scholarly journals EXPLORING THE POWER OF COMBINATORIAL HEALTH TECHNOLOGIES TO SUPPORT SELF-MANAGEMENT OF COPD AMONG OLDER PEOPLE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S443-S443
Author(s):  
Sandra Varey ◽  
Mandy Dixon ◽  
Alejandra Hernandez ◽  
Ceu Mateus ◽  
Tom Palmer ◽  
...  
Keyword(s):  
Older People ◽  
Large Scale ◽  
Digital Health ◽  
Self Management ◽  
Chronic Obstructive ◽  
Test Bed ◽  
Long Term Conditions ◽  
Health Technologies ◽  
Healthcare Needs ◽  
The Impact

Abstract Ways to address the increasing healthcare needs of older people are a priority for the National Health Service (NHS) in England. The NHS England Test Bed programme was designed to trial new models of care that are supported by digital health technologies. This paper reports on findings from one Test Bed programme, the Lancashire and Cumbria Innovation Alliance (LCIA) – a partnership between NHS England, industry and Lancaster University, which ran from 2016 to 2018. A key aim of the LCIA Test Bed was to explore the extent to which supported self-care telehealth technology helped older people with long-term conditions to better self-manage their own care, promoting independence and enabling them to remain at home for longer. Each patient received a combination of health technologies over a six-month period. This paper presents results from the qualitative data that formed part of a large-scale mixed-methods evaluation. Specifically it draws on the analysis of 34 observational interviews with 17 participants with chronic obstructive pulmonary disease (COPD) to understand the role of these technologies in the self-management of their care. The data revealed that the majority of participants felt more confident about self-managing COPD as a result of their participation in the programme. These increases in confidence were the result of participants’ increased knowledge and skills in managing their COPD. The paper demonstrates how patients learned to better manage their respiratory condition, the impact of this learning on their daily lives and that of their family carers, and the implications for healthcare practice.

scholarly journals Pragmatic Randomized Trial Assessing the Impact of Digital Health Technology on Quality of Life in Patients With Congestive Heart Failure: Design and Rationale

2021 ◽  
Author(s):  
Angela M. Victoria-Castro ◽  
Melissa Martin ◽  
Yu Yamamoto ◽  
Tariq Ahmad ◽  
Tanima Arora ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Congestive Heart Failure ◽  
Digital Health ◽  
Digital Technologies ◽  
Management Tool ◽  
Self Management ◽  
Health Technologies ◽  
The Impact

Heart failure is a complex syndrome that contributes significantly to mortality and morbidity in the Unites States. Self- management is an ACC/AHA-recommended management tool for chronic conditions, however, those with congestive heart failure have historically poor compliance, low health literacy, and comorbidities that lead to reduced adherence to therapies and lifestyle modifications. Digital health technologies have the potential to enhance care and improve self-management. This manuscript describes the rationale and challenges of the design and implementation of a pragmatic randomized controlled trial to evaluate the efficacy of three digital health technologies in the management of congestive heart failure. Leveraging the use of a fully electronic enrollment and consent platform, the trial will randomize 200 patients across heart failure clinics in the Yale New Haven Health system to receive either usual care or one of three distinct digital technologies designed to promote self-management and provide critical data to clinicians. Our primary outcome will measure the change in quality of life as assessed by the Kansas City Cardiomyopathy Questionnaire (KCCQ) at 3 months. Initial recruitment efforts have highlighted the large digital divide in our population of interest. Assessing not only clinical outcomes, but patient usability and ease of clinical integration of digital technologies will prove beneficial in determining the feasibility and success of the integration of such technologies into the healthcare system. Future learnings will illustrate strategies to improve patient engagement with, and integration of, digital health technologies to enhance the patient-clinician relationship.

scholarly journals How effective and cost-effective are innovative combinatorial technologies and practices for supporting older people with long-term conditions to remain well in the community? An evaluation protocol for an NHS Test Bed in North West England

