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De Keyser H, Vuong V, Kaye L, Anderson WC, Szefler S, Stempel DA. Reply to "Breath-taking compliance: Does lower adherence translate to inferiority?". J Allergy Clin Immunol Pract 2023; 11:3813-3814. [PMID: 38065642 DOI: 10.1016/j.jaip.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 12/18/2023]
Affiliation(s)
- Heather De Keyser
- Breathing Institute, Children's Hospital Colorado and Adult and Child Center for Outcomes Research and Dissemination Science, University of Colorado, Aurora, Colo.
| | - Vy Vuong
- ResMed Science Center, San Francisco, Calif
| | | | - William C Anderson
- Allergy and Immunology Section, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colo
| | - Stanley Szefler
- Breathing Institute, Children's Hospital Colorado and Adult and Child Center for Outcomes Research and Dissemination Science, University of Colorado, Aurora, Colo
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Hirons N, Allen A, Matsuyoshi N, Su J, Kaye L, Barrett MA. Prediction of short-acting beta-agonist usage in patients with asthma using temporal-convolutional neural networks. JAMIA Open 2023; 6:ooad091. [PMID: 37900973 PMCID: PMC10602590 DOI: 10.1093/jamiaopen/ooad091] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/21/2023] [Accepted: 10/17/2023] [Indexed: 10/31/2023] Open
Abstract
Objective Changes in short-acting beta-agonist (SABA) use are an important signal of asthma control and risk of asthma exacerbations. Inhaler sensors passively capture SABA use and may provide longitudinal data to identify at-riskpatients. We evaluate the performance of several ML models in predicting daily SABA use for participants with asthma and determine relevant features for predictive accuracy. Methods Participants with self-reported asthma enrolled in a digital health platform (Propeller Health, WI), which included a smartphone application and inhaler sensors that collected the date and time of SABA use. Linear regression, random forests, and temporal convolutional networks (TCN) were applied to predict expected SABA puffs/person/day from SABA usage and environmental triggers. The models were compared with a simple baseline model using explained variance (R2), as well as using average precision (AP) and area under the receiving operator characteristic curve (ROC AUC) for predicting days with ≥1-10 puffs. Results Data included 1.2 million days of data from 13 202 participants. A TCN outperformed other models in predicting puff count (R2 = 0.562) and day-over-day change in puff count (R2 = 0.344). The TCN predicted days with ≥10 puffs with an ROC AUC score of 0.952 and an AP of 0.762 for predicting a day with ≥1 puffs. SABA use over the preceding 7 days had the highest feature importance, with a smaller but meaningful contribution from air pollutant features. Conclusion Predicted SABA use may serve as a valuable forward-looking signal to inform early clinical intervention and self-management. Further validation with known exacerbation events is needed.
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Affiliation(s)
| | - Angier Allen
- ResMed Science Center, San Diego, CA, United States
| | | | - Jason Su
- School of Public Health, University of California Berkeley, Berkeley, CA, United States
| | - Leanne Kaye
- ResMed Science Center, San Diego, CA, United States
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Boers E, Barrett M, Su JG, Benjafield AV, Sinha S, Kaye L, Zar HJ, Vuong V, Tellez D, Gondalia R, Rice MB, Nunez CM, Wedzicha JA, Malhotra A. Global Burden of Chronic Obstructive Pulmonary Disease Through 2050. JAMA Netw Open 2023; 6:e2346598. [PMID: 38060225 PMCID: PMC10704283 DOI: 10.1001/jamanetworkopen.2023.46598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/25/2023] [Indexed: 12/08/2023] Open
Abstract
Importance Chronic obstructive pulmonary disease (COPD) is a respiratory condition that is associated with significant health and economic burden worldwide. Previous studies assessed the global current-day prevalence of COPD, but to better facilitate resource planning and intervention development, long-term projections are needed. Objective To assess the global burden of COPD through 2050, considering COPD risk factors. Design, Setting, and Participants In this modeling study, historical data on COPD prevalence was extracted from a recent meta-analysis on 2019 global COPD prevalence, and 2010 to 2018 historical prevalence was estimated using random-effects meta-analytical models. COPD risk factor data were obtained from the Global Burden of Disease database. Main Outcomes and Measures To project global COPD prevalence to 2050, generalized additive models were developed, including smoking prevalence, indoor and outdoor air pollution, and development indices as predictors, and stratified by age, sex, and World Bank region. Results The models estimated that the number of COPD cases globally among those aged 25 years and older will increase by 23% from 2020 to 2050, approaching 600 million patients with COPD globally by 2050. Growth in the burden of COPD was projected to be the largest among women and in low- and middle-income regions. The number of female cases was projected to increase by 47.1% (vs a 9.4% increase for males), and the number of cases in low- and middle-income regions was expected to be more than double that of high-income regions by 2050. Conclusions and Relevance In this modeling study of future COPD burden, projections indicated that COPD would continue to affect hundreds of millions of people globally, with disproportionate growth among females and in low-middle income regions through 2050. Further research, prevention, and advocacy are needed to address these issues so that adequate preparation and resource allocation can take place.
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Affiliation(s)
- Elroy Boers
- ResMed Science Center, Halifax, Nova Scotia, Canada
| | | | | | | | - Sanjeev Sinha
- All India Institute of Medical Sciences, New Delhi, India
| | - Leanne Kaye
- ResMed Science Center, San Diego, California
| | - Heather J. Zar
- Department of Paediatrics and Child Health and SA-MRC Unit on Child & Adolescent Health, University of Cape Town, South Africa
| | - Vy Vuong
- ResMed Science Center, San Diego, California
| | | | | | - Mary B. Rice
- Division of Pulmonary, Sleep and Critical Care Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Woehrle H, Mastoridis P, Stempel D, Kaye L, Vuong V, Mezzi K. Medication Adherence and Asthma Control with Once-Daily Indacaterol/Glycopyrronium/Mometasone Furoate Breezhaler Digital Companion: 90-Day Analysis from Germany. Pulm Ther 2023; 9:429-434. [PMID: 37120785 PMCID: PMC10447847 DOI: 10.1007/s41030-023-00225-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/11/2023] [Indexed: 05/01/2023] Open
Abstract
INTRODUCTION Suboptimal adherence to inhaled asthma therapy is associated with poor clinical outcomes. Digital companion paired inhaler devices record medication use and provide reminders, thereby improving treatment adherence and asthma outcomes. This analysis assessed the impact of indacaterol/glycopyrronium/mometasone furoate (IND/GLY/MF) Breezhaler® digital companion on medication adherence and symptom control in adults with asthma from Germany. METHODS This retrospective analysis included adults (≥ 18 years) with asthma and prescribed Breezhaler digital companion. Assessments included: mean medication adherence (number of puffs taken/prescribed × 100) and change in Asthma Control Test (ACT) scores [well controlled (≥ 20), not well controlled (15-20) and poorly controlled (≤ 15)] at 1 month after the first ACT (second ACT). The percent of patients with ≥ 80% medication adherence (days 16-30 and 76-90) and the change in ACT (baseline and ≥ 30 days) were analysed. RESULTS Of the 163 patients with 90 days data, ≥ 80% medication adherence was achieved in 82.8% and 72.4% of patients at months 1 and 3, respectively. Change in asthma control was examined in ~ 60% (n = 97) of patients who completed ≥ 2 ACTs through the application. At baseline, 33.0% of patients were well controlled and 53.6% were well controlled at second ACT. Furthermore, 43.3% patients reported very poor control at baseline which decreased to 22.7% at second ACT. CONCLUSION The use of IND/GLY/MF (Breezhaler) with a digital companion (sensor + application) may be associated with improved symptom control and high level of controller medication adherence in patients with asthma.
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Affiliation(s)
- Holger Woehrle
- Lung Center Ulm, Pulmonary Group Practice, Olgastraße 83, 89073, Ulm, Germany.
| | | | | | | | - Vy Vuong
- ResMed Science Center, San Diego, CA, USA
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De Keyser H, Vuong V, Kaye L, Anderson WC, Szefler S, Stempel DA. Is Once Versus Twice Daily Dosing Better for Adherence in Asthma and Chronic Obstructive Pulmonary Disease? J Allergy Clin Immunol Pract 2023; 11:2087-2093.e3. [PMID: 37088377 PMCID: PMC10330551 DOI: 10.1016/j.jaip.2023.03.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Patients with asthma and chronic obstructive pulmonary disease (COPD) may be prescribed once- or twice-daily dosing of controller inhalers. OBJECTIVE To assess differences in controller adherence by dosing schedule and age. METHODS Electronic medication monitors (EMMs) captured the date and time of inhaler actuations over 90 days in patients using the Propeller Health platform. Prescribed inhaler schedule was self-reported. Once- versus twice-daily schedule comparisons were assessed retrospectively using regressions adjusting for age. RESULTS A total of 6294 patients with asthma and 1791 patients with COPD were included. On average, once-daily users had significantly higher median (interquartile range [IQR]) daily adherence than twice-daily users (asthma: 63.3 [IQR: 31.1, 86.7]% vs 50.3 [IQR: 21.1, 78.3]%, P < .001; COPD: 83.3 [IQR: 57.2, 95.6]% vs 64.7 [IQR: 32.8, 88.9]%, P < .001). This pattern persisted in all age groups, with the exception of 4- to 17-year-olds in asthma. The lowest adherence was in the young adult population (18- to 29-year-olds). The percentage of patients who achieved ≥80% adherence was significantly higher among once- versus twice-daily users in asthma (34.3% vs 23.6%, P < .001) and COPD (54.8% vs 38.6%, P < .001). The adjusted odds of once- versus twice-daily users achieving ≥80% adherence was 1.36 (95% confidence interval: 1.19-1.56, P < .001) in asthma and 1.73 (95% confidence interval: 1.38-2.17, P < .001) in COPD. Most once-daily patients with COPD took their medication in the morning versus at night; there was no difference in morning versus afternoon/evening administration in all other asthma and COPD groups. CONCLUSION Patients with asthma and COPD who were prescribed once-daily versus twice-daily medications were more likely to adhere to their inhalers. Patients with COPD had higher adherence than those with asthma, possibly reflecting, in part, the older cohort age. The effect of greater adherence on exacerbations is a topic for future analysis.
