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Singleton AC, Raeside R, Partridge SR, Hyun KK, Tat-Ko J, Sum SCM, Hayes M, Chow CK, Thiagalingam A, Maka K, Sherman KA, Elder E, Redfern J. Supporting women's health outcomes after breast cancer treatment comparing a text message intervention to usual care: the EMPOWER-SMS randomised clinical trial. J Cancer Surviv 2023; 17:1533-1545. [PMID: 35460441 PMCID: PMC9034445 DOI: 10.1007/s11764-022-01209-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 04/01/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of this study is to evaluate the efficacy, feasibility and acceptability of a co-designed lifestyle-focused text message intervention (EMPOWER-SMS) for breast cancer survivors' self-efficacy, quality of life (QOL), mental (anxiety, depression, stress) and physical (endocrine therapy medication adherence, physical activity, BMI) health. METHODS Single-blind randomised controlled trial (1:1) comparing EMPOWER-SMS to usual care at 6-months (intention-to-treat). SETTING public Breast Cancer Institute (Sydney, Australia). ELIGIBILITY CRITERIA adult (> 18 years) females, < 18-months post-active breast cancer treatment (stage I-III), owned a mobile phone, written informed consent. PRIMARY OUTCOME Self-Efficacy for Managing Chronic Disease Scale at 6 months. Process data: message delivery analytics, cost, and post-intervention survey. RESULTS Participants (N = 160; mean age ± SD 55.1 ± 11.1 years) were recruited 29th-March-2019 to 7th-May-2020 and randomised (n = 80 EMPOWER-SMS: n = 80 control). Baseline mean self-efficacy was high (I: 7.1 [95%CI 6.6, 7.5], C: 7.4 [7, 7.8]). Six-month follow-up: no significant differences between groups for self-efficacy (I: 7.6 [7.3, 7.9], C: 7.6 [7.3, 7.9], adjusted mean difference 0 (95%CI 0.4, 0.4), QOL, mental health, physical activity, or BMI. Significantly less EMPOWER-SMS participants missed ≥ 1 endocrine therapy medication doses compared to control (I: 3/42[7.1%], C: 8/47[17.0%], Adjusted RR 0.13 [95%CI 0.02, 0.91]). Text messages were delivered successfully (7925/8061, 98.3%), costing $13.62USD/participant. Participants strongly/agreed EMPOWER-SMS was easy-to-understand (64/64; 100%), useful (58/64; 90.6%), motivating for lifestyle change (43/64; 67.2%) and medication adherence (22/46; 47.8%). CONCLUSION EMPOWER-SMS was feasible, inexpensive, acceptable for delivering health information to breast cancer survivors between medical appointments, with minor improvements in medication adherence. IMPLICATIONS FOR CANCER SURVIVORS Text messages offer a feasible strategy for continuity-of-care between medical appointments.
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Affiliation(s)
- Anna C Singleton
- Engagement and Co-design Research Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
| | - Rebecca Raeside
- Engagement and Co-design Research Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Stephanie R Partridge
- Engagement and Co-design Research Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Prevention Research Collaboration, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Karice K Hyun
- Engagement and Co-design Research Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Justin Tat-Ko
- Engagement and Co-design Research Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Stephanie Che Mun Sum
- Engagement and Co-design Research Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Molly Hayes
- Engagement and Co-design Research Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
- George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Research Education Network, Western Sydney Local Health District, Sydney, NSW, Australia
| | - Aravinda Thiagalingam
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
- George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Katherine Maka
- Department of Physiotherapy, Westmead Hospital, Sydney, NSW, Australia
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, NSW, Australia
| | - Kerry A Sherman
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Elisabeth Elder
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, NSW, Australia
| | - Julie Redfern
- Engagement and Co-design Research Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Research Education Network, Western Sydney Local Health District, Sydney, NSW, Australia
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Singleton AC, Estapé T, Ee C, Hyun KK, Partridge SR. Editorial: Digital health quality, acceptability, and cost: steps to effective continuity of cancer care. Front Digit Health 2023; 5:1264638. [PMID: 37636592 PMCID: PMC10455910 DOI: 10.3389/fdgth.2023.1264638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 08/01/2023] [Indexed: 08/29/2023] Open
Affiliation(s)
- Anna C. Singleton
- Engagement and Co-Design Research Hub, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Tanie Estapé
- Department of Psychosocial Oncology, FEFOC Foundation, Barcelona, Spain
| | - Carolyn Ee
- The National Institute of Complementary Medicine, Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Karice K. Hyun
- Engagement and Co-Design Research Hub, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Stephanie R. Partridge
- Engagement and Co-Design Research Hub, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Singleton AC, Raeside R, Hyun KK, Hayes M, Sherman KA, Elder E, Redfern J, Partridge SR. A National Health and Wellness SMS Text Message Program for Breast Cancer Survivors During COVID-19 (EMPOWER-SMS COVID-19): Mixed Methods Evaluation Using the RE-AIM Framework. J Med Internet Res 2023; 25:e45164. [PMID: 37490319 PMCID: PMC10410388 DOI: 10.2196/45164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 05/05/2023] [Accepted: 05/23/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND COVID-19 lockdowns caused widespread closures of supportive care services for breast cancer survivors in Australia. In a randomized controlled trial, our team's lifestyle-focused, evidence-based SMS text message support program (EMPOWER-SMS COVID-19) was found to be acceptable and useful for breast cancer survivors, and it was ready for rapid widespread delivery. OBJECTIVE This study aims to evaluate the reach (uptake) of an adapted 3-month lifestyle-focused SMS text message program (EMPOWER-SMS COVID-19) and barriers and enablers to implementation using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. METHODS A mixed methods pre-post study was conducted to evaluate the EMPOWER-SMS COVID-19 program. The study evaluated the following aspects: (1) reach/representativeness, which refers to the proportion of participant enrollment (ie, number enrolled/number that visited the study website) and demographics (eg, age, sex, ethnicity, time since completing treatment, Index of Relative Socio-economic Advantage and Disadvantage [IRSAD; quintile 1, which refers to most disadvantaged areas, to quintile 5, which refers to least disadvantaged areas, and remoteness); (2) effectiveness, in which participant engagement and acceptability were evaluated using SMS text message reply data and a feedback survey (5-point Likert scale and free-text responses); (3) adoption, which corresponds to the proportion of organizations or health professionals who agreed to promote the program; (4) implementation fidelity and maintenance, which evaluated SMS text message delivery data, opt-outs, costs, and adaptations. Quantitative data were summarized using means and SDs or frequencies and percentages, while qualitative data were analyzed thematically. RESULTS With regard to the reach/representativeness of the program, 841/1340 (62.8%) participants enrolled and provided electronic consent. Participants had a mean age of 58.8 (SD 9.8; range 30-87) years. According to the data collected, most participants identified as female (837/840, 99.6%) and White (736/840, 87.6%) and nearly half (418/841, 49.7%) finished treatment ≤18 months ago. Most resided in major cities (574/838, 68.5%) and 30% (251/838) in IRSAD quintile 1 or 2. In terms of effectiveness, 852 replies were received from 511 unique participants (median 1; range 1-26). The most common replies were participants stating how they heard about the program (467/852, 54.8%) or "thank you" (131/852, 15.4%). None of the replies contained urgent safety concerns. Among participants who provided feedback (449/841, 53.4%), most "(strongly) agreed" the SMS text messages were easy to understand (445/448, 99.3%), useful (373/440, 84.8%), helped participants feel supported (388/448, 86.6%), and motivated participants to be physically active (312/445, 70.1%) and eat healthier (313/457, 68.5%). Free-text responses revealed 5 factors influencing engagement: (1) feeling supported and less alone, (2) motivation and reassurance for health self-management, (3) the variety of information, (4) weblinks to information and resources, and (5) the option to save the SMS text messages. Concerning adoption, 50% (18/36) of organizations/health professionals agreed to promote the program. With regard to implementation/maintenance, SMS text messages were delivered as planned (97.43% [41,257/42,344] of SMS text messages were successfully delivered) with minimal opt-outs (62/838, 7.4%) and low cost (Aus $15.40/participant; Aus $1=US $0.67). No adaptations were made during the intervention period. Postintervention adaptations included adding weblinks and participant-selected customizations. CONCLUSIONS EMPOWER-SMS COVID-19 was implemented quickly, had a broad reach, and had high engagement and acceptability among socioeconomically diverse participants. The program had high fidelity, low cost, and required minimal staff oversight, which may facilitate future implementation. However, further research is needed to evaluate barriers and enablers to adoption and implementation for health professionals and strategies for long-term maintenance.
