A Review of Current Heart Failure Apps

Background: Heart disease is the second leading cause of death in Canada, with tremendous economic impacts on the healthcare system. Currently, there are several smartphone based heart failure (HF) apps available for patients. These apps provide information to patients regarding HF, and how to monitor and manage their condition. This review describes the current literature on HF apps, and describes the features offered by these apps. Methods and Results: Peer-reviewed literature was searched and revealed only a limited number of studies (8) related to HF apps, including HeartMapp, SUPPORT-HF and CardioManager.  A Google-based grey literature search was conducted, and Google Play and the Apple Store were also searched to identify additional HF-related apps. These searches revealed several other HF-related apps (total 11), the features of which are described in the current review. Conclusion: This review will help healthcare providers select apps for themselves and recommend HF apps to their patients that provide the most suitable disease and management information and monitoring capability. The insight will also help software developers design apps in the future that will provide better support to patients with HF and help the healthcare providers monitor their condition better

The SMILe integrated care model in allogeneic SteM cell TransplantatIon faciLitated by eHealth: a protocol for a hybrid effectiveness-implementation randomised controlled trial

While effectiveness outcomes of eHealth-facilitated integrated care models (eICMs) in transplant and oncological populations are promising, implementing and sustaining them in real-world settings remain challenging. Allogeneic stem cell transplant (alloSCT) patients could benefit from an eICM to enhance health outcomes. To combat health deterioration, integrating chronic illness management, including continuous symptom and health behaviour monitoring, can shorten reaction times. We will test the 1st-year post-alloSCT effectiveness and evaluate bundled implementation strategies to support the implementation of a newly developed and adapted eICM in allogeneic stem cell transplantation facilitated by eHealth (SMILe-ICM). SMILe-ICM has been designed by combining implementation, behavioural, and computer science methods. Adaptions were guided by FRAME and FRAME-IS. It consists of four modules: 1) monitoring & follow-up; 2) infection prevention; 3) physical activity; and 4) medication adherence, delivered via eHealth and a care coordinator (an Advanced Practice Nurse). The implementation was supported by contextually adapted implementation strategies (e.g., creating new clinical teams, informing local opinion leaders).; Using a hybrid effectiveness-implementation randomised controlled trial, we will include a consecutive sample of 80 adult alloSCT patients who were transplanted and followed by University Hospital Basel (Switzerland). Inclusion criteria are basic German proficiency; elementary computer literacy; internet access; and written informed consent. Patients will be excluded if their condition prevents the use of technology, or if they are followed up only at external centres. Patient-level (1:1) stratified randomisation into a usual care group and a SMILe-ICM group will take place 10 days pre-transplantation. To gauge the SMILe-ICM's effectiveness primary outcome (re-hospitalisation rate), secondary outcomes (healthcare utilization costs; length of inpatient re-hospitalizations, medication adherence; treatment and self-management burden; HRQoL; Graft-versus-Host Disease rate; survival; overall survival rate) and implementation outcomes (acceptability, appropriateness, feasibility, fidelity), we will use multi-method, multi-informant assessment (via questionnaires, interviews, electronic health record data, cost capture methods).; The SMILe-ICM has major innovative potential for reengineering alloSCT follow-up care, particularly regarding short- and medium-term outcomes. Our dual focus on implementation and effectiveness will both inform optimization of the SMILe-ICM and provide insights regarding implementation strategies and pathway, understudied in eHealth-facilitated ICMs in chronically ill populations.; ClinicalTrials.gov. Identifier: NCT04789863 . Registered April 01, 2021

eHealth in transplantation

eHealth ("electronic" Health) is a new field in medicine that has the potential to change medical care, increase efficiency, and reduce costs. In this review, we analyzed the current status of eHealth in transplantation by performing a PubMed search over the last 5 years with a focus on clinical studies for post-transplant care. We retrieved 463 manuscripts, of which 52 clinical reports and eight randomized controlled trials were identified. Most studies were on kidney (n = 19), followed by liver (n = 10), solid organ (n = 7), bone-marrow (n = 6), and lung transplantation (n = 6). Eleven articles included adolescents/children. Investigated eHealth features covered the whole spectrum with mobile applications for patients (n = 24) and video consultations (n = 18) being most frequent. Prominent topics for patient apps were self-management (n = 16), adherence (n = 14), symptom-reporting (11), remote monitoring of vital signs (n = 8), educational (n = 7), and drug reminder (n = 7). In this review, we discuss opportunities and strengths of such new eHealth solutions, the implications for successful implementation into the healthcare process, the human factor, data protection, and finally, the need for better evidence from prospective clinical trials in order to confirm the claims on better patient care, potential efficiency gains and cost savings

Mobile solutions in depression: Enhancing communication with patients using an SMS-based intervention