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Affiliation(s)
- Heather De Keyser
- Breathing Institute, Children's Hospital Colorado and Adult and Child Center for Outcomes Research and Dissemination Science, University of Colorado, Aurora, Colo.
| | - Vy Vuong
- Medical Affairs, ResMed Science Center, San Francisco, Calif
| | - Leanne Kaye
- Medical Affairs, ResMed Science Center, San Francisco, Calif
| | - William C Anderson
- Allergy and Immunology Section, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colo
| | - Stanley Szefler
- Breathing Institute, Children's Hospital Colorado and Adult and Child Center for Outcomes Research and Dissemination Science, University of Colorado, Aurora, Colo
| | - David A Stempel
- Clinical and Medical Affairs, Propeller Health, Madison, Wis
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Inocencio TJ, Sterling KL, Sayiner S, Minshall ME, Kaye L, Hatipoğlu U. Budget impact analysis of a digital monitoring platform for COPD. Cost Eff Resour Alloc 2023; 21:36. [PMID: 37271821 DOI: 10.1186/s12962-023-00443-x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/18/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a progressive debilitating condition with frequent exacerbations that have a high burden for patients and society. Digital tools may help to reduce the economic burden for patients and payers by improving outcomes. The Propeller platform is a digital self-management tool that facilitates passive monitoring of inhaler medication utilization, potentially assisting the healthcare team to identify patients at risk of a COPD exacerbation who may require further intervention. This study estimated the budget impact of Propeller from commercial payer and Medicare fee-for-service payer perspectives. METHODS An Excel-based model was used to estimate the budget impact of Propeller for COPD patients in commercial and Medicare population sizes of 5 million members. Data on prevalence, baseline healthcare resource utilization (HCRU), and baseline use of rescue and controller inhaler medications with unit costs (adjusted to 2020 US dollars) were obtained from peer-reviewed literature. Data on reductions in HCRU during Propeller usage were based on direct evidence. Estimates for costs of remote monitoring were obtained from publicly available information. All patients were assumed to have insurance claims related to ongoing remote monitoring. RESULTS The estimated number of annual eligible COPD patients for commercial and Medicare was 212,200 and 606,600, respectively. Propeller decreased costs by an estimated $2,475 (commercial) and $915 (Medicare) per enrolled patient. The greatest increase in expenditure was for remote monitoring related expenses. After accounting for estimated reductions in hospitalizations, emergency department visits and short-acting beta-agonist use, total net savings were approximately $1.60 and $1.70 per-member per-month for commercial and Medicare payers, respectively. CONCLUSION Propeller is projected to be cost saving from both the commercial and Medicare payer perspectives.
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Affiliation(s)
| | - Kimberly L Sterling
- ResMed Science Center, 9001 Spectrum Center Boulevard, San Diego, CA, 92123, USA.
| | | | - Michael E Minshall
- ResMed Science Center, 9001 Spectrum Center Boulevard, San Diego, CA, 92123, USA
| | - Leanne Kaye
- ResMed Science Center, 9001 Spectrum Center Boulevard, San Diego, CA, 92123, USA
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Barrett M, Gondalia R, Vuong V, Kaye L, Hill AB, Attisha E, Holtrop T. Retrospective assessment of a collaborative digital asthma program for Medicaid-enrolled children in southwest Detroit: reductions in short-acting beta-agonist (SABA) medication use. Asthma Res Pract 2023; 9:3. [PMID: 37210572 DOI: 10.1186/s40733-023-00092-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/15/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Real-world evidence for digitally-supported asthma programs among Medicaid-enrolled children remains limited. Using data from a collaborative quality improvement program, we evaluated the impact of a digital intervention on asthma inhaler use among children in southwest Detroit. METHODS Children (6-13 years) enrolled with Kids Health Connection (KHC), a program involving home visits with an asthma educator, were invited to participate in a digital self-management asthma program (Propeller Health). Patients were provided with a sensor to capture short-acting beta-agonist (SABA) medication use, and given access to a paired mobile app to track usage. Patients' healthcare providers and caregivers ("followers") were invited to view data as well. Retrospective paired t-tests assessed change in mean SABA use and SABA-free days (SFD) over time, and regressions explored the relationship between followers and medication use. RESULTS Fifty-one patients were assessed. Mean program participation was nine months, and patients had on average 3 followers. From the first to last participation month, mean SABA use decreased from 0.68 to 0.25 puffs/day (p < 0.001), and mean SFD increased from 25.2 to 28.1 days/month (p < 0.001). 76% of patients had an increase in the number of SFD. There was a positive, but non-significant, relationship between the number of followers and reductions in SABA inhaler use. CONCLUSIONS We observed a significant reduction in SABA inhaler use and an increase in the number of SABA-free days among Medicaid-enrolled children enrolled in a multi-modal digital asthma program.
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Affiliation(s)
| | | | - Vy Vuong
- ResMed Science Center, San Diego, USA
| | | | - Alex B Hill
- Department of Urban Studies and Planning, Wayne State University; formerly Detroit Health Department, Detroit, USA
| | - Elliott Attisha
- Formerly Detroit Public Schools Community District, Detroit, USA
| | - Teresa Holtrop
- Wayne Children's Healthcare Access Program, Inc, Dba Kids' Health Connections, Detroit, USA
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Kaye L, Vuong V, Johns J, Monacelli S, Barrett M. Direct and Indirect Cost-savings Associated With A Digital Intervention In Uncontrolled Asthma: A Literature-based Estimate. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Cameron A, Barrett M, Malik A, Woodford C, Alpert N, Kaye L, Vuong V, Sterling K. Healthcare Resource Use And Costs Among A Large, Diverse Sample Of Asthma Patients In The United States. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Castro Sweet C, Kaye L, Alabduljabbar M, Myers V. Training the next generation of behavioral medicine scientists to accelerate digital health. Transl Behav Med 2022; 12:834-840. [PMID: 35866841 DOI: 10.1093/tbm/ibac050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
We trace the evolution of digital health industry careers for behavioral medicine specialists. We discuss the current misalignment of career opportunities in the private sector with the predominant graduate education training model that emphasizes the pursuit of academic positions. We describe the potential risks to the profession and public health if the field does not adapt professional training models to be inclusive of private sector industry roles. Finally, we offer a series of recommendations aimed at trainees, faculty advisors, and training programs to better prepare trainees for meaningful careers in industry.
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Affiliation(s)
| | - Leanne Kaye
- ResMed Science Center, San Francisco, CA, USA
| | | | - Valerie Myers
- Glooko, Inc., Clinical Research & Evidence Generation, Palo Alto, CA, USA
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Shapiro B, Garner F, Kaye L, Rasouli M, Verma K, Bedient C. P-146 Blastocyst morphometry and morphology predict ploidy. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Are objective measurements and subjective assessments of blastocysts predictive of aneuploidy?
Summary answer
Aneuploidy was predicted equally well by lower trophectoderm cell count (objectively measured morphometry) or by a lower subjective trophectoderm grade.
What is known already
Blastocyst morphological grade has been reported to be moderately predictive of embryo ploidy. However, due to its subjective nature, morphological grade may be significantly more difficult to code into artificial intelligence algorithms when compared to objective measurements.
Study design, size, duration
This retrospective cohort study included all 1409 blastocysts that were subject to pre-implantation genetic testing (PGT) in a 30-month study period.
Participants/materials, setting, methods
Per clinic routine, embryos from oocyte were cultured to the blastocyst stage following conventional ovarian stimulation, oocyte retrieval, and intracytoplasmic sperm injection. If the patients opted for PGT, a laser was used to open the zona at the cleavage stage, trophectoderm biopsies were collected at the blastocyst stage, and biopsies were analyzed by next-generation sequencing. Inner cell mass sizes were measured by ocular micrometer and trophectoderm cells were counted in one plane of focus.