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Affiliation(s)
- Anna C Singleton
- Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Rebecca Raeside
- Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Karice K Hyun
- Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, Australia
| | - Molly Hayes
- Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Kerry A Sherman
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Elisabeth Elder
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, Australia
| | - Julie Redfern
- Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Research Education Network, Western Sydney Local Health District, Sydney, Australia
| | - Stephanie R Partridge
- Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Singleton AC, Raeside R, Hyun KK, Partridge SR, Di Tanna GL, Hafiz N, Tu Q, Tat-Ko J, Sum SCM, Sherman KA, Elder E, Redfern J. Reply to M. Lv et al. J Clin Oncol 2023; 41:144-145. [PMID: 36122319 DOI: 10.1200/jco.22.01571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Anna C Singleton
- Anna C. Singleton, PhD, and Rebecca Raeside, MPH, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia; Karice K. Hyun, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia, Department of Cardiology, Concord Repatriation General Hospital, ANZAC Research Institute, New South Wales, Australia; Stephanie R. Partridge, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia, Prevention Research Collaboration, Charles Perkins Center, The University of Sydney, New South Wales, Australia; Gian Luca Di Tanna, PhD, The George Institute for Global Health, University of NSW, New South Wales, Australia; Nashid Hafiz, MIPH, Qiang Tu, PhD, Justin Tat-Ko, BMSc, and Stephanie Che Mun Sum, BMSc, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia; Kerry A. Sherman, PhD, Department of Psychology, Center for Emotional Health, Macquarie University, New South Wales, Australia; Elisabeth Elder, PhD, Westmead Breast Cancer Institute, Westmead Hospital, New South Wales, Australia; and Julie Redfern, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia, The George Institute for Global Health, University of NSW, New South Wales, Australia
| | - Rebecca Raeside
- Anna C. Singleton, PhD, and Rebecca Raeside, MPH, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia; Karice K. Hyun, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia, Department of Cardiology, Concord Repatriation General Hospital, ANZAC Research Institute, New South Wales, Australia; Stephanie R. Partridge, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia, Prevention Research Collaboration, Charles Perkins Center, The University of Sydney, New South Wales, Australia; Gian Luca Di Tanna, PhD, The George Institute for Global Health, University of NSW, New South Wales, Australia; Nashid Hafiz, MIPH, Qiang Tu, PhD, Justin Tat-Ko, BMSc, and Stephanie Che Mun Sum, BMSc, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia; Kerry A. Sherman, PhD, Department of Psychology, Center for Emotional Health, Macquarie University, New South Wales, Australia; Elisabeth Elder, PhD, Westmead Breast Cancer Institute, Westmead Hospital, New South Wales, Australia; and Julie Redfern, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia, The George Institute for Global Health, University of NSW, New South Wales, Australia
| | - Karice K Hyun
- Anna C. Singleton, PhD, and Rebecca Raeside, MPH, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia; Karice K. Hyun, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia, Department of Cardiology, Concord Repatriation General Hospital, ANZAC Research Institute, New South Wales, Australia; Stephanie R. Partridge, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia, Prevention Research Collaboration, Charles Perkins Center, The University of Sydney, New South Wales, Australia; Gian Luca Di Tanna, PhD, The George Institute for Global Health, University of NSW, New South Wales, Australia; Nashid Hafiz, MIPH, Qiang Tu, PhD, Justin Tat-Ko, BMSc, and Stephanie Che Mun Sum, BMSc, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia; Kerry A. Sherman, PhD, Department of Psychology, Center for Emotional Health, Macquarie University, New South Wales, Australia; Elisabeth Elder, PhD, Westmead Breast Cancer Institute, Westmead Hospital, New South Wales, Australia; and Julie Redfern, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia, The George Institute for Global Health, University of NSW, New South Wales, Australia
| | - Stephanie R Partridge
- Anna C. Singleton, PhD, and Rebecca Raeside, MPH, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia; Karice K. Hyun, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia, Department of Cardiology, Concord Repatriation General Hospital, ANZAC Research Institute, New South Wales, Australia; Stephanie R. Partridge, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia, Prevention Research Collaboration, Charles Perkins Center, The University of Sydney, New South Wales, Australia; Gian Luca Di Tanna, PhD, The George Institute for Global Health, University of NSW, New South Wales, Australia; Nashid Hafiz, MIPH, Qiang Tu, PhD, Justin Tat-Ko, BMSc, and Stephanie Che Mun Sum, BMSc, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia; Kerry A. Sherman, PhD, Department of Psychology, Center for Emotional Health, Macquarie University, New South Wales, Australia; Elisabeth Elder, PhD, Westmead Breast Cancer Institute, Westmead Hospital, New South Wales, Australia; and Julie Redfern, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia, The George Institute for Global Health, University of NSW, New South Wales, Australia
| | - Gian Luca Di Tanna
- Anna C. Singleton, PhD, and Rebecca Raeside, MPH, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia; Karice K. Hyun, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia, Department of Cardiology, Concord Repatriation General Hospital, ANZAC Research Institute, New South Wales, Australia; Stephanie R. Partridge, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia, Prevention Research Collaboration, Charles Perkins Center, The University of Sydney, New South Wales, Australia; Gian Luca Di Tanna, PhD, The George Institute for Global Health, University of NSW, New South Wales, Australia; Nashid Hafiz, MIPH, Qiang Tu, PhD, Justin Tat-Ko, BMSc, and Stephanie Che Mun Sum, BMSc, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia; Kerry A. Sherman, PhD, Department of Psychology, Center for Emotional Health, Macquarie University, New South Wales, Australia; Elisabeth Elder, PhD, Westmead Breast Cancer Institute, Westmead Hospital, New South Wales, Australia; and Julie Redfern, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia, The George Institute for Global Health, University of NSW, New South Wales, Australia
| | - Nashid Hafiz
- Anna C. Singleton, PhD, and Rebecca Raeside, MPH, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia; Karice K. Hyun, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia, Department of Cardiology, Concord Repatriation General Hospital, ANZAC Research Institute, New South Wales, Australia; Stephanie R. Partridge, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia, Prevention Research Collaboration, Charles Perkins Center, The University of Sydney, New South Wales, Australia; Gian Luca Di Tanna, PhD, The George Institute for Global Health, University of NSW, New South Wales, Australia; Nashid Hafiz, MIPH, Qiang Tu, PhD, Justin Tat-Ko, BMSc, and Stephanie Che Mun Sum, BMSc, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia; Kerry A. Sherman, PhD, Department of Psychology, Center for Emotional Health, Macquarie University, New South Wales, Australia; Elisabeth Elder, PhD, Westmead Breast Cancer Institute, Westmead Hospital, New South Wales, Australia; and Julie Redfern, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia, The George Institute for Global Health, University of NSW, New South Wales, Australia
| | - Qiang Tu
- Anna C. Singleton, PhD, and Rebecca Raeside, MPH, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia; Karice K. Hyun, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia, Department of Cardiology, Concord Repatriation General Hospital, ANZAC Research Institute, New South Wales, Australia; Stephanie R. Partridge, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia, Prevention Research Collaboration, Charles Perkins Center, The University of Sydney, New South Wales, Australia; Gian Luca Di Tanna, PhD, The George Institute for Global Health, University of NSW, New South Wales, Australia; Nashid Hafiz, MIPH, Qiang Tu, PhD, Justin Tat-Ko, BMSc, and Stephanie Che Mun Sum, BMSc, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia; Kerry A. Sherman, PhD, Department of Psychology, Center for Emotional Health, Macquarie University, New South Wales, Australia; Elisabeth Elder, PhD, Westmead Breast Cancer Institute, Westmead Hospital, New South Wales, Australia; and Julie Redfern, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia, The George Institute for Global Health, University of NSW, New South Wales, Australia
