Developing and evaluating an interactive app to support self-care among older persons receiving home care

The proportion of older persons worldwide is growing. With older age, complex health problems may occur and the need for home care increases. To support older persons to maintain health and self-care, innovative ways need to be developed. The aim of the project was to develop and evaluate an interactive app among older persons receiving home care. The project had several phases: i) to define and understand the problem ii) develop the intervention iii) develop and optimise evaluation. Qualitative and quantitative methods were employed. Data were collected through a scoping review, interviews with healthcare experts, older persons and nursing assistants (study I); interviews with older persons (studies II, III); focus groups with homecare nurses (study II). Questionnaires at baseline, end of intervention and 6-month follow-up; with instruments to assess aspects of health, health literacy, self-care, and a study specific question regarding sense of security were used (studies III-IV). Logged data from reported health concerns, alerts, and notes were collected (study IV). Data were analysed using qualitative content analysis (study I), thematic analysis (study II), qualitative content analysis with directed approach (study III) and descriptive and inferential statistics (studies III, IV). Results: Important aspects for health and self-care from the older persons’ perspectives were described as: frame of mind, having relationships and social activities, physical ability and concerns, and maintaining self-care (I). These results were included in the app as questions with self-care advice, graphs and alerts to homecare nurses. The app use was described as an enabler for learning (II). The older persons showed improved communicative and critical health literacy at the 6- month follow-up (IV). They described an increased sense of security (II and III), which decreased at the 6-month follow-up (III). They expressed increased self-confidence (II) and support in self-care, but reported a decrease in self-care ability at the 6-month follow-up (III). App usage was high, with the health concern pain triggering the most alerts (IV). Their aspects of health were unchanged at the three assessments points (IV). In this context using an app may increase older persons’ participation in their care. The results show that for some older persons, an app can be implemented as a tool for support in conventional home care

När söker patienter med kroniskt obstruktiv lungsjukdom för akuta exacerbationer?

Kroniskt obstruktiv lungsjukdom (KOL) förväntas bli den tredje vanligaste sjukdomen i världen och tredje vanligaste dödsorsaken i Sverige 2020. Huvudorsaken är ciggarettrökning och utvecklar en irreversibel obstruktion av de små bronkiolerna. Efterhand får en del patienter frekventa akuta exacerbationer som kräver omhändertagande inom hälso-och sjukvården. Studier har påvisat olika invidivd-och organisationsfaktorer som kan inverka på patientens behov av vård pga akuta exacerbationer. Denna studiens syfte var att undersöka sambandet för patienter med KOL när de sökte pga akuta exacerbationer och deras vårdbehov.Datainsamling var mellan januari-maj 2009. Alla konsekutiva patienter som sökte akutmottagning pga akut exacerbation var inkluderade. Patienternas journaler undersöktes för socio-demografisk och sjukdomskarakteristiska, vilken tid de sökte och tidigare vårdbehov. Ett frågefromulär utarbetades baserat på tidigare litteratur och egen erfarenhet. Endast inskrivna patienter har ingått pga bristande registreringsrutiner för de som blev direkt utskrivna. 160 hade aktuella diagnoskoder av vilka 98 hade COPD och 30 patienter uppfyllde inklusionskriterierna. Fördelades på 17 kvinnor och 13 män. Flest patienter sökte dagtid och nästan lika ofta vardagar som helg. Patienter med kortare sjukdomshistoria sökte dag och natt medan de med längre sökte dagtid.Denna studien baseras på ett litet urval och kan endast påvisa några trender. Dock visar den på ny aspekt när patienter med KOL söker pga akuta exacerbationer. Fortsatt forskning behövs för att förbättra patienternas copingförmåga och optimera hälso-och sjukvårdsorganisationen.Chronic obstructive pulmonary disease (COPD) is expected to be the third common disease worldvide and third common cause of death in Sweden 2020.The main cuase is smoking and build up an irreversible respiratory obstruction of the small bronchioles. With time some patiens have frequent acute exacerbations wich demand repeatedly need of treatment. Studies have shown different factors of individual-and organization which influence on patients needs of care due to acute exacerbation.The aim of this study was to investigate connection for patients with COPD when they seek emergency ward due to acute exacerbation and their early need for care. Data was collected between january-may 2009. All consecutive patients who seek acute to emergency ward due to acute exacerbation was included. Patient´s medical records was examined for socio-demographic and clinical characteristics, which time they seek and early care. A questionnaire was constructed based on literature and own empirical experience.Only in-patiens have sureyed regard to lack of registratin routine for patients who was directly discharged. 160 patients seek of current diagnosis related groups of whom 98 had COPD and 30 meet inclusionscriteria. Distributed on 17 women and 13 men. Most patients seek daytimes and nearly as often weekdays as weekends. Patients with shorter duration of disease seek day and night while patiens with longer duration seek daytime. This studie is based on a small sample and only discern some trends. However,it show new aspect regarding timeaspect when patients with COPD seek due to acute exacerbation. Further research is required for improve patients coping and optimize organization