Main results and the role of chance
The mean patient age (including oocyte donors) was 31.9±6.4 years and the mean number of collected oocytes was 23.0±12.9. In multivariable logistic regression, greater patient age was the best available predictor of blastocyst aneuploidy (P < 0.0001). Along with age in the model, the observation of fewer trophectoderm cells (P = 0.0019) was also predictive of aneuploidy. Alternatively, the failure to have an A-grade trophectoderm (P = 0.0007) was also predictive of aneuploidy, also with age in the model. Neither the objectively measured inner cell mass size nor subjective inner cell mass grade were significant predictors of ploidy. Overall, objectively measured blastocyst morphometry was about equally predictive of ploidy as was subjective blastocyst grading, and area under the receiver operating characteristic curve was 0.62 for each model.
Limitations, reasons for caution
This study was retrospective, allowing the possibility of selection bias among patients and among embryos chosen for biopsy.
Wider implications of the findings
Artificial intelligence algorithms assessing embryos might benefit from the similar performance of subjective grading and objective measurements, because it is much easier to code objective measurements into the algorithms.
Trial registration number
None.
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Affiliation(s)
- B Shapiro
- Fertility Center of Las Vegas, Reproductive Endocrinology , Las Vegas, U.S.A
| | - F Garner
- Fertility Center of Las Vegas, Reproductive Endocrinology , Las Vegas, U.S.A
| | - L Kaye
- Fertility Center of Las Vegas, Reproductive Endocrinilogy , Las Vegas, U.S.A
| | - M Rasouli
- University of Nevada School of Medicine, Ob/gyn , Las Vegas, U.S.A
| | - K Verma
- University of Nevada School of Medicine, Ob/gyn , Las Vegas, U.S.A
| | - C Bedient
- Fertility Center of Las Vegas, Reproductive Endocrinilogy , Las Vegas, U.S.A
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Parikh S, Henderson K, Gondalia R, Kaye L, Remmelink E, Thompson A, Barrett M. Perceptions of Environmental Influence and Environmental Information-Seeking Behavior Among People With Asthma and COPD. Front Digit Health 2022; 4:748400. [PMID: 35592458 PMCID: PMC9113516 DOI: 10.3389/fdgth.2022.748400] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 04/06/2022] [Indexed: 01/01/2023] Open
Abstract
Environmental exposures and socioeconomic status (SES) are associated with asthma and chronic obstructive pulmonary disease (COPD) morbidity and mortality. Despite efforts to reduce the impact of environmental exposures through regulation and education, knowledge gaps remain. We sought to understand how adults with asthma and COPD perceive and seek information about environmental factors, and how these responses varied by disease or socioeconomic characteristics. Participants with self-reported asthma or COPD enrolled in a digital platform for respiratory disease self-management, consisting of sensors to track medication use and a companion smartphone app, completed an electronic survey exploring perceptions of environmental factors. Using mixed-method analyses, we evaluated differences in responses by disease (asthma vs. COPD), education (≤ vs. > some college), annual household income (< vs. ≥ $50,000), and mean annual residential air pollutant exposure (> vs. ≤80th percentile). Survey responses from 698 participants [500 asthma (72%) and 198 COPD (28%)] were analyzed. A high percentage of participants perceived that environmental factors could influence their symptoms, including: pollen (93% for asthma vs. 86% for COPD), mold (89 vs. 85%), second-hand smoke (89 vs. 83%), and air pollution (84% for both). Participants reported seeking environmental information daily from an average of three sources, preferring mobile apps and television (TV) programs. Significant differences were identified by disease.ConclusionParticipants with asthma and COPD perceive a relationship between their respiratory symptoms and their environment and regularly seek out environmental information. This information can help inform digital health development for respiratory education and self-management.
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Affiliation(s)
- Shivani Parikh
- Harvard T. H. Chan School of Public Health, Environmental Health, Boston, MA, United States
- ResMed Inc., Science Center, San Diego, CA, United States
| | - Kelly Henderson
- Propeller Health, User Research, San Francisco, CA, United States
| | - Rahul Gondalia
- ResMed Inc., Science Center, San Diego, CA, United States
| | - Leanne Kaye
- ResMed Inc., Science Center, San Diego, CA, United States
| | - Esther Remmelink
- Propeller Health, Data Analytics, San Francisco, CA, United States
| | - Alesha Thompson
- Council of State and Territorial Epidemiologists, Programs, Atlanta, GA, United States
| | - Meredith Barrett
- ResMed Inc., Science Center, San Diego, CA, United States
- *Correspondence: Meredith Barrett
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Hoch H, Vuong V, Kaye L, Anderson W, Szefler S, Stempel D. Differences in medication adherence by dosing schedule among patients with asthma. J Allergy Clin Immunol 2022. [DOI: 10.1016/j.jaci.2021.12.756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mosnaim GS, Stempel DA, Gonzalez C, Adams B, BenIsrael-Olive N, Gondalia R, Kaye L, Shalowitz M, Szefler S. Electronic medication monitoring versus self-reported use of inhaled corticosteroids and short-acting beta 2-agonists in uncontrolled asthma. J Asthma 2021; 59:2024-2027. [PMID: 34699302 DOI: 10.1080/02770903.2021.1996600] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Current standard of care, patient self-report and clinician estimation, overestimates true inhaled corticosteroids (ICS) adherence. We compare self-reported inhaled ICS and short-acting beta 2-agonists (SABA) use with objective data from electronic medication monitors (EMMs). METHODS Adults with uncontrolled asthma and prescribed ICS and SABA were enrolled. At visit one, participants' ICS and SABA inhalers were fitted with EMMs to track real-time medication usage over 14 days. Participants were asked to complete paper diaries to self-report medication usage over the same period. Participant self-report of ICS adherence and SABA use versus objective ICS adherence and SABA use was compared using Wilcoxon signed-rank tests. RESULTS One hundred participants (80% female, mean age 48.5 years, 60% completed college, 80% privately insured) had complete data. Participant self-report (median (IQR): 0.8 (0.0, 2.0)) was greater than objectively measured (median (IQR): 0.43 (0.1, 2.1)) SABA use, but the difference was not statistically significant (P = 0.64). Participant self-report (median (IQR): 97 (67, 100)) was significantly greater than objectively measured (median (IQR): 75 (54, 93)) ICS adherence (P = 0.002). CONCLUSIONS Significant discrepancies between self-report and objective ICS usage were observed. EMM can provide clinicians with accurate data on ICS medication taking behavior, thus reducing medication regimen complexity, side effects, and costs.
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Affiliation(s)
- Giselle S Mosnaim
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - David A Stempel
- Propeller Health, Clinical and Medical Affairs, San Francisco, California, USA
| | - Candy Gonzalez
- Research Institute, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Brittney Adams
- Research Institute, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Naomi BenIsrael-Olive
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Rahul Gondalia
- ResMed Science Center, Medical Affairs, San Francisco, California, USA
| | - Leanne Kaye
- Department of Pediatrics, Section of Allergy and Immunology and Pulmonary and Sleep Medicine, University of Colorado School of Medicine and the Breathing Institute, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Madeleine Shalowitz
- Research Institute, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Stanley Szefler
- Department of Pediatrics, Section of Allergy and Immunology and Pulmonary and Sleep Medicine, University of Colorado School of Medicine and the Breathing Institute, Children's Hospital Colorado, Aurora, Colorado, USA
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15
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Kaye L, Gondalia R, Barrett MA, Williams M, Stempel DA. Concurrent Improvement Observed in Patient-Reported Burden and Sensor-Collected Medication Use Among Patients Enrolled in a COPD Digital Health Program. Front Digit Health 2021; 3:624261. [PMID: 34713098 PMCID: PMC8521990 DOI: 10.3389/fdgth.2021.624261] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 02/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The COPD assessment test (CAT) is an 8-item questionnaire widely used in clinical practice to assess patient burden of disease. Digital health platforms that leverage electronic medication monitors (EMMs) are used to track the time and date of maintenance and short-acting beta-agonist (SABA) inhaler medication use and record patient-reported outcomes. The study examined changes in CAT and SABA inhaler use in COPD to determine whether passively collected SABA and CAT scores changed in a parallel manner. Methods: Patients with self-reported COPD enrolled in a digital health program, which provided EMMs to track SABA and maintenance inhaler use, and a companion smartphone application (“app”) to provide medication feedback and reminders. Patients completing the CAT questionnaire in the app at enrollment and at 6 months were included in the analysis. Changes in CAT burden category [by the minimally important difference (MID)] and changes in EMM-recorded mean SABA inhaler use per day were quantified at baseline and 6 months. Results: The analysis included 611 patients. At 6 months, mean CAT improved by −0.9 (95% CI: −1.4, −0.4; p < 0.001) points, and mean SABA use decreased by −0.6 (−0.8, −0.4; p < 0.001) puffs/day. Among patients with higher burden (CAT ≥ 21) at enrollment, CAT improved by −2.0 (−2.6, −1.4; p < 0.001) points, and SABA use decreased by −0.8 (−1.1, −0.6; p < 0.001) puffs/day. Conclusion: Significant and parallel improvement in CAT scores and SABA use at 6 months were noted among patients enrolled in a digital health program, with greater improvement for patients with higher disease burden.