| | - Justin Tat-Ko
- Anna C. Singleton, PhD, and Rebecca Raeside, MPH, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia; Karice K. Hyun, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia, Department of Cardiology, Concord Repatriation General Hospital, ANZAC Research Institute, New South Wales, Australia; Stephanie R. Partridge, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia, Prevention Research Collaboration, Charles Perkins Center, The University of Sydney, New South Wales, Australia; Gian Luca Di Tanna, PhD, The George Institute for Global Health, University of NSW, New South Wales, Australia; Nashid Hafiz, MIPH, Qiang Tu, PhD, Justin Tat-Ko, BMSc, and Stephanie Che Mun Sum, BMSc, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia; Kerry A. Sherman, PhD, Department of Psychology, Center for Emotional Health, Macquarie University, New South Wales, Australia; Elisabeth Elder, PhD, Westmead Breast Cancer Institute, Westmead Hospital, New South Wales, Australia; and Julie Redfern, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia, The George Institute for Global Health, University of NSW, New South Wales, Australia
| | - Stephanie Che Mun Sum
- Anna C. Singleton, PhD, and Rebecca Raeside, MPH, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia; Karice K. Hyun, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia, Department of Cardiology, Concord Repatriation General Hospital, ANZAC Research Institute, New South Wales, Australia; Stephanie R. Partridge, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia, Prevention Research Collaboration, Charles Perkins Center, The University of Sydney, New South Wales, Australia; Gian Luca Di Tanna, PhD, The George Institute for Global Health, University of NSW, New South Wales, Australia; Nashid Hafiz, MIPH, Qiang Tu, PhD, Justin Tat-Ko, BMSc, and Stephanie Che Mun Sum, BMSc, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia; Kerry A. Sherman, PhD, Department of Psychology, Center for Emotional Health, Macquarie University, New South Wales, Australia; Elisabeth Elder, PhD, Westmead Breast Cancer Institute, Westmead Hospital, New South Wales, Australia; and Julie Redfern, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia, The George Institute for Global Health, University of NSW, New South Wales, Australia
| | - Kerry A Sherman
- Anna C. Singleton, PhD, and Rebecca Raeside, MPH, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia; Karice K. Hyun, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia, Department of Cardiology, Concord Repatriation General Hospital, ANZAC Research Institute, New South Wales, Australia; Stephanie R. Partridge, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia, Prevention Research Collaboration, Charles Perkins Center, The University of Sydney, New South Wales, Australia; Gian Luca Di Tanna, PhD, The George Institute for Global Health, University of NSW, New South Wales, Australia; Nashid Hafiz, MIPH, Qiang Tu, PhD, Justin Tat-Ko, BMSc, and Stephanie Che Mun Sum, BMSc, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia; Kerry A. Sherman, PhD, Department of Psychology, Center for Emotional Health, Macquarie University, New South Wales, Australia; Elisabeth Elder, PhD, Westmead Breast Cancer Institute, Westmead Hospital, New South Wales, Australia; and Julie Redfern, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia, The George Institute for Global Health, University of NSW, New South Wales, Australia
| | - Elisabeth Elder
- Anna C. Singleton, PhD, and Rebecca Raeside, MPH, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia; Karice K. Hyun, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia, Department of Cardiology, Concord Repatriation General Hospital, ANZAC Research Institute, New South Wales, Australia; Stephanie R. Partridge, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia, Prevention Research Collaboration, Charles Perkins Center, The University of Sydney, New South Wales, Australia; Gian Luca Di Tanna, PhD, The George Institute for Global Health, University of NSW, New South Wales, Australia; Nashid Hafiz, MIPH, Qiang Tu, PhD, Justin Tat-Ko, BMSc, and Stephanie Che Mun Sum, BMSc, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia; Kerry A. Sherman, PhD, Department of Psychology, Center for Emotional Health, Macquarie University, New South Wales, Australia; Elisabeth Elder, PhD, Westmead Breast Cancer Institute, Westmead Hospital, New South Wales, Australia; and Julie Redfern, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia, The George Institute for Global Health, University of NSW, New South Wales, Australia
| | - Julie Redfern
- Anna C. Singleton, PhD, and Rebecca Raeside, MPH, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia; Karice K. Hyun, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia, Department of Cardiology, Concord Repatriation General Hospital, ANZAC Research Institute, New South Wales, Australia; Stephanie R. Partridge, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia, Prevention Research Collaboration, Charles Perkins Center, The University of Sydney, New South Wales, Australia; Gian Luca Di Tanna, PhD, The George Institute for Global Health, University of NSW, New South Wales, Australia; Nashid Hafiz, MIPH, Qiang Tu, PhD, Justin Tat-Ko, BMSc, and Stephanie Che Mun Sum, BMSc, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia; Kerry A. Sherman, PhD, Department of Psychology, Center for Emotional Health, Macquarie University, New South Wales, Australia; Elisabeth Elder, PhD, Westmead Breast Cancer Institute, Westmead Hospital, New South Wales, Australia; and Julie Redfern, PhD, Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, New South Wales, Australia, The George Institute for Global Health, University of NSW, New South Wales, Australia
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Raeside R, Singleton AC, Todd A, Partridge SR, Hyun KK, Kulas H, Wootton SL, Dale MT, Alison JA, McKeough Z, McNamara RJ, Spencer L, Jenkins C, Redfern J. Lung Support Service: Implementation of a Nationwide Text Message Support Program for People with Chronic Respiratory Disease during the COVID-19 Pandemic. Int J Environ Res Public Health 2022; 19:17073. [PMID: 36554954 PMCID: PMC9779082 DOI: 10.3390/ijerph192417073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND COVID-19 pandemic lockdowns led to the closure of most in-person pulmonary rehabilitation programs in Australia. Text message programs are effective for delivering health support to aid the self-management of people with chronic diseases. This study aimed to evaluate the implementation of a six-month pre-post text message support program (Texting for Wellness: Lung Support Service), and the enablers and barriers to its adoption and implementation. METHODS This mixed-methods pre-post study used the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to evaluate the Texting for Wellness: Lung Support Service, which is an automated six-month text message support program that included evidence-based lifestyle, disease-self management and COVID-19-related information. Reach was measured by the proportion of participant enrolments and demographic characteristics. Adoption enablers and barriers were measured using text message response data and a user feedback survey (five-point Likert scale questions and free-text responses). Implementation was evaluated to determine fidelity including text message delivery data, opt-outs, and intervention costs to promote and deliver the program. RESULTS In total, 707/1940 (36.4%) participants enrolled and provided e-consent, with a mean age (±standard deviation) of 67.9 (±9.2) years old (range: 23-87 years). Of participants who provided feedback, (326/707) most 'agreed' or 'strongly agreed' that the text messages were easy to understand (98.5%), helpful them to feel supported (92.3%) and helped them to manage their health (88.0%). Factors influencing engagement included a feeling of support and reducing loneliness, and its usefulness for health self-management. Messages were delivered as planned (93.7% successfully delivered) with minimal participant dropouts (92.2% retention rate) and low cost ($AUD24.48/participant for six months). A total of 2263 text message replies were received from 496 unique participants. There were no reported adverse events. CONCLUSION Texting for Wellness: Lung Support Service was implemented quickly, had a broad reach, with high retention and acceptability among participants. The program was low cost and required minimal staff oversight, which may facilitate future implementation. Further research is needed to evaluate the efficacy of text messaging for the improvement of lung health outcomes and strategies for long-term pulmonary rehabilitation program maintenance.
