Factors Affecting Patient and Physician Engagement in Remote Health Care for Heart Failure: Systematic Review.

BackgroundAdult chronic heart failure mainly affects an elderly population with multiple comorbidities that often require frequent medical visits to prevent poor health outcomes. However, the heart failure disease process reduces their independence by reducing mobility, exercise tolerance, and cognitive decline. Remote care technologies can bridge the gap in care for these patients by allowing them to be followed up within the comfort of their home and encourage their self-care. However, patients, carers, and health care professionals need to engage with the technology for it to be useful.ObjectiveThis systematic review explores qualitative primary studies of remote care technologies used in heart failure, to determine the factors that affect user engagement with the technology. This is explored from the perspective of patients, carers, and health care professionals.MethodsRelevant studies published between January 1, 1990, and September 19, 2020, were identified from EMBASE, Ovid MEDLINE, PubMed, Cochrane Library, and Scopus. These studies were then synthesized using thematic analysis. Relevant user experiences with remote care were extracted using line-by-line coding. These codes were summarized into secondary codes and core concepts, which were further merged into overarching themes that encapsulate user experience with remote care.ResultsThe review included 47 studies, which led to the generation of 5 overarching themes that affect engagement: (1) "Convenience" relates to time saved by the intervention; (2) "Clinical Care" relates to perceived quality of care and health outcomes; (3) "Communication" involves feedback and interaction between patients, staff, and carers; (4) "Education" concerns the tailored information provided; and (5) "Ease of Use" relates to accessibility and technical barriers to engagement. Each theme was applied to each user base of patient, carer, and health care professional in a different manner.ConclusionsThe 5 themes identified highlight aspects of remote care that facilitate engagement, and should be considered in both future design and trials evaluating these technologies

Ikäihmisten kokemukset terveydenhuollon sähköisten palvelujen käytöstä ja kokemusten hyödyntäminen palvelujen kehittämisessä – kuvaileva kirjallisuuskatsaus

Electronic services are becoming more common in the near future also in social and health care. One of their purposes is to activate and support people’s ability to take responsibility of their own health and well-being. However, new technologies and electronic services can cause disparity between demographic groups as, for example, technology related skills are lower among elderly people. The share of elderly people is heavily increasing in the near future due to a large number of retirement, a low rate of mortality and, on the other hand, a lowering share of children and working-age people. Consequently, elderly people are becoming more and more important users of social and health services. The objective of this descriptive review is to describe what kind of experiences elderly people have of using electronic health services, and which factors influence their use of electronic health services. Moreover, the objective is to find out usability factors that arise during the use of electronic services and which issues related to elderly people should be taken into consideration during system development. Based on 36 studies selected, it was observed that elderly people feel mainly positive about using electronic services. However, many factors affect their use of electronic health services. In general, problems were noticed in relation to usability issues such as too small fonts, unclear symbols and buttons difficult navigation structure. Worries about information security and confidentiality as well as being marked were also noticed.Lähivuosien sosiaali- ja terveydenhuollon palvelujen sähköistämisen yhtenä tarkoituksena on tukea kansalaisen aktiivisempaa otetta oman hyvinvointinsa ylläpitämiseksi ja edistämiseksi. Uudet teknologiat ja palvelujen sähköistäminen voivat kuitenkin aiheuttaa eriarvoistumista väestöryhmien välillä, sillä esimerkiksi ikääntyneiden valmiudet sähköisten palvelujen käyttöön ovat muita ryhmiä matalampia. Ikäihmisten osuus väestörakenteesta kasvaa lähitulevaisuudessa voimakkaasti suurten ikäluokkien eläköitymisen, kuolleisuuden alenemisen sekä toisaalta lasten ja työikäisten osuuden vähenemisen seurauksena. Tämän vuoksi vanhimmista ikäluokista tulee entistä merkittävämpi sosiaali- ja terveydenhuollon käyttäjäryhmä. Sosiaali- ja terveydenhuollon palvelujen sähköistäminen vaikuttaa lähivuosina voimakkaasti sosiaali- ja terveydenhuollon palvelujen järjestämiseen. Tämän artikkelin tarkoituksena on kuvailevan kirjallisuuskatsauksen menetelmin kuvata, minkälaisia kokemuksia ikäihmisillä on terveydenhuollon sähköisten palvelujen käytöstä ja mitkä tekijät vaikuttavat terveydenhuollon sähköisten palvelujen käyttöön. Lisäksi katsauksessa kartoitetaan ikäihmisten sähköisten palvelujen käytössä kokemia ongelmakohtia, joita tulisi huomioida ikäihmisille suunnattujen palvelujen järjestelmäkehityksessä alusta alkaen. Katsaukseen valikoituneiden artikkeleiden (n=36) perusteella havaittiin, että ikäihmisten kokemukset terveydenhuollon sähköisten palvelujen käytöstä ovat pääasiallisesti myönteisiä. Käyttöön vaikuttavat monet tekijät, joiden vaikutus on usein yksilöllinen. Joitakin yleisiä olettamia tekijöiden vaikutuksesta voidaan kuitenkin löytää. Havaitut ongelmakohdat liittyvät usein järjestelmien, sovellusten ja apuvälineiden käytettävyyteen. Yleisesti ongelmia aiheuttavat hahmottamiseen liittyvät seikat kuten sivustojen ja sovellusten ulkoasu, liian pienet fontit tai painikkeet sekä hankala navigointirakenne. Lisäksi tutkimuksessa havaittiin tietoturvaan liittyviä huolia sekä käyttäjän kokemaa leimautumisen tunnetta