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Affiliation(s)
- Leanne Kaye
- ResMed Science Center, San Francisco, CA, United States
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16
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Yawn BP, McCreary GM, Linnell JA, Pasquale CB, Malanga E, Choate R, Stempel DA, Gondalia R, Kaye L, Collison KA, Wu BS, Gratie D, Stanford RH, Tomlinson R. Pilot Study of a Patient Experience with an ELLIPTA Inhaler Electronic Medication Monitor and Associated Integrated System: A Prospective Observational Study Using the COPD Patient-Powered Research Network. Chronic Obstr Pulm Dis 2021; 8:488-501. [PMID: 34592085 DOI: 10.15326/jcopdf.2021.0218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Electronic medication monitors (EMMs) are associated with decreased rescue inhaler use, symptom burden, and increased medication adherence in asthma. However, the use of EMMs in people with chronic obstructive pulmonary disease (COPD) using the ELLIPTA dry powder inhaler has not been studied. Methods This was an open-label, single-arm, prospective observational study of EMMs and associated application (app) use over 12 weeks and up to 24 weeks (April-October 2019) in people with self-reported COPD aged ≥40 years enrolled in the COPD Patient-Powered Research Network, using an ELLIPTA inhaler. The primary outcome was daily active use of the app over 12 weeks. Treatment adherence, rescue inhaler use, and participant satisfaction were assessed over the same period. Results Among the 122 participants, mean (standard deviation [SD]) proportion of days participants opened the app was 59.5% (31.4), 51.1% (33.5) and 41.3% (34.2) for Days 1-30, 31-60 and 61-90, respectively. Mean (SD) adherence to maintenance medication remained stable: 80.2% (22.7) and 79.9% (26.7) for Days 1-30 and 61-90, respectively. In participants using a rescue inhaler and EMM, mean (SD) rescue-free days increased from 18.5 (10.0; Days 1-30, n=51) to 21.4 (9.6; Days 61-90, n=48). Participants reported high levels of confidence in using the EMM, valued app reminders highly and reported high system satisfaction (mean [SD] scale: 1=low, 5=high; 4.6 [1.1], 4.3 [1.1] and 4.1 [1.1], respectively). Conclusions Use of an ELLIPTA EMM with frequent app engagement, high participant satisfaction and decreased rescue medication use may aid COPD management.
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Affiliation(s)
- Barbara P Yawn
- COPD Foundation, Miami, Florida, United States.,Department of Family and Community Health, University of Minnesota, Minneapolis, Minnesota, United States
| | | | | | | | | | - Radmila Choate
- COPD Foundation, Miami, Florida, United States.,Department of Epidemiology, College of Public Health University of Kentucky, Lexington, Kentucky, United States
| | - David A Stempel
- Respiratory Therapy Area, GlaxoSmithKline plc., Research Triangle Park, North Carolina, United States
| | | | - Leanne Kaye
- Propeller Health, Madison, Wisconsin, United States
| | - Kathryn A Collison
- Respiratory Therapy Area, GlaxoSmithKline plc., Research Triangle Park, North Carolina, United States
| | - Benjamin S Wu
- Respiratory Therapy Area, GlaxoSmithKline plc., Research Triangle Park, North Carolina, United States
| | - Daniel Gratie
- Respiratory Therapy Area, GlaxoSmithKline plc., Research Triangle Park, North Carolina, United States
| | - Richard H Stanford
- Respiratory Therapy Area, GlaxoSmithKline plc., Research Triangle Park, North Carolina, United States
| | - Ryan Tomlinson
- Respiratory Therapy Area, GlaxoSmithKline plc., Collegeville, Pennsylvania, United States
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17
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Su JG, Barrett MA, Combs V, Henderson K, Van Sickle D, Hogg C, Simrall G, Moyer SS, Tarini P, Wojcik O, Sublett J, Smith T, Renda AM, Balmes J, Gondalia R, Kaye L, Jerrett M. Identifying impacts of air pollution on subacute asthma symptoms using digital medication sensors. Int J Epidemiol 2021; 51:213-224. [PMID: 34664072 DOI: 10.1093/ije/dyab187] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 11/01/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Objective tracking of asthma medication use and exposure in real-time and space has not been feasible previously. Exposure assessments have typically been tied to residential locations, which ignore exposure within patterns of daily activities. METHODS We investigated the associations of exposure to multiple air pollutants, derived from nearest air quality monitors, with space-time asthma rescue inhaler use captured by digital sensors, in Jefferson County, Kentucky. A generalized linear mixed model, capable of accounting for repeated measures, over-dispersion and excessive zeros, was used in our analysis. A secondary analysis was done through the random forest machine learning technique. RESULTS The 1039 participants enrolled were 63.4% female, 77.3% adult (>18) and 46.8% White. Digital sensors monitored the time and location of over 286 980 asthma rescue medication uses and associated air pollution exposures over 193 697 patient-days, creating a rich spatiotemporal dataset of over 10 905 240 data elements. In the generalized linear mixed model, an interquartile range (IQR) increase in pollutant exposure was associated with a mean rescue medication use increase per person per day of 0.201 [95% confidence interval (CI): 0.189-0.214], 0.153 (95% CI: 0.136-0.171), 0.131 (95% CI: 0.115-0.147) and 0.113 (95% CI: 0.097-0.129), for sulphur dioxide (SO2), nitrogen dioxide (NO2), fine particulate matter (PM2.5) and ozone (O3), respectively. Similar effect sizes were identified with the random forest model. Time-lagged exposure effects of 0-3 days were observed. CONCLUSIONS Daily exposure to multiple pollutants was associated with increases in daily asthma rescue medication use for same day and lagged exposures up to 3 days. Associations were consistent when evaluated with the random forest modelling approach.
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Affiliation(s)
- Jason G Su
- Division of Environmental Health Sciences, School of Public Health, University of California at Berkeley, Berkeley, CA, USA
| | | | - Veronica Combs
- Center for Healthy Air, Water and Soil, University of Louisville, Louisville, KY, USA
| | | | - David Van Sickle
- Propeller Health, Madison, WI, USA.,Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Chris Hogg
- Propeller Health, San Francisco, CA, USA
| | - Grace Simrall
- Louisville Metro, Office of Civic Innovation, Louisville, KY, USA
| | - Sarah S Moyer
- Louisville Metro, Department of Public Health and Wellness, Louisville, KY, USA
| | - Paul Tarini
- Robert Wood Johnson Foundation, Princeton, NJ, USA
| | | | | | - Ted Smith
- Center for Healthy Air, Water and Soil, University of Louisville, Louisville, KY, USA.,Envirome Institute, School of Medicine, University of Louisville, Louisville, KY, USA
| | | | - John Balmes
- Division of Environmental Health Sciences, School of Public Health, University of California at Berkeley, Berkeley, CA, USA
| | | | | | - Michael Jerrett
- Fielding School of Public Health, University of California, Los Angeles, CA, USA
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18
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Stempel DA, Kaye L, Bender BG. Defining optimal medication adherence for persistent asthma and COPD. J Allergy Clin Immunol Pract 2021; 9:4239-4242. [PMID: 34352449 DOI: 10.1016/j.jaip.2021.07.034] [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] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/01/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
Adherence to prescribed medications for chronic respiratory disease is considered a keystone for successful management. There is little consensus though, on how to measure adherence, what is optimal adherence or the goals of appropriate medication utilization. These criteria may differ when studying medication utilization at the patient or population level. The role of consistent medication use in chronic respiratory disease is associated with better outcomes. Shared decision-making is one strategy to achieve appropriate levels of adherence that requires negotiation, compromise by both patient and provider. It also recognizes that both success and failure to achieve goals of adherence is shared. As such, we discuss the current understanding of adherence measures in respiratory disease and identify the need for more nuanced approaches to evaluate adherence to reach acceptable patient outcomes.
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19
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Jarrin R, Barrett MA, Kaye L, Sayiner S, von Leer A, Johns J, D'Andrea L, Nunez C, Ostrovsky A. Need for clarifying remote physiologic monitoring reimbursement during the COVID-19 pandemic: a respiratory disease case study. NPJ Digit Med 2021; 4:50. [PMID: 33712676 PMCID: PMC7954815 DOI: 10.1038/s41746-021-00421-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 02/08/2021] [Indexed: 11/14/2022] Open
Abstract
The use of remote monitoring and virtual visits has accelerated to support socially-distanced patient care during the COVID-19 pandemic. Despite the necessity of this expansion, ambiguity in coding is hindering adoption and patient access, most notably for remote physiologic monitoring due to a lack of definition of the term “physiologic”. In this analysis, we describe the history of remote monitoring code development, present several examples in respiratory disease and other chronic conditions in which gaps and confusion remain and suggest ways to clarify and broaden coverage to ensure equitable access to remote monitoring.