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Affiliation(s)
- Rebecca Raeside
- Engagement and Co-Design Research Hub, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2145, Australia
| | - Anna C. Singleton
- Engagement and Co-Design Research Hub, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2145, Australia
| | - Allyson Todd
- Engagement and Co-Design Research Hub, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2145, Australia
| | - Stephanie R. Partridge
- Engagement and Co-Design Research Hub, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2145, Australia
| | - Karice K. Hyun
- Engagement and Co-Design Research Hub, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2145, Australia
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, NSW 2137, Australia
| | - Helen Kulas
- NSW Agency for Clinical Innovation, Sydney, NSW 2065, Australia
| | - Sally L. Wootton
- Chronic Disease Community Rehabilitation Service, Northern Sydney Local Health District, Sydney, NSW 2103, Australia
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Marita T. Dale
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Jennifer A. Alison
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
- Allied Health Research and Education Unit, Sydney Local Health District, Sydney, NSW 2050, Australia
| | - Zoe McKeough
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Renae J. McNamara
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
- Department of Physiotherapy, Prince of Wales Hospital, Sydney, NSW 2031, Australia
- Woolcock Institute of Medical Research, Sydney, NSW 2037, Australia
| | - Lissa Spencer
- Department of Physiotherapy, Sydney Local Health District, Sydney, NSW 2050, Australia
| | - Christine Jenkins
- Institute of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
| | - Julie Redfern
- Engagement and Co-Design Research Hub, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2145, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2042, Australia
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Singleton AC, Raeside R, Hyun KK, Partridge SR, Di Tanna GL, Hafiz N, Tu Q, Tat-Ko J, Sum SCM, Sherman KA, Elder E, Redfern J. Electronic Health Interventions for Patients With Breast Cancer: Systematic Review and Meta-Analyses. J Clin Oncol 2022; 40:2257-2270. [PMID: 35500200 PMCID: PMC9273371 DOI: 10.1200/jco.21.01171] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Ongoing supportive care using electronic health (eHealth) interventions has the potential to provide remote support and improve health outcomes for patients with breast cancer. This study aimed to evaluate the effectiveness of eHealth interventions on patient-reported outcomes (quality of life [QOL], self-efficacy, and mental or physical health) for patients during and after breast cancer treatment and patient-reported experience measures (acceptability and engagement). METHODS Systematic review with meta-analyses (random-effects model) of randomized controlled trials was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Nine databases were searched using a prespecified search strategy. Patient-directed eHealth interventions for adult patients during or after active breast cancer treatment measuring QOL, self-efficacy, and mental (depressive, anxiety, and distress symptoms) or physical (physical activity, nutrition, and fatigue) health outcomes were included. Data from eligible full-text articles were independently extracted by six observers. RESULTS Thirty-two unique studies (4,790 patients) were included. All were health self-management interventions, and most were multicomponent (videos, forums, and electronic reminder systems) websites. Meta-analyses revealed a significant effect of eHealth interventions on QOL (standardized mean difference [SMD], 0.20 [95% CI, 0.03 to 0.36]), self-efficacy (SMD, 0.45 [95% CI, 0.24 to 0.65]), distress (SMD, -0.41 [95% CI,-0.63 to -0.20]), and fatigue (SMD, -0.37 [95% CI, -0.61 to -0.13]). Twenty-five studies (78.1%) measured patient-reported experience measures. Acceptability (n = 9) was high, with high ratings for satisfaction (range, 71%-100%), usefulness (range, 71%-95%), and ease-of-use (range, 73%-92%). Engagement (n = 25) decreased over time, but disease-focused information and interactive support were most engaging. CONCLUSION eHealth interventions may provide an acceptable and effective strategy for improving QOL, distress, self-efficacy, and fatigue among patients with breast cancer.
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Affiliation(s)
- Anna C. Singleton
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia,Anna C. Singleton, PhD, Level 6 Block K Westmead Hospital, Westmead, New South Wales 2753, Australia; Twitter: @DrAnnaSingleton; e-mail:
| | - Rebecca Raeside
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Karice K. Hyun
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia,Department of Cardiology, Concord Repatriation General Hospital, ANZAC Research Institute, Concord, New South Wales, Australia
| | - Stephanie R. Partridge
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia,Prevention Research Collaboration, Charles Perkins Center, The University of Sydney, Sydney, New South Wales, Australia
| | - Gian Luca Di Tanna
- The George Institute for Global Health, University of NSW, Kensington, New South Wales, Australia
| | - Nashid Hafiz
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Qiang Tu
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Justin Tat-Ko
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Stephanie Che Mun Sum
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Kerry A. Sherman
- Department of Psychology, Center for Emotional Health, Macquarie University, Sydney, New South Wales, Australia
| | - Elisabeth Elder
- Westmead Breast Cancer Institute, Westmead Hospital, Westmead, New South Wales, Australia
| | - Julie Redfern
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia,The George Institute for Global Health, University of NSW, Kensington, New South Wales, Australia
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Singleton A, Raeside R, Partridge SR, Hayes M, Maka K, Hyun KK, Thiagalingam A, Chow CK, Sherman KA, Elder E, Redfern J. Co-designing a Lifestyle-Focused Text Message Intervention for Women After Breast Cancer Treatment: Mixed Methods Study. J Med Internet Res 2021; 23:e27076. [PMID: 34125072 PMCID: PMC8240797 DOI: 10.2196/27076] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 04/07/2021] [Accepted: 05/06/2021] [Indexed: 12/30/2022] Open
Abstract
Background Breast cancer is the most common cancer among women globally. Recovery from breast cancer treatment can be mentally and physically challenging. SMS text message programs offer a novel way to provide health information and support, but few programs are co-designed with consumer representatives. Objective This study aims to report the procedures and outcomes of a co-design process of a lifestyle-focused SMS text message program to support women’s mental and physical health after breast cancer treatment. Methods We followed an iterative mixed methods two-step process: (1) co-design workshop with consumers and health professionals and researchers to draft text messages and (2) evaluation of message content, which was scored (5-point Likert scale; 1=strongly disagree to 5=strongly agree) for ease of understanding, usefulness, and appropriateness, and readability (Flesch-Kincaid score). Additional free-text responses and semistructured interviews were coded into themes. Messages were edited or deleted based on the evaluations, with consumers’ evaluations prioritized. Results In step 1, co-designed text messages (N=189) were semipersonalized, and the main content themes were (1) physical activity and healthy eating, (2) medications and side effects, (3) mental health, and (4) general breast cancer information. In step 2, consumers (n=14) and health professionals and researchers (n=14) provided 870 reviews of 189 messages and found that most messages were easy to understand (799/870, 91.8%), useful (746/870, 85.7%), and appropriate (732/870, 84.1%). However, consumers rated 50 messages differently from health professionals and researchers. On the basis of evaluations, 37.6% (71/189) of messages were deleted, 36.5% (69/189) were edited, and 12 new messages related to fatigue, self-care, and cognition were created. The final 130 text messages had a mean 7.12 (SD 2.8) Flesch-Kincaid grade level and 68.9 (SD 15.5) ease-of-reading score, which represents standard reading ease. Conclusions Co-designing and evaluating a bank of evidence-based mental and physical health-themed text messages with breast cancer survivors, health professionals, and researchers was feasible and resulted in a bank of 130 text messages evaluated highly by participants. Some consumer evaluations differed from health professionals and researchers, supporting the importance of co-design.
