eHealth interventions for people with chronic kidney disease

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: This review aims to look at the benefits and harms of using eHealth interventions in the CKD population

Social networks : the future for health care delivery

With the rapid growth of online social networking for health, health care systems are experiencing an inescapable increase in complexity. This is not necessarily a drawback; self-organising, adaptive networks could become central to future health care delivery. This paper considers whether social networks composed of patients and their social circles can compete with, or complement, professional networks in assembling health-related information of value for improving health and health care. Using the framework of analysis of a two-sided network – patients and providers – with multiple platforms for interaction, we argue that the structure and dynamics of such a network has implications for future health care. Patients are using social networking to access and contribute health information. Among those living with chronic illness and disability and engaging with social networks, there is considerable expertise in assessing, combining and exploiting information. Social networking is providing a new landscape for patients to assemble health information, relatively free from the constraints of traditional health care. However, health information from social networks currently complements traditional sources rather than substituting for them. Networking among health care provider organisations is enabling greater exploitation of health information for health care planning. The platforms of interaction are also changing. Patient-doctor encounters are now more permeable to influence from social networks and professional networks. Diffuse and temporary platforms of interaction enable discourse between patients and professionals, and include platforms controlled by patients. We argue that social networking has the potential to change patterns of health inequalities and access to health care, alter the stability of health care provision and lead to a reformulation of the role of health professionals. Further research is needed to understand how network structure combined with its dynamics will affect the flow of information and potentially the allocation of health care resources

Systematic review of transition models for young people with long-term conditions: A report for NHS Diabetes.

Aims For many young people with Type 1 diabetes, transition from paediatric to adult care can result in a marked deterioration in glycaemic control. A systematic review assessed the effectiveness of transition models, or components of models, for managing the transition process in young people with long-term conditions, including Type 1 diabetes. This involved identifying (i) the main barriers and facilitators in implementing a successful transition programme, and (ii) the key issues for young people with long-term conditions and professionals involved in the transition process. Methods The following databases were searched from inception to August 2012: MEDLINE, EMBASE, PsychINFO, CINAHL, ASSIA, Social Services Abstracts, Academic Search Complete, Social Science Citation Index, Cochrane and Campbell Libraries. Selected studies included young people aged 11 to 25 diagnosed with long-term conditions who were in transition from paediatric to adult secondary health care services. Results 16 systematic reviews and 13 primary studies were included from 9992 records retrieved. No single transition model was uniquely effective. The most successful transitions centred around: young person-focused; age and developmentally appropriate content and delivery; self-management education; family participation; paediatric and adult collaboration; designated transition clinics; transition co-ordinator; young person’s portfolio; specific professionals training; multidisciplinary approach; structured process embedded in service delivery. There were no distinctive characteristics of condition-specific Type 1 diabetes services. Conclusion This important and timely review summarises the key factors that need to be considered for the development of transition programmes for young people with long-term conditions, including those with Type 1 diabetes

Re-thinking technology and its growing role in enabling patient empowerment

© The Author(s) 2018. The presence and increase of challenges to eHealth in today’s society have begun to generate doubts about the capability of technology in patient empowerment, especially within the frameworks supporting empowerment. Through the review of existing frameworks and articulation of patient demands, weaknesses in the current application of technology to support empowerment are explored, and key constituents of a technology-driven framework for patient empowerment are determined. This article argues that existing usage of technology in the design, development and implementation of patient empowerment in the healthcare system, although well intentioned, is insufficiently constituted, primarily as a result of fragmentation. Systems theory concepts such as holism and iteration are considered vital in improving the role of technology in enabling patient empowerment

Patient and public attitudes to and awareness of clinical practice guidelines : a systematic review with thematic and narrative syntheses

Article Accepted Date: 15 July 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Acknowledgements The research leading to these results has received funding from the European Community’s Seventh Framework Programme (FP7/2007-2013) under grant agreement n° 258583 (DECIDE project). The Health Services Research Unit, Aberdeen University, is funded by the Chief Scientist Office of the Scottish Government Health Directorates. The authors accept full responsibility for this paper and the views expressed in it are those of the authors and do not necessarily reflect those of the Chief Scientist Office. NS receives funding through a Knowledge Translation Fellowship from the Canadian Institutes of Health Research. No funding bodies had a role in the manuscript. We would like to thank Healthcare Improvement Scotland and the University of Dundee for support, including access to literature. We would also like to thank Lorna Thompson (Healthcare Improvement Scotland), for her help with the protocol for this review.Peer reviewedPublisher PD

Do people with intellectual disabilities understand their prescription medication? A scoping review

© 2019 The Authors. Journal of Applied Research in Intellectual Disabilities Published by John Wiley & Sons Ltd.Background: People with intellectual disabilities are more likely to experience poor health than the general population and are frequently prescribed multiple medications. Therefore, it is important that people with intellectual disabilities understand their medication and potential adverse effects. Method: A scoping review explored people with intellectual disabilities' knowledge of prescription medications, their risks and how medication understanding can be improved. Results: Ten journal articles were included. People with intellectual disabilities often lacked understanding of their medication, including its name, purpose and when and how to take it. Participants were often confused or unaware of adverse effects associated with their medication. Information was sometimes explained to carers rather than people with intellectual disabilities. Some interventions and accessible information helped to improve knowledge in people with intellectual disabilities. Conclusion: There is a need for accessible and tailored information about medication to be discussed with people with intellectual disabilities in order to meet legal and best practice standards.Peer reviewe

Examining professionals' and parents' views of using transanal irrigation with children: Understanding their experiences to develop a shared health resource for education and practise