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Affiliation(s)
- Robert Jarrin
- The Omega Concern, LLC, Washington, DC, USA.,Department of Emergency Medicine, George Washington University, Washington, DC, USA.,Department of Biochemistry and Molecular & Cellular Biology, Georgetown University Medical Center, Washington, DC, USA
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20
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Gondalia R, Anderson W, Kaye L, De Keyser H, Barrett M, Szefler S, Stempel D. Medication adherence was greater in a digital asthma platform consisting of controller and rescue vs. controller inhalers alone. J Allergy Clin Immunol 2021. [DOI: 10.1016/j.jaci.2020.12.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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Theye B, Kaye L, Nagano J, Gondalia R, Barrett M, Stempel D. Increased adherence to controller medication maintained during the COVID-19 pandemic. J Allergy Clin Immunol 2021. [PMCID: PMC7849418 DOI: 10.1016/j.jaci.2020.12.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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Kaye L, Gondalia R, Barrett M, Bender B, Stempel D. Weekly and Seasonal Variation in Controller Adherence by Age in Asthma. J Allergy Clin Immunol 2021. [DOI: 10.1016/j.jaci.2020.12.437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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23
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Barrett M, Gondalia R, Rowland C, Hill A, Attisha E, Kaye L, Holtrop T. Impact of a Digital Asthma Intervention on Short-acting Beta-agonist (SABA) Medication Use Among Medicaid-enrolled Children in Southwest Detroit. J Allergy Clin Immunol 2021. [DOI: 10.1016/j.jaci.2020.12.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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24
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Mosnaim GS, Stempel DA, Gonzalez C, Adams B, BenIsrael-Olive N, Gondalia R, Kaye L, Shalowitz M, Szefler S. The Impact of Patient Self-Monitoring Via Electronic Medication Monitor and Mobile App Plus Remote Clinician Feedback on Adherence to Inhaled Corticosteroids: A Randomized Controlled Trial. J Allergy Clin Immunol Pract 2020; 9:1586-1594. [PMID: 33212239 DOI: 10.1016/j.jaip.2020.10.064] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 10/25/2020] [Accepted: 10/31/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Poor adherence to inhaled corticosteroids (ICSs) and overuse of short-acting beta2-agonists (SABAs) are associated with increased asthma morbidity. OBJECTIVE To assess whether patient self-monitoring via electronic medication monitoring and smartphone application plus remote clinician feedback influences ICS and SABA use. METHODS Adults with uncontrolled asthma and prescribed ICS and SABA were enrolled in this 14-week study. Inhalers were fitted with electronic medication monitoring to track real-time usage. After a 14-day baseline, participants were randomly assigned to the treatment group where they received reminders and feedback on ICS and SABA use via a smartphone application and clinician phone calls, or control group without feedback. Linear mixed models compared the baseline percentage of SABA-free days and ICS adherence to the last 14 study days. RESULTS Participants (n = 100) had a mean age of 48.5 years, 80% were female, 68% white, and 80% privately insured. The percentage of SABA-free days increased significantly in the treatment group (19%; 95% CI, 12 to 26; P < .01) and nonsignificantly in the control group (6%, 95% CI, -3 to 16; P = .18), representing a 13% (95% CI, 1-26; P = .04) difference. ICS adherence changed minimally in the treatment group (-2%; 95% CI, -7 to 3; P = .40), but decreased significantly (-17%; 95% CI, -26 to -8; P < .01) in the control group, representing a 15% (95% CI, 4 to 25; P < .01) difference. CONCLUSIONS Patient self-monitoring via a digital platform plus remote clinician feedback maintained high baseline ICS adherence and decreased SABA use.
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Affiliation(s)
- Giselle S Mosnaim
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, NorthShore University HealthSystem, Evanston, Ill.
| | - David A Stempel
- Propeller Health, an Affiliate of ResMed, San Francisco, Calif
| | - Candy Gonzalez
- Research Institute, NorthShore University HealthSystem, Evanston, Ill
| | - Brittany Adams
- Research Institute, NorthShore University HealthSystem, Evanston, Ill
| | - Naomi BenIsrael-Olive
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, NorthShore University HealthSystem, Evanston, Ill
| | | | | | | | - Stanley Szefler
- Department of Pediatrics, Section of Allergy and Immunology and Pulmonary and Sleep Medicine, University of Colorado School of Medicine and the Breathing Institute, Children's Hospital Colorado, Aurora, Colo
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25
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Anderson WC, Gondalia R, De Keyser HE, Kaye L, Szefler SJ, Stempel DA. Digital assessment of medication utilization by age and diagnosis of asthma or COPD. J Allergy Clin Immunol Pract 2020; 9:1723-1725. [PMID: 33212238 DOI: 10.1016/j.jaip.2020.10.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/27/2020] [Accepted: 10/31/2020] [Indexed: 01/20/2023]
Affiliation(s)
- William C Anderson
- Section of Allergy and Immunology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo.
| | | | - Heather E De Keyser
- Breathing Institute, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | | | - Stanley J Szefler
- Breathing Institute, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
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26
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McCreary G, Yawn B, Linnell J, Pasquale C, Malanga E, Choate R, Stempel D, Gondalia R, Kaye L, Collison K, Stanford R, Gratie D, Wu B, Tomlinson R. ASSESSMENT OF PATIENT INTERACTION WITH A DRY POWDER INHALER ELECTRONIC MEDICATION MONITOR AND INTEGRATED SYSTEM WITHIN THE COPD FOUNDATION PATIENT POWERED RESEARCH NETWORK. Chest 2020. [DOI: 10.1016/j.chest.2020.08.1534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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27
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Kaye L, Theye B, Smeenk I, Gondalia R, Barrett MA, Stempel DA. Changes in medication adherence among patients with asthma and COPD during the COVID-19 pandemic. J Allergy Clin Immunol Pract 2020; 8:2384-2385. [PMID: 32371047 PMCID: PMC7194036 DOI: 10.1016/j.jaip.2020.04.053] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 12/21/2022]
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28
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Casey JA, Su JG, Henneman LR, Zigler C, Neophytou AM, Catalano R, Gondalia R, Chen YT, Kaye L, Moyer SS, Combs V, Simrall G, Smith T, Sublett J, Barrett MA. Improved asthma outcomes observed in the vicinity of coal power plant retirement, retrofit, and conversion to natural gas. Nat Energy 2020; 5:398-408. [PMID: 32483491 PMCID: PMC7263319 DOI: 10.1038/s41560-020-0600-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 03/06/2020] [Indexed: 05/25/2023]
Abstract
Coal-fired power plants release substantial air pollution, including over 60% of U.S. sulfur dioxide (SO2) emissions in 2014. Such air pollution may exacerbate asthma however direct studies of health impacts linked to power plant air pollution are rare. Here, we take advantage of a natural experiment in Louisville, Kentucky, where one coal-fired power plant retired and converted to natural gas, and three others installed SO2 emission control systems between 2013 and 2016. Dispersion modeling indicated exposure to SO2 emissions from these power plants decreased after the energy transitions. We used several analysis strategies, including difference-in-differences, first-difference, and interrupted time-series modeling to show that the emissions control installations and plant retirements were associated with reduced asthma disease burden related to ZIP code-level hospitalizations and emergency room visits, and individual-level medication use as measured by digital medication sensors.
