Strengthening primary health care in Europe with digital solutions

This article provides an in-depth analysis of digital transformation in European primary healthcare (PHC). It assesses the impact of digital technology on healthcare delivery and management, highlighting variations in digital maturity across Europe. It emphasizes the significance of digital tools, especially during the COVID-19 pandemic, in enhancing accessibility and efficiency in healthcare. It discusses the integration of telehealth, remote monitoring, and e-health solutions, showcasing their role in patient empowerment and proactive care. Examples are included from various countries, such as Greece's ePrescription system, Lithuania's adoption of remote consultations, Spain's use of risk stratification solutions, and the Netherlands' advanced use of telemonitoring solutions, to illustrate the diverse implementation of digital solutions in PHC. The article offers insights into the challenges and opportunities of embedding digital technologies into a multidisciplinary healthcare framework, pointing towards future directions for PHC in Europe.

[Teleconsultation: finding its place in primary care]

Teleconsultation is a remote health consultation using information and communication technologies. There are different modalities and specific practical and communication skills are required. Notwithstanding its prominence in Spain, there is little evidence on teleconsultation. This article explores the applicability, barriers, facilitators and future challenges of teleconsultation. While it has the potential to improve access to healthcare, as well as save time and costs for both patients and healthcare professionals, it faces a number of challenges such as the digital divide and resistance to change. To address new challenges and overcome obstacles, it is crucial to gain the trust of patients and professionals. Improving training in the skills required to optimize their use is also essential. Future research should aim to provide robust evidence regarding safety and cost-effectiveness to ensure successful implementation.

AVIP Project (Prosthetic Virtual Friend): Study of clinical-functional outcomes and satisfaction with a mobile application in the perioperative management and follow-up of hip arthroplasty

OBJECTIVE

To analyze the clinical, quality of life, and healthcare quality outcomes obtained in a series of patients undergoing total hip arthroplasty (THA), who were empowered and monitored using the AVIP application. These results will be compared with a control group followed through a standard protocol.

MATERIAL AND METHOD

Randomized clinical trial with parallel groups involving patients with an indication for THA. Clinical variables were measured and compared using the WOMAC and mHHS, pain assessed by the VAS, quality of life with the SF-12 test. Walking capabilities were analyzed using the Functional Gait Assessment Scale, along with satisfaction levels assessed through the SUCE questionnaire, and perceived anxiety levels related to the process.

RESULTS

A total of 68 patients were evaluated, with 31 patients in the AVIP group and 33 in the Control group completing the follow-up. Both groups demonstrated improvement in clinical outcomes based on the WOMAC and mHHS hip tests, a reduction in perceived pain, and an enhancement in quality of life according to the SF-12 test. Patients in the AVIP study group exhibited non-inferiority in clinical outcomes and satisfaction compared to the control group, as well as lower anxiety levels and improved walking capabilities after the first month of follow-up. Notably, 82.25% of the follow-up visits for this group were conducted remotely.

CONCLUSION

The implementation of a mHealth application like AVIP can be safely offered to selected patients undergoing hip arthroplasty, enabling effective monitoring and providing continuous information and training.

The artificial intelligence revolution in primary care: Challenges, dilemmas and opportunities

Artificial intelligence (AI) can be a valuable tool for primary care (PC), as, among other things, it can help healthcare professionals improve diagnostic accuracy, chronic disease management and the overall efficiency of the care they provide. It is important to emphasise that AI should not be seen as a replacement tool, but as an aid to PC professionals. Although AI is capable of processing large amounts of data and generating accurate predictions, it cannot replace the skill and expertise of professionals in clinical decision making. AI still requires the interpretation and clinical judgement of a trained healthcare professional and cannot provide the empathy and emotional support often required in healthcare.

Mobile and eHealth technologies in the management and prevention of nephrolithiasis: A systematic review

INTRODUCTION

Kidney stone disease (KSD) is a common urological condition that often requires long-term care. Mobile health (mHealth) and eHealth technologies have the potential to enhance chronic disease management and behavioral change. To assess opportunities to apply these tools to improve KSD treatment and prevention, we aimed to assess current evidence on the use, benefits, and limitations of mHealth and eHealth in KSD.