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e017268 ◽  
Author(s):  
Sandra Varey ◽  
Alejandra Hernández ◽  
Tom M Palmer ◽  
Céu Mateus ◽  
Joann Wilkinson ◽  
...  
Keyword(s):  
Older People ◽  
Phase 1 ◽  
Cost Effective ◽  
Control Analysis ◽  
Phase 2 ◽  
Test Bed ◽  
Model Framework ◽  
Long Term Conditions ◽  
Health Technologies

IntroductionThe Lancashire and Cumbria Innovation Alliance (LCIA) Test Bed is a partnership between the National Health Service in England, industry (led by Philips) and Lancaster University. Through the implementation of a combination of innovative health technologies and practices, it aims to determine the most effective and cost-effective ways of supporting frail older people with long-term conditions to remain well in the community. Among the Test Bed’s objectives are to improve patient activation and the ability of older people to self-care at home, reduce healthcare system utilisation, and deliver increased workforce productivity.Methods and analysisPatients aged 55 years and over are recruited to four cohorts defined by their risk of hospital admission, with long-term conditions including chronic obstructive pulmonary disease, dementia, diabetes and heart failure. The programme is determined on an individual basis, with a range of technologies available. The evaluation is adopting a two-phase approach: phase 1 includes a bespoke patient survey and a mass matched control analysis; and phase 2 is using observational interviews with patients, and weekly diaries, action learning meetings and focus groups with members of staff and other key stakeholders. Phase 1 data analysis consists of a statistical evaluation of the effectiveness of the programme. A health economic analysis of its costs and associated cost changes will be undertaken. Phase 2 data will be analysed thematically with the aid of Atlas.ti qualitative software. The evaluation is located within a logic model framework, to consider the processes, management and participation that may have implications for the Test Bed’s success.Ethics and disseminationThe LCIA Test Bed evaluation has received ethical approval from the Health Research Authority and Lancaster University’s Faculty of Health and Medicine Research Ethics Committee. A range of dissemination methods are adopted, including deliberative panels to validate findings and develop outcomes for policy and practice.

scholarly journals Self-Management Interventions in Patients with Long-Term Conditions: A Structured Review of Approaches to Reporting Inclusion, Assessment, and Outcomes in Multimorbidity

2014 ◽  
Vol 4 (1) ◽  
pp. 37-45 ◽  
Author(s):  
Cassandra Kenning ◽  
Peter A. Coventry ◽  
Peter Bower
Keyword(s):  
Rapid Development ◽  
Healthcare Delivery ◽  
Self Management ◽  
Chronic Obstructive ◽  
Long Term Conditions ◽  
Management Interventions ◽  
Cochrane Reviews ◽  
Secondary Analyses ◽  
The Impact

Background Multimorbidity has many potential implications for healthcare delivery, but a particularly important impact concerns the validity of trial evidence underpinning clinical guidelines for individual conditions. Objective To review how authors of published trials of self-management interventions reported inclusion criteria, sample descriptions, and consideration of the impact of multimorbidity on trial outcomes. Methods We restricted our analysis to a small number of exemplar long-term conditions: type 2 diabetes mellitus, coronary heart disease, and chronic obstructive pulmonary disease. We focussed our search on published Cochrane reviews. Data were extracted from the trials on inclusion/exclusion, sample description, and impact on outcomes. Results Eleven reviews consisting of 164 unique trials were identified. Sixty percent of trials reported excluding patients with forms of multimorbidity. Reasons for exclusion were poorly described or defined. Reporting of multimorbidity within the trials was poor, with only 35% of trials reporting on multimorbidity in their patient samples. Secondary analyses, exploring the impact of multimorbidity, were very rare. Conclusions The importance of multimorbidity in trials is only going to become more important over time, but trials often exclude patients with multimorbidity, and reporting of multimorbidity in trials including such patients is generally poor. This limits judgements about the external validity of the results for clinical populations. A consistent approach to the conduct and reporting of secondary analyses of the effects of multimorbidity on outcomes, using current best-practice guidance, could lead to a rapid development of the evidence base.

scholarly journals Digital Health Interventions for Healthy Aging: A Qualitative User Evaluation and Ethical Assessment