The PERMIT Project: Personalised Renal Function Monitoring via Information Technology

Patients with heart failure are typically elderly and are among those most at risk of renal failure due to both their condition and their medication. Regular monitoring of renal function may allow early detection of renal decline and appropriate intervention to prevent renal failure. However, clinical guidance on renal function monitoring in heart failure is sparse and based on anecdotal evidence. To reduce unnecessary admissions caused by renal impairment in heart failure due to inadequate monitoring, standardised practice for renal monitoring would be of benefit. Given that each patient has individual co-morbidities and rates of renal decline, general guidelines may have minimal impact and there may be a need for renal monitoring that is personalised case-by-case. The aim of the PERMIT project (Personalised Renal Function Monitoring via Information Technology) was to develop the framework for creating such personalised guidance by using machine-learning on large clinical datasets. The goal was to create a prediction model that could highlight which patients with heart failure were most at risk of renal decline, in order to intervene before they required hospital admission. In light of developing a future predictive algorithm for use in clinical care, patient and clinician engagement with heart failure-related remote healthcare technologies was investigated. The aim of this was to improve the knowledge base so that future technologies, such as remote renal monitoring, can improve upon their accessibility and acceptability in this patient cohort. Studies examining remote care in heart failure were thematically synthesised in a qualitative systematic review. This generated 5 core themes of engagement: Clinical Care, Convenience, Communication, Ease of use, and Education, with different perspectives from patients and healthcare staff. The themes which were generated were assessed prospectively via a discrete-choice questionnaire survey given to heart failure patients (n=93). Binary logit analysis showed that ‘Clinical care’ was most valued by patients with heart failure and was almost twice as important as ‘Communication’, the lowest ranked theme. The study provided important insights into the lived experiences of patients with heart failure that will allow the development of future interventions with greater acceptability and engagement rates. To create the predictive model for renal decline, retrospective primary care data was obtained from SIR (Salford Integrated Records). This data was processed into a longitudinal dataset which included 3800 adult patients with newly diagnosed heart failure, over an 8.5 year study window. The clinical parameters of each patient were mapped longitudinally with creatinine over time. A model-based clustering algorithm known as ‘flexmix’ was applied to the data. In order to select appropriate clinical variables to input into the clustering predictive model, pairwise mixed-model linear regression was used to determine correlation between each clinical parameter and log(creatinine). The most correlative covariates were serum urea and serum potassium, with urea showing the highest R-squared value for explaining variance in creatinine over time. The final clustering model therefore used the inputs of: age at heart failure diagnosis; time since heart failure diagnosis; gender; IMD decile; and serum urea. This process produced seven discrete clusters of renal change over time which were ranked by severity. Evaluation of the algorithm was made using the assigned cluster models to predict creatinine over time in patients with heart failure. The MAPE (mean absolute percentage error) of the creatinine prediction was between 17-33% depending on the cluster assigned. The work outlined in this thesis represents an important step towards developing personalised renal monitoring guidance. Important clinical correlates of renal function decline, identified in the process, can be used for prognostic research in future studies. The error of the prediction values was variable and will thus require further optimisation using additional datasets and clinical studies in the future

The Right to Mental Health in the Digital Era

People with mental illness usually experience higher rates of disability and mortality. Often, health care systems do not adequately respond to the burden of mental disorders worldwide. The number of health care providers dealing with mental health care is insufficient in many countries. Equal access to necessary health services should be granted to mentally ill people without any discrimination. E-mental health is expected to enhance the quality of care as well as accessibility, availability and affordability of services. This paper examines under what conditions e-mental health can contribute to realising the right to health by using the avail- ability, accessibility, acceptability and quality (AAAQ) framework that is developed by the Committee on Economic, Social and Cultural Rights. Research shows e-mental health facilitates dissemination of information, remote consultation and patient monitoring and might increase access to mental health care. Furthermore, patient participation might increase, and stigma and discrimination might be reduced by the use of e-mental health. However, e-mental health 146 might not increase the access to health care for everyone, such as the digitally illiterate or those who do not have access to the Internet. The affordability of this service, when it is not covered by insurance, can be a barrier to access to this service. In addition, not all e-mental health services are acceptable and of good quality. Policy makers should adopt new legal policies to respond to the present and future developments of modern technologies in health, as well as e-Mental health. To analyse the impact of e-mental health on the right to health, additional research is necessary