3,076 research outputs found

    Factors determining patients’ intentions to use point-of-care testing medical devices for self-monitoring: The case of international normalised ratio self-testing

    Get PDF
    This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. - Copyright @ 2012 Dove Medical Press LtdThis article has been made available through the Brunel Open Access Publishing Fund.Purpose: To identify factors that determine patients' intentions to use point-of-care medical devices, ie, portable coagulometer devices for self-testing of the international normalized ratio (INR) required for ongoing monitoring of blood-coagulation intensity among patients on long-term oral anticoagulation therapy with vitamin K antagonists, eg, warfarin. Methods: A cross-sectional study that applied the technology-acceptance model through a self-completed questionnaire, which was administered to a convenience sample of 125 outpatients attending outpatient anticoagulation services at a district general hospital in London, UK. Data were analyzed using descriptive statistics, factor analyses, and structural equation modeling. Results: The participants were mainly male (64%) and aged ≄ 71 years (60%). All these patients were attending the hospital outpatient anticoagulation clinic for INR testing; only two patients were currently using INR self-testing, 84% of patients had no knowledge about INR self-testing using a portable coagulometer device, and 96% of patients were never offered the option of the INR self-testing. A significant structural equation model explaining 79% of the variance in patients’ intentions to use INR self-testing was observed. The significant predictors that directly affected patients' intention to use INR self-testing were the perception of technology (ÎČ = 0.92, P < 0.001), trust in doctor (ÎČ = −0.24, P = 0.028), and affordability (ÎČ = 0.15, P = 0.016). In addition, the perception of technology was significantly affected by trust in doctor (ÎČ = 0.43, P = 0.002), age (ÎČ = −0.32, P < 0.001), and affordability (ÎČ = 0.23, P = 0.013); thereby, the intention to use INR self-testing was indirectly affected by trust in doctor (ÎČ = 0.40), age (ÎČ = −0.29), and affordability (ÎČ = 0.21) via the perception of technology. Conclusion: Patients’ intentions to use portable coagulometers for INR self-testing are affected by patients' perceptions about the INR testing device, the cost of device, trust in doctors/clinicians, and the age of the patient, which need to be considered prior to any intervention involving INR self-testing by patients. Manufacturers should focus on increasing the affordability of INR testing devices for patients’ self-testing and on the potential role of medical practitioners in supporting use of these medical devices as patients move from hospital to home testing.This study is funded by the Multidisciplinary Assessment of Technology Centre for Healthcare (MATCH) program (EPSRC grant EP/GO12393/1)

    Randomized controlled trial of a coordinated care intervention to improve risk factor control after stroke or transient ischemic attack in the safety net: Secondary stroke prevention by Uniting Community and Chronic care model teams Early to End Disparities (SUCCEED).

    Get PDF
    BackgroundRecurrent strokes are preventable through awareness and control of risk factors such as hypertension, and through lifestyle changes such as healthier diets, greater physical activity, and smoking cessation. However, vascular risk factor control is frequently poor among stroke survivors, particularly among socio-economically disadvantaged blacks, Latinos and other people of color. The Chronic Care Model (CCM) is an effective framework for multi-component interventions aimed at improving care processes and outcomes for individuals with chronic disease. In addition, community health workers (CHWs) have played an integral role in reducing health disparities; however, their effectiveness in reducing vascular risk among stroke survivors remains unknown. Our objectives are to develop, test, and assess the economic value of a CCM-based intervention using an Advanced Practice Clinician (APC)-CHW team to improve risk factor control after stroke in an under-resourced, racially/ethnically diverse population.Methods/designIn this single-blind randomized controlled trial, 516 adults (≄40&nbsp;years) with an ischemic stroke, transient ischemic attack or intracerebral hemorrhage within the prior 90&nbsp;days are being enrolled at five sites within the Los Angeles County safety-net setting and randomized 1:1 to intervention vs usual care. Participants are excluded if they do not speak English, Spanish, Cantonese, Mandarin, or Korean or if they are unable to consent. The intervention includes a minimum of three clinic visits in the healthcare setting, three home visits, and Chronic Disease Self-Management Program group workshops in community venues. The primary outcome is blood pressure (BP) control (systolic BP &lt;130&nbsp;mmHg) at 1&nbsp;year. Secondary outcomes include: (1) mean change in systolic BP; (2) control of other vascular risk factors including lipids and hemoglobin A1c, (3) inflammation (C reactive protein [CRP]), (4) medication adherence, (5) lifestyle factors (smoking, diet, and physical activity), (6) estimated relative reduction in risk for recurrent stroke or myocardial infarction (MI), and (7) cost-effectiveness of the intervention versus usual care.DiscussionIf this multi-component interdisciplinary intervention is shown to be effective in improving risk factor control after stroke, it may serve as a model that can be used internationally to reduce race/ethnic and socioeconomic disparities in stroke in resource-constrained settings.Trial registrationClinicalTrials.gov Identifier NCT01763203

