Mobile Health Technologies

Mobile Health Technologies, also known as mHealth technologies, have emerged, amongst healthcare providers, as the ultimate Technologies-of-Choice for the 21st century in delivering not only transformative change in healthcare delivery, but also critical health information to different communities of practice in integrated healthcare information systems. mHealth technologies nurture seamless platforms and pragmatic tools for managing pertinent health information across the continuum of different healthcare providers. mHealth technologies commonly utilize mobile medical devices, monitoring and wireless devices, and/or telemedicine in healthcare delivery and health research. Today, mHealth technologies provide opportunities to record and monitor conditions of patients with chronic diseases such as asthma, Chronic Obstructive Pulmonary Diseases (COPD) and diabetes mellitus. The intent of this book is to enlighten readers about the theories and applications of mHealth technologies in the healthcare domain

Patient-Related Characteristics Associated with Rehospitalization in Medicare Recipients with Heart Failure Receiving Telehomecare

Heart failure (HF) is the leading cause of rehospitalization in the United State. One potential way to reduce HF rehospitalizations is through the use of telehomecare, which is a remote monitoring intervention in home care settings. However, studies on telehomecare use conducted in the United States have demonstrated mixed results in reducing HF rehospitalizations. Little is known about risk factors for rehospitalization during a telehomecare episode. The aims of the study were to identify patient characteristics associated with all-cause rehospitalizations and patient characteristics associated with time-to-first rehospitalization within 60 days of the home health care episode. This is a non-experimental, cross-sectional secondary analysis of the Outcome Assessment Information Set dataset from Medicare recipients with HF provided with telehomecare. This study used multiple logistic regression, decision tree techniques and survival analysis methods. The main findings of this study were that results of a formal pain assessment and the ability to dress one\u27s lower body safely were associated with rehospitalizations. In particular, subjects who were independent in dressing their lower body had a consistently higher risk of rehospitalization than functionally dependent groups. While the logistic regression model and survival analysis presented the associations between rehospitalization and single risk factors, the decision tree techniques presented the relative contributions of and interactions between risk factors for rehospitalization as a global picture, which may provide clinicians with a visual guide to targeting those patients most likely to benefit from telehomecare, or who may need additional interventions

Effectiveness of Remotely Delivered Interventions to Simultaneously Optimize Management of Hypertension, Hyperglycemia and Dyslipidemia in People With Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background: Remotely delivered interventions may be more efficient in controlling multiple risk factors in people with diabetes. Purpose: To pool evidence from randomized controlled trials testing remote management interventions to simultaneously control blood pressure, blood glucose and lipids. Data Sources: PubMed/Medline, EMBASE, CINAHL and the Cochrane library were systematically searched for randomized controlled trials (RCTs) until 20th June 2021. Study Selection: Included RCTs were those that reported participant data on blood pressure, blood glucose, and lipid outcomes in response to a remotely delivered intervention. Data Extraction: Three authors extracted data using a predefined template. Primary outcomes were glycated hemoglobin (HbA1c), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), systolic and diastolic blood pressure (SBP & DBP). Risk of bias was assessed using the Cochrane collaboration RoB-2 tool. Meta-analyses are reported as standardized mean difference (SMD) with 95% confidence intervals (95%CI). Data Synthesis: Twenty-seven RCTs reporting on 9100 participants (4581 intervention and 4519 usual care) were included. Components of the remote management interventions tested were identified as patient education, risk factor monitoring, coaching on monitoring, consultations, and pharmacological management. Comparator groups were typically face-to-face usual patient care. Remote management significantly reduced HbA1c (SMD -0.25, 95%CI -0.33 to -0.17, p<0.001), TC (SMD -0.17, 95%CI -0.29 to -0.04, p<0.0001), LDL-c (SMD -0.11, 95%CI -0.19 to -0.03, p=0.006), SBP (SMD -0.11, 95%CI -0.18 to -0.04, p=0.001) and DBP (SMD -0.09, 95%CI -0.16 to -0.02, p=0.02), with low to moderate heterogeneity (I²= 0 to 75). Twelve trials had high risk of bias, 12 had some risk and three were at low risk of bias. Limitations: Heterogeneity and potential publication bias may limit applicability of findings. Conclusions: Remote management significantly improves control of modifiable risk factors

Effects of telemonitoring on glycaemic control and healthcare costs in type 2 diabetes: a randomised controlled trial