2020 ◽  
Author(s):  
Marcello Ienca ◽  
Christophe Schneble ◽  
Reto Kressig ◽  
Tenzin Wangmo
Keyword(s):  
Older Adults ◽  
Older People ◽  
Healthy Aging ◽  
Ethical Issues ◽  
Digital Health ◽  
Functional Independence ◽  
Community Dwelling ◽  
Healthy Ageing ◽  
Health Technologies ◽  
Community Dwelling Older Adults

Abstract BackgroundDigital health technologies are being increasingly developed with the aim of allowing older adults to maintain functional independence throughout the old age, a process known as healthy ageing. Such digital health technologies for healthy ageing are expected to mitigate the socio-economic effects of population ageing and improve the quality of life of older people. However, little is known regarding the views and needs of older people regarding these technologies. AimThe aim of this study is to explore the views, needs and perceptions of community-dwelling older adults regarding the use of digital health technologies for healthy ageing. MethodFace-to-face, in-depth qualitative interviews were conducted with community-dwelling older adults (median age 79.6 years). The interview process involved both abstract reflections and practical demonstrations. The interviews were transcribed verbatim and analyzed according to inductive content analysis. ResultsThree main themes and twelve sub-themes emerged. The three main themes revolved around the following thematic areas: favorable views and perceptions on technology-assisted living, usability evaluations and ethical considerations. ConclusionsOur study reveals a generally positive attitude towards digital health technologies as participants believed digital tools could positively contribute to improving their overall wellbeing, especially if designed in a patient-centered manner. Safety concerns and ethical issues related to privacy, empowerment and lack of human contact also emerged as key considerations.

scholarly journals Co-creating a large-scale adolescent health survey integrated with access to digital health interventions

2020 ◽  
Author(s):  
Roshini Peiris-John ◽  
Lovely Dizon ◽  
Kylie Sutcliffe ◽  
Kristy Kang ◽  
Theresa Fleming
Keyword(s):  
Adolescent Health ◽  
Health Survey ◽  
Large Scale ◽  
Service Providers ◽  
Digital Health ◽  
Health Interventions ◽  
Future Research ◽  
Health Providers ◽  
Health And Wellbeing ◽  
The Impact

Aim This paper describes how we engaged with adolescents and health providers to integrate access to digital health interventions as part of a large-scale secondary school health and wellbeing survey in New Zealand. Methods We conducted nine participatory, iterative co-design sessions involving 29 adolescents, and two workshops with young people (n = 11), digital and health service providers (n = 11) and researchers (n = 9) to gain insights into end-user perspectives on the concept and how best to integrate digital interventions in to the survey. Results Students’ perceived integrating access to digital health interventions into a large-scale youth health survey as acceptable and highly beneficial. They did not want personalized/normative feedback, but thought that every student should be offered all the help options. Participants identified key principles: assurance of confidentiality, usability, participant choice and control, and language. They highlighted wording as important for ease and comfort, and emphasised the importance of user control. Participants expressed that it would be useful and acceptable for survey respondents to receive information about digital help options addressing a range of health and wellbeing topics. Conclusion The methodology of adolescent-practitioner-researcher collaboration and partnership was central to this research and provided useful insights for the development and delivery of adolescent health surveys integrated with digital help options. The results from the ongoing study will provide useful data on the impact of digital health interventions integrated in large-scale surveys, as a novel methodology. Future research on engaging with adolescents once interventions are delivered will be useful to explore benefits over time.

Digital health technologies for long term self-management of osteoporosis: a systematic review and meta-analysis (Preprint)

2021 ◽  
Author(s):  
Ghada Alhussein ◽  
Leontios Hadjileontiadis
Keyword(s):  
Physical Activity ◽  
Systematic Review ◽  
Digital Health ◽  
Meta Analysis ◽  
Self Management ◽  
Current Status ◽  
Future Research ◽  
Common Chronic Disease ◽  
Health Technologies ◽  
Management Interventions