    Efeitos das intervençÔes de autogestão em pessoas com doença pulmonar intersticial: revisão sistemåtica e meta-anålise

    Get PDF
    Background: Self-management interventions (SMIs) aim to empower people with chronic diseases to manage their health more effectively. In people with chronic respiratory diseases, such as asthma, SMIs significantly improve health-related quality of life (HRQoL). However, their effectiveness has not yet been systematized in people with interstitial lung disease (ILD), which limits their implementation in healthcare. Objectives: To review and summarize the effects of SMIs on HRQoL (primary outcome), functional capacity and performance, psychological and social factors, symptoms, exacerbations, healthcare utilization, and survival, in people with ILD. Methods: The protocol of this systematic review has been registered (PROSPERO ID: CRD42022329199). A search was performed for randomized controlled studies in 6 databases, on May 31, 2022, with monthly updates until February 2023. Studies implementing SMIs in people with any type of ILD were included. Two independent reviewers implemented the Cochrane tool for risk of bias assessment (RoB2) and the grading of recommendations, assessment, development, and evaluations (GRADE) system. Between groups differences, effect direction plots, and meta-analysis were used to summarize the results. Results: Four studies that examined 217 participants (81% men, 71 years old, 91% idiopathic pulmonary fibrosis) were included. There was great heterogeneity in the duration, content, and structure of SMIs, and little detail in the reporting of control interventions. There were no statistically significant between-groups differences in HRQoL (standardized mean difference: 0.08; 95% confidence interval: -0.21 to 0.37; p-value: 0.58) nor in the secondary measures. The quality of evidence ranged from low to very low. Conclusions: There is low to very low evidence that SMIs do not significantly change HRQoL, functional performance, psychological and social factors, symptoms, and healthcare utilization, in people with ILD. No evidence for the effects of SMIs on functional capacity, exacerbations, and survival was found. It is necessary to find a universal and consensual definition of SMIs to implement comparable interventions and provide more reliable results.Introdução: As intervençÔes de autogestĂŁo (IA) visam capacitar as pessoas com doença crĂłnica para realizarem uma gestĂŁo mais eficaz da sua saĂșde. Em pessoas com doenças respiratĂłrias crĂłnicas, como por exemplo a asma, as IA resultam em aumentos significativos da qualidade de vida relacionada com a saĂșde (QVRS). Contudo, a sua eficĂĄcia ainda nĂŁo foi sistematizada em pessoas com doença pulmonar intersticial (DPI), o que limita a sua implementação nos cuidados de saĂșde. Objetivos: Rever e sumariar os efeitos das IA na QVRS (medida principal), capacidade e performance funcional, fatores psicolĂłgicos e sociais, sintomas, exacerbaçÔes, utilização dos serviços de saĂșde, e sobrevida, em pessoas com DPI. MĂ©todos: O protocolo desta revisĂŁo sistemĂĄtica foi registado (PROSPERO ID: CRD42022329199). Realizou-se uma pesquisa por estudos randomizados e controlados em 6 bases de dados, a 31 de maio de 2022 com atualizaçÔes mensais atĂ© fevereiro de 2023. Foram incluĂ­dos estudos que implementaram IA em pessoas com qualquer tipo de DPI. Dois revisores independentes implementaram a avaliação do risco de viĂ©s da Cochrane (RoB2) e o sistema de classificação de recomendaçÔes, avaliação, desenvolvimento e apreciação (GRADE). As diferenças entre grupos, tabelas de direção do efeito e meta-analises foram utilizadas para sintetizar os resultados. Resultados: Quatro estudos que examinaram 217 participantes (81% homens, 71 anos, 91% fibrose pulmonar idiopĂĄtica) foram incluĂ­dos. Verificou-se grande heterogeneidade na duração, conteĂșdo e estrutura das IA e pouco detalhe no reporte das intervençÔes de controlo. NĂŁo se verificaram diferenças estatisticamente significativas entre grupos na QVRS (diferença mĂ©dia padronizada: 0.08; 95% intervalo de confiança: -0.21 a 0.37; p-value: 0.58), nem nas medidas secundĂĄrias. A qualidade da evidĂȘncia variou entre baixa e muito baixa. ConclusĂ”es: Existe evidĂȘncia baixa a muito baixa de que as IA nĂŁo alterem significativamente a QVRS, performance funcional, fatores psicolĂłgicos e sociais, sintomas, e a utilização dos serviços de saĂșde em pessoas com DPI. NĂŁo foi encontrada evidĂȘncia para os efeitos da IA na capacidade funcional, exacerbaçÔes e sobrevida. É necessĂĄrio encontrar uma definição universal e consensual de IA de forma a implementar intervençÔes comparĂĄveis e fornecer resultados mais confiĂĄveis.Mestrado em Fisioterapi

