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Lussier M, Couture M, Giroux S, Aboujaoudé A, Ngankam HK, Pigot H, Gaboury S, Bouchard K, Bottari C, Belchior P, Paré G, Bier N. Codevelopment and Deployment of a System for the Telemonitoring of Activities of Daily Living Among Older Adults Receiving Home Care Services: Protocol for an Action Design Research Study. JMIR Res Protoc 2024; 13:e52284. [PMID: 38422499 PMCID: PMC10940984 DOI: 10.2196/52284] [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: 08/30/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Telemonitoring of activities of daily living (ADLs) offers significant potential for gaining a deeper insight into the home care needs of older adults experiencing cognitive decline, particularly those living alone. In 2016, our team and a health care institution in Montreal, Quebec, Canada, sought to test this technology to enhance the support provided by home care clinical teams for older adults residing alone and facing cognitive deficits. The Support for Seniors' Autonomy program (SAPA [Soutien à l'autonomie des personnes âgées]) project was initiated within this context, embracing an innovative research approach that combines action research and design science. OBJECTIVE This paper presents the research protocol for the SAPA project, with the aim of facilitating the replication of similar initiatives in the future. The primary objectives of the SAPA project were to (1) codevelop an ADL telemonitoring system aligned with the requirements of key stakeholders, (2) deploy the system in a real clinical environment to identify specific use cases, and (3) identify factors conducive to its sustained use in a real-world setting. Given the context of the SAPA project, the adoption of an action design research (ADR) approach was deemed crucial. ADR is a framework for crafting practical solutions to intricate problems encountered in a specific organizational context. METHODS This project consisted of 2 cycles of development (alpha and beta) that involved cyclical repetitions of stages 2 and 3 to develop a telemonitoring system for ADLs. Stakeholders, such as health care managers, clinicians, older adults, and their families, were included in each codevelopment cycle. Qualitative and quantitative data were collected throughout this project. RESULTS The first iterative cycle, the alpha cycle, took place from early 2016 to mid 2018. The first prototype of an ADL telemonitoring system was deployed in the homes of 4 individuals receiving home care services through a public health institution. The prototype was used to collect data about care recipients' ADL routines. Clinicians used the data to support their home care intervention plan, and the results are presented here. The prototype was successfully deployed and perceived as useful, although obstacles were encountered. Similarly, a second codevelopment cycle (beta cycle) took place in 3 public health institutions from late 2018 to late 2022. The telemonitoring system was installed in 31 care recipients' homes, and detailed results will be presented in future papers. CONCLUSIONS To our knowledge, this is the first reported ADR project in ADL telemonitoring research that includes 2 iterative cycles of codevelopment and deployment embedded in the real-world clinical settings of a public health system. We discuss the artifacts, generalization of learning, and dissemination generated by this protocol in the hope of providing a concrete and replicable example of research partnerships in the field of digital health in cognitive aging. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/52284.
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Affiliation(s)
- Maxime Lussier
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Université de Montréal, Montreal, QC, Canada
- École de réadaptation, Faculté de médecine, Université de Montréal, Montréal, QC, Canada
| | - Mélanie Couture
- Centre for Research and Expertise in Social Gerontology, Integrated Health and Social Services University Network for West-Central Montreal, Côte- Saint-Luc, QC, Canada
- School of Social Work, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Sylvain Giroux
- Computer Science Department, Faculty of Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Aline Aboujaoudé
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Université de Montréal, Montreal, QC, Canada
- École de réadaptation, Faculté de médecine, Université de Montréal, Montréal, QC, Canada
| | - Hubert Kenfack Ngankam
- Computer Science Department, Faculty of Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Hélène Pigot
- Computer Science Department, Faculty of Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Sébastien Gaboury
- Department of Mathematics and Computer Science, Université du Québec à Chicoutimi, Chicoutimi, QC, Canada
| | - Kevin Bouchard
- Department of Mathematics and Computer Science, Université du Québec à Chicoutimi, Chicoutimi, QC, Canada
| | - Carolina Bottari
- École de réadaptation, Faculté de médecine, Université de Montréal, Montréal, QC, Canada
| | - Patricia Belchior
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Université de Montréal, Montreal, QC, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Guy Paré
- Research Chair in Digital Health, HEC Montréal, Montréal, QC, Canada
| | - Nathalie Bier
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Université de Montréal, Montreal, QC, Canada
- École de réadaptation, Faculté de médecine, Université de Montréal, Montréal, QC, Canada
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Biswas B, Roy PB. Identifying Patient Perceptions of Inequality in Public Health Care Services: Evidence From a Single Indian Administrative District. J Patient Cent Res Rev 2023; 10:121-127. [PMID: 37483556 PMCID: PMC10358969 DOI: 10.17294/2330-0698.2013] [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: 07/25/2023] Open
Abstract
Purpose Assessment of patient experiences is an essential step to revamp patient-centered care and identify systemic effectiveness as part of universal health coverage. This paper analyzes the variation of health care at different levels of the public health care system in India by measuring patients' experience with the care they have received in the Alipurduar district of India. Methods From May 2021 to April 2022, stratified sampling technique was applied to collect primary data from 450 patients having different health problems from different levels of the public health care system. In addition, Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey results were used to evaluate patient experience, with the reliability of questions measured by Cronbach's alpha. Collected data were categorized with the help of exploratory factor analysis; after which, analysis of variance and post-hoc tests were applied to understand specific variations in patient experiences. Results This study identified that the services delivered in the health centers were not suitable (6.160 out of 10) to fulfill the needs of the patients. Among the three domains of health care services - namely, proficiency, tangibility, and information - the experience of patients significantly varied (P<0.001) when comparing primary, secondary, and tertiary levels of the public health care system. Conclusions Patients receiving services from the centers under the tertiary level have expressed lesser satisfaction than those patients who have received care at primary or secondary levels because of excessive patient load, inadequate manpower, and other infrastructure deficits at the tertiary level.
