected in the near future. We suggest that developing a generic model (not diagnosis specific) for electronic patient symptom reporting for long-term conditions may benefit the field.
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Affiliation(s)
- Monika Alise Johansen
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway.
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