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Affiliation(s)
- Joan A. Casey
- School of Public Health, University of California, Berkeley, California, USA 94720
- Columbia University Mailman School of Public Health, New York, New York, USA 10032
| | - Jason G. Su
- School of Public Health, University of California, Berkeley, California, USA 94720
| | - Lucas R.F. Henneman
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA 02115
| | - Corwin Zigler
- Department of Statistics and Data Sciences and Department of Women's Health, University of Texas, Austin, Texas, USA
| | - Andreas M. Neophytou
- School of Public Health, University of California, Berkeley, California, USA 94720
- Department of Environmental and Radiological Sciences, Colorado State University, Fort Collins, Colorado, USA 80523
| | - Ralph Catalano
- School of Public Health, University of California, Berkeley, California, USA 94720
| | | | - Yu-Ting Chen
- Louisville Metro Department of Public Health and Wellness, Louisville, Kentucky, USA 40202
| | - Leanne Kaye
- Propeller Health, San Francisco, California, USA 94108
| | - Sarah S. Moyer
- Louisville Metro Department of Public Health and Wellness, Louisville, Kentucky, USA 40202
| | - Veronica Combs
- Christina Lee Brown Environment Institute, University of Louisville, Louisville, Kentucky, USA 40202
| | - Grace Simrall
- Louisville Metro Office of Civic Innovation, Louisville, Kentucky, USA 40202
| | - Ted Smith
- Christina Lee Brown Environment Institute, University of Louisville, Louisville, Kentucky, USA 40202
| | - James Sublett
- Family Allergy & Asthma, Louisville, Kentucky, USA 40223
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29
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Kaye L, Gondalia R, Gonzalez C, Adams B, Zhu L, QUAN PRISCILLIA, BenIsrael Olive N, Shalowitz M, Stempel D. Electronic Medication Monitoring vs. Self-Reported Use of Inhaled Corticosteroids and Short Acting Beta2 Agonists in Adult Patients with Uncontrolled Asthma. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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30
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Anderson WC, Gondalia R, Hoch HE, Kaye L, Barrett M, Szefler SJ, Stempel DA. Assessing asthma control: comparison of electronic-recorded short-acting beta-agonist rescue use and self-reported use utilizing the asthma control test. J Asthma 2019; 58:271-275. [PMID: 31668103 DOI: 10.1080/02770903.2019.1687715] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Question 4 (Q4) of the Asthma Control Test (ACT) asks patients to report their SABA use over the prior 4 weeks, a criterion for evaluating the impairment domain of asthma control. Biases in recall may lead to a misclassification of asthma control and has implications for asthma control determination and management strategies.Objective: To correlate objective electronic-recorded short-acting beta-agonist (SABA) use with self-reported use via Q4 of the ACT.Methods: Patients ≥18 years of age with a self-reported diagnosis of asthma were enrolled in a digital health electronic medication monitoring (EMM) platform, which recorded the date and time of SABA actuations and prompted the completion of the ACT. The correlations between ACT Q4 responses and EMM-recorded SABA use were evaluated using Spearman's rank correlation coefficients.Results: 1,062 patients (mean age: 35.4 years, mean ACT: 16.3) were included in analyses. Higher Q4 scores, indicating lower SABA use, were moderately and negatively correlated with EMM-recorded SABA use (ρ = -0.59 [95% CI: -0.63, -0.54]). Thirty-five percent of patients underreported SABA use when comparing Q4 to EMM-recorded SABA use.Conclusions: While ACT Q4 and EMM-recorded use were moderately correlated, underreported SABA use on the ACT highlights the need for objective measures of SABA use in asthma control assessments. The use of EMM-recorded SABA data has the potential for clinicians to more accurately determine asthma control, guide changes to controller therapy, and estimate imminent exacerbation risk.
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Affiliation(s)
- William C Anderson
- Department of Pediatrics, Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Heather E Hoch
- Department of Pediatrics, Section of Pulmonary and Sleep Medicine, Breathing Institute, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Leanne Kaye
- Propeller Health, San Francisco, California, USA
| | | | - Stanley J Szefler
- Department of Pediatrics, Section of Pulmonary and Sleep Medicine, Breathing Institute, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
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31
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Chen J, Kaye L, Tuffli M, Barrett MA, Jones-Ford S, Shenouda T, Gondalia R, Henderson K, Combs V, Van Sickle D, Stempel DA. Passive Monitoring of Short-Acting Beta-Agonist Use via Digital Platform in Patients With Chronic Obstructive Pulmonary Disease: Quality Improvement Retrospective Analysis. JMIR Form Res 2019; 3:e13286. [PMID: 31647471 PMCID: PMC7010108 DOI: 10.2196/13286] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 07/26/2019] [Accepted: 08/19/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Digital health programs assist patients with chronic obstructive pulmonary disease (COPD) to better manage their disease. Technological and adoption barriers have been perceived as a limitation. OBJECTIVE The aim of the research was to evaluate a digital quality improvement pilot in Medicare-eligible patients with COPD. METHODS COPD patients were enrolled in a digital platform to help manage their medications and symptoms as part of their routine clinical care. Patients were provided with electronic medication monitors (EMMs) to monitor short-acting beta-agonist (SABA) use passively and a smartphone app to track use trends and receive feedback. Providers also had access to data collected via a secure website and were sent email notifications if a patient had a significant change in their prescribed inhaler use. Providers then determined if follow-up was needed. Change in SABA use and feasibility outcomes were evaluated at 3, 6, and 12 months. RESULTS A total of 190 patients enrolled in the pilot. At 3, 6, and 12 months, patients recorded significant reductions in daily and nighttime SABA use and increases in SABA-free days (all P<.001). Patient engagement, as measured by the ratio of daily active use to monthly active use, was >90% at both 6 and 12 months. Retention at 6 months was 81% (154/190). Providers were sent on average two email notifications per patient during the 12-month program. CONCLUSIONS A digital health program integrated as part of standard clinical practice was feasible and had low provider burden. The pilot demonstrated significant reduction in SABA use and increased SABA-free days among Medicare-eligible COPD patients. Further, patients readily adopted the digital platform and demonstrated strong engagement and retention rates at 6 and 12 months.
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Affiliation(s)
| | - Leanne Kaye
- Propeller Health, San Francisco, CA, United States
| | | | | | | | - Tina Shenouda
- JenCare Senior Medical Center, Louisville, KY, United States
| | | | | | - Veronica Combs
- Content Strategy Solutions, Louisville, KY, United States
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Anderson WC, Gondalia R, Hoch HE, Kaye L, Szefler SJ, Stempel DA. Screening for inhalation technique errors with electronic medication monitors. J Allergy Clin Immunol Pract 2019; 7:2065-2067. [PMID: 30776523 DOI: 10.1016/j.jaip.2019.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/26/2018] [Accepted: 02/04/2019] [Indexed: 10/27/2022]
Affiliation(s)
- William C Anderson
- Department of Pediatrics, Sections of Allergy and Immunology and Pulmonary and Sleep Medicine, University of Colorado School of Medicine and the Breathing Institute, Children's Hospital Colorado, Aurora, Colo
| | - Rahul Gondalia
- Clinical Affairs & Research, Propeller Health, San Francisco, Calif.
| | - Heather E Hoch
- Department of Pediatrics, Sections of Allergy and Immunology and Pulmonary and Sleep Medicine, University of Colorado School of Medicine and the Breathing Institute, Children's Hospital Colorado, Aurora, Colo
| | - Leanne Kaye
- Clinical Affairs & Research, Propeller Health, San Francisco, Calif
| | - Stanley J Szefler
- Department of Pediatrics, Sections of Allergy and Immunology and Pulmonary and Sleep Medicine, University of Colorado School of Medicine and the Breathing Institute, Children's Hospital Colorado, Aurora, Colo
| | - David A Stempel
- Clinical Affairs & Research, Propeller Health, San Francisco, Calif
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Gondalia R, Anderson W, Hoch H, Kaye L, Szefler SJ, Stempel DA. Assessing the sensitivity and specificity of self-reported short-acting beta agonist (SABA) inhaler use with electronic medication monitors (EMMs). J Allergy Clin Immunol 2019. [DOI: 10.1016/j.jaci.2018.12.517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Zhu L, Ramirez Y, Villalobos-Terrazas D, Reyes K, BenIsrael-Olive N, Gondalia R, Kaye L, Stempel DA, Mosnaim G. Aligning Guideline Criteria for Asthma Control with Digitally Collected Data. J Allergy Clin Immunol 2019. [DOI: 10.1016/j.jaci.2018.12.523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Anderson W, Hoch H, Gondalia R, Kaye L, Szefler SJ, Stempel DA. Digital assessment of asthma controller and rescue medication use as children transition into adulthood. J Allergy Clin Immunol 2019. [DOI: 10.1016/j.jaci.2018.12.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Merchant R, Szefler SJ, Bender BG, Tuffli M, Barrett MA, Gondalia R, Kaye L, Van Sickle D, Stempel DA. Impact of a digital health intervention on asthma resource utilization. World Allergy Organ J 2018; 11:28. [PMID: 30524644 PMCID: PMC6276132 DOI: 10.1186/s40413-018-0209-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 09/24/2018] [Indexed: 11/20/2022] Open
Abstract
Digital health interventions have been associated with reduced rescue inhaler use and improved controller medication adherence. This quality improvement project assessed the benefit of these interventions on asthma-related healthcare utilizations, including hospitalizations, emergency department (ED) utilization and outpatient visits. The intervention consisted of electronic medication monitors (EMMs) that tracked rescue and controller inhaler medication use, and a digital health platform that presented medication use information and asthma control status to patients and providers. In 224 study patients, the number of asthma-related ED visits and combined ED and hospitalization events 365 days pre- to 365 days post-enrollment to the intervention significantly decreased from 11.6 to 5.4 visits (p < 0.05) and 13.4 to 5.8 events (p < 0.05) per 100 patient-years, respectively. This digital health intervention was successfully incorporated into routine clinical practice and was associated with lower rates of asthma-related hospitalizations and ED visits.