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Affiliation(s)
- Anna Singleton
- Consumer Engagement and Codesign Research Hub, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Rebecca Raeside
- Consumer Engagement and Codesign Research Hub, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Stephanie R Partridge
- Consumer Engagement and Codesign Research Hub, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Prevention Research Collaboration, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Molly Hayes
- Consumer Engagement and Codesign Research Hub, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Katherine Maka
- Department of Physiotherapy, Westmead Hospital, Sydney, Australia.,Westmead Breast Cancer Institute, Westmead Hospital, Sydney, Australia
| | - Karice K Hyun
- Consumer Engagement and Codesign Research Hub, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Department of Cardiology, Concord Repatriation General Hospital, Sydney, Australia
| | - Aravinda Thiagalingam
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Department of Cardiology, Westmead Hospital, Sydney, Australia.,George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Department of Cardiology, Westmead Hospital, Sydney, Australia.,George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Kerry A Sherman
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Elisabeth Elder
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, Australia
| | - Julie Redfern
- Consumer Engagement and Codesign Research Hub, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,George Institute for Global Health, University of New South Wales, Sydney, Australia.,Research Education Network, Western Sydney Local Health District, Sydney, Australia
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8
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Singleton A, Partridge SR, Raeside R, Regimbal M, Hyun KK, Chow CK, Sherman K, Elder E, Redfern J. A text message intervention to support women's physical and mental health after breast cancer treatments (EMPOWER-SMS): a randomised controlled trial protocol. BMC Cancer 2019; 19:660. [PMID: 31272399 PMCID: PMC6610900 DOI: 10.1186/s12885-019-5886-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 06/26/2019] [Indexed: 01/22/2023] Open
Abstract
Background Breast cancer is the most common cancer diagnosed in women worldwide. In developed countries, 80–90% of women will survive five years after diagnosis but the transition from hospital-based care to health self-management and self-efficacy can be difficult. Text messaging programs offer a simple and proven way to provide support to people with chronic diseases. This study aims to test the effectiveness of a text message support program at improving women’s health self-efficacy, and physical and mental health outcomes after breast cancer treatments compared to usual care at 6-months and to understand the barriers and enablers to widespread implementation. Methods Single-blind randomised control trial (RCT; N = 160) comparing a text message support intervention to usual care in women with breast cancer (recruited from a large tertiary referral hospital in Sydney, Australia). The intervention group will receive a six-month text message support program, which consists of semi-personalised, supportive, lifestyle-focused text messages (4 messages/week) in addition to usual care. The control group will receive usual care without the text message program. Outcomes will be assessed at 6-months. The primary outcome is change in self-efficacy for managing chronic disease. Secondary outcomes include change in clinical outcomes (body mass index), lifestyle outcomes (physical activity levels, dietary behaviours), mood (depression and anxiety scales), quality of life, satisfaction with, and usefulness of the intervention. Analyses will be performed on the principle of intention-to-treat to examine differences between intervention and control groups. Discussion This study will test if a scalable and cost-effective text-messaging intervention is effective at improving women’s health self-efficacy, as well as physical and mental health outcomes. Moreover, this study will provide essential preliminary data to bolster a large multicentre RCT to helpsupport breast cancer survivors throughout recovery and beyond. Trial registration Australia New Zealand Clinical Trials Registry (ANZCTR) number ACTRN12618002020268, 17 December 2018
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Affiliation(s)
- A Singleton
- Faculty of Medicine and Health, Westmead Applied Research Centre (WARC), The University of Sydney, Westmead, NSW, Australia.
| | - S R Partridge
- Faculty of Medicine and Health, Westmead Applied Research Centre (WARC), The University of Sydney, Westmead, NSW, Australia.,Faculty of Medicine and Health, Sydney School Public Health, Prevention Research Collaboration, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - R Raeside
- Faculty of Medicine and Health, Westmead Applied Research Centre (WARC), The University of Sydney, Westmead, NSW, Australia
| | - M Regimbal
- Faculty of Medicine and Health, Westmead Applied Research Centre (WARC), The University of Sydney, Westmead, NSW, Australia
| | - K K Hyun
- Faculty of Medicine and Health, Westmead Applied Research Centre (WARC), The University of Sydney, Westmead, NSW, Australia
| | - C K Chow
- Faculty of Medicine and Health, Westmead Applied Research Centre (WARC), The University of Sydney, Westmead, NSW, Australia.,The George Institute for Global Health, Camperdown, NSW, Australia.,Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
| | - K Sherman
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - E Elder
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, NSW, Australia
| | - J Redfern
- Faculty of Medicine and Health, Westmead Applied Research Centre (WARC), The University of Sydney, Westmead, NSW, Australia.,The George Institute for Global Health, Camperdown, NSW, Australia
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Hyun KK, Millett ERC, Redfern J, Brieger D, Peters SAE, Woodward M. Sex Differences in the Assessment of Cardiovascular Risk in Primary Health Care: A Systematic Review. Heart Lung Circ 2019; 28:1535-1548. [PMID: 31088726 DOI: 10.1016/j.hlc.2019.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 03/13/2019] [Accepted: 04/07/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine whether sex differences exist in the assessment of cardiovascular disease (CVD) risk scores/risk factors in primary health care. DESIGN/METHODS PubMed and EMBASE were systematically searched on 31 January 2017. Clinical trials and observational studies were included if they reported on the assessment of CVD risk score, blood pressure (BP), cholesterol or smoking status in primary health care, stratified by sex. Meta-analyses were performed, using random effects models, to determine differences between sexes, separately for adjusted and unadjusted data. RESULTS Of 14,928 studies found in the search, 22 studies (including 4,754,782 patients) were included in the systematic review with the meta-analysis for quantitative assessment. Overall, the assessment rates of CVD risk score and risk factors were similar in women and men (CVD risk score: 30.7% vs. 35.2% [difference (95% CI): -4.5 (-5.1, -3.9)]; BP: 91.3% vs. 88.5% [2.8 (2.5, 3.0)]; cholesterol: 69.9% vs. 71.0% [-1.1 (-1.5, -0.8)]; and smoking: 85.9% vs. 86.7% [-0.8 (-1.1, -0.5)]). The pooled, adjusted likelihood of having the risk score, BP and cholesterol assessments were comparable between women and men: OR (95% CI): 0.87 (0.70, 1.07); 1.41 (0.89, 2.25); and 1.15 (0.82, 1.60), respectively. However, women were 32% less likely to be assessed for smoking (0.68 [0.47, 1.00]). There was substantial heterogeneity between studies and the risk of publication bias was moderate. CONCLUSION Despite the guideline recommendations, assessment of CVD risk score in primary health care was low in both sexes. Further, women were less likely to be assessed for their smoking status than men, whereas no sex discrepancies were found for BP and cholesterol assessments.