An updated national survey of triage and triage related work in Sweden : a cross-sectional descriptive and comparative study.

BACKGROUND: Triage and triage related work has been performed in Swedish Emergency Departments (EDs) since the mid-1990s. According to two national surveys from 2005 to 2011, triage was carried out with different triage scales and without guidelines or formal education. Furthermore, a review from 2010 questioned the scientific evidence for both triage as a method as well as the Swedish five level triage scale Medical Emergency Triage and Treatment System (METTS); nevertheless, METTS was applied in 65% of the EDs in 2011. Subsequently, METTS was renamed to Rapid Emergency Triage and Treatment System (RETTS©). The hypothesis for this study is that the method of triage is still applied nationally and that the use of METTS/RETTS© has increased. Hence, the aim is to describe the occurrence and application of triage and triage related work at Swedish Emergency Departments, in comparison with previous national surveys. METHODS: In this cross-sectional study with a descriptive and comparative design, an electronic questionnaire was developed, based on questionnaire from previous studies. The survey was distributed to all hospital affiliated EDs from late March to the middle of July in 2019. The data was analysed with descriptive statistics, by IBM SPSS Statistics, version 26. RESULTS: Of the 51 (75%) EDs partaking in the study, all (100%) applied triage, and 92% used the Swedish triage scale RETTS©. Even so, there was low concordance in how RETTS© was applied regarding time frames i.e., how long a patient in respective triage level could wait for assessment by a physician. Additionally, the results show a major diversion in how the EDs performed education in triage. CONCLUSION: This study confirms that triage method is nationally implemented across Swedish EDs. RETTS© is the dominating triage scale but cannot be considered as one triage scale due to the variation with regard to time frames per triage level. Further, a diversion in introduction and education in the pivotal role of triage has been shown. This can be counteracted by national guidelines in what triage scale to use and how to perform triage education

A longitudinal, retrospective registry-based validation study of RETTS©, the Swedish adult ED context version

BACKGROUND: Triage and triage related work has been performed in Swedish Emergency Departments (EDs) since the mid-1990s. The Rapid Emergency Triage and Treatment System (RETTS©), with annual updates, is the most applied triage system. However, the national implementation has been performed despite low scientific foundation for triage as a method, mainly related to the absence of adjustment to age and gender. Furthermore, there is a lack of studies of RETTS© in Swedish ED context, especially of RETTS© validity. Hence, the aim the study was to determine the validity of RETTS©. METHODS: A longitudinal retrospective register study based on cohort data from a healthcare region comprising two EDs in southern Sweden. Two editions of RETTS© was selected; year 2013 and 2016, enabling comparison of crude data, and adjusted for age-combined Charlson comorbidity index (ACCI) and gender. All patients ≥ 18 years visiting either of the two EDs seeing a physician, was included. Primary outcome was ten-day mortality, secondary outcome was admission to Intensive Care Unit (ICU). The data was analysed with descriptive, and inferential statistics. RESULTS: Totally 74,845 patients were included. There was an increase in patients allocated red or orange triage levels (unstable) between the years, but a decrease of admission, both to general ward and ICU. Of all patients, 1031 (1.4%) died within ten-days. Both cohorts demonstrated a statistically significant difference between the triage levels, i.e. a higher risk for ten-day mortality and ICU admission for patients in all triage levels compared to those in green triage level. Furthermore, significant statistically differences were demonstrated for ICU admission, crude as well as adjusted, and for adjusted data ten-day mortality, indicating that ACCI explained ten-day mortality, but not ICU admission. However, no statistically significant difference was found for the two annual editions of RETTS© considering ten-day mortality, crude data. CONCLUSION: The annual upgrade of RETTS© had no statistically significant impact on the validity of the triage system, considering the risk for ten-day mortality. However, the inclusion of ACCI, or at least age, can improve the validity of the triage system