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Affiliation(s)
- Rajan Merchant
- 1Dignity Health, Woodland Clinic Medical Group, 632 W Gibson Rd, Woodland, CA 95695 USA
| | - Stanley J Szefler
- 2Breathing Institute, University of Colorado School of Medicine and Children's Hospital Colorado, 13123 East 16th Ave, Aurora, CO 80045 USA
| | - Bruce G Bender
- 3Division of Pediatric Behavioral Health, Department of Pediatrics, National Jewish Health, 1400 Jackson St, Denver, CO 80206 USA
| | - Michael Tuffli
- Propeller Health, 47 Maiden Lane, San Francisco, CA 94108 USA
| | | | - Rahul Gondalia
- Propeller Health, 47 Maiden Lane, San Francisco, CA 94108 USA
| | - Leanne Kaye
- Propeller Health, 47 Maiden Lane, San Francisco, CA 94108 USA
| | | | - David A Stempel
- Propeller Health, 47 Maiden Lane, San Francisco, CA 94108 USA
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Anderson W, Hoch H, Gondalia R, Kaye L, Barrett M, Van Sickle D, Szefler S, Stempel D. ASTHMA CONTROL EVALUATED WITH ELECTRONIC MEDICATION MONITOR (EMM)-DEFINED OCCASIONS OF SHORT-ACTING BETA-AGONIST INHALER USE. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Hoch H, Kaye L, Anderson W, Gondalia R, Barrett M, Tuffli M, Van Sickle D, Szefler S, Stempel D. Comparing objective inhaler use among COPD and Asthma populations. Epidemiology 2018. [DOI: 10.1183/13993003.congress-2018.pa2272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Anderson W, Brinton J, Kaye L, Hoch H, Barrett M, Van Sickle D, Szefler SJ, Stempel DA. Real-Life Patterns of Short-Acting Beta-Agonist Use in Persistent Asthmatics Vary by Age, Time of Day, and Season. J Allergy Clin Immunol 2018. [DOI: 10.1016/j.jaci.2017.12.197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kaye L, Hoch H, Szefler SJ, Anderson W, Barrett M, Van Sickle D, Stempel DA. Real-Life Patterns of Asthma Controller Use Vary by Age, Time of Day and Season. J Allergy Clin Immunol 2018. [DOI: 10.1016/j.jaci.2017.12.195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Nguyen KT, Olgin JE, Pletcher MJ, Ng M, Kaye L, Moturu S, Gladstone RA, Malladi C, Fann AH, Maguire C, Bettencourt L, Christensen MA, Marcus GM. Smartphone-Based Geofencing to Ascertain Hospitalizations. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.116.003326. [PMID: 28325751 DOI: 10.1161/circoutcomes.116.003326] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [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: 09/25/2016] [Accepted: 01/13/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Ascertainment of hospitalizations is critical to assess quality of care and the effectiveness and adverse effects of various therapies. Smartphones, mobile geolocators that are ubiquitous, have not been leveraged to ascertain hospitalizations. Therefore, we evaluated the use of smartphone-based geofencing to track hospitalizations. METHODS AND RESULTS Participants aged ≥18 years installed a mobile application programmed to geofence all hospitals using global positioning systems and cell phone tower triangulation and to trigger a smartphone-based questionnaire when located in a hospital for ≥4 hours. An in-person study included consecutive consenting patients scheduled for electrophysiology and cardiac catheterization procedures. A remote arm invited Health eHeart Study participants who consented and engaged with the study via the internet only. The accuracy of application-detected hospitalizations was confirmed by medical record review as the reference standard. Of 22 eligible in-person patients, 17 hospitalizations were detected (sensitivity 77%; 95% confidence interval, 55%-92%). The length of stay according to the application was positively correlated with the length of stay ascertained via the electronic medical record (r=0.53; P=0.03). In the remote arm, the application was downloaded by 3443 participants residing in all 50 US states; 243 hospital visits at 119 different hospitals were detected through the application. The positive predictive value for an application-reported hospitalization was 65% (95% confidence interval, 57%-72%). CONCLUSIONS Mobile application-based ascertainment of hospitalizations can be achieved with modest accuracy. This first proof of concept may ultimately be applicable to geofencing other types of prespecified locations to facilitate healthcare research and patient care.
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Affiliation(s)
- Kaylin T Nguyen
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.)
| | - Jeffrey E Olgin
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.)
| | - Mark J Pletcher
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.)
| | - Madelena Ng
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.)
| | - Leanne Kaye
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.)
| | - Sai Moturu
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.)
| | - Rachel A Gladstone
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.)
| | - Chaitanya Malladi
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.)
| | - Amy H Fann
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.)
| | - Carol Maguire
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.)
| | - Laura Bettencourt
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.)
| | - Matthew A Christensen
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.)
| | - Gregory M Marcus
- From the Division of Cardiology (K.T.N., J.E.O., M.N., R.A.G., C.M., A.H.F., C.M., L.B., M.A.C., G.M.M) and Department of Epidemiology and Biostatistics (M.J.P.), University of California, San Francisco; Ginger.io, San Francisco, CA (L.K., S.M.).
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Christensen MA, Bettencourt L, Kaye L, Moturu ST, Nguyen KT, Olgin JE, Pletcher MJ, Marcus GM. Direct Measurements of Smartphone Screen-Time: Relationships with Demographics and Sleep. PLoS One 2016; 11:e0165331. [PMID: 27829040 PMCID: PMC5102460 DOI: 10.1371/journal.pone.0165331] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 10/10/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Smartphones are increasingly integrated into everyday life, but frequency of use has not yet been objectively measured and compared to demographics, health information, and in particular, sleep quality. AIMS The aim of this study was to characterize smartphone use by measuring screen-time directly, determine factors that are associated with increased screen-time, and to test the hypothesis that increased screen-time is associated with poor sleep. METHODS We performed a cross-sectional analysis in a subset of 653 participants enrolled in the Health eHeart Study, an internet-based longitudinal cohort study open to any interested adult (≥ 18 years). Smartphone screen-time (the number of minutes in each hour the screen was on) was measured continuously via smartphone application. For each participant, total and average screen-time were computed over 30-day windows. Average screen-time specifically during self-reported bedtime hours and sleeping period was also computed. Demographics, medical information, and sleep habits (Pittsburgh Sleep Quality Index-PSQI) were obtained by survey. Linear regression was used to obtain effect estimates. RESULTS Total screen-time over 30 days was a median 38.4 hours (IQR 21.4 to 61.3) and average screen-time over 30 days was a median 3.7 minutes per hour (IQR 2.2 to 5.5). Younger age, self-reported race/ethnicity of Black and "Other" were associated with longer average screen-time after adjustment for potential confounders. Longer average screen-time was associated with shorter sleep duration and worse sleep-efficiency. Longer average screen-times during bedtime and the sleeping period were associated with poor sleep quality, decreased sleep efficiency, and longer sleep onset latency. CONCLUSIONS These findings on actual smartphone screen-time build upon prior work based on self-report and confirm that adults spend a substantial amount of time using their smartphones. Screen-time differs across age and race, but is similar across socio-economic strata suggesting that cultural factors may drive smartphone use. Screen-time is associated with poor sleep. These findings cannot support conclusions on causation. Effect-cause remains a possibility: poor sleep may lead to increased screen-time. However, exposure to smartphone screens, particularly around bedtime, may negatively impact sleep.
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Affiliation(s)
- Matthew A. Christensen
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Laura Bettencourt
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Leanne Kaye
- Ginger.io Incorporated, San Francisco, California, United States of America
| | - Sai T. Moturu
- Ginger.io Incorporated, San Francisco, California, United States of America
| | - Kaylin T. Nguyen
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Jeffrey E. Olgin
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Mark J. Pletcher
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Gregory M. Marcus
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
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Allicock M, Golin CE, Kaye L, Grodensky C, Blackman LT, Thibodeaux H. SafeTalk: Training Peers to Deliver a Motivational Interviewing HIV Prevention Program. Health Promot Pract 2016; 18:410-417. [PMID: 27519260 DOI: 10.1177/1524839916663486] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
As multiple effective interventions emerge to reduce the spread of HIV, there is a need to implement and disseminate such programs cost-effectively, such as by expanding service delivery through integration of peer supporters. The benefits of peer support are well established. However, knowledge about peer counseling initiatives remain limited. This pilot study tested the feasibility, fidelity, and acceptability of a motivational interviewing (MI) counseling training with individuals living with HIV to serve as peer counselors in order to address medication adherence and safer sex. We adapted, SafeTalk, an evidence-based intervention previously delivered by health professionals to reduce risky sexual behaviors among people living with HIV. We trained six peers in a 5-day program (24 hours total) over a 2-month period. We used a combination of training observation, pre-and posttests, debriefing, and the Motivational Interviewing Treatment Integrity (MITI 3.1) scale 3.1 to assess implementation of the training. Results suggest the program was feasible, and there was positive acceptability. However, fidelity to MI was poor. While participants were dedicated and enthusiastic about the training and able to learn some skills and demonstrate the "spirit of MI," they had difficulty with reflecting and moving away from giving direct advice. Training challenges and successes are discussed.