    Preparing the Workforce for Integrated Healthcare

    Get PDF
    Integrated healthcare is recommended to deliver care to individuals with co-occurring medical and mental health conditions. Identifying the knowledge necessary for behavioral health providers to practice in integrated settings, and determining whether a computer application is an effective strategy to disseminate this knowledge, are essential steps to transitioning these individuals to integrated healthcare delivery systems. A literature review of U.S. based publications from 1999 to 2015 identified 68 articles that met inclusion criteria and identified specific knowledge for integrated healthcare settings. A survey completed by 154 behavioral health providers working in integrated healthcare settings examined the extent to which respondents agreed the specific domains of knowledge identified in the systematic review were necessary for practice in integrated healthcare settings. An internet based computer application was developed and tested through a rapid prototyping method with two focus groups and 5 individual interviews. Nielson’s usability heurstics were used to evaluate data from focus groups and interviews and changes were incorporated in development of the computer application. The computer application was evaluated through an experimental pre-test/post-test design in which the knowledge of screening measures of 15 masters level social work students was tested. The results of the literature review provided evidence that behavioral health providers require specific knowledge of medical diagnoses, psychiatric diagnoses, screening instruments and intervention skills. A first-order, four-subscale model of this knowledge was confirmed by a CFA model in the survey sample. The computer application developed through the focus groups and interviews is an introduction to integrated healthcare concepts, reinforces the integrated nature of physical and behavioral health, and puts evidence-based knowledge at the point of care. When compared to an asynchronous training session in the experimental investigation, ANCOVA results revealed no significant differences on post-test knowledge of screening measures between the two groups. Outcomes of training on an integrated healthcare topic using a computer application are comparable to those using an asynchronous instructional method. Further research is needed to evaluate the impact of computer application use in real-world practice settings

    Positively waiting: Technology as the preferred distractor in a pediatric outpatient setting