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Affiliation(s)
- Karice K Hyun
- Westmead Applied Research Centre, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; ANZAC Research Institute, University of Sydney, Sydney, NSW, Australia.
| | | | - Julie Redfern
- Westmead Applied Research Centre, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - David Brieger
- Department of Cardiology, Concord Hospital, University of Sydney, Sydney, NSW, Australia
| | - Sanne A E Peters
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Mark Woodward
- The George Institute for Global Health, University of Oxford, Oxford, UK; The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
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Chow CK, Brieger D, Ryan M, Kangaharan N, Hyun KK, Briffa T. Secondary prevention therapies in acute coronary syndrome and relation to outcomes: observational study. Heart Asia 2019; 11:e011122. [PMID: 30728864 PMCID: PMC6340555 DOI: 10.1136/heartasia-2018-011122] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 10/30/2018] [Accepted: 11/01/2018] [Indexed: 01/08/2023]
Abstract
Objective To ascertain the use of secondary prevention medications and cardiac rehabilitation after an acute coronary syndrome (ACS) and the impact on 2-year outcomes. Methods CONCORDANCE (Cooperative National Registry of Acute Coronary care, Guideline Adherence and Clinical Events) is a prospective, observational registry of 41 Australian hospitals. A representative sample of 6859 patients with an ACS and 6 months’ follow-up on 31 May 2016 were included. The main outcome measure was use of ≥75% of indicated medications (≥4/5 (or ≥3/4 if contraindicated) of angiotensin-converting enzyme (ACE) inhibitor/angiotensin receptor blocker, beta-blocker, lipid-lowering therapy, aspirin and other antiplatelet). Major adverse cardiovascular events (MACE) included myocardial infarction, stroke or cardiovascular death. Results The mean age was 65±13 years, 29% were women, and the mean Global Registry of Acute Coronary Events (GRACE) score was 106±30. At discharge, 92% were on aspirin, 93% lipid-lowering therapy, 78% beta-blocker, 74% ACE/angiotensin receptor blocker and 73% a second antiplatelet; 89% were taking ≥75% of medications at discharge, 78% at 6 months and 66% at 2 years. At 6 months, 38% attended cardiac rehabilitation, 58% received dietary advice and 32% of smokers reported quitting. Among 1896 patients followed to 2 years, death/MACE was less frequent among patients on ≥75% vs <75% of medications (8.3% vs 13.9%; adjusted OR 0.75, 95 % CI 0.56 to 0.99), and was less frequent in patients who attended versus who did not attend cardiac rehabilitation (4.6% vs 13.4%; adjusted OR 0.44, 95% CI 0.31 to 0.62). Conclusions Use of secondary prevention therapies diminishes over time following an ACS. Patients receiving secondary prevention had decreased rates of death and MACE at 2 years.
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Affiliation(s)
- Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine & Health, University of Sydney, Sydney, New South Wales, Australia.,The George Institue of Global Health, Perth, Western Australia, Australia
| | - David Brieger
- Concord Repatriation General Hospital & The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Ryan
- Deparatment of Cardiology, Shoalhaven District Memorial Hospital, Nowra, New South Wales, Australia
| | | | - Karice K Hyun
- ANZAC Research Institute, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Tom Briffa
- The George Institue of Global Health, Perth, Western Australia, Australia
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Astley CM, Ranasinghe I, Brieger D, Ellis CJ, Redfern J, Briffa T, Aliprandi-Costa B, Howell T, Bloomer SG, Gamble G, Driscoll A, Hyun KK, Hammett CJ, Chew DP. Expertise and infrastructure capacity impacts acute coronary syndrome outcomes. AUST HEALTH REV 2018; 42:277-285. [DOI: 10.1071/ah16244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 02/24/2017] [Indexed: 11/23/2022]
Abstract
Objective Effective translation of evidence to practice may depend on systems of care characteristics within the health service. The present study evaluated associations between hospital expertise and infrastructure capacity and acute coronary syndrome (ACS) care as part of the SNAPSHOT ACS registry. Methods A survey collected hospital systems and process data and our analysis developed a score to assess hospital infrastructure and expertise capacity. Patient-level data from a registry of 4387 suspected ACS patients enrolled over a 2-week period were used and associations with guideline care and in-hospital and 6-, 12- and 18-month outcomes were measured. Results Of 375 participating hospitals, 348 (92.8%) were included in the analysis. Higher expertise was associated with increased coronary angiograms (440/1329; 33.1%), 580/1656 (35.0%) and 609/1402 (43.4%) for low, intermediate and high expertise capacity respectively; P < 0.001) and the prescription of guideline therapies observed a tendency for an association with (531/1329 (40.0%), 733/1656 (44.3%) and 603/1402 (43.0%) for low, intermediate and high expertise capacity respectively; P = 0.056), but not rehabilitation (474/1329 (35.7%), 603/1656 (36.4%) and 535/1402 (38.2%) for low, intermediate and high expertise capacity respectively; P = 0.377). Higher expertise capacity was associated with a lower incidence of major adverse events (152/1329 (11.4%), 142/1656 (8.6%) and 149/149 (10.6%) for low, intermediate and high expertise capacity respectively; P = 0.026), as well as adjusted mortality within 18 months (low vs intermediate expertise capacity: odds ratio (OR) 0.79, 95% confidence interval (CI) 0.58–1.08, P = 0.153; intermediate vs high expertise capacity: OR 0.64, 95% CI 0.48–0.86, P = 0.003). Conclusions Both higher-level expertise in decision making and infrastructure capacity are associated with improved evidence translation and survival over 18 months of an ACS event and have clear healthcare design and policy implications. What is known about the topic? There are comprehensive guidelines for treating ACS patients, but Australia and New Zealand registry data reveal substantial gaps in delivery of best practice care across metropolitan, regional, rural and remote health services, raising questions of equity of access and outcome. Greater mortality and morbidity gains can be achieved by increasing the application of current evidence-based therapies than by developing new therapy innovations. Health service system characteristics may be barriers or enablers to the delivery of best practice care and need to be identified and evaluated for correlations with performance indicators and outcomes in order to improve health service design. What does this paper add? This study measures two system characteristics, namely expertise and infrastructure, evaluating the relationship with ACS guideline application and clinical outcomes in a large and diverse cohort of Australian and New Zealand hospitals. The study identifies decision-making expertise and infrastructure capacity, to a lesser degree, as enabling characteristics to help improve patient outcomes. What are the implications for practitioners? In the design of health services to improve access and equity, expertise must be preserved. However, it is difficult to have experienced personnel at the bedside no matter where the health service, and engineering innovative systems and processes of care to facilitate delivery of expertise should be considered.
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Hyun KK, Brieger D, Woodward M, Richtering S, Redfern J. The effect of socioeconomic disadvantage on prescription of guideline-recommended medications for patients with acute coronary syndrome: systematic review and meta-analysis. Int J Equity Health 2017; 16:162. [PMID: 28859658 PMCID: PMC5579970 DOI: 10.1186/s12939-017-0658-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 08/23/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There are varying data on whether socioeconomic status (SES) affects the treatment in patients with acute coronary syndrome (ACS). Our aim was to obtain a reliable estimate of the effect of SES on discharge prescription of medications following an ACS through systematic review and meta-analysis. METHODS Medline, EMBASE and Global Health were searched systematically on 6th April 2016. Studies were eligible if the participants had ACS and reported the rate/odds of guideline-recommended ACS medications prescription (aspirin, antiplatelet, beta blocker, angiotensin co-enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARB) and statin) at discharge stratified by SES. A meta-analysis was performed to pool the estimates, comparing the prescription ratio (PR) between the lowest and the highest SES groups. RESULTS Of 252 articles found from the search, seven met the eligibility criteria and it included 41,462 (20,986 from the lowest SES group) patients. We found that the individual/neighbourhood level SES did not affect the prescription of aspirin (PR (95% CI): 0.97 (0.91, 1.03)), but for beta blocker and statin, the lowest SES group were disadvantaged (0.84 (0.73, 0.94), 0.80 (0.62, 0.98), respectively). In contrast, ACEi were prescribed more often to the lowest individual/neighbourhood level SES group than the highest (1.13 (1.05, 1.22)). Although the risk of bias was low, there was considerable heterogeneity between the studies. CONCLUSIONS Despite the recommendations to close the treatment gap, the rate of prescription of guideline-recommended medications in managing ACS is significantly different between patients with the lowest and the highest groups. A solution is needed to provide equitable care across the SES groups. PROSPERO REGISTRY Systematic review registration no.: CRD42016048503. Registered 28 September 2016.