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Affiliation(s)
| | - Carol E Golin
- 2 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Allicock M, Carr C, Johnson LS, Smith R, Lawrence M, Kaye L, Gellin M, Manning M. Implementing a one-on-one peer support program for cancer survivors using a motivational interviewing approach: results and lessons learned. J Cancer Educ 2014; 29:91-8. [PMID: 24078346 PMCID: PMC4066630 DOI: 10.1007/s13187-013-0552-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Peer Connect matches cancer survivors and caregivers (guides) with those currently experiencing cancer-related issues seeking support (partners). Motivational interviewing (MI)-based communication skills are taught to provide patient-centered support. There is little guidance about MI-based applications with cancer survivors who may have multiple coping needs. This paper addresses the results and lessons learned from implementing Peer Connect. Thirteen cancer survivors and two caregivers received a 2-day MI, DVD-based training along with six supplemental sessions. Nineteen partners were matched with guides and received telephone support. Evaluation included guide skill assessment (Motivational Interviewing Treatment Integrity Code) and 6-month follow-up surveys with guides and partners. Guides demonstrated MI proficiency and perceived their training as effective. Guides provided on average of five calls to each partner. Conversation topics included cancer fears, family support needs, coping and care issues, and cancer-related decisions. Partners reported that guides provided a listening ear, were supportive, and nonjudgmental. Limited time availability of some guides was a challenge. MI can provide support for cancer survivors and caregivers without specific behavioral concerns (e.g., weight and smoking). An MI support model was both feasible and effective and can provide additional support outside of the medical system.
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Affiliation(s)
- Marlyn Allicock
- School of Public Health, Division of Health Promotion and Behavioral Sciences, The University of Texas, 5323 Harry Hines, V8.112, Dallas, TX 75390-9128, USA
| | - Carol Carr
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - La-Shell Johnson
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | | | | | - Leanne Kaye
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Mindy Gellin
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Michelle Manning
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
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Allicock M, Kaye L, Johnson LS, Carr C, Alick C, Gellin M, Campbell M. The use of motivational interviewing to promote peer-to-peer support for cancer survivors. Clin J Oncol Nurs 2013; 16:E156-63. [PMID: 23022941 DOI: 10.1188/12.cjon.e156-e163] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Motivational interviewing (MI) as a counseling approach has gained empirical support for its use in a number of settings and for a variety of behaviors. However, the majority of practitioners trained to use MI have been professionals rather than laypeople. This article presents the rationale, design, and evaluation of an MI-based training for cancer survivors and caregivers to deliver peer support. The training and evaluation of the peers ("guides") to encourage practice and increase research knowledge for using MI-based peer support models for cancer care are discussed. Thirteen cancer survivors and two caregivers received two-day DVD-based MI training, as well as supplemental monthly sessions for six months. The guides demonstrated MI proficiency as assessed by the MI Treatment Integrity scale and other process evaluation assessments. MI can be adapted to train laypeople to provide support for groups such as cancer survivors.
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Affiliation(s)
- Marlyn Allicock
- Department of Nutrition, Gillings School of Global Public Health, Chapel Hill, NC, USA.
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Campbell MK, Tessaro I, Gellin M, Valle CG, Golden S, Kaye L, Ganz PA, McCabe MS, Jacobs LA, Syrjala K, Anderson B, Jones AF, Miller K. Adult cancer survivorship care: experiences from the LIVESTRONG centers of excellence network. J Cancer Surviv 2011; 5:271-82. [PMID: 21553353 DOI: 10.1007/s11764-011-0180-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 04/21/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND The objectives of this study were to characterize survivorship models of care across eight LIVESTRONG Survivorship Center of Excellence (COE) Network sites and to identify barriers and facilitators influencing survivorship care. METHODS Using the framework of the Chronic Care Model (CCM), quantitative and qualitative methods of inquiry were conducted with the COEs. Methods included document reviews, key informant telephone interviews with 39 participants, online Assessment of Chronic Illness Care (ACIC) surveys with 40 participants, and three site visits. RESULTS Several overarching themes emerged in qualitative interviews and were substantiated by quantitative methods. Health system factors supporting survivorship care include organization and leadership commitment and program champions at various levels of the health care team. System barriers include reimbursement issues, lack of space, and the need for leadership commitment to support changes in clinical practices as well as having program "champions" among clinical staff. Multiple models of care include separate survivorship clinics and integrated models as well as consultative models. COEs' scores on the ACIC survey showed overall "reasonable support" for survivorship care; however, the clinical information system domain was least developed. Although the ACIC findings indicated "reasonable support" for self-management, the qualitative analysis revealed that self-management support was largely limited to health promotion provided in clinic-based education and counseling sessions, with few COEs providing patients with self-management tools and interventions. CONCLUSIONS The CCM framework captured experiences and challenges of these COEs and provided insight into the current state of survivorship care in the context of National Cancer Institute-designated comprehensive cancer centers. Findings showed that cancer patients and providers could benefit from clinical information systems that would better identify candidates for survivorship care and provide timely information. In addition, a crucial area for development is self-management support outside of clinical care. IMPLICATIONS FOR CANCER SURVIVORS Cancer survivors may benefit from learning about the experience and challenges faced by the eight LIVESTRONG Centers of Excellence in developing programs and models for cancer survivorship care, and these findings may inform patient and caregiver efforts to seek, evaluate, and advocate for quality survivorship programs designed to meet their needs.
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Affiliation(s)
- Marci K Campbell
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB #7461, 1700 Martin Luther King Blvd, Room 316, Chapel Hill, NC 27599, USA.
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Akerley WL, McCoy J, Hesketh P, Crowley J, Kaye L, Gandara D. SWOG 0019: A phase II study of gemcitabine and irinotecan for patients with untreated extensive stage small cell lung cancer (SCLC). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.7202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- W. L. Akerley
- Huntsman Cancer Institute, Salt Lake City, UT; Southwest Oncology Group, Seattle, WA; St. Elizabeth's Medial Center, Medford, MA; UC Davis Cancer Center, Sacremento, CA
| | - J. McCoy
- Huntsman Cancer Institute, Salt Lake City, UT; Southwest Oncology Group, Seattle, WA; St. Elizabeth's Medial Center, Medford, MA; UC Davis Cancer Center, Sacremento, CA
| | - P. Hesketh
- Huntsman Cancer Institute, Salt Lake City, UT; Southwest Oncology Group, Seattle, WA; St. Elizabeth's Medial Center, Medford, MA; UC Davis Cancer Center, Sacremento, CA
| | - J. Crowley
- Huntsman Cancer Institute, Salt Lake City, UT; Southwest Oncology Group, Seattle, WA; St. Elizabeth's Medial Center, Medford, MA; UC Davis Cancer Center, Sacremento, CA
| | - L. Kaye
- Huntsman Cancer Institute, Salt Lake City, UT; Southwest Oncology Group, Seattle, WA; St. Elizabeth's Medial Center, Medford, MA; UC Davis Cancer Center, Sacremento, CA
| | - D. Gandara
- Huntsman Cancer Institute, Salt Lake City, UT; Southwest Oncology Group, Seattle, WA; St. Elizabeth's Medial Center, Medford, MA; UC Davis Cancer Center, Sacremento, CA
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O'Connell T, Kaye L, Plosay JJ. Gamma-hydroxybutyrate (GHB): a newer drug of abuse. Am Fam Physician 2000; 62:2478-83. [PMID: 11130233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Gamma-hydroxybutyrate (GHB) is an illicitly marketed substance that has recently gained popularity among body builders and party attendees as a drug of abuse. GHB is a depressant that acts on the central nervous system. It is purported as a strength enhancer, euphoriant and aphrodisiac and is one of several agents reported as being used as a "date rape" drug. Because of its central nervous system depressant effects, GHB can be lethal when combined with alcohol or other depressants. Currently, there is no accepted medical use for GHB, and the U.S. Food and Drug Administration has prohibited its manufacture and sale. Clinicians should be familiar with the typical clinical presentation of GHB and its adverse effects. In addition, patients should be warned of its potential toxicity and be cautioned to avoid the use of GHB.
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Affiliation(s)
- T O'Connell
- Santa Monica-UCLA Medical Center, California, USA.
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Sur DK, Kaye L, Mikus M, Goad J, Morena A. Accuracy of electrocardiogram reading by family practice residents. Fam Med 2000; 32:315-9. [PMID: 10820672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVES This study evaluated the electrocardiogram (EKG) reading skills of family practice residents. METHODS A multicenter study was carried out to evaluate the accuracy of EKG reading in the family practice setting. Based on the frequency and potential for clinical significance, we chose 18 common findings on 10 EKGs for evaluation. The EKGs were then distributed to residents at six family practice residencies. Residents were given one point for the identification of each correct EKG finding and scored based on the number correct over a total of 18. RESULTS Sixty-one residents (20 first year, 23 second year, and 18 third year) completed readings for 10 EKGs and were evaluated for their ability to identify 18 EKG findings. The median score out of 18 possible points for all first-, second-, and third-year residents was 12, 12, and 11.5, respectively. Twenty-one percent of residents did not correctly identify a tracing of an acute myocardial infarction. Data analysis showed no statistically significant difference among the three groups of residents. CONCLUSIONS We evaluated the accuracy of EKG reading skills of family practice residents at each year of training. This study suggests that EKG reading skills do not improve during residency, and further study of curricular change to improve these skills should be considered.
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Affiliation(s)
- D K Sur
- Santa Monica-University of California, Los Angeles Family Practice Residency, USA.
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