How Behavior Change Strategies are Used to Design Digital Interventions to Improve Medication Adherence and Blood Pressure Among Patients With Hypertension : Systematic Review

Background: Information on how behavior change strategies have been used to design digital interventions (DIs) to improve blood pressure (BP) control or medication adherence (MA) for patients with hypertension is currently limited. Objective: Hypertension is a major modifiable risk factor for cardiovascular diseases and can be controlled with appropriate medication. Many interventions that target MA to improve BP are increasingly using modern digital technologies. This systematic review was conducted to discover how DIs have been designed to improve MA and BP control among patients with hypertension in the recent 10 years. Results were mapped into a matrix of change objectives using the Intervention Mapping framework to guide future development of technologies to improve MA and BP control. Methods: We included all the studies regarding DI development to improve MA or BP control for patients with hypertension published in PubMed from 2008 to 2018. All the DI components were mapped into a matrix of change objectives using the Intervention Mapping technique by eliciting the key determinant factors (from patient and health care team and system levels) and targeted patient behaviors. Results: The analysis included 54 eligible studies. The determinants were considered at two levels: patient and health care team and system. The most commonly described determinants at the patient level were lack of education, lack of self-awareness, lack of self-efficacy, and forgetfulness. Clinical inertia and an inadequate health workforce were the most commonly targeted determinants at the health care team and system level. Taking medication, interactive patient-provider communication, self-measurement, and lifestyle management were the most cited patient behaviors at both levels. Most of the DIs did not include support from peers or family members, despite its reported effectiveness and the rate of social media penetration. Conclusions: This review highlights the need to design a multifaceted DI that can be personalized according to patient behavior(s) that need to be changed to overcome the key determinant(s) of low adherence to medication or uncontrolled BP among patients with hypertension, considering different levels including patient and healthcare team and system involvement. © Kobra Etminani, Arianna Tao Engström, Carina Göransson, Anita Sant’Anna, Sławomir Nowaczyk

An app for supporting older people receiving home care – usage, aspects of health and health literacy : a quasi-experimental study

Background: During the last decade, there has been an increase in studies describing use of mHealth, usingsmartphones with apps, in the healthcare system by a variety of populations. Despite this, few interventions including apps are targeting older people receiving home care. Developing mobile technology to its full potential of being interactive in real time remains a challenge. The current study is part of a larger project for identifying and managing health concerns via an app by using real-time data. The aim of the study was to describe older people’s usage of an app and to evaluate the impact of usage on aspects of health and health literacy over time.Methods: A quasi-experimental design was employed. Seventeen older people self-reported health concerns via Interaktor twice a week for 3-months and answered questionnaires at baseline, the end of the intervention and at a 6–month follow-up. Logged data on app usage and data on Sense of Coherence, Health Index, Nutrition Form for the Elderly, Geriatric Depression Scale-20, Swedish Communicative and Critical Health Literacy and Swedish Functional Health Literacy were collected and analysed using descriptive and non-parametric inferential statistics.Results: The median usage of the app as intended was 96%. Pain was one of the most reported health concerns and was also the health concern that triggered an alert (n = 33). The older people’s communicative and critical health literacy improved significantly over time. Regarding the scores of Sense of Coherence, Health Index, Nutritional Form for the Elderly, Geriatric Depression Scale-20 and Swedish Functional Health Literacy scale, there were no significant differences over time.Conclusions: The high app usage showed that an app may be a suitable tool for some older people living alone and receiving home care. The results indicate that the usage of Interaktor can support older people by significantly improving their communicative and critical health literacy. Aspects of health were not shown to be affected by the usage of the app. Further research with larger sample is needed for evaluation the effect on health literacy, andwhich aspects of health of importance to support by an app. © 2020 The Author(s).Funding: The first author received internal funding from the School of Health and Welfare, Halmstad University, and the School of Health Sciences, Örebro University during data collection and analysis and preparation of the manuscript. The work was supported by a grant from the Swedish Research Council during data analysis and preparation of the manuscript. The founders had no role in study design, data collection and analysis, or preparation of the manuscript. We would like to thank Karolinska Institutet and the Swedish Research Council for supporting this study.Open access funding provided by Halmstad University.</p