METHODS

We performed a systematic review of primary research studies of mHealth and eHealth in the evaluation and management of KSD. Two independent researchers screened citations by title and abstract for relevance, then full-text review was performed for descriptive summary of the studies.

RESULTS

A total of 37 articles were included for analysis. Primary domains of evidence included: 1) "smart" water bottles and mobile-device apps for tracking fluid consumption, which showed increased intake in most studies; 2) ureteral stent tracking platforms, which improved the rate of long-term retained stents; 3) virtual stone clinics, which have been suggested to increase access, lower costs, and have satisfactory outcomes; 4) smartphone-based endoscopy platforms, which offered cost-effective image quality in resource-limited settings; 5) patient information about KSD online, which was typically characterized as poor quality and/or accuracy, particularly on YouTube. Most studies were proof-of-concept or single-arm intervention designs, with limited assessment of effectiveness or long-term clinical outcomes.

CONCLUSIONS

Mobile and eHealth technologies have significant real-world applications to KSD prevention, intervention, and patient education. A lack of rigorous effectiveness studies currently limits evidence-based conclusions and incorporation in clinical guidelines.

Entering into 2.0 cystinuric management with a medical digital tool to monitor urine pH: a prospective, randomized study

BACKGROUND AND OBJECTIVES

Individuals with cystinuria can experiment recurrent lithiasis events due to the relative insolubility of cystine at physiological urine pH, resulting in renal function decline. The Lit-Control® pH Meter is a medical device that accurately allows urine pH self-monitoring. The main objective of this study was to compare the usability of the Lit-Control® pH Meter with the reactive strips for self-monitoring of urinary pH at home by patients with cystinuria, and their overall satisfaction with each tool.

PATIENTS AND METHODS

We included 28 patients (9 females and 19 males, age 19-76 years), who were randomly assigned to monitor their urine pH with reactive strips (n = 17) or the Lit-Control® pH-meter (n = 11).

RESULTS

After six months of use, the satisfaction with the two methods was similarly high, but the patients rated (0-10 scale) the pH meter better in terms of ease of learning (mean ± SD, 8.11 ± 0.60 vs. 7.06 ± 1.18; P = 0.038), ease to prepare (8.22 ± 0.67 vs. 7.25 ± 1.18; P = 0.034), and ease of use (8.22 ± 0.67 vs. 7.25 ± 1.39; P = 0.062). Overall, patients did not reach the alkalinization goals (pH between 7.0 and 8.0).

CONCLUSIONS

The Lit-Control® pH Meter demonstrated to be an easy-to-use device that can facilitate urinary pH control by cystinuric patients. A prospective study is warranted to assess the correlation between urine pH monitoring, a treat to target approach, and the recurrence of cystine stones.

[Approach to digital transformation in healthcare to reduce the digital divide]

Digital transformation involves the integration of technology into all areas of an organization and a change in the way of operating and providing value. In the healthcare sector, digital transformation should focus on improving health for all by accelerating the development and adoption of digital solutions. The WHO considers digital health as a key factor in ensuring universal health coverage, protection against health emergencies, and better well-being for one billion people worldwide. Digital transformation in healthcare should include digital determinants of health as new factors of inequality alongside classic social determinants. Addressing digital determinants of health and the digital divide is essential to ensure that all people have access to the benefits of digital technology for their health and well-being.

[Validation of a questionnaire for the analysis of digital competence in patients with type 1 diabetes mellitus]

OBJECTIVE

Validation of a questionnaire designed to stratify the level of digital competence in chronic patients.

METHOD

Cross-sectional study, carried out in the Endocrinology and Nutrition Section of the Complejo Asistencial Universitario de León (CAULE). We selected the digital competencies section of the Cambados questionnaire, designed for the identification of digital chronic patient, with a maximum score of 20 points. The questionnaire was completed for validation by patients for whom were prescribed a digital tool for glycemic control. Reliability was assessed by assessing the correct use of the prescribed tool and internal consistency.