    Get PDF
    Visiting any pediatric outpatient clinic as a child may be considered a stressful and anxiety-inducing experience. The literature suggests that positive distractions, such as pet therapy and single-user electronic devices, may aid in reducing anxiety and maximizing patient satisfaction throughout the patient’s experience at a pediatric outpatient clinic. The aim of this pilot quality improvement project was to determine which positive distractions patients experienced and whether single-user electronic loaner devices should be provided to patients at pediatric outpatient facilities. A quantitative causal comparative approach was utilized in identifying patient exposure to key positive distraction techniques that may significantly decrease anxiety. The independent variable was the patient gender as reported by the caretaker. The term “caretaker” refers to the adult parent, guardian, relative, or friend accompanying the patient. The dependent variables were caretakers’ responses to interview questions regarding exposure to and interest in various positive distractors. Most patients reported more interactions with therapy dogs than either clowns or musicians, with none reporting magician interaction while waiting for their appointments. Many patients (71%) demonstrated interest in having access to single-user electronics during clinic appointment wait times. Male patients showed great interest (87%) in having access to single-user electronics. Findings suggest that pediatric healthcare facilities funding single-user electronics to reduce patient anxiety may increase patient satisfaction. Additionally, data suggest administrators may benefit by offering an array of positive distractions, with a particular focus on pet therapy programs. Child life specialists are particularly suited for overseeing the implementation of an efficient and effective program. Experience Framework This article is associated with the Innovation & Technology lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this len

    Brining Point-of-Care Ultrasound to a Rural Primary Care Clinic

    Get PDF
    Background and Objectives: In the rural primary care setting, the process for outpatient ultrasound testing has multiple steps, all of which provide opportunities for delay in testing and diagnosis. Point-of-care ultrasound (POCUS) is a solution that allows the physician to perform same-day ultrasound in the primary care clinic. The objective of this program development project was to implement POCUS in a rural primary care clinic to reduce time to testing and diagnosis for those patients requiring ultrasound testing. Methods: A 3-month chart audit was conducted to examine the average length of time required to complete ultrasound testing in the outpatient radiology department. Audit results were compared to POCUS testing. A 6-question Likert scale was developed to assess patient satisfaction with the POCUS process. The Donabedian Model and Promoting Action on Research Implementation in Health Services framework were used to examine and implement POCUS. Results: Chart audits revealed 34 ultrasounds that were ordered. The mean number of days from the time the ultrasound was ordered to the time it was uploaded into the electronic medical record was 27. One POCUS was performed during the implementation period. It was done same- day and its results eliminated unnecessary specialty referral. Conclusion: POCUS is a valid and reliable tool that can be used by the primary care provider to assist in diagnosis and may significantly reduce time to testing and time to diagnosis. It may also have a unique role in rural settings where resources may be limited

    Systematic review of communication technologies to promote access and engagement of young people with diabetes into healthcare

    Get PDF
    Background: Research has investigated whether communication technologies (e.g. mobile telephony, forums, email) can be used to transfer digital information between healthcare professionals and young people who live with diabetes. The systematic review evaluates the effectiveness and impact of these technologies on communication. Methods: Nine electronic databases were searched. Technologies were described and a narrative synthesis of all studies was undertaken. Results: Of 20,925 publications identified, 19 met the inclusion criteria, with 18 technologies assessed. Five categories of communication technologies were identified: video-and tele-conferencing (n = 2); mobile telephony (n = 3); telephone support (n = 3); novel electronic communication devices for transferring clinical information (n = 10); and web-based discussion boards (n = 1). Ten studies showed a positive improvement in HbA1c following the intervention with four studies reporting detrimental increases in HbA1c levels. In fifteen studies communication technologies increased the frequency of contact between patient and healthcare professional. Findings were inconsistent of an association between improvements in HbA1c and increased contact. Limited evidence was available concerning behavioural and care coordination outcomes, although improvement in quality of life, patientcaregiver interaction, self-care and metabolic transmission were reported for some communication technologies. Conclusions: The breadth of study design and types of technologies reported make the magnitude of benefit and their effects on health difficult to determine. While communication technologies may increase the frequency of contact between patient and health care professional, it remains unclear whether this results in improved outcomes and is often the basis of the intervention itself. Further research is needed to explore the effectiveness and cost effectiveness of increasing the use of communication technologies between young people and healthcare professionals

    Use of mobile devices to help cancer patients meet their information needs in non-inpatient settings: systematic review