Introduction: This study examined the effect of a telehealth intervention on the control of type 2 diabetes, and subsequent potential cost-savings to the health system. Methods: This prospective randomised controlled trial randomised adults with type 2 diabetes to the intervention (diabetes program) or control (usual care) arm. Key eligibility criteria included an HbA1c level of at least 58 mmol/mol (7.5%) without severe or unstable comorbidities. All participants continued their usual healthcare, but participants in the intervention arm received additional diabetes care from a diabetes care coordinator via a home monitor that captured clinical measures. Data collected included biomedical, quality of life measures and healthcare (GP, outpatient and inpatient) costs. The primary outcome was HbA1c collected at baseline and six-months. Analysis was conducted on a complete case intention-to-treat basis. The healthcare system perspective was taken to calculate the incremental cost per percentage-point reduction in HbA1c. Results: Results from 63 participants from each study arm were analysed. HbA1c in the intervention group decreased from a median 68 mmol/mol (8.4%) to 58 mmol/mol (7.5%), and remained unchanged in the control group at median 65 mmol/mol (8.1%) at the six-month endpoint. The intervention effect on HbA1c change was statistically significant (p=0.004). Total healthcare costs in the intervention group, including the intervention costs, were lower (mean $3,781 vs$4,662; p<0.001) compared to usual care. Discussion: There was a clinically meaningful and statistically significant benefit from the telehealth intervention at a lower cost; thus, telehealth was cost-saving and produced greater health benefits compared to usual care

An overview of patient acceptance of Health Information Technology in developing countries: a review and conceptual model

The potential to improve the quality, efficiency, outcomes, patient safety and reduce cost of healthcare by Health Information Technology (HIT) has been established by researchers. But unfortunately HIT systems are not properly utilized or are not widely available. This problem is even more glaring in developing countries. This article presents a review of some available HIT systems in order to assess the level of their presence and the technology used in developing them. Works related to acceptance of HIT systems were also reviewed so as to study the gaps in this area and propose a solution in order to fill the gaps identified. The problems discovered from this review include lack of availability of these systems especially in developing countries, low rate of HIT systems acceptance and insufficient works on patient acceptance of HIT systems. Studying the factors that affect the acceptance of HIT systems by patients and considering the factors while developing the systems will play a significant role in getting over the aforementioned limitations. As Technology Acceptance Model (TAM) is one of the most popular models for studying users' perception and acceptance of Information System (IS)/Information Technology (IT), we proposed a conceptual model of HIT acceptance in developing countries based on TAM

An overview of patient acceptance of Health Information Technology in developing countries: a review and conceptual model

The potential to improve the quality, efficiency, outcomes, patient safety and reduce cost of healthcare by Health Information Technology (HIT) has been established by researchers. But unfortunately HIT systems are not properly utilized or are not widely available. This problem is even more glaring in developing countries. This article presents a review of some available HIT systems in order to assess the level of their presence and the technology used in developing them. Works related to acceptance of HIT systems were also reviewed so as to study the gaps in this area and propose a solution in order to fill the gaps identified. The problems discovered from this review include lack of availability of these systems especially in developing countries, low rate of HIT systems acceptance and insufficient works on patient acceptance of HIT systems. Studying the factors that affect the acceptance of HIT systems by patients and considering the factors while developing the systems will play a significant role in getting over the aforementioned limitations. As Technology Acceptance Model (TAM) is one of the most popular models for studying users\u27 perception and acceptance of Information System (IS)/Information Technology (IT), we proposed a conceptual model of HIT acceptance in developing countries based on TAM