Irrigation as a bowel management approach has been reportedly used with children for more than 20 years. Parents managing their child's chronic bowel problem have previously been shown to have increased emotional stress. The aim of this study was to explore professionals' (n = 24) understanding and parents' (n = 18) experiences of using transanal irrigation with children at home as a mid to longer term bowel management approach. This study was underpinned by action research methodology and used mixed methods determined by an action research group of parents, professionals, researchers, a voluntary sector worker, commercial representative and independent observer. Data informed the study outcome which was the development and evaluation of a shared health resource to support professionals in their holistic approach when prescribing transanal irrigation and guide parents in the areas of education, management, problem solving, support and goal setting. The resource includes constructed case studies from parents of their experiences to inform choice and decision-making between parents and professionals. The shared health resource provides an approach to initiating and evaluating transanal irrigation and is available in a paper format from key Internet sites across hospital, community and voluntary services

An ICT strategy to support a patient-centred approach to diabetes care

Factors such as poverty, ethnicity, socio-economic status, poor infrastructure and governance, etc., are some of the reasons that effective and proven prevention and treatment interventions for most of the major causes of mortality and morbidity in the developing world continue to fail. Chronic diseases require complex interventions that these countries simply cannot maintain. Diabetes mellitus (DM) is a chronic disease that is on the rise worldwide. This disease is a lifestyle disease, which means, that it is brought on by poor health habits. Statistics show that 285 million (6.4%) people aged between 20 and 79 years will be affected by Diabetes in 2010 and a staggering 439 million (7.7%) by 2030. This is a projected growth of 69% in developing countries and 20% in developed countries. The findings from studies conducted from 1993 to 2003 in Sub-Saharan Africa, particularly in South Africa, around the health care services for diabetes highlights many challenges. Sadly, the challenges 10 years after that study, are very similar. The conditions of people with Diabetes can be improved through regular monitoring of patients, improvement and monitoring of health care provided, education on healthy lifestyle, as well as education on the importance of adherence to treatment plans for the successful management of the condition. The diabetes endemic in South Africa is exacerbated by the manual functions that are performed in all aspects of monitoring and management of the disease. With the advancements that have been made in ICT and the many apps that already exist for healthcare, it is sensible to state that ICT can assist in the monitoring and management of diabetes. Another factor that is considered is that of patient-centred care. The huge number of people who need acute care and treatment in hospitals and clinics have forced a previously caring environment, to turn into a cold, almost production line affair. The sick wait in long queues and are ushered in and out of the consulting rooms as fast as possible without even as much as a “hallo”. This has left a void in the healthcare delivery to South Africans which should never have been removed in the first place, namely patient-centred care. This means that the patient is at the centre of the treatment and fully involved in the decisions about his/her health. Every patient deserves to be recognised as a human-being and treated with dignity and respect. Treatment plans for long term chronic care patients such as diabetics, should be thoroughly discussed with the patient and they should believe and comit themselves to the treatment plan. These plans are life-long and require dedication and as it is vital that patients are part of decision making and understand fully what they are expected to do. Bearing this in mind, this study has investigated the needs and care plans for people with diabetes. Specialist in the field of diabetes were interviewed and recognised care plans for diabetes such as those from WHO, IDF and SEMSDA were studied. This study also established, that by practising a patient-centred approach the adherence to a treatment plan is likely to be higher. The strategy developed involves the person with diabetes, the healthcare worker and the support structure in the care plan of the diabetic. The use of ICT as part of the solution must consider the patient-centred requirements for using IT so that the people using the strategy are comfortable and not intimidated by the technology. The need to incorporate e-health into governments’ healthcare plans has been growing over the last decade. The GSMA conducted research into mobile health opportunities in South Africa and found that SA now has a penetration of 98% and that this is the ideal medium to address the inaccessibility and inequality of healthcare in SA. The causes identified as playing a major role in the rise in diabetes were identified and it was determined that through the implementation of an ICT strategy for diabetes care, many of these can be addressed. These include the use of technology for, improved monitoring and management, increased diabetes awareness and education, and promotion of healthy lifestyle. The study focuses on the self-management aspect of diabetes and produces a strategy that incorporates various ICT solutions that would assist in the daily aspects of diabetes care, as well as follow a patient-centred approach to diabetes care. This strategy developed in this study does not need any intervention from government as it is driven by the people who have diabetes and their healthcare workers, with the aid of the technology that they currently have on hand

An Analysis of the Opportunities and Challenges Involved in the Formal Delivery of Self-Management Support in Diabetes using Digital Health Initiatives

This thesis will critically analyse self-management (SM) support services available in Scotland in the form of a gap analysis and demonstrate how digital solutions are required to increase the efficiency of health services nationally in order to fill these gaps. Firstly, the overall concept of self-management will be defined, including its importance in the treatment of long term conditions (LTC), using diabetes as an exemplary condition. This will be followed by an overview of the challenges involved in the delivery of self-management support in a ‘pre-digital’ era, where digital solutions have not been widely implemented. A review of the gaps present in the current provision of self-management support services will be demonstrated and an examination of appropriate digital solutions which could fill these gaps will be presented. Emphasis will be placed on projects run by the Digital Health and Care Institute and the challenges faced in implementing them

What e-patients want from the doctor-patient relationship: content analysis of posts on discussion boards.

People with long-term conditions are encouraged to take control and ownership of managing their condition. Interactions between health care staff and patients become partnerships with sharing of expertise. This has changed the doctor-patient relationship and the division of roles and responsibilities that traditionally existed, but what each party expects from the other may not always be clear. Information that people with long-term conditions share on Internet discussion boards can provide useful insights into their expectations of health care staff. This paper reports on a small study about the expectations that people with a long-term condition (diabetes) have of their doctors using information gleaned from Internet discussion boards