Mobile solutions, namely the ones based on the Short Message Service (SMS), can play an important role in enhancing communication with patients with depression, between consultations, allowing the delivery of supportive messages or reminders. This paper presents an overview on this topic and describes a 4-stage study aiming to better understand the mHealth scenario in depression, specifically regarding the use of messaging services. The four stages comprised: (i) a diagnosis of perspectives and practices; (ii) a 6-weeks SMS intervention plan; (iii) a prototype of a digital application to support patients' follow-up and interaction; (iv) and a survey with physicians on digital experience and predisposition to use the prototype. Results underline the potential of the use of messaging systems and digital solutions to improve communication with patients with depression and point the benefits of blended-interventions (combining personal contact and SMSs, as an adjunct/complement to regular treatment). Further researched is needed, particular regarding the adjustment of these solutions to specific target groups

Enhancing Adherence to Prescribed Opioids Using a Mobile-Base Application: A Pilot Study of feasibility in Chronic Non-Cancer Pain

In this study we present feasibility of a mobile monitoring and reporting system that would provide an accurate unbiased screening tool to systematically analyze opioid adherence in Sickle cell disease patients. In addition, the software simultaneously measures pain. The Mobile Applications Rating Scale: a new and validated tool for assessing the quality of health mobile apps for engagement, functionality, aesthetics, information quality, subjective quality, relevance and overall impact was administered post usage to evaluate the application. A total of 28 patients were recruited to review and test the software at one sitting. The majority of the population found the application to be relevant for their care. Patients were also asked to report on the completeness of information within the app, the majority (96%) reported on the application’s completeness while 4% estimated the information to be minimal or overwhelming. The quality of information as it pertains to sickle cell patients was overwhelimingly reported to be relevant (91.7%); only 8.3% found the application to be poorly relevant to sickle cell disease. The application’s performance was positively rated while the ease of its use positively rated at 91.7%. Most participants (85.7%) found the application to be interesting to use while 74% found it entertaining. All users found the application’s navigation to be logical and accurate with consistent and intuitive gestural design. We conclude that surveyed patients believe it is feasible to use a smartphone application specifically targeted to monitor opioid use and behavior in patients with sickle cell disease (SCD)-associated pai

Digital innovation in Multiple Sclerosis Management

Due to innovation in technology, a new type of patient has been created, the e-patient, characterized by the use of electronic communication tools and commitment to participate in their own care. The extent to which the world of digital health has changed during the COVID-19 pandemic has been widely recognized. Remote medicine has become part of the new normal for patients and clinicians, introducing innovative care delivery models that are likely to endure even if the pendulum swings back to some degree in a post-COVID age. The development of digital applications and remote communication technologies for patients with multiple sclerosis has increased rapidly in recent years. For patients, eHealth apps have been shown to improve outcomes and increase access to care, disease information, and support. For HCPs, eHealth technology may facilitate the assessment of clinical disability, analysis of lab and imaging data, and remote monitoring of patient symptoms, adverse events, and outcomes. It may allow time optimization and more timely intervention than is possible with scheduled face-to-face visits. The way we measure the impact of MS on daily life has remained relatively unchanged for decades, and is heavily reliant on clinic visits that may only occur once or twice each year.These benefits are important because multiple sclerosis requires ongoing monitoring, assessment, and management.The aim of this Special Issue is to cover the state of knowledge and expertise in the field of eHealth technology applied to multiple sclerosis, from clinical evaluation to patient education

Using Mobile Health to Improve Mild Depression Outcomes in Adult Primary Care

Abstract Background: Mild depression is a common patient complaint in primary care, potentially impairing role function in multiple dimensions, with risk for escalation to severe Major Depressive Disorder (MDD), a chronic, recurring illness with multiple comorbidities at high emotional and economic cost to individuals, families, and society. Barriers to care include lack of access to Mental Health Specialists, financial constraints and stigma, all of which can cause escalation of symptoms to the point of disability and are magnified in underserved populations. Purpose: The primary goal of this quality improvement (QI) project was to improve depression symptoms using the evidence-based mobile app IntelliCare to deliver Cognitive Behavioral Treatment (CBT) as part of an eight-week treatment protocol. Methods: Mildly depressed adult primary care patients (PHQ-9 score 5-9) meeting inclusion criteria were asked to participate in an eight-week collaborative protocol in which they used the IntelliCare app at least weekly. Bi-weekly questionnaires were administered assessing patient symptoms, app usage and patient concerns. A post-intervention PHQ-9 was done at eight-weeks. Results: The majority of participants (67%) completed the protocol with an average improvement in post-intervention PHQ-9 scores of 53%. The Wilcoxon-matched pairs test demonstrated a statistically significant improvement in post-protocol PHQ-9 scores (p Implications to Practice: Willingness of patients to use the mobile health app IntelliCare with improvement in their depression symptoms support further study of its implementation in practice reducing barriers to care including financial constraints, limited access, and stigma. Conclusion: Evidence-based mobile apps such as IntelliCare as part of a treatment plan for mild depression may help decrease barriers to treatment for depression and improve patient outcomes. Keywords: depression, primary care, mobile apps, telehealth, adult