RESULTS

The questionnaire was completely filled in by 171 patients, with a mean age of 44.36 (SD 17.36). The mean score obtained in the questionnaire was 11.04 (SD 4.74) and a score over 12 was the most appropriate cut-off point to discriminate between patients according to their level of digital competence. 48.54% of the patients made adequate use of the tool. The scale showed good internal consistency with a Cronbach's alpha of 0.77.

CONCLUSIONS

The results reached in the present study allow us to affirm that the responses obtained from the patients in the digital competency definition questionnaire are a good indicator of the use of digital tools.

Usefulness and acceptability of a Smart pH meter and mobile medical App as a monitoring tool in patients with urolithiasis: short-term prospective study

ORIGINAL ARTICLE

Usefulness and Acceptability of a Smart pH Meter and Mobile Medical App as a Monitoring Tool in Patients with Urolithiasis: Short-term Prospective Study.

OBJECTIVE

An accurate strategy for regularly measuring urine pH is the use of portable electronic pH meters. This study evaluated the usefulness and acceptability of the smart Lit-Control® pH Meter connected with a companion mobile medical application (myLit-Control(R) App) used by patients with urolithiasis for home monitoring of urine pH. We also examined adherence and compliance rates, and users´ satisfaction levels. MATERIALS AND METHODS: This was a multicenter, prospective study conducted in 10 centers from Spain. Adult patients with a history of urolithiasis were recruited and instructed to carry out a pH measurement with the pH meter three times per day for two weeks. User tasks included turning on the device, registration and on boarding processes in the App, sync the device and the App, and data dumping. At the end of the trial, we evaluated the level of adherence and usage compliance. Participants' perceptions about the usefulness, acceptability, and satisfaction with the device/App were collected through the Computer System Usability Questionnaire (CSUQ) and subjective surveys. RESULTS: Participants were 27 men and 10 women. The mean age of participants was 48.7 (SD = 10.4) years, ranging from 25 to 66. The predominant type of stone was calcium oxalate. The mean pH of all readings was 5.83 (SD = 0.41). Seventy-three (73%) patients met the "good adherence" criterion (not being more than 2 days without recording any pH value). The compliance (actual vs. theoretical readings) was 87.6%. Participants rated the usability of the App 5.4 and above (on a 7-point scale) in all the items of CSUQ. Satisfaction was high, as indicated by the mean score of 6.0 in item 16. In the subjective questionnaire (0 to 3 scale), nearly all mean values were above 2. Patients scored their probability to recommend the App with an average of 8.2 on a 0 to 10 scale.

CONCLUSION

The new smart Lit-Control® pH Meter and the accompanying medical App were deemed useful and acceptable by urolithiasis patients as a portable tool for urine pH monitoring at home. The usage compliance rates were high and the satisfaction with the products was good.

On stethoscopes, patient records, artificial intelligence, and zettabytes: A glimpse into the future of digital medicine in Mexico

Science and technology are modifying medicine at a dizzying pace. Although access in our country to the benefits of innovations in the area of devices, data storage and artificial intelligence are still very restricted, the advance of digital medicine offers the opportunity to solve some of the biggest problems faced by medical practice and public health in Mexico. The potential areas where digital medicine can be disruptive are accessibility to quality medical care, centralization of specialties in large cities, dehumanization of medical treatment, lack of resources to access evidence-supported treatments, and among others. This review presents some of the advances that are guiding the new revolution in medicine, discusses the potential barriers to implementation, and suggest crucial elements for the path of incorporation of digital medicine in Mexico.

On stethoscopes, patient records, artificial intelligence and zettabytes: a glimpse into the future of digital medicine in Mexico

Science and technology are modifying medicine at a dizzying pace. Although access in our country to the benefits of innovations in the area of devices, data storage and artificial intelligence is still very restricted, the advance of digital medicine offers the opportunity to solve some of the biggest problems faced by medical practice and public health in Mexico. The potential areas where digital medicine can be disruptive are: accessibility to quality medical care, centralization of specialties in large cities, dehumanization of medical treatment, lack of resources to access evidence-supported treatments, among others. This review presents some of the advances that are guiding the new revolution in medicine, discusses the potential and potential barriers to implementation, and suggests crucial elements for the path of incorporation of digital medicine in Mexico.