1,669 research outputs found

    Mental Health Service Users\u27 Mobile Phone Contact Method: Preference and Medication Adherence

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    Research suggests that medication adherence among individuals with mental health problems is problematic. The issue of medication non-adherence among this population is consistent among the different mental health diagnoses. Numerous factors contribute to medication non-adherence: patient issues, service delivery issues, and issues related to the measurement of medication adherence, which lacks a gold standard. This dissertation is a compendium of three manuscripts that represent three distinct but related studies on medication adherence among individuals with mental health challenges. The first manuscript is an integrative review that seeks to assess the validity, reliability, and levels of evidence of existing instruments for measuring medication adherence in patients with schizophrenia. The second is another integrative review that examines literature in the past decade (2006-2016) on the use of mobile phone contacts (MPC) in individuals with severe mental illness to improve medication adherence after hospital discharge. The third, a descriptive correlational study, examines mental health services (MHS) users’ preferred MPC delivery method when receiving support to increase medication adherence after discharge. The findings from the first integrative review show the importance of validating medication adherence measures in this population. Findings from the second show the extent to which MPC support the increase of medication adherence in this population. Findings from the third show the importance of identifying patients’ preferences for an MPC method when providing support to increase medication adherence in this population. The findings of the two integrative reviews and the descriptive correlational study are integrated at the conclusion of the dissertation

    Health Insurance Reform and Efficiency of Township Hospitals in Rural China: An Analysis from Survey Data

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    In the rural health-care organization of China, township hospitals ensure the delivery of basic medical services. Particularly damaged by the economic reforms implemented from 1975 to the end of the 1990s, township hospitals efficiency is questioned, mainly with the implementation since 2003 of the reform of health insurance in rural areas. From a database of 24 randomly selected township hospitals observed over the period 2000-2008 in Weifang prefecture (Shandong), the study examines the efficiency of township hospitals through a two-stage approach. As curative and preventive medical services delivered at township hospital level use different production processes, two data envelopment analysis models are estimated with different orientation chosen to compute scores. Results show that technical efficiency declines over time. Factors explaining the technical efficiency are mainly environmental characteristics rather than internal factors, but our results suggest also that in the context of China, the efficiency of township hospitals is influenced by unobservable factors.China, New Rural Cooperative Medical Scheme, Technical efficiency, data envelopment analysis, Township Hospitals.

    A Pain Reporting Platform for Adolescents with Sickle-Cell Disease

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    This paper presents the latest version of the Pain Reporting and Management mHealth Platform for adolescent Sickle Cell Disease, developed in collaboration by Arizona State University and the Children’s National Health System. This platform supports a cross-platform mHealth app, reporting and task management API, and portal dashboard for care provider monitoring. Extending our prior work, the latest version adds enhanced app features (games, power-ups, badges, notifications) to promote sustained adherence to the reporting protocol, and enhanced reporting features for providers that track high fidelity compliance measures and aggregate outcome scores. This paper summarizes the architecture and principle features of the platform, and presents data supporting improved compliance

    Appointment reminder systems are effective but not optimal: results of a systematic review and evidence synthesis employing realist principles

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    Missed appointments are an avoidable cost and resource inefficiency which impact upon the health of the patient and treatment outcomes. Healthcare services are increasingly utilizing reminder systems to manage these negative effects. This study explores the effectiveness of reminder systems for promoting attendance, cancellations and rescheduling of appointments across all healthcare settings and for particular patient groups and the contextual factors which indicate that reminders are being employed sub-optimally. We used three inter-related reviews of quantitative and qualitative evidence. Firstly, using pre-existing models and theories, we developed a conceptual framework to inform our understanding of the Contexts and Mechanisms which influence reminder effectiveness. Secondly, we performed a review following Centre for Reviews & Dissemination (CRD) guidelines to investigate the effectiveness of different methods of reminding patients to attend health service appointments. Finally, to supplement the effectiveness information, we completed a review informed by realist principles to identify factors likely to influence non-attendance behaviors and the effectiveness of reminders. We found consistent evidence that all types of reminder systems are effective at improving appointment attendance across a range of health care settings and patient populations. Reminder systems may also increase cancellation and rescheduling of unwanted appointments. “Reminders plus”, which provide additional information beyond the reminder function, may be more effective than simple reminders at reducing non-attendance at appointments in particular circumstances. We identified six areas of inefficiency which indicate that reminder systems are being used sub-optimally. Unless otherwise indicated, all patients should receive a reminder to facilitate attendance at their healthcare appointment. The choice of reminder system should be tailored to the individual service. To optimize appointment and reminder systems, healthcare services need supportive administrative processes to enhance attendance, cancellation, rescheduling and re-allocation of appointments to other patients

    Mobile Enhancement of Motivation in Schizophrenia: A Pilot Trial of a Personalized Text-Message Intervention for Motivation Deficits