Technology-Enabled Health Care Collaboration in Pediatric Chronic Illness: Pre-post Interventional Study for Feasibility, Acceptability, and Clinical Impact of an Electronic Health Record–Linked Platform for Patient-Clinician Partnership

Background: Mobile health (mHealth) technology has the potential to support the Chronic Care Model\u27s vision of closed feedback loops and patient-clinician partnerships. Objective: This study aims to evaluate the feasibility, acceptability, and short-term impact of an electronic health record-linked mHealth platform (Orchestra) supporting patient and clinician collaboration through real-time, bidirectional data sharing. Methods: We conducted a 6-month prospective, pre-post, proof-of-concept study of Orchestra among patients and parents in the Cincinnati Children\u27s Hospital inflammatory bowel disease (IBD) and cystic fibrosis (CF) clinics. Participants and clinicians used Orchestra during and between visits to complete and view patient-reported outcome (PRO) measures and previsit plans. Surveys completed at baseline and at 3- and 6-month follow-up visits plus data from the platform were used to assess outcomes including PRO completion rates, weekly platform use, disease self-efficacy, and impact on care. Analyses included descriptive statistics; pre-post comparisons; Pearson correlations; and, if applicable, effect sizes. Results: We enrolled 92 participants (CF: n = 52 and IBD: n = 40), and 73% (67/92) completed the study. Average PRO completion was 61%, and average weekly platform use was 80%. Participants reported improvement in self-efficacy from baseline to 6 months (7.90 to 8.44; P = .006). At 6 months, most participants reported that the platform was useful (36/40, 90%) and had a positive impact on their care, including improved visit quality (33/40, 83%), visit collaboration (35/40, 88%), and visit preparation (31/40, 78%). PRO completion was positively associated with multiple indicators of care impact at 3 and 6 months. Conclusions: Use of an mHealth tool to support closed feedback loops through real-time data sharing and patient-clinician collaboration is feasible and shows indications of acceptability and promise as a strategy for improving pediatric chronic illness management

Using mHealth to Increase Treatment Utilization Among Recently Incarcerated Homeless Adults (Link2Care): Protocol for a Randomized Controlled Trial

Background: There is a significant revolving door of incarceration among homeless adults. Homeless adults who receive professional coordination of individualized care (ie, case management) during the period following their release from jail experience fewer mental health and substance use problems, are more likely to obtain stable housing, and are less likely to be reincarcerated. This is because case managers work to meet the various needs of their clients by helping them to overcome barriers to needed services (eg, food, clothing, housing, job training, substance abuse and mental health treatment, medical care, medication, social support, proof of identification, and legal aid). Many barriers (eg, limited transportation, inability to schedule appointments, and limited knowledge of available services) prevent homeless adults who were recently released from incarceration from obtaining available case management, crisis management, substance abuse, and mental health services. Objective: The aim of the Link2Care study is to assess the effectiveness of a smartphone app for increasing case management and treatment service utilization, and in turn reduce homelessness and rearrest. The goals of this research are to (1) assess the impact of an innovative smartphone app that will prompt and directly link recently incarcerated homeless adults to community-based case management services and resources and (2) utilize in-person and smartphone-based assessments to identify key variables (eg, alcohol or drug use, social support, psychological distress, and quality of life) that predict continued homelessness and rearrest. Methods: Homeless adults (N=432) who enroll in a shelter-based Homeless Recovery Program after release from the Dallas County Jail will be randomly assigned to one of the three treatment groups: (1) usual case management, (2) usual case management plus smartphone, and (3) usual case management with a study-provided smartphone that is preloaded with an innovative case management app (smartphone-based case management). Those assigned to smartphone-based case management will receive smartphones that prompt (twice weekly) connections to shelter-based case managers. The app will also offer direct links to case managers (available during normal business hours) and crisis interventionists (available 24 hours a day, 7 days a week) with the touch of a button. Results: Recruitment began in the spring of 2018, and data collection will conclude in 2021. Conclusions: This research represents an important step toward integrated service connection and health care service provision for one of the most underserved, high need, and understudied populations in the United States. Trial Registration: ClinicalTrials.gov NCT03399500; https://clinicaltrials.gov/ct2/show/NCT03399500 (Archived by WebCite at http://www.webcitation.org/6zSJwdgUS) Registered Report Identifier: RR1-10.2196/986