BACKGROUND Osteoporosis is the fourth most common chronic disease in the world. Adopting preventative measures and effective self-management interventions help in improving bone health. Mobile health (mHealth) technologies can play a key role in osteoporosis patient care and self- management. OBJECTIVE This study presents a systematic review and meta-analysis of the currently available mHealth applications targeting osteoporosis self-management, aiming to determine the current status, gaps and challenges the future research could address, proposing appropriate recommendations. METHODS In this systematic review and meta-analysis, we searched PubMed, Scopus, EBSCO, Web of Science, and IEEExplore databases between Jan 1, 2010 and May 31, 2021, for all English publications that describe apps dedicated to or being useful for osteoporosis, targeting self-management, nutrition, physical activity, risk assessment, delivered on smartphone devices for young and older adults. In addition, a survey of all osteoporosis-related apps available in iOS and Android app stores as of May 31, 2021 was also conducted. Primary outcomes of interest were the prevention or reduction of unhealthy behaviours or improvement in healthy behaviours of the six behaviours. Outcomes were summarised in a narrative synthesis and combined using random-effects meta-analysis. RESULTS In total, 3906 unique articles were identified. Of these, 32 articles met the inclusion criteria and were reviewed in depth. The 32 studies were comprising 14 235 participants, of whom on average 69.5% were female, with a mean age of 49.8 years (SD 17.8). The app search identified 23 relevant apps for osteoporosis self-management. The meta-analysis revealed that mHealth supported interventions resulted in a significant reduction in pain (Hedge’s g -1.09, 95%CI -1.68 to -0.45) and disability (Hedge’s g -0.77, 95%CI -1.59 to 0.05). The post-treatment effect of the digital intervention was significant for physical function (Hedge’s g 2.54, 95%CI -4.08 to 4.08); yet nonsignificant for wellbeing (Hedge’s g 0.17, 95% CI -1.84 to 2.17), physical activity (Hedges’ g 0.09, 95%CI -0.59 to 0.50), anxiety (Hedge’s g -0.29, 95%CI -6.11 to 5.53), fatigue (Hedge’s g -0.34, 95%CI -5.84 to 5.16), calcium (Hedge’s g -0.05, 95%CI -0.59 to 0.50) and vitamin D (Hedge’s g 0.10, 95% CI -4.05 to 4.26) intake, and trabecular score (Hedge’s g 0.06, 95%CI -1.00 to 1.12). CONCLUSIONS Osteoporosis apps have the potential to support and improve the management of the disease and its symptoms; they also appear to be a valuable tool for patients and health professionals. However, the majority of the apps that are currently available lack clinically validated evidence of their efficacy and they most focus on a limited number of symptoms. A more holistic and personalized approach, within a co-creation design ecosystem, is needed.

OP348 Assessing The Potential Value Of Wearable Digital Health Technologies In Chronic Kidney Disease Using Early Health Technology Assessment Methods

2021 ◽  
Vol 37 (S1) ◽  
pp. 15-16
Author(s):  
Vijay S. Gc ◽  
Andrea Manca ◽  
Alexander J. Casson ◽  
Steven Antrobus ◽  
Cynthia Iglesias
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Digital Health ◽  
Qualitative Interviews ◽  
Cost Effective ◽  
Health Technology ◽  
Self Management ◽  
Health Technologies ◽  
Early Health Technology Assessment ◽  
Early Health

IntroductionWearable digital health technologies (WDHTs) offer several solutions in terms of disease monitoring, management and delivery of specific interventions. In chronic conditions, WDHTs can be used to support individuals’ self-management efforts, potentially improving adherence to (and outcomes resulting from) interventions. Early health technology assessment (HTA) methods can inform considerations about the potential clinical and economic benefits of technology in the initial phases of the product's lifecycle, facilitating identification of those Research & Development (R&D) investments with the greatest potential stakeholders’ payoff. We report our experience of using early HTA methods to support R&D decisions relating to novel WDHT being designed to support self-management of chronic kidney disease (CKD).MethodsWe performed a literature review, focus-group interviews with patients, and qualitative interviews with the prototype development team to understand the relevant characteristics of WDHTs, quantify relevant clinical indications and existing technological constraints. An early economic evaluation was used to identify the key drivers of value for money, and a discrete choice experiment shed light onto patient preferences towards what key features the WDHT should have for the users to adopt it. Then a model-based cost-effectiveness analysis was undertaken incorporating headroom analysis, return on investment, one-way sensitivity analysis and scenario analyses using data from secondary sources.ResultsThe review of the literature, focus groups with CKD patients, and qualitative interviews with technology developers helped to understand relevant characteristics of WDHT and user preferences helped inform the next R&D iteration. Compared to the standard care, WDHT that support stage ≥3 CKD patients self-management at home by measuring blood pressure and monitor mobility has the potential to be cost-effective at conventional cost-effectiveness threshold levels. From the headroom analysis, novel WDHT can be priced up to GBP280 (EUR315, USD360) and still be cost-effective compared to standard home blood pressure monitoring.ConclusionsOur study provides valuable information for the further development of the WDHT, such as defining a go/no-go decision, as well as providing a template for performing early HTA of Digital Health Interventions.