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Affiliation(s)
- Karice K Hyun
- Sydney Medical School, University of Sydney, Sydney, Australia. .,The George Institute for Global Health, Sydney, Australia. .,, Level 10, King George V Building, 83-117 Missenden Rd, Camperdown, NSW, 2050, Australia.
| | - David Brieger
- Department of Cardiology, Concord Hospital, University of Sydney, Sydney, Australia
| | - Mark Woodward
- The George Institute for Global Health, Sydney, Australia.,The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Julie Redfern
- The George Institute for Global Health, Sydney, Australia
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13
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Hyun KK, Redfern J, Patel A, Peiris D, Brieger D, Sullivan D, Harris M, Usherwood T, MacMahon S, Lyford M, Woodward M. Gender inequalities in cardiovascular risk factor assessment and management in primary healthcare. Heart 2017; 103:492-498. [PMID: 28249996 DOI: 10.1136/heartjnl-2016-310216] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 11/14/2016] [Accepted: 11/17/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To quantify contemporary differences in cardiovascular disease (CVD) risk factor assessment and management between women and men in Australian primary healthcare services. METHODS Records of routinely attending patients were sampled from 60 Australian primary healthcare services in 2012 for the Treatment of Cardiovascular Risk using Electronic Decision Support study. Multivariable logistic regression models were used to compare the rate of CVD risk factor assessment and recommended medication prescriptions, by gender. RESULTS Of 53 085 patients, 58% were female. Adjusting for demographic and clinical characteristics, women were less likely to have sufficient risk factors measured for CVD risk assessment (OR (95% CI): 0.88 (0.81 to 0.96)). Among 13 294 patients (47% women) in the CVD/high CVD risk subgroup, the adjusted odds of prescription of guideline-recommended medications were greater for women than men: 1.12 (1.01 to 1.23). However, there was heterogeneity by age (p <0.001), women in the CVD/high CVD risk subgroup aged 35-54 years were less likely to be prescribed the medications (0.63 (0.52 to 0.77)), and women in the CVD/high CVD risk subgroup aged ≥65 years were more likely to be prescribed the medications (1.34 (1.17 to 1.54)) than their male counterparts. CONCLUSIONS Women attending primary healthcare services in Australia were less likely than men to have risk factors measured and recorded such that absolute CVD risk can be assessed. For those with, or at high risk of, CVD, the prescription of appropriate preventive medications was more frequent in older women, but less frequent in younger women, compared with their male counterparts. TRIAL REGISTRATION NUMBER 12611000478910, Pre-results.
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Affiliation(s)
- Karice K Hyun
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Julie Redfern
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Anushka Patel
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - David Peiris
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - David Brieger
- Department of Cardiology, Concord Hospital, University of Sydney, Sydney, Australia
| | - David Sullivan
- Department of Chemical Pathology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Tim Usherwood
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia.,Sydney Medical School Westmead, University of Sydney, Sydney, Australia
| | - Stephen MacMahon
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia.,The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Marilyn Lyford
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia.,WA Centre for Rural Health, University of Western Australia, Perth, Australia
| | - Mark Woodward
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia.,The George Institute for Global Health, University of Oxford, Oxford, UK
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14
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Hyun KK, Essue BM, Woodward M, Jan S, Brieger D, Chew D, Nallaiah K, Howell T, Briffa T, Ranasinghe I, Astley C, Redfern J. The household economic burden for acute coronary syndrome survivors in Australia. BMC Health Serv Res 2016; 16:636. [PMID: 27825335 PMCID: PMC5101825 DOI: 10.1186/s12913-016-1887-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 10/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies of chronic diseases are associated with a financial burden on households. We aimed to determine if survivors of acute coronary syndrome (ACS) experience household economic burden and to quantify any potential burden by examining level of economic hardship and factors associated with hardship. METHODS Australian patients admitted to hospital with ACS during 2-week period in May 2012, enrolled in SNAPSHOT ACS audit and who were alive at 18 months after index admission were followed-up via telephone/paper survey. Regression models were used to explore factors related to out-of-pocket expenses and economic hardship. RESULTS Of 1833 eligible patients at baseline, 180 died within 18 months, and 702 patients completed the survey. Mean out-of-pocket expenditure (n = 614) in Australian dollars was A$258.06 (median: A$126.50) per month. The average spending for medical services was A$120.18 (SD: A$310.35) and medications was A$66.25 (SD: A$80.78). In total, 350 (51 %) of patients reported experiencing economic hardship, 78 (12 %) were unable to pay for medical services and 81 (12 %) could not pay for medication. Younger age (18-59 vs ≥80 years (OR): 1.89), no private health insurance (OR: 2.04), pensioner concession card (OR: 1.80), residing in more disadvantaged area (group 1 vs 5 (OR): 1.77), history of CVD (OR: 1.47) and higher out-of-pocket expenses (group 4 vs 1 (OR): 4.57) were more likely to experience hardship. CONCLUSION Subgroups of ACS patients are experiencing considerable economic burden in Australia. These findings provide important considerations for future policy development in terms of the cost of recommended management for patients.
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Affiliation(s)
- Karice K Hyun
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia. .,, Level 10, King George V Building, 83-117 Missenden Rd, Camperdown, NSW, 2050, Australia.
| | - Beverley M Essue
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia.,Menzies Centre for Health Policy, University of Sydney, Sydney, Australia
| | - Mark Woodward
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia.,Nuffield Department of Population Health, The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Stephen Jan
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - David Brieger
- Department of Cardiology, Concord Hospital, University of Sydney, Sydney, Australia
| | - Derek Chew
- Department of Cardiology, Flinders University, Adelaide, Australia
| | - Kellie Nallaiah
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | | | - Tom Briffa
- School of Population Health, University of Western Australia, Perth, Australia
| | | | - Carolyn Astley
- South Australia Division, The Heart foundation, Adelaide, Australia
| | - Julie Redfern
- The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia
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15
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Wechkunanukul K, Grantham H, Teubner D, Hyun KK, Clark RA. Presenting characteristics and processing times for culturally and linguistically diverse (CALD) patients with chest pain in an emergency department: Time, Ethnicity, and Delay (TED) Study II. Int J Cardiol 2016; 220:901-8. [PMID: 27404505 DOI: 10.1016/j.ijcard.2016.06.244] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 06/26/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND To date there has been limited published data presenting the characteristics and timeliness of the management in an Emergency Department (ED) for culturally and linguistically diverse (CALD) patients presenting with chest pain. This study aimed to describe the presenting characteristics and processing times for CALD patients with chest pain compared to the Australian-born population, and current guidelines. METHODS This study was a cross sectional analysis of a cohort of patients who presented with chest pain to the metropolitan hospital between 1 July 2012 and 30 June 2014. RESULTS Of the total study population (n=6640), 1241 (18.7%) were CALD and 5399 (81.3%) were Australian-born. CALD patients were significantly older than Australian-born patients (mean age 62 vs 56years, p<0.001). There were no differences in the proportion of patients who had central chest pain (74.9% vs 75.7%, p=0.526); ambulance utilisation (41.7% vs 41.1%, p=0.697); and time to initial treatment in ED (21 vs 22min, p=0.375). However, CALD patients spent a significantly longer total time in ED (5.4 vs 4.3h, p<0.001). There was no difference in guideline concordance between the two groups with low rates of 12.5% vs 13%, p=0.556. Nonetheless, CALD patients were 22% (95% CI, 0.65, 0.95, p=0.015) less likely to receive the guideline management for chest pain. CONCLUSIONS The initial emergency care was equally provided to all patients in the context of a low rate of concordance with three chest pain related standards from the two guidelines. Nonetheless, CALD patients spent a longer time in ED compared to the Australian-born group.