Diabetic foot ulcers - predictors of healing time and aspects of telemedicine

Background: A diabetic foot ulcer (DFU) is a feared complication of diabetes. Both duration and severity of ulcer before start of treatment in specialist health care are factors that can effect healing time for patient with DFUs. More research about duration and severity of DFUs before seeking care as predictors of healing time might contribute to knowledge of importance for clinical interventions. Treatment of DFUs puts pressure on the health care system in terms of utilization of available resources. Moreover, the prevalence of diabetes is increasing dramatically and, as a result, longterm diabetes-related complications are also likely to increase. Telemedicine can be one way to address these issues, because telemedicine follow up may enable more integrated care pathways across health care levels. Telemedicine has been used in different settings, but knowledge of telemedicine’s effect on clinical outcomes and patients’ experiences among patients with DFUs is limited. Aims: The overall aim of this study was to provide new knowledge about predictors of healing time in patients with a DFU and to assess the effect of and experience with a telemedicine intervention for patients with a DFU. To achieve the overall aim, three specific aims were established: 1) to investigate whether A) duration of ulcer before start of treatment in specialist health care, and B) severity of ulcer according to the University of Texas (UT) classification system at the start of treatment (baseline), are independent predictors of healing time; 2) to evaluate whether telemedicine follow up of patients with DFUs treated in primary health care, in collaboration with hospital outpatient specialist care, is noninferior to standard outpatient care in terms of ulcer healing time. Further, to assess for superior whether amputations, death, consultations and patient satisfaction are different from telemedicine follow up compared to standard outpatient care; and, 3) to explore the experiences of patients with DFUs receiving telemedicine compared to patients receiving standard outpatient care health care delivered in the context of a cluster randomised controlled trial. Methods: Three different study designs were used. Study I: A retrospective cohort study included data from electronic medical records system of 105 patients with new DFUs from two outpatient clinics in Western Norway during 2009-2011. Competing risk regression with adjustment for potential confounders was used to evaluate the associations of duration and severity of the ulcer with healing time. Study II: In this pragmatic cluster randomised controlled non-inferiority trial, 182 patients (94/88 in telemedicine/standard outpatient care; 42 clusters) with a new DFU were recruited from three hospital outpatient clinics in Western Norway (from September 2012 to June 2016). The primary endpoint was healing time and secondary endpoints included amputation, death, number of consultations per month, and patient satisfaction. Study III: In the qualitative study individual interviews were conducted with 24 adults recruited from the cluster randomised controlled non-inferiority trial (n=13/ n=11 from the telemedicine /standard outpatient care group) in the period March 2014-May 2015. Results: Study 1: Of the 105 adults, 48 (45.7%) achieved ulcer healing, 38 (36.2%) underwent amputations, 10 (9.5%) died before ulcer healing and 9 (8.5%) were lost to follow up. For those who healed, mean healing time was 3.8 months (113 days), measured from start of treatment in the specialist health care to end of follow up. Time from patient-reported ulcer onset to referral by general practitioner (GP) to specialist health care was found to be a strong predictor of healing time. Patients who were referred to specialist health care by a GP ≥ 52 days after ulcer onset had a 58% (Sub hazard ratio (SHR) 0.42, CI 0.18, 0.98) decreased healing rate compared with patients who were referred earlier. Ulcers with the highest severity i.e. ulcer penetrating to tendon or bone (grade 2/3) and peripheral arterial disease with and without infection (stage C/D) according to the UT classification system had an 86% (SHR 0.14, CI 0.05, 0.43) decreased healing rate compared with low severity i.e. superficial ulcer (grade 1) with infection (stage A/B) or ulcer penetration to tendon/capsula (grad 2) and clean ulcer (stage A). Study II: Of 182 patients, 142 (78.9%) achieved complete ulcer healing, and 75 (79.8%) healed in the telemedicine group and 67 (76.1%) in the standards outpatient care group. Mean healing including only those who healed was 3.4 months and 3.8 months in the telemedicine group and standard outpatient group, respectively. Telemedicine was non-inferior to standard outpatient care regarding healing time (mixed-effects regression analysis: (mean difference –0.43 months, 95% CI –1.50, 0.65). This finding persisted also after taking into account competing risk from death and amputation (SHR 1.16, 95% CI 0.85, 1.59). There were no significant differences between the telemedicine follow up and standard outpatient care related to the effect estimate of the secondary outcomes, except for significantly fewer amputations in the telemedicine group. Study III: Three themes emerged from the analysis: 1) competence of health care professionals, 2) continuity of care, and 3) easy access, i.e. to receive treatment and follow up near home or at their home. Group allocation seemed to have limited impact on the patients’ follow-up experiences. Competence of health care professionals and continuity of care were important, because they could either enhance or impair wound care. When telemedicine functioned as intended, it was an advantage in the treatment. Easy access was important for the participants, but the importance of accessibility appeared only when competence among health care professionals and continuity of care were present. Conclusions: Early referral to specialist health care if an ulcer occurs is crucial for optimal ulcer healing and has a clear implication for routine care. Grade and stage severity are also important predictors for healing time, and early screening to assess the severity and initiation of prompt treatment is important. Telemedicine can be an alternative but also a supplement to usual care for patients with DFUs, at least for patients with more superficial ulcers. As the number of outpatient clinic consultations in the telemedicine group did not differ from the standard care group, there is need to focus on organisational aspects to facilitate the use of telemedicine. Health care professionals’ competence, continuity of care and easy access to health care services were essential for patients with DFUs, and telemedicine may compensate for lack of these factors