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    Indiana University-Purdue University Indianapolis (IUPUI)Motivation deficits remain an unmet treatment need in schizophrenia. Recent preclinical research has identified novel mechanisms underlying motivation deficits, namely impaired effort-cost computations and reduced future reward-value representation maintenance, that may serve as more effective treatment targets to improve motivation. The main aim of this study was to test the feasibility and preliminary effectiveness of a translational mechanism-based intervention, MEMS (Mobile Enhancement of Motivation in Schizophrenia), which leverages mobile technology to target these mechanisms with text-messages. Fifty-six participants with a schizophrenia-spectrum disorder were randomized to MEMS (n = 27) or a control condition (n = 29). All participants set recovery goals to complete over eight-weeks. The MEMS group also received personalized, interactive text-messages each weekday to support motivation. Retention and engagement in MEMS was high: 92.6% completed 8 weeks of MEMS, with an 86.1% text-message response rate, and 100% reported that they were satisfied with the text-messages. Compared to the control condition, the MEMS group had significantly greater improvements in interviewer-rated motivation and anticipatory pleasure and obtained significantly more recovery-oriented goals at the end of the 8-week period. There were no significant group differences in performance-based effort-cost computations and future reward-value representations, self-reported motivation, quality of life, functioning, or additional secondary outcomes of positive symptoms, mood symptoms, or neurocognition. Results suggest that MEMS is feasible as a relatively brief, low-intensity mobile intervention that could effectively improve interviewer-rated motivation, anticipatory pleasure, and recovery goal attainment in those with schizophrenia-spectrum disorders

    Targeting the use of reminders and notifications for uptake by populations (TURNUP): a systematic review and evidence synthesis.

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    Background: Missed appointments are an avoidable cost and a resource inefficiency that impact on the health of the patient and treatment outcomes. Health-care services are increasingly utilising reminder systems to counter these negative effects. Objectives: This project explores the differential effect of reminder systems for different segments of the population for improving attendance, cancellation and rescheduling of appointments. Design: Three inter-related reviews of quantitative and qualitative evidence relating to theoretical explanations for appointment behaviour (review 1), the effectiveness of different approaches to reminding patients to attend health service appointments (review 2) and factors likely to influence non-attendance (review 3). Data sources: Database searches were conducted on Allied and Complementary Medicine, Cumulative Index to Nursing and Allied Health Literature Plus with Full Text, The Cochrane Library, EMBASE (via NHS Evidence from 1 January 2000 to January/February 2012), Health Management Information Consortium database, Institute of Electrical and Electronics Engineers Xplore, The King’s Fund Library Catalogue, Maternity and Infant Care, MEDLINE, Physiotherapy Evidence Database, PsycINFO, SPORTDiscus and Web of Science from 1 January 2000 to January/February 2012. Supplementary screening of references of included studies was conducted to identify additional potentially relevant studies. Conceptual papers were identified for review 1, randomised controlled trials (RCTs) and systematic reviews for review 2 and a range of quantitative and qualitative research designs for review 3. Methods: We conducted three inter-related reviews of quantitative and qualitative evidence, involving a review of conceptual frameworks of reminder systems and adherence behaviours, a review of the reminder effectiveness literature and a review informed by realist principles to explain the contexts and mechanisms that explain reminder effectiveness. A preliminary conceptual framework was developed to show how reminder systems work, for whom they work and in which circumstances. Six themes emerged that potentially influence the effectiveness of the reminder or whether or not patients would attend their appointment, namely the reminder–patient interaction, reminder accessibility, health-care settings, wider social issues, cancellation and rebookings, and distal/proxy attributes. Standardised review methods were used to investigate the effectiveness of reminders to promote attendance, cancellation or rebooking across all outpatient settings. Finally, a review informed by realist principles was undertaken, using the conceptualframework to explain the context and mechanisms that influence how reminders support attendance, cancellation and rebooking. Results: A total of 466 papers relating to 463 studies were identified for reviews 2 and 3. Findings from 31 RCTs and 11 separate systematic reviews (review 2 only) revealed that reminder systems are consistently effective at reducing non-attendance at appointments, regardless of health-care setting or patient subgroups. Simple reminders that provide details of timing and location of appointments are effective for increasing attendance at appointments. Reminders that provide additional information over and above the date, time and location of the appointment (‘reminder plus’) may be more effective than simple reminders at reducing non-attendance and may be particularly useful for first appointments and screening appointments; simple reminders may be appropriate thereafter for most patients the majority of the time. There was strong evidence that the timing of reminders, between 1 and 7 days prior to the appointment, has no effect on attendance; substantial numbers of patients do not receive their reminder; reminders promote cancellation of appointments; inadequate structural factors prevent patients from cancelling appointments; and few studies investigated factors that influence the effectiveness of reminder systems for population subgroups. Limitations: Generally speaking, the systematic review method seeks to provide a precise answer to a tightly focused question, for which there is a high degree of homogeneity within the studies. A wide range of population types, intervention, comparison and outcomes is included within the RCTs we identified. However, use of this wider approach offers greater analytical capability in terms of understanding contextual and mechanistic factors that would not have been evident in a more narrowly focused review and increases confidence that the findings will have relevance in a wide range of service settings. Conclusions: Simple reminders or ‘reminder plus’ should be sent to all patients in the absence of any clear contraindication. Other reminder alternatives may be relevant for key groups of patients: those from a deprived background, ethnic minorities, substance abusers and those with comorbidities and/or illnesses. We are developing a practice guideline that may help managers to further tailor their reminder systems for their service and client groups. We recommend future research activities in three main areas. First, more studies should routinely consider the potential for differential effects of reminder systems between patient groups in order to identify any inequalities and remedies. Second, ‘reminder plus’ systems appear promising, but there is a need for further research to understand how they influence attendance behaviour. Third, further research is required to identify strategies to ‘optimise’ reminder systems and compare performance with current approaches
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