Health Disparities and New Health Technologies – A Patients’ and Human Rights Perspective

2021 ◽  
pp. 1-23
Author(s):  
Mette Hartlev
Keyword(s):  
Human Rights ◽  
Health Disparities ◽  
Digital Health ◽  
Population Based ◽  
Human Right ◽  
Health Technologies ◽  
Left Behind ◽  
Human Rights Based Approach ◽  
Based Medicine ◽  
The Impact

Abstract The human right to health requires that everyone should have equal opportunities to enjoy the highest attainable standard of health. In practice, this is hard to achieve, as health is shaped by social determinants. This article explores the impact personalized medicine and use of big data may have on health disparities. New health technologies offer a lot of hope for more individual and better health promotion and care, which potentially could be beneficial for the most deprived. However, there are also concerns that not all population groups will profit equally from this new population-based medicine, and that new digital health technologies will maintain – or even reinforce – existing health disparities. This article suggests using insights from poverty studies combined with a patients’ and human rights-based approach to ensure that the most deprived are not left behind in the application of new health technologies.

Pharmacist-Led Transition of Care Pilot Targeting Older People After Emergency Department Discharge

2020 ◽  
Vol 35 (6) ◽  
pp. 273-282
Author(s):  
Scott M. Pearson ◽  
Anushka Tandon ◽  
Danielle R. Fixen ◽  
Sunny A. Linnebur ◽  
Gretchen M. Orosz ◽  
...  
Keyword(s):  
Emergency Department ◽  
Older People ◽  
Primary Outcome ◽  
Transitional Care ◽  
Intervention Group ◽  
Chronic Obstructive ◽  
P Value ◽  
Historical Cohort ◽  
Obstructive Pulmonary Disease ◽  
The Impact

OBJECTIVE: To evaluate the impact of a pharmacist-led transitional care intervention targeting high-risk older people after an emergency department (ED) visit.<br/> DESIGN: Retrospective cohort study of older people with ED visits prior to and during a pharmacist-led intervention.<br/> SETTING: Patients receiving primary care from the University of Colorado Health Seniors Clinic.<br/> PARTICIPANTS: The intervention cohort comprised 170 patients with an ED visit between August 18, 2018, and February 19, 2019, and the historical cohort included 166 patients with an ED visit between August 18, 2017, and February 19, 2018. All included patients either had a historical diagnosis of heart failure or chronic obstructive pulmonary disease, or they had an additional ED visit in the previous six months.<br/> INTERVENTIONS: The pilot intervention involved postED discharge telephonic outreach and assessment by a clinical pharmacist, with triaging to other staff if necessary.<br/> MAIN OUTCOME MEASURE: The primary outcome was the proportion of patients with at least one repeat ED visit, hospitalization, or death within 30 days of ED discharge. Outcome rates were also assessed at 90 days postdischarge.<br/> RESULTS: The primary outcome occurred in 21% of the historical cohort and 25% of the intervention cohort (adjusted P-value = 0.48). The incidence of the composite outcome within 90 days of ED discharge was 43% in the historical group compared with 38% in the intervention group (adjusted P-value = 0.29).<br/> CONCLUSION: A pharmacist-led telephonic intervention pilot targeting older people did not appear to have a significant effect on the composite of repeat ED visit, hospitalization, or death within 30 or 90 days of ED discharge. A limited sample size may hinder the ability to make definitive conclusions based on these findings.

Sign in / Sign up

Export Citation Format

Share Document