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Affiliation(s)
- Kannikar Wechkunanukul
- School of Nursing and Midwifery, Flinders University, GPO BOX 2100, Adelaide, SA 5001, Australia.
| | - Hugh Grantham
- Paramedic Department, Flinders University, GPO BOX 2100, Adelaide, SA 5001, Australia.
| | - David Teubner
- Paramedic Department, Flinders University, GPO BOX 2100, Adelaide, SA 5001, Australia.
| | - Karice K Hyun
- The George Institute for Global Health, Cardiovascular division, Sydney Medical School, University of Sydney, Level 10, King George V Building, 83-117 Missenden Rd, Camperdown, NSW 2050, Australia.
| | - Robyn A Clark
- School of Nursing and Midwifery, Flinders University, GPO BOX 2100, Adelaide, SA 5001, Australia.
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16
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Briffa TG, Hammett CJ, Cross DB, Macisaac AI, Rankin JM, Board N, Carr B, Hyun KK, French J, Brieger DB, Chew DP. Should fee-for-service be for all guideline-advocated acute coronary syndrome (ACS) care? Observations from the Snapshot ACS study. AUST HEALTH REV 2016; 39:379-386. [PMID: 25913297 DOI: 10.1071/ah14153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 02/04/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of the present study was to explore the association of health insurance status on the provision of guideline-advocated acute coronary syndrome (ACS) care in Australia. METHODS Consecutive hospitalisations of suspected ACS from 14 to 27 May 2012 enrolled in the Snapshot study of Australian and New Zealand patients were evaluated. Descriptive and logistic regression analysis was performed to evaluate the association of patient risk and insurance status with the receipt of care. RESULTS In all, 3391 patients with suspected ACS from 247 hospitals (23 private) were enrolled in the present study. One-third of patients declared private insurance coverage; of these, 27.9% (304/1088) presented to private facilities. Compared with public patients, privately insured patients were more likely to undergo in-patient echocardiography and receive early angiography; furthermore, in those with a discharge diagnosis of ACS, there was a higher rate of revascularisation (P < 0.001). Each of these attracts potential fee-for-service. In contrast, proportionately fewer privately insured ACS patients were discharged on selected guideline therapies and were referred to a secondary prevention program (P = 0.056), neither of which directly attracts a fee. Typically, as GRACE (the Global Registry of Acute Coronary Events) risk score rose, so did the level of ACS care; however, propensity-adjusted analyses showed lower in-hospital adverse events among the insured group (odds ratio 0.68; 95% confidence interval 0.52-0.88; P = 0.004). CONCLUSION Fee-for-service reimbursement may explain differences in the provision of selected guideline-advocated components of ACS care between privately insured and public patients.
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Affiliation(s)
- Thomas G Briffa
- University of Western Australia, M431, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - Christopher J Hammett
- Royal Brisbane and Women's Hospital, Butterfield Terrace, Brisbane, Qld 4029, Australia. Email
| | - David B Cross
- Heart Care Partners, L5, Sandford Jackson Building, 30 Chasely Street, Auchenflower, Qld 4066, Australia. Email
| | - Andrew I Macisaac
- St Vincent's Hospital Melbourne, PO Box 2900, Fitzroy, Vic. 3065, Australia. Email
| | - James M Rankin
- Royal Perth Hospital, Wellington Street, Perth, WA 6000, Australia. Email
| | - Neville Board
- eHealth & Medication Safety, L5, 255 Elizabeth Street, Sydney, NSW 2000, Australia. Email
| | - Bridie Carr
- Agency for Clinical Innovation (ACI), 67 Albert Street, Sydney, NSW 2057, Australia. Email
| | - Karice K Hyun
- The George Institute for Global Health, L10, King George V Building, 83-117 Missenden Road, Camperdown, NSW 2050, Australia. Email
| | - John French
- Liverpool Hospital, Elizabeth Street, Liverpool, NSW 2170, Australia. Email
| | - David B Brieger
- Concord Hospital, Hospital Road, Concord, NSW 2139, Australia. Email
| | - Derek P Chew
- Flinders University and Flinders Medical Centre, Flinders Drive, Bedford Park, 5042, SA, Australia. Email
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17
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Hyun KK, Huxley RR, Arima H, Woo J, Lam TH, Ueshima H, Fang X, Peters SAE, Jee SH, Giles GG, Barzi F, Woodward M. A Comparative Analysis of Risk Factors and Stroke Risk for Asian and Non-Asian Men: The Asia Pacific Cohort Studies Collaboration. Int J Stroke 2013; 8:606-11. [DOI: 10.1111/ijs.12166] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background The risk of stroke is high in men among both Asian and non-Asian populations, despite differences in risk factor profiles; whether risk factors act similarly in these populations is unknown. Aim To study the associations between five major risk factors and stroke risk, comparing Asian with non-Asian men. Methods We obtained data from the Asia Pacific Cohort Studies Collaboration, a pooled analysis of individual participant data from 44 studies involving 386 411 men with 9·4 years follow-up. Using cohorts from Asia and Australia/New Zealand Cox models were fitted to estimate risk factor associations for ischemic and haemorrhagic stroke. Results We identified significant, positive associations between all five risk factors and risk of ischemic stroke. The associations between body mass index, smoking, and diabetes with ischemic stroke were comparable for men from Asia and Australia/New Zealand. The association between systolic blood pressure and ischemic stroke was stronger for Asian than Australia/New Zealand cohorts, whereas the reverse was true for total cholesterol. For haemorrhagic stroke, only systolic blood pressure and smoking were associated with increased risk, although the relationship with systolic blood pressure was significantly stronger for men from Asia than Australia/New Zealand ( Pinteraction = 0·03), whereas the reverse was true for smoking ( Pinteraction = 0·001). There was an inverse trend of total cholesterol with haemorrhagic stroke, significant only for Asian men. Conclusions Men from the Asia-Pacific region share common risk factors for stroke. Strategies aimed at lowering population levels of systolic blood pressure, total cholesterol, body mass index, smoking, and diabetes are likely to be beneficial in reducing stroke risk, particularly for ischemic stroke, across the region.
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Affiliation(s)
- Karice K. Hyun
- The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
| | - Rachel R. Huxley
- The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
- Division of Epidemiology and Community Health, School of Public Health University of Minnesota, Minneapolis, MN, USA
| | - Hisatomi Arima
- The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
| | - Jean Woo
- Chinese University of Hong Kong, Hong Kong, China
| | - Tai Hing Lam
- Department of Community Medicine, The University of Hong Kong, Hong Kong, China
| | - Hirotsugu Ueshima
- Department of Health Science, Shiga University of Medical Science, Shiga, Japan
| | - Xianghua Fang
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Sanne A. E. Peters
- The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sun Ha Jee
- Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Graham G. Giles
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Vic., Australia
- Centre for MEGA Epidemiology, School of Public Health, University of Melbourne, Melbourne, Vic., Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Federica Barzi
- The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
| | - Mark Woodward
- The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
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18
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Chew DP, French J, Briffa TG, Hammett CJ, Ellis CJ, Ranasinghe I, Aliprandi‐Costa BJ, Astley CM, Turnbull FM, Lefkovits J, Redfern J, Carr B, Gamble GD, Lintern KJ, Howell TEJ, Parker H, Tavella R, Bloomer SG, Hyun KK, Brieger DB. Acute coronary syndrome care across Australia and New Zealand: the SNAPSHOT ACS study. Med J Aust 2013; 199:185-91. [DOI: 10.5694/mja12.11854] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 05/02/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Derek P Chew
- Department of Cardiovascular Medicine, Flinders University, Adelaide, SA
| | - John French
- Department of Cardiology, Liverpool Hospital, Sydney, NSW
| | - Tom G Briffa
- School of Population Health, University of Western Australia, Perth, WA
| | | | | | | | | | | | | | | | | | | | - Greg D Gamble
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | | | - Tegwen E J Howell
- Clinical Access and Redesign Unit, Queensland Department of Health, Brisbane, QLD
| | - Hella Parker
- Clinical Service Development, Victoria Health, Melbourne, VIC
| | | | - Stephen G Bloomer
- Health Networks Branch, Department of Health of Western Australia, Perth, WA
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