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Affiliation(s)
- Barnali Biswas
- Department of Geography, Cooch Behar Panchanan Barma University, Cooch Behar, India
| | - Piyal Basu Roy
- Department of Geography, Cooch Behar Panchanan Barma University, Cooch Behar, India
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Rossi EG, Bosinelli F, Di Stefano M, Picchi M, Noberasco C, Baccetti S. Implementing an Integrative Oncology Paradigm in Cancer Care: The Tuscan Regional Healthcare System. J Integr Complement Med 2022; 28:965-968. [PMID: 36103278 DOI: 10.1089/jicm.2022.0522] [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] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: Recent cancer research highlighted specific patient needs, with a growing interest in integrative oncology (IO). Design: This is a narrative review concerning the Tuscan Healthcare System, which represents a virtuous example of progressive integration of complementary medicine in conventional cancer care. Results: The main steps of the process are described, with a specific focus on the 2021 Diagnostic and Therapeutic Care Pathway on Integrative Oncology. Conclusions: Implementing an IO service may contribute to respond to patients' demand for complementary therapies, also providing safety and equity of therapeutic access within public health care systems.
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Affiliation(s)
- Elio G Rossi
- Clinic for Complementary Medicine and Diet in Oncology, Local Health Authority Tuscany North-West, Lucca, Italy
| | - Francesca Bosinelli
- Clinic for Complementary Medicine and Diet in Oncology, Local Health Authority Tuscany North-West, Lucca, Italy
| | - Mariella Di Stefano
- Regional Center for Integrative Medicine, Directorate of Health Welfare and Social Cohesion, Region of Tuscany, Florence, Italy
| | - Marco Picchi
- Clinic for Complementary Medicine and Diet in Oncology, Local Health Authority Tuscany North-West, Lucca, Italy
| | - Cristina Noberasco
- Clinic for Complementary Medicine and Diet in Oncology, Local Health Authority Tuscany North-West, Lucca, Italy
| | - Sonia Baccetti
- Regional Center for Integrative Medicine, Directorate of Health Welfare and Social Cohesion, Region of Tuscany, Florence, Italy
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Abstract
Background: Hematuria is the most common presenting symptom in bladder cancer, but many patients are not adequately evaluated. Objectives: To evaluate the type and frequency of hematuria evaluation in a large public health care system. Patients and Methods: Electronic medical records of adult patients with urinalysis positive for hematuria (≥3 RBCs/HPF) from January 2015 to April 2018 in an outpatient setting were reviewed. Logistic regression was performed to determine factors associated with urology referral and complete evaluation. Results: 11,422 patients met the inclusion criteria; the majority were females (72%) and white race (60%). There were an additional 3,221 patient’s with initial diagnosis of UTI. Median age was 49.0 years. Testing included repeat urinalysis (50%), imaging (26%), urology referral (11.4%), cystoscopy (4.4%) and complete evaluation defined as cystoscopy and US/CT/MRI (4%). In the multivariable analysis, factors independently associated with higher referral to urology were age >35, male gender, hypertension, RBCs ≥20. African American race was associated with less referral to urology. Smoking was a significant variable on univariable analysis only. 37 patients (0.25%) were diagnosed with urological malignancies, with bladder cancer in 33, 12 of whom are missed by excluding UTI patients. Conclusions: In the outpatient setting of a public health care system, the vast majority of patients with hematuria are not referred and evaluated properly across all age categories and regardless of smoking status. This might result in missed cancer diagnoses and requires quality improvement measures.
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Affiliation(s)
- Rashed Ghandour
- Department of Urology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
| | - Yuval Freifeld
- Department of Urology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
| | - Nirmish Singla
- Department of Urology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
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