    Get PDF
    Background: The shift from inpatient to outpatient cancer care means that patients are now required to manage their condition at home, away from regular supervision by clinicians. Subsequently, research has consistently reported that many patients with cancer have unmet information needs during their illness. Mobile devices, such as mobile phones and tablet computers, provide an opportunity to deliver information to patients remotely. To date, no systematic reviews have evaluated how mobile devices have been used specifically to help patients meet to their information needs. Objective: A systematic review was conducted to identify studies that describe the use of mobile interventions to enable patients with cancer to meet their cancer-related information needs in non-inpatient settings, and to describe the effects and feasibility of these interventions. Methods: MEDLINE EMBASE and PsychINFO databases were searched up until January 2017. Search terms related to ‘mobile devices’, ‘information needs’ and ‘cancer’. There were no restrictions on study type in order to be as inclusive as possible. Study participants were patients with cancer undergoing treatment. Interventions had to be delivered by a mobile or handheld device, attempt to meet patients’ cancer-related information needs, and be for use in non-inpatient settings. Critical Appraisal Skills Programme (CASP) checklists were used to assess the methodological quality of included studies. A narrative synthesis was performed and findings were organised by common themes found across studies. Results: The initial search yielded 1020 results. Twenty-three articles describing 20 studies were included. Interventions aimed to improve the monitoring and management of treatment-related symptoms (n=17, 85%), directly increase patients’ knowledge related to their condition (n=2, 10%) and improve communication of symptoms to clinicians in consultations (n=1, 5%). Studies were of adult (n=17; age range 24-87 years) and adolescent (n=3; age range 8-18 years) patients. Sample sizes ranged from 4-125, with 13 studies consisting of 25 participants or less. Most studies were conducted in the UK (n=12, 52%) or US (n=7, 30%). Of the 23 articles included, twelve were of medium quality, nine were of poor quality and two were of good quality. Overall, interventions were reported to be acceptable and were perceived as useful and easy to use. Few technical problems were encountered. Adherence was generally consistent and high (periods ranged from 5 days to 6 months), however there was considerable variation in use of intervention components within and between studies. Reported benefits of the interventions included improved symptom management, patient empowerment and improved clinician-patient communication, although mixed findings were reported for patients’ health-related quality of life and anxiety. Conclusions: The current review highlighted that mobile interventions for patients with cancer are only meeting treatment or symptom-related information needs. There were no interventions designed to meet patients’ full range of cancer-related information needs, from information on psychological support to how to manage finances during cancer, and the long-term effects of treatment. More comprehensive interventions are required for patients to meet their information needs when managing their condition in non-inpatient settings. Controlled evaluations are needed to further determine the effectiveness of these types of intervention

    How are information and communication technologies supporting routine outcome monitoring and measurement-based care in psychotherapy? A systematic review

    Get PDF
    Psychotherapy has proven to be effective for a wide range of mental health problems. However, not all patients respond to the treatment as expected (not-on-track patients). Routine outcome monitoring (ROM) and measurement-based care (MBC), which consist of monitoring patients between appointments and using this data to guide the intervention, have been shown to be particularly useful for these not-on-track patients. Traditionally, though, ROM and MBC have been challenging, due to the difficulties associated with repeated monitoring of patients and providing real-time feedback to therapists. The use of information and communication technologies (ICTs) might help reduce these challenges. Therefore, we systematically reviewed evidence regarding the use of ICTs for ROM and MBC in face-to-face psychological interventions for mental health problems. The search included published and unpublished studies indexed in the electronic databases PubMed, PsycINFO, and SCOPUS. Main search terms were variations of the terms "psychological treatment", "progress monitoring or measurement-based care", and "technology". Eighteen studies met eligibility criteria. In these, ICTs were frequently handheld technologies, such as smartphone apps, tablets, or laptops, which were involved in the whole process (assessment and feedback). Overall, the use of technology for ROM and MBC during psychological interventions was feasible and acceptable. In addition, the use of ICTs was found to be effective, particularly for not-on-track patients, which is consistent with similar non-ICT research. Given the heterogeneity of reviewed studies, more research and replication is needed to obtain robust findings with different technological solutions and to facilitate the generalization of findings to different mental health populations
    • 

    corecore